WESLEY E. CRAWFORD аnd COLLEEN A. CRAWFORD v. METRO KNOXVILLE HMA, LLC, d/b/a TENNOVA HEALTHCARE—NORTH KNOXVILLE MEDICAL CENTER
No.: 3:24-CV-382-TAV-DCP
UNITED STATES DISTRICT COURT EASTERN DISTRICT OF TENNESSEE
August 29, 2025
Thomas A. Varlan
Before the Court are plaintiffs’ Motion for Reconsideration of Court‘s Order [Doc. 59], Motion for Leave to File Supplemental Brief [Doc. 68], Motion to Compel Preliminary Relief [Doc. 76], Motion to Appoint Colleen Crawford as Next Friend for Wesley Crawford [Doc. 81], and Motion to Stay Discovery Pending Resolution of Pending Motions and Service of Summons [Doc. 82]. Also pending before the Court are defendant‘s Motion to Dismiss Plaintiffs’ First Amended Complaint [Doc. 65] and Motion for Clarification [Doc. 70 (as amended by Doc. 71)]. The parties have responded to the opposing party‘s various motions [Docs. 61, 62, 63, 64, 67, 69, 72, 78, 79, 83]. Accordingly, these matters are ripe for the Court‘s review. See
For the reasons explained below, plaintiffs’ Motion for Reconsideration of Court‘s Order [Doc. 59] will be DENIED, defendant‘s Motion to Dismiss Plaintiffs’ First Amended Complaint [Doc. 65] will be GRANTED, the remaining pending motions [Docs. 68, 70, 76, 81, 82] will be DENIED as moot, and this case will be DISMISSED.
This action arises from events related to plaintiff Wesley E. Crawford‘s treatment in the emergency department at Tennova Healthcare, North Knoxville Medical Center (“Tennova North“) from November 27 to 29, 2022 [See Doc. 1]. The Court presumes familiarity with the faсtual background and legal issues of this case [See Docs. 47, 57, 90].
On May 8, 2025, the Court entered a Memorandum Opinion and Order dismissing all claims and defendants except for plaintiffs’ Emergency Medical Treatment and Labor Act (“EMTALA“) claims against defendant Tennova North [Doc. 57, p. 13]. The Court reasoned that, given its obligation to construe pro se pleadings liberally, plaintiffs should “be afforded an opportunity to amend and clarify the nature of this claim” [Id. at 8]. To that end, the Court further ordered plaintiffs to file an amended complaint [Id. at 14], which they did on May 21, 2025 [Doc. 60].
Before filing their amended complaint, however, plaintiffs moved the Court on May 11, 2025, to reconsider its Memorandum Opinion and Order [Doc. 59]. Specifically, they argue that the Court erred in dismissing certain counts and defendants [Id.]. While that motion remained pending, defendant moved to dismiss plaintiffs’ amended complaint [Doc. 65]. Most recently, the Court entered a Memorandum Opinion and Order denying plaintiffs’ recusal request and staying this case pending the Court‘s adjudication of the instant pending motions [Doc. 90]. Given this procedural posture, the Court will begin by addressing plaintiffs’ reconsideration motion; then, it will turn to dеfendant‘s motion to dismiss.
A. Background
Plaintiffs move the Court pursuant to
Defendant Tennova responds by arguing, inter alia,1 that plaintiffs fail to identify a manifest error of law or fact sufficient to warrant reconsideration [Doc. 61, p. 7]. Specifically, it contends that plaintiffs do not cite any law or precedent in support of their reconsideration arguments; instead, they reargue points that were previously presented to the Court [Id. at 9]. Further, defendant cites case law in support of the Court‘s prior holding that plaintiffs’ state law claims are subject to the THLA‘s statute of limitation [Id. at 10].
The Corporate defendants, now dismissed from this action, also respond in opposition to plaintiffs’ motion for reconsideration [Doc. 63], joining in Section B of
Plaintiffs reply to both sets of responses, reiterating that the Court committed clear errors on the two bases previously discussed, as well as alleging that new evidence regarding Tennova‘s data loss warrants reconsideration [Docs. 62, 64].
B. Legal Standard
Upon careful review of the parties’ arguments and the Court‘s prior Memorandum Opinion and Order, the Court declines to reconsider its decision. When the Court determined that “plaintiffs were on inquiry notice more than one year before filing their suit,” it expressly “interpret[ed] the timing of these events in the light most favorable to plaintiffs,” and nevertheless found that “their cause(s) of action accrued no later than January 20, 2023, when they confirmеd the presence of Shiga Toxin bacteria and directly informed defendants of the same” [Doc. 57, pp. 11–12]. Plaintiffs have not adduced new or contradictory evidence that would otherwise disturb this conclusion.
