*1 juris- the district court did have whether
diction; simply acknowledge we the need
to remove doubt the district court had matter.) juris- also retain
about case. If the district
diction over the court agreement
accepts plea and enters it,
judgment accordance with will
favorably entertain a motion to vacate the
judgment of conviction and sentence en- May
tered in the one now on
appeal. DE-
MOTION TO DISMISS AS MOOT
NIED; CASE REMANDED TO THE
DISTRICT COURT FOR LIMITED
PURPOSE; RE- JURISDICTION
TAINED. HARRY, Represen
Bernie as Personal Normil,
tative of the Estate of Lisa
deceased, Plaintiff-Appellant,
Wayne MARCHANT, M.D., Bazzi, Ali
M.D., al., et Defendants-
Appellees.
No. 99-13205. Appeals,
United States Court of
Eleventh Circuit.
May Loblack,
Peter Law of Peter Office Lob- lack, Miami, FL, P.A., Plaintiff-Appel- lant. McGrane,
Miles Ambrose McGrane & Nosich, P.A., Edwards, Marlow,' William G. Connell, Valerius, Adler, Miami, Abrams *2 Galicia, Hartz, I. George, BACKGROUND FL, Esther Elisa Lundeen, Fulmer, Reyn- Flagg & Vanessa Background A. Factual Scherer, Lauderdale, Ft. olds, Conrad & FL, Defendants-Appellees. for complaint alleges this case 1:17
following approximately facts. At 26, 1997, Miami-Dade a.m. on November Lisa Nоrmil to the brought Fire Rescue and emergency Hospital room at Aventura ANDERSON, Judge, Chief and Before (Aventura and Hospital) Medical Center BIRCH, EDMONDSON, TJOFLAT, requested medical treatment on her behalf. BLACK, CARNES, DUBINA, by Wayne Mar- Normil was seen first Dr. BARKETT, HULL, and MARCUS chant, emergency physician, an room WILSON, Judges. Circuit diagnosis indicated a
whose notes
BLACK,
Judge:
Circuit
sepsis.”
rule out
“pneumonia
Emergency
involves the
Medi-
This case
Coy,
Dr. Marchant contacted Dr. Kevin
(EM-
Act
and Active Labor
cаl Treatment
attending
acting
as the on-call
TALA),
EMTALA
1395dd.
U.S.C.
primary
physician on behalf
Normil’s
dumping,”
prevent “patient
enacted to
provider,
report
diagnosis
care
to
his
practice
hospitals
of some
publicized
into
request permission
to
to admit Normil
transferring indigent pa-
turning away or
(ICU)
hospi-
unit
of the
the intensive care
or treatment.
tients without evaluation
manage-
tal for concentrated care
pres-
an individual
Under
when
Coy
ment.2 Dr.
refused to authorize ad-
de-
ents for treatment at
into the
directed
mission
ICU and instead
must
hospital
of a
partment
perfu-
Dr. Marchant to obtain a ventilation
provide
Scan).
(VQ
sion scan
Dr. Marchant ad-
emergency medi-
to determine whether an
Coy VQ
vised Dr.
Scan could not be
exists.
If an
cal condition
performed
hospital
because the
had insuf-
exist,
determined to
medical condition is
De-
isotopes
ficient
conduct the scan.
ordinаrily
provide
must
stabi-
Scan,
unavailability
VQ
Dr.
spite the
of a
transferring the
lization treatment before
Coy
deny
continued to
authorization
this Court is
patient.1 The issue before
Normil’s admittance into the ICU.
a federal stat-
imposes
EMTALA
whether
utory
morning,
Later that
Dr. Marchant was
obligation
on
primary
phy-
treatment to a
with an able
contact Normil’s
care
sician,
Approximately
Dr. Ali Bazzi.
five
emergency medical condition who is
by Dr.
duty
no such
exists
hours after he was contacted
Mar-
We hold
transferred.
chant, Dr. Bazzi examined Normil in the
under EMTALA.
cases,
(in-
physicians
room
1. "Transfer” is defined as "the movement
most
privileges
hospital admitting
do not have
cluding
discharge)
of an individual out-
depend
attending
approval
must
on the
hospital's
side
facilities.”
primary
physician
care
for admittance.
