Pauly v. Stanford Health Care

Background

Makenzie Pauly alleged that Stanford Health Care violated the Emergency Medical Treatment and Labor Act, a federal law requiring participating hospitals to screen people who seek emergency care and, when the hospital determines that a patient has an emergency medical condition, provide stabilizing treatment or an appropriate transfer. Pauly’s four claims alleged that Stanford Health Care:

The dispute arose from Pauly’s treatment for severe abdominal pain. The opinion states that she had undergone extensive testing and procedures before visiting Stanford Health Care’s emergency room on December 10, 2008. At that visit, nurses triaged her, took her vital signs, and administered medication. Dr. Grant Lipman took her medical history, examined her, consulted pain services, and recorded that she was stable. Pauly and her mother described the examination as rude and inadequate and said she was discharged without sufficient treatment. Pauly later stated that the pain resolved about five weeks after the Stanford visit.

Stanford Health Care moved for summary judgment, which asks whether the evidence shows that no genuine dispute of important fact exists and that the moving party is entitled to judgment under the law. Pauly filed a cross-motion for summary judgment, arguing that undisputed evidence established each of her claims. The court accepted that cross-motion despite its late filing.

Preliminary Motion

Pauly moved to strike Stanford Health Care’s arguments and evidence concerning events before Sutter’s transfer request and after Stanford discharged her, as well as medical events that Stanford allegedly did not know about at the time. The court denied that motion. It ruled that Pauly’s medical history and her condition before and after the emergency-room visit could be relevant to the adequacy of the examination and stabilizing care, whether she had an emergency medical condition, whether she was stabilized, and whether Stanford’s conduct caused injury.

Transfer Claim

The court granted summary judgment to Stanford Health Care on Pauly’s first claim. The claim alleged that Stanford violated the law’s “reverse-dumping” provision by failing to accept a transfer from Sutter to Louise Packard Children’s Hospital.

The court held that the transfer nondiscrimination provision applies only when the receiving hospital has the capacity to treat the patient. An appropriate transfer also requires the receiving facility to have available space and qualified personnel and to agree to accept the transfer. Transfer-log entries and Sutter’s records showed that no beds were available at Louise Packard Children’s Hospital during the relevant period. Pauly offered no evidence that beds were available or that the hospital customarily accommodated patients beyond its occupancy limits. Because the evidence that no space was available was unrebutted, the court ruled that the transfer provision did not apply. It did not reach Stanford Health Care’s separate argument that Stanford Health Care and Louise Packard Children’s Hospital were legally separate entities.

Screening Claim

The court granted summary judgment to Stanford Health Care on Pauly’s second claim, which alleged that the hospital failed to provide an appropriate medical screening examination.

The court explained that the screening requirement is satisfied when a hospital provides an examination comparable to the examination given to other patients with similar symptoms. The examination need not correctly diagnose the patient’s condition. Pauly argued that the examination was too brief, that the doctors were angry, that she was denied admission, and that the attending physician’s specialty was not pediatric care.

The court found that Stanford Health Care provided evidence that Pauly received an appropriate examination. The evidence showed that nurses performed triage, the physician took a detailed medical history, examined her, palpated her abdomen, ordered laboratory testing and a urinalysis, and provided pain medication. Stanford Health Care also submitted a physician’s declaration stating that the screening was appropriate. Pauly provided evidence that the examination was rude and that the physician did not want to deal with her, but she did not provide evidence that the examination differed from examinations given to similar patients or was so cursory that it was not designed to identify an emergency medical condition. The court therefore granted summary judgment to Stanford Health Care.

On-Call-Specialist Claim

The court granted summary judgment to Stanford Health Care on Pauly’s third claim. Pauly alleged that Stanford violated a statutory provision concerning on-call specialists who fail or refuse to appear after being called.

The court held that the cited provision is part of the statute’s enforcement section and creates an exception to certain physician penalties. It does not create a separate cause of action that a patient can bring. The court therefore granted Stanford Health Care’s motion on this claim without deciding whether the on-call physicians acted appropriately.

Stabilization Claim

The court granted Stanford Health Care’s motion for summary judgment on Pauly’s fourth claim, which alleged failure to stabilize an emergency medical condition.

The stabilization duty arises when a hospital determines that a patient has an emergency medical condition. The statute defines such a condition, in relevant part, as a condition involving acute symptoms of sufficient severity, including severe pain, where the absence of immediate medical attention could reasonably be expected to cause serious danger to health, serious impairment of bodily functions, or serious dysfunction of a bodily organ or part.

The court found that Stanford Health Care knew Pauly was experiencing severe abdominal pain. But the evidence did not show that the hospital determined that she had acute symptoms meeting the statutory requirements or that failing to treat her would create the required risk of serious harm. Her doctors recorded that the pain had lasted more than a month, that earlier procedures and hospital admissions had not produced a diagnosis, and that she was stable. Pauly did not offer evidence rebutting Stanford Health Care’s evidence that her doctors did not consider her to have an emergency medical condition. The court ruled that her stabilization claim therefore failed.

Disposition

The court granted Stanford Health Care’s motion for summary judgment in full and denied Pauly’s cross-motion for summary judgment. The court dismissed the action. Because summary judgment resolved all claims in Stanford Health Care’s favor, the court did not reach Stanford Health Care’s arguments concerning causation or limits on damages. Judge Susan Illston signed the order.