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William F. Byrne v. the Cleveland Clinic

March 30, 2011

WILLIAM F. BYRNE,
PLAINTIFF,
v.
THE CLEVELAND CLINIC, AND THE CHESTER COUNTY HOSPITAL, DEFENDANTS.



The opinion of the court was delivered by: Gene E.K. Pratter, J.

MEMORANDUM

William F. Byrne, a pro se litigant, has sued The Cleveland Clinic (the "Clinic") and Chester County Hospital (the "Hospital") relating to events that occurred on February 15, 2007 when he arrived in the Hopsital's emergency room needing medical care. Mr. Byrne's case has undergone certain pleadings surgeries so that he now has one surviving claim, a medical screening claim, based on the theory that Defendants failed to provide him with the appropriate medical screening required by the Emergency Medical Treatment and Active Labor Act ("EMTALA"). Following discovery and related motion practice concerning the screening claim, the Clinic now seeks summary judgment.*fn1 For the reasons set forth below, the Court grants the Clinic's motion.

STANDARDOFREVIEW

Upon motion of a party, granting summary judgment is appropriate "if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law."Fed. R. Civ. P. 56(a). An issue is "genuine" if there is a sufficient evidentiary basis on which a reasonable jury could return a verdict for the non-moving party. Kaucher v. County of Bucks, 455 F.3d 418, 423 (3d Cir. 2006) (citing Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986)). A factual dispute is "material" if it might affect the outcome of the case under governing law. Id.

A party seeking summary judgment always bears the initial responsibility for informing the court of the basis for its motion and identifying those portions of the record that it believes demonstrate the absence of a genuine issue of material fact. Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986). Where the non-moving party bears the burden of proof on a particular issue, the moving party's initial burden can be met simply by "pointing out to the district court that there is an absence of evidence to support the non-moving party's case." Id. at 325. After the moving party has met its initial burden, the nonmoving party must set forth specific facts showing that there is a genuinely disputed factual issue for trial by "citing to particular parts of materials in the record, including depositions, documents, electronically stored information, affidavits or declarations, stipulations . . . , admissions, interrogatory answers, or other materials" or by "showing that the materials cited do not establish the absence or presence of a genuine dispute." Fed. R. Civ. P. 56(c). Summary judgment is appropriate if the non-moving party fails to rebut by making a factual showing "sufficient to establish the existence of an element essential to that party's case, and on which that party will bear the burden of proof at trial." Celotex, 477 U.S. at 322. Under Rule 56, the Court must view the evidence presented on the motion in the light most favorable to the opposing, that is, the non-moving party. Anderson, 477 U.S. at 255.

Additionally, in considering the present motion, the Court recognizes the challenges presented to a pro se litigant in such circumstances, and notes that Mr. Byrne's pro se submissions are "liberally construed." Estelle v. Gamble, 429 U.S. 97, 106 (1976). Due to an "understandable difference in legal sophistication," pro se litigants such as Mr. Byrne are held to a "less exacting standard" than trained counsel. Lopez v. Brown, No. 04-6267, 2005 WL 2972843, at * 2 (D.N.J. Nov. 4, 2005) (citing Haines v. Kerner, 404 U.S. 519, 520 (1972)). Accordingly, the Court gives pro se litigants like Mr. Byrne "greater leeway where they have not followed the technical rules of pleading and procedure," Tabron v. Grace, 6 F.3d 147, 153, n.2 (3d Cir. 1993).*fn1

DISCUSSION

The allegations contained in Mr. Byrne's Amended Complaint, as well as the legal framework applicable to this case pursuant to EMTALA were set forth at length in the Court's Memorandum dated February 5, 2010 (Docket No. 31), and will not be recounted extensively here other than as necessary.

EMTALA imposes screening obligations that require a hospital's emergency department to provide "an appropriate medical screening examination within the capability of the hospital's emergency department . . . to determine whether or not an emergency medical condition . . . exists." 42 U.S.C. §§ 1395dd(a). A private cause of action for damages arises when a hospital fails to meet its screening obligations. 42 U.S.C. § 1395dd(d)(2)(A) ("Any individual who suffers personal harm as a direct result of a participating hospital's violation of a requirement of this section may, in a civil action against the participating hospital, obtain those damages available for personal injury under the law of the State in which the hospital is located, and such equitable relief as is appropriate.").

