Dr. Larsen states in an affidavit that he discussed with Mr. Hunter his complaints, conducted a physical examination and determined that his condition was not an emergency. Physicians' Mot. for Summary Judgment or to Dismiss, Att. B. He also states that after determining that the decedent's condition was not an emergency, he advised him that he could either return with a deposit for additional medical services, or, if he preferred to be seen immediately, the hospital would pay for a taxicab to D.C. General Hospital. Id. During his deposition, based on his independent recollection, Dr. Larsen described the examination he conducted and explained his conclusion that the patient's condition was not an emergency. He testified that he took a history of complaints, performed a gross neurologic examination to rule out emergency conditions such as intracranial bleed or meningitis, and concluded that the patient had a mild upper respiratory infection. Physicians' Supp. Reply, Ex. D at 83, 87-89. 116-17. He stated that the results of this examination are documented by his written conclusion that the patient was "non-emergent." Id. at 89-90. Moreover, he averred that his examination and screening would have been the same regardless of the patient's insured status; if the patient had demonstrated the ability to pay for care, Dr. Larsen would have "written him a prescription for antihistamines and sent him home." Id. at 118-19.
The defendants argue that they have demonstrated that the decedent was screened first by the medical technician, who deemed his condition routine, and then received a screening examination from Dr. Larsen, who concluded that his condition was non-emergent and arranged for his transportation to D.C. General Hospital. Therefore, they argue, the hospital's standard screening procedures were followed and there was no violation of the Emergency Act.
The plaintiff makes a valiant attempt to find a genuine dispute as to a material fact in this regard. She argues that the hospital's Emergency Department has a charting policy, which requires the maintenance of certain documentation in the Emergency Department. Pl. Supp. Opp., Tab 2 at 3. She cites Dr. Turner's deposition testimony that there are policies regarding proper documentation of a screening exam which provide that:
the elements of the exam that's documented have to include aspects of the history, the observations or the physical exam that the physician does, his conclusions and whether or not it's an emergency case or not and what his advice to the patient is.
Physicians' Supp. Reply, Tab B at 68. Dr. Turner went on to state that this policy as to documentation does not ("strictly speaking") constitute a policy as to what constitutes an adequate screening exam, although it could represent a minimum threshold for a screening exam. Id. at 68-69.
Plaintiff argues that Dr. Larsen failed to comply with required documentation procedures, because his record of the screening examination does not document all of the tests he performed and conclusions he reached. Therefore, she argues, it may be inferred that he did not perform the examination he claims he performed, and that he did not provide the sort of screening he would provide to similarly situated patients who had insurance. She also contends that she is entitled to challenge the credibility of Dr. Larsen via live testimony at trial.
These arguments are without merit. The Emergency Act does not require any particular documentation of the screening examination. Therefore deviance from any documentation requirements does not, in itself, constitute a violation of the Emergency Act. Neither is any incompleteness in the record sufficient to support an inference that in conducting his screening examination, Dr. Larsen deviated from GSCH's standard screening procedures and conducted an inappropriate screening examination. Construing Dr. Turner's testimony in the light most favorable to the plaintiff, it can be argued that a standard screening examination would include aspects of the patient's history, the physician's observations, his conclusions, and his advice to the patient.
Physicians' Supp. Reply, Tab B at 68. The scanty medical record of Dr. Larsen's screening examination does not include details regarding his observations and conclusions, which, arguably, would be part of a standard screening examination. However, Dr. Larsen testified at length during his deposition about his observations and conclusions during his screening of the decedent, and the medical record is not inconsistent with Dr. Larsen's testimony.
Plaintiff's contention that the medical record supports an inference that Dr. Larsen did not examine the decedent as he claims he did is merely speculative. There is no evidence that Dr. Larsen's medical record of the screening examination of another similarly situated patient would have been any different. Its brevity offers no evidence one way or another as to the content of the screening examination.
The plaintiff's inability to independently confirm or rebut Dr. Larsen's testimony as to the content of his screening examination does not create a genuine dispute as to a material fact.
Accordingly, the court concludes that the defendants have shown that there was no violation of the Emergency Act. The evidence demonstrates that the hospital's standard screening procedures were followed in this case; the decedent was treated no differently than another patient in similar medical circumstances would have been treated. Whether that treatment was consonant with the applicable standard of care is an issue this Court need not reach, as the jurisdiction to consider it lies with the Superior Court of the District of Columbia.
The Court notes that its conclusion here does not preclude relief under the Emergency Act in other cases. The total absence of a record that a patient received a screening examination by a physician would support a claim of an Emergency Act violation. Similarly, as defense counsel pointed out, if there were evidence that a case involved a physical complaint for which some specific screening procedure, such as, for example, an X-ray, would normally be used, and was not used, that evidence would support a claim under the Emergency Act. By contrast, in this case, there is no evidence that Dr. Larsen failed to perform any standard diagnostic procedure mandated by plaintiff's specific complaints. Nor is there any other evidence from which a legitimate inference can be drawn that the decedent was treated any differently from similarly situated patients.
For all of the reasons previously stated herein, the Court shall grant the defendants' Motions for Summary Judgment. There are no genuine disputes as to material facts regarding the federal Emergency Medical Treatment and Active Labor Act claim, and defendants are therefore entitled to judgment as a matter of law. The Court shall also dismiss the remaining pendent negligence claims, because there is no basis for federal jurisdiction as to those claims. Therefore, this entire case shall be dismissed from the dockets of this Court.
The Court shall enter an appropriate Order on this date consistent with the foregoing Memorandum Opinion.
May 28th, 1992
CHARLES R. RICHEY
UNITED STATES DISTRICT JUDGE
ORDER - May 28, 1992, Filed
In accordance with the Court's Memorandum Opinion entered in the above-captioned case on this date, it is, by the Court, this 28 day of May, 1992,
ORDERED that the defendants' Motions for Summary Judgment shall be, and hereby are, GRANTED; and it is
FURTHER ORDERED that the above-captioned case shall be, and hereby is, DISMISSED from the dockets of this Court.
CHARLES R. RICHEY
UNITED STATES DISTRICT JUDGE