Bernie Harry, as Personal Representative of the Estate of Lisa Normil, Deceased v. Wayne Marchant, M.D., Ali Bazzi, M.D.Bernie Harry, as Personal Representative of the Estate of Lisa Normil, Deceased v. Wayne Marchant, M.D., Ali Bazzi, M.D.
Lead Opinion
This case involves the Emergency Medical Treatment and Active Labor Act (EM-TALA),
I. BACKGROUND
A. Factual Background
The complaint in this case alleges the following facts. At approximately 1:17 a.m. on November 26, 1997, Miami-Dade Fire Rescue brought Lisa Normil to the emergency room at Aventura Hospital and Medical Center (Aventura Hospital) and requested medical treatment on her behalf. Normil was seen first by Dr. Wayne Mar-chant, an emergency room physician, whose notes indicated a diagnosis of “pneumonia rule out sepsis.”
Dr. Marchant contacted Dr. Kevin Coy, who was acting as the on-call attending physician on behalf of Normil’s primary care provider, to report his diagnosis and to request permission to admit Normil into the intensive care unit (ICU) of the hospital for concentrated care and management.
Later that morning, Dr. Marchant was able to contact Normil’s primary care physician, Dr. Ali Bazzi. Approximately five hours after he was contacted by Dr. Mar-chant, Dr. Bazzi examined Normil in the
After Normil’s admittance into the ICU, she lapsed into respiratory and cardiac failure. Dr. Christopher Hanner, a physician working at the hospital, unsuccessfully attempted to resuscitate Normil. She died at approximately 12:45 p.m.
B. Procedural Background
Following Normil’s death, Appellant Bernie Harry, personal representative of her estate, filed suit against Dr. Mar-chant, Dr. Bazzi, Dr. Hanner, Dr. Coy, Linker, and Aventura Hospital
In response to Appellant’s complaint, Aventura Hospital moved to dismiss for failure to state a claim under EMTALA.
II. STANDARD OF REVIEW
We review de novo the dismissal of a complaint for failure to state a claim, accepting all allegations in the complaint as true and construing facts in the light most favorable to the plaintiff. Brown v. Budget Rent-A-Car Sys., Inc.,
In 1986, Congress enacted EMTA-LA in rеsponse to widely publicized reports of emergency care providers transferring indigent patients from one hospital to the next while the patients’ emergency medical conditions worsened. EMTALA was designed specifically to address this important societal concern; it was not intended to be a federal malpractice statute. Under EMTALA, hospital emergency rooms are subject to two principаl obligations, commonly referred to as the appropriate medical screening requirement and the stabilization requirement. See
In resolving this issue, we begin by scrutinizing the language of the statute. Then, we review the statute’s legislative history. Finally, we examine the cases discussing EMTALA’s stabilization requirement.
A. Language of the Statute
As with any question of statutory interpretation, we begin by examining the text of the statute to determine whether its meaning is clear. See Hughes Aircraft Co. v. Jacobson, 525 U.S. 432, 438, 119 S.Ct. 755, 760,
The stabilization requirement of EMTA-LA provides in relevant part:
(b) Necessary stabilizing treatment for emergency medical conditions and labor.
(1) In general.
If any individual (whether or not eligible for benefits under this sub-chapter) comes to a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either—
(A) within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition, or
(B) for transfer of the individual to another medical faсility in accordance with subsection (c).9
The term “to stabilize” is specifically defined by the statute. Under EMTALA, the term “to stabilize” means “with respect
In order to accurately determine the requirements of EMTALA, we must insert the definition of the term “to stabilize” where the term is used in the statute. When the definition of “to stabilize” is inserted into the stabilization requirement, the statute provides:
(b) Necessary stabilizing treatment for emergency medical conditions and labor.
(1) In general.
If any individual (whether or not eligible for benefits under this sub-chapter) comes to a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either—
(A) within the staff and facilities available at the hospital, for such further medical exаmination and such treatment as may be required [fo assure, within reasonable medical probability, that no material deterioration of the condition is likely to result or occur during the transfer of the individual from a facility ], or
(B) for transfer of the individual to another medical facility in accordance with subsection (c).