Direct liability for an EMTALA screening violation is restricted explicitly under the statute to certain institutions and specific circumstances. First, EMTALA only applies to "participating hospitals," which are institutions that voluntarily participate in the Medicare program and have an effective Medicare provider agreement with the federal government pursuant to 42 U.S.C. § 1395cc. See 42 U.S.C.A. § 1395dd; see also In re Univ. Med. Ctr., 973 F.2d 1065, 1083 (3d Cir. 1992); Jackson v. East Bay Hosp., 246 F.3d 1248, 1260 n.6 (9th Cir. 2001); Miller v. Med. Ctr. of Sw. Louisiana, 22 F.3d 626, 628 n.4 (5th Cir. 1994). Second, to be subject to the screening requirement, an institution must satisfy the multi-part definition of "hospital" under 42 U.S.C. § 1395x(e). See Rodriguez v. Am. Intern. Ins. Co. of Puerto Rico, 402 F.3d 45, 48 (1st Cir. 2005) (determining that a "regional diagnostic and treatment center" did not meet the definition of "hospital" under Section 1395x(e) and thus was not subject to EMTALA); East Bay Hosp., 246 F.3d at 1260 (finding that the defendant health system had no direct liability under EMTALA, in part, because it was not a "hospital" pursuant to Section 1395x(e)). Third, screening duties imposed under 42 U.S.C. §§ 1395dd(a) are only triggered if a patient seeks treatment from the hospital's emergency department. See Baber v. Hosp. Corp. of Am., 977 F.2d 872, 884 (4th Cir.1992) ("[T]he hospital's duty to provide an appropriate medical screening arises only if the patient seeks treatment from the emergency department."); Rodriguez, 402 F.3d at 48 ("[T]he screening requirement under EMTALA only applies to patients seeking treatment at the emergency room, not elsewhere in a hospital." (citing Lopez-Soto v. Hawayek, 175 F.3d 170, 173 (1st Cir.1999); Baber, 977 F.2d at 884)); Miller, 22 F.3d at 629 (requiring that a patient physically arrive at the hospital's emergency department and request treatment in order for EMTALA screening liability to arise).

In light of these criteria, the Court finds that the Clinic cannot be held directly liable under Mr. Byrne's EMTALA screening claim. Even assuming, arguendo, that the Clinic is a "participating hospital"*fn2 and is a "hospital" as defined by Section 1395x(e), *fn3 the Clinic still cannot be directly liable to Mr. Byrne for an EMTALA screening claim because Mr. Byrne never physically entered the Clinic's emergency department, which is located in Cleveland, Ohio.

Am. Compl. at Docket No. 4 ¶ 2; Clinic Answer at Docket No. 43 ¶ 2. Likewise, at no time did he request treatment from the Clinic. Clinic Mot. at Docket No. 51, Exhibit D, at 194 (Q: "Have you ever contacted anyone from the Cleveland Clinic"; Mr. Byrne: "No."). Indeed, the record reflects that Mr. Byrne went to Chester County Hospital in West Chester, Pennsylvania on February 15, 2007; all medical care that he received on that date occurred on the Hospital's premises. See Am. Compl. at Docket No. 4, at 2 ("Statement of the Case"); Pl.'s Resp. at Docket No. 57 at ¶ 7; Clinic Mot. at Docket No. 51, ¶ 7; id., Exhibit D, at 149, 159, 161, 163-175, 190-191.*fn4 Furthermore, Mr. Byrne does not dispute these facts, Am. Compl. at Docket No. 4, at 2; Pl.'s Resp. at Docket No. 57 at ¶ 7; nor does he cite any evidence that contradicts these facts.

Mr. Byrne does contest the Clinic's motion on the basis that the Clinic is vicariously liable for an alleged screening violation committed by the Hospital. Mr. Byrne argues that the Clinic and the Hospital have an affiliation agreement that creates an agency relationship between the two institutions, which imputes liability to the Clinic for the Hospital's actions relating to Mr. Byrne's medical care.*fn5 In support of his theory, Mr. Byrne has provided as exhibits printed copies of the Hospital's website pages and apparent Hospital marketing materials that identify and describe the "affiliation" relationship that exists between the Clinic and the Hospital.

Upon close review of Mr. Byrne's exhibits, and reviewing them in a light most favorable to Mr. Byrne, the Court concludes that such documents cannot provide a sufficient evidentiary basis on which a reasonable jury could find that the "affiliation" relationship between the Hospital and the Clinic is one that could impute liability to the Clinic for the Hospital's alleged screening violation. Most of the materials Mr. Byrne provides only appear to confirm that an "affiliation" exists between ...


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