Jane M. Roberts, Guardian for Wanda Y. Johnson, Petitioner
v.
Galen of Virginia, Inc., formerly dba Humana Hospital -- University of Louisville, dba University of Louisville Hospital
United States Supreme Court
January 13, 1999
ON WRIT OF CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR THE SIXTH CIRCUIT.
PER CURIAM
The Emergency Medical Treatment and Active Labor
Act, as added by 9121(b) of the Consolidated
Omnibus Budget Reconciliation Act of 1985, 100
Stat. 164, and as amended, 42 U.S.C. 1395dd,
(EMTALA), places obligations of screening and
stabilization upon hospitals and emergency rooms
who receive patients suffering from an "emergency
medical condition." The Court of Appeals held that
in order to recover in a suit alleging a violation of
1395dd(b), a plaintiff must prove that the hospital
acted with an improper motive in failing to stabilize
her. Finding no support for such a requirement in the
test of the statute, we reverse.
Section 1395dd(a) imposes a "[m]edical screening
requirement" upon hospitals with emergency
departments: "[I]f any individual ... comes to the
emergency department and a request is made on the
individual's behalf for examination or treatment for a
medical condition, the hospital must provide for an
appropriate medical screening examination within the
capability of the hospital's emergency department."
42 U.S.C. 1395dd(a). Section 1395dd(b), entitled
"Necessary stabilizing treatment for emergency
medical conditions and labor," provides in relevant
part as follows:
"(1)" In general
If any individual (whether or not elegible for benefits
under this subchapter) 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
facility in accordance with subsection (c) of this
section ..."
Section 1395dd(c) generally restricts transfers of
unstabilized patients, and 1395dd(d) authorizes both
civil fines and a private cause of action for violations
of the statute.
Petitioner Wanda Johnson was run over by a truck in
May 1992, and was rushed to respondent's hospital,
The Humana Hospital - University of Louisville,
Kentucky (Humana). Johnson had been severely
injured and had suffered serious injuries to her brain,
spine, right leg, and pelvis. After about six weeks'
stay at Humana, during which time Johnson's health
remained in a volatile state, respondent's agents
arranged for her transfer to the Crestview Health
Care Facility, across the river in Indiana. Johnson
was transferred to Crestview on July 24, 1992, but
upon arrival at that facility, her condition deteriorated
significantly. Johnson was taken to the Midwest
Medical Center, also in Indiana, where she remained
for many months and incurred substantial medical
expenses as a result of her deterioration. Johnson
applied for financial assistance under Indiana's
Medicaid program, but her application was rejected
on the grounds that she had failed to satisfy Indiana's
residency requirements. Plaintiff Jane Roberts,
Johnson's guardian, then filed this federal action
under 1395dd(d) of EMTALA, alleging violations of
1395dd(b) of the Act.
The District Court granted summary judgment for
respondents on the grounds that the plaintiffs had
failed to show the " 'either the medical opinion that
Johnson was stable or the decision to authorize her
transfer was caused by an improper motive.' "The
Court of Appeals affirmed, holding that in order to
state a claim in an EMTALA suit alleging a violation
of 1395dd(b)'s stabilization requirement, a plaintiff
must show that the hospital's inappropriate
stabilization resulted from an improper motive such
as one involving the indigency, race, or sex of the
patient. 111 F. 3d 405 (CA6 1997). In order to
decide whether subsection (b) of EMTALA imposes
such a requirement, we granted certiorari, 524 U.S.
___ (1998), and now reverse.
The Court of Appeals' holding - that proof of
improper motive was necessary for recovery under
1395dd(b)'s stabilization requirement - extended
earlier Circuit precedent deciding that the
"appropriate medical screening" duty under
1395dd(a) also required proof of an improper
motive. See Cleland v. Bronson Health Care
Group, Inc., 917 F. 2d 166 (CA6 1990). The Court
of Appeals in Cleland was concerned that Congress'
use of the work "appropriate" in 1395dd(a) might
be interpreted incorrectly to permit federal liability
under EMTALA for any violaiton covered by state
malpractice law. Id., at 271. Accordingly, rather
than interpret EMTALA so as to cover "at a
minimum, the full panoply of state malpractice law,
and at a maximum, ... a guarantee of a successful
result" in medical treatment, ibid., the Court of
Appeals read 1395dd(a)'s "appropriate medical
screening" duty as requiring a plaintiff to show an
improper reason why he or she received "less than
standard attention [upon arrival] ... at the emergency
room." Id., at 272.