1395dd(e)(4) (1994).
We use the term
99-146,
S.Rep.
reprinted
No.
opinion
in this
as defined in EM-
"transfer”
(statement
1986 U.S.C.C.A.N.
430 & 441
to a
who is "trans-
TALA. Reference
by
College
submitted
the American
of Emer
therefore,
ferred,”
apply equally
pa-
will
gency Physicians); see also Reed v. Good Sa
discharged.
tient who is
Ass’n,Inc.,
(Fla.
Hosp.
maritan
B. Procedural 2001).7 Rehearing granted en banc was death, Following Appellant Normil’s solely scope to determine the of EMTA- Harry, personal representative of Bernie LA’s stаbilization estate, against filed Dr. Mar- her suit Bazzi, Hanner, chant, Coy, Dr. Dr. Dr. (collec- Linker, Hospital3 Aventura II. STANDARD OF REVIEW complaint, Ap- In his
tively, Appellees). review de novo the of a dismissal violated pellant alleged Hospital Aventura claim, complaint for failure to state a ac- and treat by failing EMTALA stabilize allegations all cepting complaint as emergency medical condition.4 Normil’s construing light true and facts in the most however, Appellаnt, allege did not Normil plaintiff. favorable to the Brown v. Bud- Hospital. was transferred Aventura Inc., 922, Rather, get Sys., primary allegation un- Rent-A-Car Appellant’s Cir.1997). provided der EMTALA was the treatment complaint § with 3. The named Miami Beach Health- 6. The 1981 claims also were dismissed Ltd., Group, Hospital care Aventura prejudice. Declining supplemental jurisdic- d/b/a tion, Medical Center as a defendant. the district court the state law dismissed prejudice. claims without The state law complaint alleged 4. The two additional feder- by Appel- subsequently pursued were claims against Hospital: vio- al law claims Aventura lant in state court. appropriate lation of EMTALA’s medical screening requirement and violation of panel allegations 7. The further held the con- § 1981. Dr. Bazzi and Linker also support complaint did not tained in the § alleged to have violated were failing against Hospital for claim Aventura addition, complaint alleged a number of conduct an claims, including wrongful state law death determine whether Normil suffered from against Appellees, negligence per claims all medical condition. 237 F.3d Hospital, against Aventura and a se claim however, against panel, liability 1319-20. The concluded vicarious claim Aventura Hos- Marchant, Coy, pital. support and Hanner were complaint Drs. did the claims for violation sued under state law. Id. at 1322. of 1981. Appellees 5. The sued under 1981 and sought Appellees sued under state law dis- missal of those claims. Jacobson, 432, 438, 119 S.Ct.
III. DISCUSSION
(1999);
Cmty.
