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Hatzell v. Health and Hospital Corp. of Marion County

United States District Court, S.D. Indiana, Indianapolis Division

November 18, 2016




         Plaintiffs Alice Hatzell, Guardian of the Estate of Cheryl Hatzell (“Cheryl”), Alice Hatzell, Individually (“Alice”) and Richard Hatzell (“Richard”) (collectively, “Plaintiffs”), have moved for partial summary judgment on their claims brought under the Emergency Medical Treatment and Active labor Act (“EMTALA”), for failure to provide an appropriate medical screening examination and failure to provide stabilizing treatment of Cheryl at Wishard Hospital[1] in Indianapolis, Indiana, on May 29, 2013, and May 30, 2013. Defendants The Health and Hospital Corporation of Marion County, Wishard Health Services, Eskenazi Health and Eskenazi Health Foundation, Inc. (collectively, “Defendants”), have moved for summary judgment on Plaintiffs' claims, or, in the alternative partial summary judgment. Defendants assert that the EMTALA does not apply to Plaintiffs' claims, alleging that they sound in malpractice.[2] For the reasons stated herein, the Court GRANTS Defendants' Motion for Summary Judgment and DENIES Plaintiffs' Motion for Partial Summary Judgment.


         The parties agree on the operative facts taken in the light most favorable to Plaintiffs; the Court summarizes them here. On May 29, 2013, Alice took Cheryl, her adult, mentally handicapped daughter, to the emergency room at Wishard Hospital because Cheryl had not been feeling well, was constipated and had not been urinating. Alice related to the emergency room receptionist that Cheryl “was lethargic, and that she wasn't-she wasn't having normal bathroom, like bowel movements or urinating, and that she need to see a doctor . . . .” Alice Hatzell Dep. at 17:19-25. A nurse took Cheryl's medical history from Alice. Alice and Cheryl were taken into an examination room where a nurse took Cheryl's vital signs. Id. at 18:5-19:5.

         Dr. Robert Cantor, the emergency room resident physician of the day, arrived and inquired of Cheryl's complaints. Cantor Dep. at 8-9; Alice Hatzell Dep. at 19:14-20:2. Cheryl denied being in pain. Id. at 82:6-12. Alice told Dr. Cantor of Cheryl's lack of bowel movement for four days and Cheryl's lack of urination. Id. at 79:19-24, 20:5-11; Defs.' Ex. 2. Cheryl then reported that her stomach hurt. Alice Hatzell Dep. at 82:13-15. Alice, upon inquiry from the doctor listed Cheryl's medications. Id. at 20:3-5. Alice reported that Cheryl had trouble with constipation in the past from her medications. Id. at 20:5-11. Alice further reported that a stool softener had been given the day before to no apparent avail, but Cheryl had been passing gas. Id. at 71:18-72:11. Alice also reported that Cheryl appeared to be having abdominal pain and that she had not eaten for a day. Id. at 71:18-72:11. Alice added that Cheryl had been depressed for a few days and that her activity had decreased. Id. at 70:17-24; Defs.' Ex. 1 at 3.

         Dr. Cantor ordered a urinalysis. Wishard Chart at 14. In addition, Cheryl was taken to another room in the emergency room to run tests. Alice Hatzell Dep. at 20:17-22. An x-ray of Cheryl's abdomen was taken to assess whether she was constipated. Cantor Dep. at 54:4-12.

         Cheryl was taken back to the room where Alice was waiting, and the two of them were moved to yet another room to wait for Dr. Cantor. Alice Hatzell Dep. at 20:25-21:12. Alice asked whether or not the nurse needed a urine sample from Cheryl and asked for a “hat” to place on the commode to collect one, which another nurse provided. Id. at 21:13-22:9. Alice declined help from the nurse. Id. at 22:5-9. Alice tried to get Cheryl to urinate for 15-20 minutes without success; a nurse checked in on them and Alice told her that Cheryl had not done anything. Id. at 22:12-23:7. The nurse responded that she would take Alice and Cheryl back to a room to meet with Dr. Cantor. Id.

         The x-rays revealed that Cheryl had a moderate stool burden and Dr. Cantor prescribed Cheryl with a laxative. Defs.' Ex. 1 at 3-4; Alice Hatzell Dep. at 24:14-22. Dr. Cantor advised Alice of his diagnosis and stated that otherwise they could not find anything physically wrong with Cheryl. Alice Hatzell Dep. at 23:9-13. Alice told Dr. Cantor that Cheryl had not urinated, despite Alice trying for an hour to get her to go in the hospital.[3] Id. at 23:19-21. Dr. Cantor repeated that the medical staff could not find anything physically wrong with Cheryl. Id. at 23:21-23. Alice then stated, “Well, what am I supposed to do? I can't get her to urinate and I know she had [urinary tract infections] UTIs in the past and I'm afraid that she has a severe UTI.” Id. at 23:23-24. Dr. Cantor advised Alice to have Cheryl follow-up with her primary care physician; Cheryl had an appointment already scheduled for the following Tuesday, June 4. Id. at 24:2-10. Cheryl was given a dose of stool softener, and Alice took Cheryl home. Id. at 24:23-25:9, 30:3-14.