Unlike the provision of EMTALA at issue in
Cleland, 1395dd(a), the provision at issue in this
case, 1395dd(b), contains no requirement of
appropriateness. Subsection (b)(1)(A) of EMTALA
requires instead the provision of "such further
medical examination and treatment as may be
required to stabilize the medical condition." 42
U.S.C. 1395dd(b)(1)(A). The question of the
correctness of the Cleland Court's reading of
1395dd(a)'s "appropriate medical screening" is not
before us, and we express no opinion on it here.
[FN1] But there is no question that the text of
1395dd(b) does not require an "appropriate"
stabilization, not can it reasonably be read to require
an improper motive. This fact is conceded by the
respondent, which notes in its brief that "the
'motive' test adopted by the court below ... lacks
support in any of the traditional sources of statutory
construction. Brief for Respondent 17.
Although the concession of a point on appeal by the
respondent is by no means dispositive of a legal
issue, we take it as a further indication of the
correctness of our decision today, and hold that
1395dd(b) contains no express or implied
"improper motive" requirement.
Although respondent presents two alternative
grounds for the affirmance of the decision below
[FN2] we decline to address these claims at this
stage in the litigation. The Court granted certiorari
on only the EMTALA issue, and these claims do not
appear to have been sufficiently developed below for
us to assess them in any event. Accordingly, we
reverse the Court of Appeals's holding htat the
District Court's grant of summary judgment was
proper, and remand the case for further proceedings
consistent with this opinion.
It is so ordered.
FN1. We note, however, that Cleland's
interpretation of subsection (a) of EMTALA is
in conflict with the law of other circuits which
do not read subsection (a) as imposing an
improper motive requirement. See Summers v.
Baptist Med Ctr. Arkadelphia, 91 F 3d 1132,
1137-38 (CA8 1996) (en banc); correa v.
Hospital San Francisco, 69 F. 3d 1184, 1193-94
(CA1 1995); Repp v. Anadarko Mun. Hosp., 43
F 3d 519, 522 (CA10 1994); Power v.
Arlington Hosp. Ass'n., 42 F. 3d 851, 857
(CA4 1994); Gatewood v. Washington
Healthcare Corp., 933 F. 2d 1037, 1041
(CADC 1991).
FN2. Respondents argue that the record
demonstrated that did not have actual
knowledge of the patient's condition, and that
the hospital properly screened Johnson, which
terminated its duty under EMTALA. We
express no opinion as to the factual correctness
or legal dispositiveness of these claims, and
leave their resolution to the courts below on
remand.
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Analysis by Stephen A. Frew, J.D.
Although the Supreme Court has issued the above opinion striking down the requirement for an improper motive to be proven for EMTALA stabilization and transfer cases, the court tactfully avoided specifically over-ruling the 6th Circuit requirement for an improper motive for EMTALA screening. It is clear from the opinion, however, that the 6th Circuit stands little or no chance in maintaining that requirement in screening cases.
More importantly, however, is the fact that the Court applied the same type of analysis (strict statutory analysis) that was used in theSmith v. Richmond Memorial Hospital case. The Smith case ruled that COBRA applies housewide when it comes to stabilization issues and transfer rules. The clear import of this for hospitals, physicians, and defense is that medical practice has to adapt to the statute, because the US Supreme Court will not adapt the law to fit the preferences of the health care delivery system
This case has already set the stage for a revolution in COBRA/EMTALA application. Following the clear direction of this case, the US First Circuit Court of Appeals has ruled that COBRA/EMTALA applies house-wide. See the Lopez decision of April 1999
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