vidual order emergency medical conditions and labor. an emer mine whether the individual has general. 1395dd(a). § condition. Id. gency medical exists, (whether If condition emergency an medical If or not individual hospital required provide the is to stabili for benefits under this eligible sub- transferring the zation treatment before hospital a and the chapter) comes to 1395dd(b). § Id. The sole is individual. hospital that the individual determines extent to sue this Court is the condition, before has an medical requires hospital a which EMTALA provide must either— provide stabilization treatment (A) within the staff and facilities an medical condition who with for available such nоt transferred.8 is further medical examination and issue, resolving begin by this we scru- may required such treatment as be Then, tinizing statute. condition, the medical to stabilize legislative history. the statute’s we review (B) of the individual to for transfer Finally, discussing we examine the cases facility another medical in accor- EMTALA’s stabilization (c).9 dance subsection 1395dd(b)(l) (1994) (emphasis § 42 U.S.C. Language A. the Statute added). any question statutory As with inter- specifically The term “to stabilize” is pretation, begin by examining the text by whether its defined the statute. Under of the statute to determine meaning Hughes respect is clear. See Co. the term “to stabilize” means “with Aircraft screened, treated, case, (c) 9. Subsection delineates the standards for In this Normil eventually Consequently, making sets forth admitted. transfer and Hospital procedures transferring patients did not "transfer” her as for who are Aventura 1395dd(c). § 42 U.S.C. defined EMTALA. not stabilized. (B) condition ... for transfer the individual to [а to an facility another medical in accor- such medical treat- provide must] (c). may necessary dance with subsection the condition as ment of assure, prob- reasonable medical within 1395dd(b)(l). § Reading ability, that no material deterioration context, specifically statute in its defined it likely to result or occur the condition is is evident EMTALA mandates stabiliza- from a during the transfer of the individual tion of an individual the event of a 1395dd(e)(3)(A). facility.” 42 U.S.C. “transfer” as defined in EMTALA.10 explicit includes an defini- When statute By limiting application the stabiliza- followed, tion, even that definition must be transfers, requirement ordinary if it varies from the term’s mean- 1395dd(b)(l) statutory structure Carhart, ing. Stenberg logically makes sense. The statute is 147 L.Ed.2d S.Ct. options structured to set forth two (2000). Thus, the extent the defini- transferring patient with an departs “to from its com- tion of stabilize” a hospital condition: must either ordinary statutory pre- usage, mon or prior stabilization treаtment scription governs. transferring patient pursuant to subsec- *5 or, (B), (A), pursuant to subsection accurately In order to determine the provide no treatment and transfer accord- we must insert requirements ing statutorily recognized to one of the the definition of the term “to stabilize” Hence, exceptions. the re- stabilization the term is used the statute. where quirement only sets forth for standards is the definition of “to stabilize” When transferring a in either a stabilized rеquirement, into the stabilization inserted By condition. own or unstabilized its provides: statute the terms, guide- the does not set forth statute (b) stabilizing Necessary treatment patients fines for the care and treatment of emergency medical conditions and labor. are transferred. general. full the gives This effect to construction (whether any If or not individual language and structure the eligible for benefits under this sub- elementary prin- is an “[I]t the chapter) comes to a and that, in con- ciple statutory construction hospital determines that the individual statute, give meaning we must struing a condition, has an Legal in the Envtl. all the words statute.” the must either— Found., EPA, Inc. v. Assistance (11th Cir.2001) (A) 1253, (citing Bailey v. within the staff and facilities States, 137, 146, 516 U.S. 116 S.Ct. available at the for such United (1995)); also L.Ed.2d 472 see further medical examination and Canals-Jimenez, may required such treatment as United States Cir.1991) (“A assure, 1284, prem- basic within reasonable medi- [fo that a stat- statutory de- ise of сonstruction is probability, cal that no material that no words likely interpreted condition is ute is to be so terioration the being meaningless, as during to result or occur the trans- shall be discarded redundant, surplusage.”). mere Con- the individual fer from facili- ], struing EMTALA to mandate stabilization ty or 10. note 1. supra unambiguous statutory language of a transfer ren- because irrespective transfer,” statutory language prin- is the “during “[t]he the con- itself
ders the words cipal warring bаttlefield where the inter- statutory definition of the tained the other, struggle against ests each and it is stabilize,” superfluous.11 give To term “to to that we should look for the statute, battlefield language effect to the clear CBS, Inc., 245 results of the battle.” triggering we must mecha- conclude at 1228. nism for stabilization treatment under EMTALA transfer. is Despite important elementary prin- this construction, ciple statutory “sometimes Legislative History
B.