As for their argument regarding the scope of the THLA, the Court specifically noted that “[t]he parties do not appear to object to [the R&R‘s finding that] the THLA governs plaintiffs’ state claims in the first instance” [Id. at 57 (citing Docs. 48 (as amended by Doc. 49), 51, 52, 55)]. The Honorable Debra C. Poplin, United States Magistrate Judge, aptly discussed the THLA‘s coverage of plaintiffs’ statе law claims in her original Report and Recommendation, including contract and battery claims [See Doc. 47, pp. 23–24]. Plaintiffs never objected to this determination, which the Court ultimately adopted [See Doc. 57], until their instant motion, which, as defendant notes also fails to identify legal support for the proposition that the Court erred as to this finding.
In sum, plaintiffs’ Motion for Reconsideration of Court‘s Order [Doc. 59] is DENIED and the Court will proceed to evaluate the remaining pending motions under the
III. Defendant‘s Motion to Dismiss Plaintiffs’ Amended Complaint [Doc. 65]
A. Background
Defendant moves to dismiss plaintiffs’ amended complaint pursuant to
Plaintiffs respond in opposition, arguing that their amended complaint contains allegations regarding defendant‘s failure to provide a “protocol-required stool test” and defendant‘s “premature dischаrge” of Mr. Crawford “due to cash-paying status,” in violation of EMTALA [Doc. 67, p. 3]. They repeatedly disavow defendant‘s characterization of their complaint as one sounding in negligence, instead contending that it focuses on defendant‘s “non-uniform screening and stabilization failures” [Id. at 5–9].
B. Legal Standard
Under
Further, on a
To briefly summarize plaintiffs’ amended complaint, they allege that Mr. Crawford presented to Tennova North on November 27, 2022, seeking emergency medical сare for dehydration and suspected food poisoning [Doc. 60 ¶ 8]. Tennova allegedly triaged patients based on the severity of their condition, and Mr. Crawford was immediately admitted for treatment upon a determination that his condition was serious [Id. ¶ 10]. Plaintiffs allege that defendant “failed to provide adequate emergency care” to Mr. Crawford at several points, including his being restrained to a gurney for “several hours” and his physicians’ refusal to conduct a stool test at Mrs. Crawford‘s request [Id. ¶¶ 11–13]. Ultimately, Mr. Crawford was discharged from Tennova on November 29, 2022, allеgedly “without stabilizing his food poisoning” and “exacerbating his condition” [Id. ¶ 14]. After his discharge, plaintiffs allegedly obtained further proof that Tennova “intentionally concealed EMTALA violations” during their correspondence with defendant‘s personnel [Id. ¶¶ 15-23, 26–27].
Congress enacted EMTALA to “deal with the problem of patients being turned away from emergency rooms for non-medical reasons.” Bryan v. Rectors & Visitors of Univ. of Va., 95 F.3d 349, 351 (4th Cir. 1996). As the United States Court of Appeals for the Fourth Circuit has explained, “[o]nce EMTALA has met that purpose of ensuring that a hospital undertakes stabilizing treatment for a patient who аrrives with an emergency condition, the patient‘s care becomes the legal responsibility of the hospital and the treating physicians,” and “the legal adequacy of that care is then governed not by EMTALA but by
Plaintiffs allege that defendant violated each of these requirements [See Doc. 60].
1. Whether Plaintiffs State a Claim for Failure to Provide an Appropriate Medical Screening
EMTALA first requires a hospital to “provide for an appropriate medical screening examination within the capability of the hospital‘s emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition . . . exists.”
Cleland, which both parties cite [See, e.g., Doc. 66, p. 7; Doc. 60, p. 11], is instructive. See 917 F.2d at 266. In that case, a 15-year-old boy presented to a Michigan emergency room wherein he was incorrectly diagnosed with influenza. Id. at 268. Within 24 hours of his discharge, the young patient died due to an undiagnosed case of intussusception. Id. In affirming the district court‘s dismissal of the decedent‘s parents’ complaint, the United States Court of Appeals for the Sixth Circuit interpreted “the vague phrase ‘appropriate medical screening’ to mean a screening that the hospital would have offered to any paying patient[.]” Id. Specifically, the Sixth Circuit instructed courts to screen for an improper motive on the part of a hospital provider, such that “[i]f it acts in the same manner as it would have for the usual paying patient, then the screening provided is ‘appropriate’ within the meaning of the statute.” Id. at 272. In other words, despite the patient‘s tragic death, EMTALA does not allow “resort to a malpractice or other objective standard of care as the meaning of the term ‘appropriate.‘” Id.
