State's Malpractice Cap Applies to Award in Civil EMTALA Action

From BNA’s Health Care Daily (Volume 10 Number 164, Thursday, August 25, 2005, ISSN 1091-4021)

6th Circuit Says State's Malpractice Cap Applies to Award in Civil EMTALA Action

Noneconomic damages awarded in a failure-to-stabilize claim brought under the Emergency Medical Treatment and Labor Act must be reduced in accordance with Michigan's limitation on malpractice awards because the federal statute incorporates state law and the claim would be considered a medical malpractice action under state law, a federal court of appeals held Aug. 18 (Smith v. Botsford General Hospital, 6th Cir., No. 04-1436, 8/18/05).

In an issue of first impression for the U.S. Court of Appeals for the Sixth Circuit, Judge Deborah L. Cook reduced the $5 million district court jury award to less than $400,000, ruling that Michigan's malpractice cap on noneconomic damages applied to Andrea Smith's EMTALA claim.

Smith sued Botsford General Hospital under EMTALA's civil enforcement provision, alleging the hospital failed to stabilize her husband, Kelly Smith, before transferring him to another hospital better equipped to deal with a man of his size. Kelly Smith, a 600 pound man whose suffered a broken left femur that pierced the skin of his thigh in an automobile accident, died from extensive blood loss while being transferred, according to Cook.

Cook affirmed the jury verdict in favor of Smith, but reduced the award pursuant to Michigan's malpractice law.

EMTALA Incorporates State Law

EMTALA's civil enforcement provision allows individuals harmed as a result of a hospital's violation of the federal statute to recover personal injury damages "under the law of the State in which the hospital is located," according to Cook, quoting 42 U.S.C. §1395dd(2)(A). The plain language of the statute therefore incorporates state law, Cook said.

The next step, Cook said, is to determine whether Smith's claim would constitute a medical malpractice action under Michigan law. A claim sounds in malpractice if it relates to an action that occurred during the course of a professional relationship and involves a question of "medical judgment beyond the realm of common knowledge and experience," Cook said, highlighting the test the Michigan Supreme Court set forth in Bryant v. Oakpointe Villa Nursing Center, 684 N.W. 2d 864 (Mich. 2004).

Smith's claim met the definition on both counts, Cook said. There was no dispute that Botsford's treatment and transfer of Smith occurred within the course of a professional medical relationship. Further, Cook concluded that Smith's claim necessarily involved questions of medical judgment, even though an EMTALA action does not require a breach of the professional standard of care.

The statute's stabilization requirement demands a medical judgment to determine "within a reasonable medical probability" whether a patient can be transferred without risking a deterioration in his or her condition, Cook said.

Cook also addressed Smith's challenge that Michigan's cap on damages violated the Seventh Amendment and her right to equal protection under the constitution.

Concluding there was no Seventh Amendment violation, Cook noted that the role of jury is to determine the extent of a plaintiff's injuries, not the legal consequences of its factual findings. As to equal protection, Cook said Michigan's choice to limit the amount of a plaintiff's recovery did not violate a fundamental right and served the legitimate state interest in controlling health care costs.

Full text of the decision is available at http://www.ca6.uscourts.gov/opinions.pdf/05a0355p-06.pdf.