The Court of Appeals of Indiana (“Indiana Appellate Court”) held in its opinion filed on February 18, 2020 that the trial court properly denied the Indiana medical malpractice plaintiff’s request to amend his medical malpractice complaint to add an additional count alleging a federal claim under the Emergency Medical Treatment and Active Labor Act (“EMTALA”) to allege that the defendants had violated EMTALA on December 2, 2012 because they had failed to stabilize his condition before he had been transferred/discharged from the hospital’s emergency room.
The Underlying Facts
The Indiana medical malpractice plaintiff had gone to the Emergency Department of the defendant hospital on December 2, 2012, complaining to the defendant emergency room physician that he had pain in his back that was radiating into his buttocks and down both legs, as well as numbness in his groin, genitals, and perianal area for over one week, and that he could not always feel when he needed to urinate but that he had not had any bladder or bowel incontinence or accidents.
The defendant emergency room physician ordered an MRI that showed a herniated disc at L4-L5 and central spinal stenosis. The defendant emergency room physician discussed the MRI results with the plaintiff and diagnosed the plaintiff with having a central disc extrusion with central spinal stenosis and muscle strain. The plaintiff was discharged from the defendant hospital that same day with instructions to follow up with a specific orthopedic surgeon within two to three days. The plaintiff was prescribed steroids, pain medication, and muscle relaxants and instructed to return to the emergency department if his symptoms worsened.
On December 6, 2012, the plaintiff returned to the emergency department at the defendant hospital and was again physically examined by the defendant emergency room physician, complaining that he had decreased pain in his hamstrings but continued pain and numbness in his scrotum and anus. The defendant emergency room physician ordered a bladder scan that revealed no bladder issue. The defendant emergency room physician then arranged for the plaintiff to have a neurosurgical consult. The plaintiff was admitted to the defendant hospital, and the following day, the neurosurgeon performed an L4-L5 laminectomy and discectomy on the plaintiff. The plaintiff was discharged from the defendant hospital on December 14, 2012.
In April 2014, the plaintiff filed a proposed complaint, pursuant to the Indiana Medical Malpractice Act, with the Indiana Department of Insurance, alleging that the defendant emergency room physician had negligently failed to obtain a neurosurgical consult prior to discharging the plaintiff on December 2, 2012. On September 12, 2014, the plaintiff filed an Indiana medical malpractice complaint in the trial court.
On November 1, 2017, the medical review panel issued a unanimous opinion, finding that the evidence did “not support the conclusion that the Defendants [had] failed to meet the standard of care” and that “the conduct complained of was not a factor of [Williams’] resultant damages.”
On December 18, 2017, the plaintiff filed a motion to amend his trial court complaint. Specifically, he sought to amend the complaint so that he could: (1) identify the anonymous defendants by name (pursuant to INDIANA CODE § 34-18-8-7); and (2) add an additional count alleging a federal claim under the Emergency Medical Treatment and Active Labor Act (“EMTALA”).
The defendant hospital filed an objection to the plaintiff’s request to add an EMTALA count to the complaint. Specifically, the defendant hospital asserted that the two-year statute of limitations for the plaintiff’s federal EMTALA claim had passed and could not be tolled for any reason, including waiting for an opinion from the medical review panel.
On February 16, 2018, the trial court issued an order in which it granted the plaintiff’s request to identify the defendants by name but denied his request to add the EMTALA count to the trial court complaint.
EMTALA was enacted to address the problem of patient ‘dumping,’ in which hospitals would not provide the same treatment to uninsured patients as to paying patients, either by refusing care to the uninsured patients or by transferring them to other facilities. EMTALA imposes two duties on hospitals with respect to patients who come to their emergency rooms: first, to provide medical screening for any emergency condition; and second, as to any emergency condition, to stabilize the patient prior to any transfer to another facility.
EMTALA created a federal cause of action under federal law, governed exclusively by the federal act, but that may be pursued in federal or state court. The EMTALA statute provides that “[t]he provisions of [EMTALA] do not preempt any State or local law requirement, except to the extent that the requirement directly conflicts with a requirement of this section.” 42 U.S.C. § 1395dd(f). The statute of limitations for an EMTALA claim is two years from the date of the alleged EMTALA violation. 42 U.S.C. § 1395dd(d)(2)(C): “[n]o action may be brought under this paragraph more than two years after the date of the violation with respect to which the action is brought.”
The Indiana Appellate Court held in the case it was deciding: “as the [defendant] Hospital argued to the trial court below, the two-year statute of limitations for the EMTALA claim had already passed by the time Williams sought to amend his trial court complaint, making an amendment to add an EMTALA claim futile [“Williams contends that the Hospital violated EMTALA on December 2, 2012. He filed his initial trial court complaint on September 12, 2014. He did not allege a violation of EMTALA in this initial complaint. Williams sought to amend his complaint to add an EMTALA claim on December 18, 2017, which was five years after the date that he alleges the Hospital had violated EMTALA”].”
The Indiana Appellate Court stated: “we have explained that “there is no provision in EMTALA which effectively tolls the statute of limitations while awaiting a state procedural prerequisite, such as an opinion from a medical review panel, as is contained in the State [Medical Malpractice] Act.””
The Indiana Appellate Court held: “Williams attempted to file an EMTALA claim on December 18, 2017, which was more than two years after the date of the alleged violation of EMTALA on December 2, 2012. Thus, Williams’ EMTALA claim was barred by EMTALA’s two-year statute of limitations. Because his proposed amendment to add this claim would have been futile, we conclude that the trial court did not abuse its discretion by denying Williams’ motion to amend his complaint.”
Source Williams v. Inglis, Opinion 19A-CT-1438.
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