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Anderson v. Kindred Hospital

March 24, 2008


The opinion of the court was delivered by: Judge Mattice


Before the Court are Defendant Kindred Hospital's and Kathy Day's Motions for Summary Judgment (Court Docs. 70, 75). In its Memorandum and Order of October 29, 2007 (Court Doc. 158), the Court reserved ruling on these motions and ordered the remaining parties to submit briefs on the issue of whether potential liability under the Emergency Medical Treatment and Active Labor Act ("EMTALA"), 42 U.S.C. § 1395dd, ends when a hospital admits in good faith a patient as an inpatient. The parties have briefed the issue. For the reasons set forth below, the Court will GRANT summary judgment to Defendant Kindred and will DECLINE to exercise supplemental jurisdiction over Plaintiffs' state-law claims.


Summary judgment is proper where "the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(c). In ruling on a motion for summary judgment, the Court must view the facts contained in the record and all inferences that can be drawn from those facts in the light most favorable to the nonmoving party. Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986); Nat'l Satellite Sports, Inc. v. Eliadis Inc., 253 F.3d 900, 907 (6th Cir. 2001). The Court cannot weigh the evidence, judge the credibility of witnesses, or determine the truth of any matter in dispute. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249 (1986).

The moving party bears the initial burden of demonstrating that no genuine issue of material facts exists. Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). The moving party may bear this burden by either producing evidence that demonstrates the absence of a genuine issue of material fact, or by simply " 'showing'--that is, pointing out to the district court--that there is an absence of evidence to support the nonmoving party's case." Id. at 325. To refute such a showing, the nonmoving party may not simply rest on its pleadings. Behrens v. Pelletier, 516 U.S. 299, 309 (1996); see Anderson, 477 U.S. at 249. The nonmoving party must present some significant, probative evidence indicating the necessity of a trial for resolving a material factual dispute. Celotex, 477 U.S. at 322. A mere scintilla of evidence is not enough. Anderson, 477 U.S. at 252; McLean v. Ontario, Ltd., 224 F.3d 797, 800 (6th Cir. 2000). The Court's role is limited to determining whether the case contains sufficient evidence from which a jury could reasonably find for the nonmoving party. Anderson, 477 U.S. at 248-49; Nat'l Satellite Sports, 253 F.3d at 907. If the nonmoving party fails to make a sufficient showing on an essential element of its case with respect to which it has the burden of proof, the moving party is entitled to summary judgment. Celotex, 477 U.S. at 323. If the Court concludes that a fair-minded jury could not return a verdict in favor of the nonmoving party based on the evidence presented, it may enter a summary judgment. Anderson, 477 U.S. at 251-52; Lansing Dairy, Inc. v. Espy, 39 F.3d 1339, 1347 (6th Cir. 1994).


The following facts are not in dispute.

Decedent, Ms. Cora Cameron, was admitted to Defendant Kindred for hemodialysis and rehabilitation. (Court Doc. 1-4, Compl. ¶ 12.) Decedent was relatively stable at this time. (Cf. Court Doc. 164, Def. Kindred Hospital's Supplemental Mem. in Supp. of Mot. Summ. J. 2; Court Doc. 176, Pls.' Second Reply Br. to Kindred's Mot. Summ. J. 6 ("[A]s stated by Kindred . . . and conceded by Plaintiffs, the patient was relatively stable when she was admitted" to Kindred.)) After 17 days, Decedent developed an emergent condition. (Compl. ¶ 17; Def. Kindred Hospital's Supplemental Mem. in Supp. of Mot. Summ. J. 2). After Kindred's staff informed Plaintiffs that it could not perform dialysis on Decedent until the following day, "Plaintiffs . . . demanded that [Decedent] be taken by ambulance to Memorial Hospital for [immediate] stabilization and dialysis. An order for transportation was obtained" and Decedent was transported to Memorial Hospital by ambulance. (Court Doc. 1-4, Compl. ¶ 17.)


The United States Congress has delegated to the United States Department of Health and Human Services ("DHHS") the authority to promulgate regulations implementing the EMTALA. See 42 U.S.C. § 1302(a) and 1395hh. In accordance with this authority, the DHHS has stated that "[i]f the hospital admits the individual as an inpatient [in good faith] for further treatment, the hospital's obligation under [the EMTALA] ends . . . ." 42 C.F.R. § 489.24(a)(1)(ii); see 42 C.F.R. § 489.24(d)(2).

To determine the extent to which this regulation binds the Court, the Court must first determine whether the regulation is merely interpretive, or rather substantive or legislative in nature. Interpretive regulations "do not have the force and effect of law and are not accorded that weight in the adjudicatory process." Shalala v. Guernsey Mem'l Hosp., 514 U.S. 87, 99 (1995) (citing Chrysler Corp. v. Brown, 441 U.S. 281, 302 n.31 (1979)). Conversely, a legislative regulation "has the force of law . . . ." State of Ohio Dep't of Human Servs. v. United States Dep't of Health & Human Servs., 862 F.2d 1228, 1233 (6th Cir. 1988) (quoting Guardian Fed. Sav. & Loan v. Fed. Sav. & Loan Ins. Corp., 589 F.2d 658, 664-65 (D.C. Cir. 1978)).

In order to determine whether a particular [regulation] is a binding rule or a general, non-binding policy statement, courts must examine both the language of the statement and the purpose it serves. If a pronouncement implements a statute by enacting a legislative-type rule affecting individual rights and obligations, it is likely to be a substantive rule. A [regulation] is also likely to be considered binding if it narrowly circumscribes administrative discretion in all future cases, and if it finally and conclusively determines the issues to which it relates.

Dyer v. Sec'y of Health and Human Servs., 889 F.2d 682, 685 (6th Cir. 1989) (internal quotations omitted). In other words, legislative regulations " 'grant rights, impose obligations, or produce other significant effects on private interests,' while interpretive rules do not 'foreclose alternative courses of action or conclusively affect rights of private parties.' " State of Ohio Dep't of Human Servs., 862 F.2d at 1233 (quoting Batterton v. Marshall, 648 F.2d 694, 701-02 (D.C. Cir. 1980)).

The regulation at issue here is clearly legislative or substantive in nature. By delineating the boundaries of liability under the EMTALA, the regulation "conclusively affect[s] the rights of private parties." Id.; see Morgan v. N. Miss. Med. Ctr., Inc., 458 F. Supp. 2d 1341, 1350 (S.D. Ala. 2006) (applying as binding the regulation at issue without analyzing its validity); Quinn v. BJC Health Sys., 364 F. Supp. 2d 1046, 1054 (E.D.Mo. 2005) (same); Prickett v. Hot Spring County Med. Ctr., No. 6:07-CV-6050, 2007 WL 2926862, at *3 (W.D. Ark. Oct. 5, 2007) (same). Contra Lima-Rivera v. UHS of Puerto Rico, Inc., 476 F. Supp. 2d 92, 97-98 (D.P.R. 2007) (finding the ...

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