With the benefit of hindsight some decades later, the Sixth Circuit explained its interpretation of “appropriate” in Cleland as “an effort to distinguish a cause of аction under § 1395dd(a) from state-law claims for medical malpractice.” Elmhirst v. McLaren N. Mich., 726 F. App‘x 439, 442 (6th Cir. 2018) (unpublished). While acknowledging other courts’ criticism of the improper motive requirement, the appellate court ultimately
Construing the allegations in plaintiffs’ amended complaint in the light most favorable to them, the Court ultimately finds that they have not adequately pled a claim for failure to provide an appropriate medical screening. See Bishop, 520 F.3d at 519. Plaintiffs, themselves, state that “Defendant documented thеir knowledge of an EMC” [Doc. 60 ¶ 37], meaning that Tennova “determine[d] whether or not an emergency medical condition . . . exist[ed].”
Plaintiffs’ allegations regarding defendant‘s refusal to administer a specific test for food poisoning attempt to expand EMTALA liability in precisely the manner that the Sixth Circuit foreclosed in Cleland. They allege that “Defendant‘s complete failure to screen for STEC2 deviates from any objective standard, as no reasonable hospital protocol would omit
In sum, рlaintiffs have failed to state a plausible claim that defendant failed to provide an adequate medical screening, and this count of their amended complaint is hereby DISMISSED. See
2. Whether Plaintiffs State a Claim for Failure to Stabilize an Emergency Medical Condition
If, upon completion of an appropriate medical screening, a hospital determines an individual has an emergency medical condition, EMTALA requires hospitals to provide “such further medical examination and such treatment as may be required to stabilize the medical cоndition” or to transfer the individual to an appropriate medical facility.
While a plaintiff who brings a failure to stabilize claim is not required to demonstrate a hospital‘s improper motive as in a
As a threshold matter, the Court finds that plaintiffs have adequately pleaded facts sufficient to trigger the stabilization requirement. Defendant argues that its medical personnel lacked actual knowledge of Mr. Crawford‘s underlying condition such that the stabilization requirement never arose [See Doc. 66, pp. 16–17].3 But the Court must accept
Like their allegations in support of Count 1, several of plaintiffs’ allegations in support of Count 2 reflect the view “that he did not receive the type of medical treatment he believes he should have received.” Mitchell, 2014 WL 1154233, at *5. For example, they allege that defendant failed to provide “adequate fluid therapy” and administered antibiotics despite their claim that such medication was “irrelevant to stabilizing his EMC” [Doc. 60 ¶¶ 49, 51]. As stated previously in the Court‘s analysis of plaintiffs’ Count 1 (see supra Section III(C)(1)), these allegations fall outside the scope of liability created by EMTALA. In the stabilization context, specifically, the Court reiterates that while dеfendant must provide emergency care “until the patient‘s emergency medical condition is stabilized,” Thornton, 895 F.2d at 1135, the federal statute does not prescribe specific stabilizing treatments or procedures to which a patient is entitled.
Construing plaintiffs’ own allegations regarding the care that Mr. Crawford received at Tennova in the light most favorable to them, the Court finds that they “can prove no set of facts in support of [these] allegations that would entitle them to relief,” under EMTALA‘s stabilization provision. Bishop, 520 F.3d at 519. While the Court has not been made aware of another case in which an EMTALA claimant declined medical treatment offered by a hospital during a patient‘s stabilization, this allegation appears particularly detrimental to plaintiffs’ stabilization theory. Regardless of the veracity of plaintiffs’ allegation that the tests offered by defendant were “expensive” [Doc. 60 ¶ 14],5 EMTALA‘s requirement that a hospital “provide such further medical examination and such treatment as may be required to stabilize the medical condition” seems to assume that patients will authorize said medical treatment.
In sum, plaintiffs havе failed to state a plausible claim that defendant failed to stabilize Mr. Crawford‘s emergency medical condition, and this count of their amended complaint is hereby DISMISSED. See
3. Whether Plaintiffs State a Claim for Failure to Transfer
Based upon the Court‘s analysis and ultimate dismissal of plaintiffs’ second claim (see supra Section III(C)(2)), their third and final claim is also due to be dismissed. If an individual‘s emergency medical condition has not been stabilized, EMTALA imposes further requirements on hospitals to prevent the premature transfer of patients. See
IV. Remaining Pending Motions [Docs. 68, 70, 76, 81, 82]
Given that the Court has dismissed plaintiffs’ amended complaint in its entirety (see supra Section III), the parties’ remaining pending motions [Docs. 68, 70, 76, 81, 82] are hereby DENIED as moot.
V. Conclusion
For the reasons explаined above, plaintiffs’ Motion for Reconsideration of Court‘s Order [Doc. 59] is DENIED, defendant‘s Motion to Dismiss Plaintiffs’ First Amended Complaint [Doc. 65] is GRANTED, the remaining pending motions [Docs. 68, 70, 76, 81, 82] are DENIED as moot, and this case is DISMISSED. An appropriate order shall enter.
IT IS SO ORDERED.
s/ Thomas A. Varlan
UNITED STATES DISTRICT JUDGE