By limiting application of the stabilization requirement to patient transfers, the statutory structure of
This construction gives full effect to the language and structure of the stabilization requirement. “[I]t is an elementary principle of statutory construction that, in construing a statute, we must give meaning to all the words in the statute.” Legal Envtl. Assistance Found., Inc. v. EPA,
B. Legislative History
Where the language of a statute is unambiguous, as it is here, we need not, and ought not, consider legislative history. See United. States v. Gonzales,
Despite this important elementary principle of statutory construction, “sometimes judges ... cannot resist the temptation to set out [legislative] history.” Harris,
The legislative history оf EMTALA indicates it was intended to prevent “patient dumping,” the practice of some hospital emergency rooms turning away or transferring indigents to public hospitals without prior assessment or stabilization treatment. See H.R.Rep. No. 99-241, pt. 3, at 5 (1986), reprinted in 1986 U.S.C.C.A.N. 726, 726-27; see also Gatewood v. Washington Healthcare Corp.,
The legislative history of EMTALA makes clear the statute was not intended to be a federal malpractice stаtute, but instead was meant to supplement state law solely with regard to the provision of limited medical services to patients in emergency situations. See 131 Cong. Rec. S13,904 (1985) (remarks of Sen. Kennedy) (“Some States have laws which ensure that no emergency patient is denied emergency care because of inability to pay. But, 28 States have no such law. Federal legislation in this area is long overdue.”); see also Hardy v. New York City Health & Hosps. Corp,,
The legislative history of EMTALA is consistent with the clear language of the
C. Cases Discussing EMTALA’s Stabilization Requirement
In the sixteen years since EMTALA’s enactment, there have been relatively few cases discussing the stabilization requirement imposed by the statute. The only opportunity we have hаd to address EM-TALA was in Holcomb v. Monahan,
In Holcomb, a patient was discharged after a hospital provided an appropriate medical screening and determined there was no emergency medical condition. Id. Subsequently, the patient died and the ad-ministratis of the patient’s estate brought suit claiming violations of
Like this Circuit, no other Circuit has squarely addressed whether EMTALA’s stabilization requirement imposes an obligation on hospitals to provide treatment to individuals outside the context of a transfer.
IV. CONCLUSION
There is no duty under EMTALA to provide stabilization treatment to a patient with an emergency medical condition who is not transferred. Because Normil was not transferred, Appellant’s
AFFIRMED in part, REVERSED in part, and REMANDED.
Notes
. "Transfer” is defined as "the movement (including the discharge) of an individual outside of a hospital's facilities.”
. In most cases, emergency room physicians do not have hospital admitting privileges and must depend on the approval of the attending or primary care physician for admittance. S.Rep. No. 99-146, at 471 & 482, reprinted in 1986 U.S.C.C.A.N. 42, 430 & 441 (statement submitted by the American College of Emergency Physiciаns); see also Reed v. Good Samaritan Hosp. Ass’n, Inc.,
. The complaint named Miami Beach Healthcare Group, Ltd., d/b/a Aventura Hospital and Medical Center as a defendant.
. The complaint alleged two additional federal law claims against Aventura Hospital: violation of EMTALA’s appropriate medical screening requirement and violation of
. The Appellees sued under
. The
. The panel further held the allegations contained in the complaint did not support a claim against Aventura Hospital for failing to conduct an appropriate medical screening to determine whether Normil suffered from an emergency medical condition.
. In this case, Normil was scrеened, treated, and eventually admitted. Consequently, Aventura Hospital did not "transfer” her as defined by EMTALA.
. Subsection (c) delineates the standards for making an appropriate transfer and sets forth procedures for transferring patients who are not stabilized.
. See supra note 1.
. Additionally, interpreting EMTALA to require stabilization treatment outside the context of a transfer raises questions not answered by Congress, such as: when the duty to provide stabilization trеatment terminates; if treatment is prolonged, and transfer is not imminent, how long treatment must be provided; and when the temporal delay between a determination of an emergency medical condition and the initiation of treatment constitutes a violation of a duty to provide stabilization treatment. Of course, such an interpretation would lead to the imposition of arbitrary limits, not supported by the statutory text, in an effort to fill the patent gaps of legislative direction. ■
. Some limited exceptions to the stabilization requirement exist. See supra note 9.
. We recognize the Fourth Circuit opinion in In re Baby “K”,
. See Baker v. Adventist Health, Inc.,
. We reinstate the panel opinion except for Part I.B., which discusses EMTALA’s stabilization requirement.
Concurrence Opinion
concurring:
Upon reconsidering the language of EMTALA, I concur in the opinion of the court and agree that because Lisa Normil was admitted as a patient, redress for negligence occurring during her emergency room care is available through state medical malpractice laws, rather than federal law.