409 F. App'x 769
5th Cir.2011Background
- Guzmans sued Memorial Hermann Southeast Hospital for EMTALA violations relating to screening of their son T.
- T, a seven-year-old, presented to Memorial’s ED with vomiting and dehydration concerns; he was initially triaged and placed in a room for physician evaluation.
- Memorial’s MSC policy required a medical screening exam by non-physician staff and a focused exam related to chief complaint.
- Memorial’s Triage Guidelines allowed pre-physician testing to expedite evaluation but were not applicable if a physician saw the patient promptly.
- Nursing Guidelines required vitals to be checked within one hour of discharge, and T’s vitals were not all recorded within that period.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Memorial provided an appropriate screening under EMTALA | Guzmans: Memorial failed to follow screening policy (Differential Results read) and deviated from guidelines. | Memorial: T was promptly evaluated by a physician; guidelines cited do not apply or require reading all results before discharge. | No EMTALA violation; screening was appropriate under the circumstances. |
| Whether failing to read the Differential Results created a material fact issue | Guzmans: Not reading Differential Results shows disparate treatment. | Memorial: physician policies did not require waiting for all results before discharge. | No genuine dispute; DE differential results not read did not create fact issue. |
| Whether not ordering a urinalysis constitutes disparate screening | Guzmans: UTI concern should have triggered urinalysis. | No material fact issue since UTI analysis would not have changed outcome or diagnosis. | District court proper; no EMTALA violation from not ordering urinalysis. |
| Whether taking and recording vital signs within one hour of discharge was violated | Guzmans: Nursing Guidelines require vitals within one hour of discharge. | Memorial took vitals earlier and recorded heart rate near discharge; inability to show all vitals would have altered outcome. | No EMTALA violation; substantial deviation required, which did not occur. |
| Whether the Rule 56(d) continuance was abused | Guzmans: Needed discovery to respond to motion. | District court properly denied continuance; discovery would not create material fact. | No abuse of discretion; denial affirmed. |
Key Cases Cited
- Battle v. Memorial Hosp. at Gulfport, 228 F.3d 544 (5th Cir. 2000) (emphasizes screening standard and private EMTALA remedy)
- Marshall v. E. Carroll Parish Hosp. Serv. Dist., 134 F.3d 319 (5th Cir. 1998) (defines appropriate screening as what would be offered to similarly situated patients)
- Summers v. Baptist Med. Ctr. Arkadelphia, 91 F.3d 1132 (4th Cir. 1996) (disparate impact standard for screening examinations)
- Correa v. Hosp. S.F., 69 F.3d 1184 (1st Cir. 1995) (no-screening so cursory as to be EMTALA violation)
- Power v. Arlington Hospital Assoc., 42 F.3d 851 (4th Cir. 1994) (evidence of deviation from standard procedure can show disparate treatment)
- Fraticelli-Torres v. Hosp. Hermanos, 300 F. App’x 1 (1st Cir. 2008) (illustrates non-application of specific guidelines when not applicable to ER patients)