Michael Smith v. Crisp Regional Hospital, Inc.
985 F.3d 1306
| 11th Cir. | 2021Background
- Minor child (MS) presented to Crisp Regional Hospital ER around 9:00 p.m. with diabetic ketoacidosis (DKA).
- Appellant signed transfer paperwork around 10:30 p.m. for transfer to Children’s Hospital in Macon (about one hour away); ambulance left ~2:30 a.m. and arrived ~3:25 a.m.
- Appellant alleged the Hospital’s delay in transferring MS violated the Emergency Medical Treatment and Active Labor Act (EMTALA) and caused permanent nerve damage to MS’s eyes.
- District court dismissed the amended complaint under Fed. R. Civ. P. 12(b)(6) for failure to state an EMTALA claim and declined supplemental jurisdiction over state-law malpractice claims.
- On appeal, Appellant abandoned challenges to screening and stabilization; he raised a new argument at oral argument that “appropriate transfer” under EMTALA requires timeliness.
- The Eleventh Circuit affirmed: EMTALA does not create federal malpractice remedies and does not impose a time limitation on transfer decisions; the new argument was waived and, in any event, statutory definition of “appropriate transfer” contains no time requirement.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether an unreasonable delay in transferring a patient violates EMTALA | Delay in transfer caused harm and therefore violates EMTALA | EMTALA governs screening and stabilization, not negligent timing of transfers | Dismissal affirmed: delay alone is not an EMTALA violation |
| Whether EMTALA’s term “appropriate transfer” includes a time/quality-of-care requirement | “Appropriate transfer” should encompass timely, non-negligent transfer | Statutory definition of “appropriate transfer” lists documentation and qualified transport but no time rule; court cannot rewrite statute | Rejected: no time obligation in statutory definition; cannot read malpractice standards into EMTALA |
| Whether argument raised first at oral argument may be considered on appeal | Raised new “appropriate transfer” timeliness claim at oral argument | Not raised in briefs and therefore waived | Waived and not considered; alternatively, merits fail under existing EMTALA precedents |
Key Cases Cited
- Harry v. Marchant, 291 F.3d 767 (11th Cir. 2002) (en banc) (EMTALA narrowly prescribes screening and transfer rules and was not intended as a federal malpractice statute)
- Holcomb v. Monahan, 30 F.3d 116 (11th Cir. 1994) (EMTALA does not create federal malpractice claims; screening requirement tied to hospital’s standard procedures)
- Ray v. Spirit Airlines, Inc., 836 F.3d 1340 (11th Cir. 2016) (appellate de novo review of Rule 12(b)(6) dismissals)
- Friends of Everglades v. S. Fla. Water Mgmt. Dist., 570 F.3d 1210 (11th Cir. 2009) (courts may not add words to a statute)
- Access Now, Inc. v. Sw. Airlines Co., 385 F.3d 1324 (11th Cir. 2004) (issues not briefed on appeal are deemed abandoned)