...
judges
temptation
cannot resist the
Harris,
[legislative] history.”
set out
Where the
of a statute
977;
Weaver,
F.3d at
see also
275 F.3d at
here,
not,
unambiguous,
is
as it is
we need
(“Notwithstanding
recognized
this
not,
ought
legislative history.
consider
rule,
plain meaning
judges sometimes have
Gonzales,
See United. States
out
temptation
not resisted
to set
117 S.Ct.
773 death, or loss or seri- Cir.1990). probability, result (6th enacting EM- 268-69 bodily parts or or- impairment of ous with wide- TALA, Congress was concerned (1985) (re- S13,904 Cong. 131 Rec. gans.”); rooms of reports spread (“Public Kennedy) hospitals marks of Sen. hos- from one indigent patients “dumping” rise in 400-percent reported have us to the regard next without to the pital who have been patients number of sent 131 See medical conditions. patients’ visiting after emergency rooms to their (1985) (remarks S13,904 Rec. Cong. hospital.”). another Dole, Bau- Kennedy, Durenberger, Sens. Proxmire). so- Heinz, Congress’
cus, of EMTALA history legislative The entry into patient guarantee lution was was not intended makes clear the statute mandatory appro- via system statute, a federal but to be and stabilization screenings priate law supplement meant state instead was 99-146, S.Rep. No. to transfer.12 prior provision to thе of limit- solely regard (1986), 1986 462, reprinted 464 emergen- patients services to ed medical (letter submitted S13,904 U.S.C.C.A.N. Cong. Rec. cy situations. See 131 & Kenny (“Some Nachwalter (remarks law firm by Kennedy) of Sen. (“Section contain- the bill Seymour) [of ensure that no have laws which States seeks EMTALA] ing early version is denied emergency patient But, transfers inappropriate patient prohibit pay. inability care because exami- require a medical legisla and to law. Fеderal have no such States requests overdue.”); patient long for each see nation in this area is one.”). goal of legislative Health primary City York Hardy also New (2d 789, problem remedying Hosps. Corp,, Cir. EMTALA by hospi- 1999); E. Carroll Parish transfers Marshall v. inappropriate 99-146, Dist., at 469-70 S.Rep. Hosp. tals. See No. Serv. 42, Cir.1998); Hosp., v. Nash Gen.
(1986),
U.S.C.C.A.N.
Vickers
reprinted in 1986
(4th Cir.1996);
Inc.,
(statement
Hol
the Amer-
submitted
428-29
Monahan, 30 F.3d
Physicians)
comb
College
Emergency
ican
Cir.1994).
not intended to
EMTALA was
(“The
Emergency
College
American
care,
guidelines
establish
con-
Physicians shares
Committee’s
remedies,
pro
or to
available state
replace
inappropriate
and does not condone
cerns
remedy
negli
for medical
federal
vide a
transfers,
re-
*7
of which have
some
patient
Bryan v. Rectors Visitors
gence. See
in the television and
light
cently come
Va.,
350-52
the Univ.
agree-
in
are
newspaper media....
[W]e
of
(4th Cir.1996);
142-43;
Vickers,
F.3d at
objective
legislation
of the
with the
ment
Indeed,
Holcomb,
EMTA-
116.
at
(i.e.,
inappropriate patient
to eliminate
non-preemption
expressly
LA
contains
99-146,
transfers).”);
S.Rep. No.
see also
See
remedies.
for state
provision
(1986),
reprinted
(“The
1395dd(f) (1994)
provisions
on
(policy
statement
U.S.C.C.A.N.
any
preempt
do
State
this section
not
(“Patients
not
should
patients)
transfer
except to the extent
requirement,
local law
facility
without
another
be transferred
directly conflicts with
requirement
that the
in-
Stabilization
being stabilized.
first
section.”).
of this
requirement
and initiation
adequate evaluation
cludes
is
history of EMTALA
legislative
pa-
transfer of
to assure
treatment
the
clear
consistent
the
not,
medical
within reasonable
tient will
supra
note
requirement
exist.
exceptions
stabiliza-
to the
12. Some limited
objective
main
Subsequently,
EMTALA’s
was to
patient
statute.
the
died and the ad-
“patient
prevent
practice
dumping.”
the
patient’s
brought
ministratis of the
estate
By mandating
only
treatment
in the con-
1395dd(a)
§§
claiming
suit
violations of
transfer, the
patient
text of a
stabilization
(b).
addressing
plaintiffs
and
Id. In
the
requirement
Congress’
addresses
concern
claims, we set forth
requirements
the
that
rejection of
regarding
patients without must be established to
on
succeed
converting EMTALA into a federal mal-
1395dd(b)
requirement
stabilization
practice
prescribing
statute.
