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The parents of a young girl who was paralyzed after a hospital allegedly failed to properly diagnose an injury to her spinal cord can seek an immediate appeal of a court order capping the damages available to her under federal emergency treatment laws ( Scott v. Ruston La. Hosp. Co. , 2017 BL 120167, W.D. La., No. 3:16-cv-376, 4/12/17 ).
Judge S. Maurice Hicks Jr. of the U.S. District Court for the Western District of Louisiana April 12 granted a motion for interlocutory appeal in the case after previously ruling the claims under the Emergency Medical Treatment and Labor Act (EMTALA) were subject to damages caps present in Louisiana’s medical malpractice law.
The question presented to the U.S. Court of Appeals for the Fifth Circuit could have far-reaching effects for hospitals that find themselves subject to EMTALA claims by patients whose injuries were allegedly caused by medical malpractice. As an example, under Louisiana’s malpractice law, a plaintiff can only recover between $100,000 and $500,000 for injuries caused by medical malpractice.
“This is one of those cases to watch, because if it gets escalated and the U.S. Supreme Court decides the state medical malpractice caps don’t apply, hospitals can be liable for some serious damages under EMTALA,” Nathan A. Kottkamp, a health-care attorney at McGuireWoods LLP in Richmond, Va., told Bloomberg BNA.
Defending the earlier ruling establishing caps on damages, Hicks noted that “most federal courts have held that EMTALA’s incorporation of state law extends to caps on damages for medical malpractice claims so long as the challenged conduct falls within the particular state’s definition of malpractice.” As evidence, he cited a 1994 decision by the U.S. Court of Appeals for the Fourth Circuit, Power v. Arlington Hosp. Ass’n , 42 F.3d 851 (4th Cir. 1994).
However, Hicks noted a 2005 opinion by Judge Helen Berrigan of the U.S. District Court for the Eastern District of Louisiana had ruled the other way, finding EMTALA preempted the state malpractice law and its provisions capping damages ( Jeff v. Universal Health Servs., Inc. , No. 2:04-cv-1507, 2005 BL 26244 (E.D. La. 7/27/05)).
In granting the motion to appeal his decision, Hicks asked the Fifth Circuit to determine whether EMTALA claims were never subject to damages caps or whether those claims should be evaluated on a case-by-case basis to see if they fit within the state’s definition for medical malpractice and thus are subject to the caps.
According to Kottkamp, the differences between the courts are a symptom of EMTALA itself. “Certain parts of EMTALA are extremely well defined, the law was not meant to replace the substantive medical malpractice standards of a particular state,” he said. “And similarly it is clear that EMTALA uses a malpractice standard, but it is more of a procedural malpractice standard.”
As an example, Kottkamp, who was not involved in this case, said EMTALA is not meant to cover a situation where the hospital and the physicians followed proper procedure but just misdiagnosed a patient through mere negligence. “It is not designed to get at the right answer, that is the substantive standard of care and that is what state malpractice caps are there for,” he said.
Instead, he said, EMTALA demands attention to the procedures that should be followed when diagnosing or stabilizing a patient. “But should a damages cap that is based on a state substantive standard of care be applied to a procedural standard of care under EMTALA?” he asked. “I think reasonable minds could differ on that.”
The underlying claims in the case relate to an experience by a young girl who came to the emergency room at Northern Louisiana Medical Center in Ruston, La., in August 2014 complaining of neurological deficiencies in both her upper and lower extremities.
Despite a request from the attending emergency physician for an MRI to assist with diagnosis, the hospital didn’t perform the test for several hours. It was later discovered the patient had a hematoma on her spinal cord. Despite treatment, she developed permanent paralysis and other severe symptoms.
The girl’s parents, Gregory and Michelle Scott, filed a medical malpractice claim with the state’s patient compensation fund as required by Louisiana’s malpractice law. During the deposition of the attending physician in that matter, the parents determined an alleged hospital policy denying tests until insurance coverage is confirmed could have been the cause of the delay for their daughter’s MRI.
As a result, the parents brought EMTALA claims in federal court against the hospital and its CEO as well as state law tort and negligence claims. The girl’s parents also asserted that their claims weren’t subject to the damages caps in the state malpractice law.
In the same order in this case that capped damages, the court also dismissed EMTALA claims against the chief executive of the hospital as well as state intentional tort claims. Hicks framed his grant of the appeal by saying the Fifth Circuit should only review the decision on the damages. However, he acknowledged the appeals court has the power to review the entirety of its order, including both the damages cap and the dismissal of some claims.
Russell A. Woodard Jr. of Breithaupt, Dunn, DuBos, Shafto & Wolleson LLC in Monroe, La., who represented the Scotts, said his clients appreciated the court certifying the case for immediate appeal. “We are optimistic about our chances with the Fifth Circuit,” he told Bloomberg BNA.
Representatives for the hospital didn’t respond to Bloomberg BNA’s requests for comment.
The hospital is represented by Blue Williams LLP in Metairie, La. The Scotts are represented by Breithaupt, Dunn, DuBos, Shafto & Wolleson LLC in Monroe, La.
To contact the reporter on this story: Matthew Loughran in Washington at firstname.lastname@example.org
To contact the editor responsible for this story: Peyton M. Sturges at PSturges@bna.com
The court's decision is at http://src.bna.com/nUo.
Copyright © 2017 The Bureau of National Affairs, Inc. All Rights Reserved.
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