United States District Court, S.D. Indiana, Indianapolis Division
ALICE HATZELL, GUARDIAN OF THE ESTATE OF CHERYL HATZELL, ALICE HATZELL INDIVIDUALLY, and RICHARD HATZELL INDIVIDUALLY, Plaintiffs,
THE HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY a/k/a WISHARD MEMORIAL HOSPITAL, WISHARD HEALTH SERVICES, ESKENAZI HEALTH, and ESKENAZI HEALTH FOUNDATION, INC. f/k/a WISHARD MEMORIAL FOUNDATION, INC., Defendants.
ORDER ON CROSS MOTIONS FOR SUMMARY JUDGMENT
J. McKINNEY, JUDGE.
Alice Hatzell, Guardian of the Estate of Cheryl Hatzell
(“Cheryl”), Alice Hatzell, Individually
(“Alice”) and Richard Hatzell
“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 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. For the reasons stated herein,
the Court GRANTS Defendants' Motion for Summary Judgment
and DENIES Plaintiffs' Motion for Partial Summary
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
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.
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.
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.
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. 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.
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.
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.
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
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.
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.
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
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 ...