         The order to perform a urinalysis was never carried out or followed up on by the Wishard staff. There is no record in Cheryl's chart to indicate why the urinalysis had not been performed or discussed amongst the emergency room staff. There is no dispute that Dr. Cantor knew how to diagnose and treat patients with a urinary tract infection and that an untreated urinary tract infection can lead to renal failure, uremia, bladder rupture and impairment of bodily functions. Cantor Dep. at 11, 18-21. Further, Dr. Cantor knew that a urinalysis would help determine whether a patient had a urinary tract infection or impaired kidney function. Id. at 60. Dr. Cantor also knew the protocols for patients who present with a concern for acute urinary retention, urinary tract infection, and/or an outlet obstruction. Id. at 25-58. Dr. Cantor did not recall either being told about Cheryl's inability to void or that the urinalysis that had been ordered had not been performed. Id. at 52-53.

         Once she was at home, Cheryl went to bed. Alice Hatzell Dep, at 24:23-25:9, 30:3-14. The laxative worked; Cheryl woke up Alice in the middle of the night because of the mess in her bed. Id. at 30:15-24. Alice and Richard cleaned up Cheryl in the bathroom. Id. at 30:25-31:11. They placed Cheryl on the commode, but she fell off of it. Id. at 31:11-17. Once Cheryl was dressed again, she headed back to bed. Id. at 31:18-24, 31:25-32:7.

         The next day, on May 30, Cheryl fell down the stairs of her home and the family called for an ambulance. Id. at 32:17-33:6. Emergency Medical Technicians (“EMTs”) found Cheryl at the bottom of the stairs when they arrived. Id. at 33:13-18. Cheryl was unresponsive and disoriented at first, but later repeated the phrase, “I'm tired, ” after being moved by the EMTs. Id. at 86:6-22. Alice advised the EMTs that Cheryl had been seen the previous day “because she was not going to the bathroom.” Id. at 87:13-17.

         Cheryl was taken by ambulance to Wishard hospital. Id. at 33:22-34:14. Once she arrived at the emergency room, medical staff ran a number of screening procedures to assess Cheryl's injuries from the fall, including a CT scans of the head, C-Spine, and Maxillofacial bones, as well as an x-ray of her ankle and chest. Perry Dep. at 27:23-28:2 & Defs.' Ex. 5, at 2.

         According to Alice, when she arrived in Cheryl's room she observed that Cheryl seemed to be in “La La Land” and was not talking or doing anything. Alice Hatzell Dep. at 35. The chart reflects that Cheryl was complaining of “tummy pain.” Wishard Chart at 35. Dr. Eric Savory, the emergency room resident on duty on May 30, advised Alice and her older daughter, Cynthia Perry (who had been called to the hospital by Alice), that the only thing they had found wrong with Cheryl was a broken nose. Alice Hatzell Dep. at 35:18-36:3. Because there was no treatment available for the broken nose, Dr. Savory told Alice to have Cheryl's primary care physician look at it in two to three days. Cynthia told Dr. Savory that something was wrong with her sister, because her behavior was not normal. Perry Dep. at 31:25-34:11. Alice agreed. Alice Hatzell Dep. at 33:8-10. Alice claims that she also told Dr. Savory that Cheryl had not urinated in days and asked what the medical staff was going to do about it. Id. at 36:6-15. Alice claims that Cheryl's abdomen was noticeably distended. Alice Hatzell Supp. Aff. Dr. Savory responded that the medical staff could not find anything physically wrong with Cheryl. Alice Hatzell Dep. at 36:17-37:24. He discharged Cheryl and told Alice to follow up with Cheryl's primary care physician the following Tuesday. Id.

         Dr. Savory was generally familiar with the protocol regarding care of emergency department patients presenting with particular problems, including urinary tract problems. Savory Dep. at 10-11, 16-17. Dr. Savory was also familiar with common tests that would be performed if a patient had acute urinary retention. Id. at 17-18, 20-21. Further, when a patient with limited ability to communicate due to a mental disability arrived at the emergency room, it was customary to try to obtain medical history from the family and review any hospital records of which the staff was aware. Id. at 24-25. Further, Dr. Savory knew the protocols and/or standard procedure if a patient had not been urinating or had repeated episodes of unsteadiness or falling. Id. at 26-34. There is no evidence in Cheryl's chart that anyone in the emergency room questioned Alice or Cynthia about Cheryl's medical history or that a “systems review” of Cheryl had been performed on May 30.

         After her release from the hospital, Cheryl returned home with Alice and Cynthia. Id. at 47:19-48:1. Alice reported to friends that Cheryl was resting at home and that the hospital could not find anything physically wrong with her; Alice suggested that there might be other causes ...

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