In
minimаl
(1)
patient
claim:
the
an emergency
had
screening
standards for
and transferring
(2)
condition;
the
knew
patients,
patient
but not for
care outside
(3)
condition;
was not sta-
contexts,
narrowly
these two
defined
Con-
transferred;
being
bilized before
and
gress
solely
confined EMTALA
to address
the hospital
patient’s
neither obtained the
and,
time,
its concerns
at the same
avoided consent to transfer nor
a certifi-
completed
supplanting
available state
indicating
cate
the transfer would be bene-
tort remedies.
patient.
ficial to the
Although
Id.
we did
to,
not,
not need
and did
discuss the con-
Discussing
C. Cases
EMTALA’s Sta-
stabilization
tours of the
requirement,
Requirement
bilization
stated elements could be read
imply
years
the sixteen
since EMTALA’s
treatment,
that stabilization
claim
enactment,
relatively
there have been
few
therefrom,
arising
under EMTALA
arises
discussing
cases
require-
stabilization
only in the context оf a transfer.
imposed by
ment
only
statute. The
Circuit,
Like
this
no other Circuit
opportunity
have had to
EM-
has
address
Monahan,
TALA
squarely
was
Holcomb v.
addressed whether EMTALA’s
(11th Cir.1994).
F.3d 116
Although we did
requirement
stabilization
imposes an obli-
squarely
address whether EMTALA’s gation
hospitals
provide
on
requirement
imposes an obli-
individuals
outside
context of a trans-
gation
hospitals
provide
on
treatment to
date,
fer.13 To
cases from other Circuits
individuals outside the
context
a trаns-
discussing EMTALA’s stabilization re-
fer, our discussion in Holcomb is consis- quirement
have addressed
tangential
tent with our conclusion here.
arising
issues
alleged
out of an
failure to
Holcomb,
medical screening,
a discharged
an alleged failure to
emergen-
after a
stabilize an
provided an appropriate
cy
prior
determined there
medical condition
to an actual
transfer,
no
medical condition. Id.
We,
or a combination thereof.14
Thus,
recognize
13. We
opinion
patient.
Fourth Circuit
the Fourth Circuit has held
“K”,
(4th Cir.1994)
Baby
Baby
In re
775 BARKETT, Judge, concurring: Circuit language therefore, solely on the clear rely conclusion. reaching our in the statute of reconsidering Upon opinion I in the of the concur IV. CONCLUSION that because Lisa Normil agree court and redress for patient, admittеd as under EMTALA duty no There is occurring during emergen- her negligence a patient stabilization through care is available state cy room medical condition with an laws, malpractice rather than fed- Normil was Because transferred. is not law. eral 1395dd(b) transferred, Appellant’s claim fails requirement action. In so hold- cause of state a valid is not without recognize Appellant
ing, we by state provided Remedies
recourse. tort law remain available by hospi- patient care negligent
to redress judgment of the Accordingly, the
tals. respect affirmed with court is
district EMTALA claims
the dismissal reversed, 1395dd(a) (b)),
(§§ with panel opinion,
accordance
Appellant’s
to the dismissal
respect
COCHRAN,
and all
D.
for herself
Jessie
claim.15
1981
persons
Defendant
from whom
other
demand, under 42 USC
or will
part,
REVERSED
has
AFFIRMED
(b)(2), subrogation
1395y
for medical
and REMANDED.
part,
Monahan,
Cir.1994);
Dist.,
(10th
v.
Holcomb
519
Liberty Hosp.
209 F.3d
v. New
Root
Shalala,
“K",
Cir.2000);
(11th Cir.1994);
(8th
Baby
In re
Cherukuri v.
116
1068
30 F.3d
Cir.1999);
(6th
Ahrens,
Lopez-Soto
Cir.1994);
(4th
v.
King
446
v.