Expert Answer:BLAW 6500 Middle Tennessee Legal Aspects of Health

  

Solved by verified expert:assignment is attached. Only do part 2 A & B of the assignment. The reading is provided.Use only the reading and article provided as a reference. Written assignment should be in 12 point Times New Roman font, 1 inch margins, double spaced of a minimum of three pages.For part 2 B write out and answer the 7 questions based on Nolen Case:What are the facts?What legal claim(s) applies?What are the elements of each claim?What facts relate to each element?What does the defendant argue?How does the court rule and why?What are the ethics and how could this lawsuit be prevented in the future?
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Assignment for Meeting #2 6500 Legal Aspects of Healthcare
NOTE: Unless indicated otherwise, all written assignment are to be in 12 point Times New
Roman font, 1 inch margins, double-spaced of a minimum of three (3) pages; and the cases,
questionnaire, articles, and links to videos are located in the weekly module for this
assignment on D2L (unless noted otherwise). The LearnScapes episodes are located in the
publisher site (Jones & Bartlett) using the access code that you purchased with your
bundle.
1. Read
a. Chapter 7 (pages 244-250), Chapter 13 (pages 417-433) in our textbook, Legal and
Ethical Issues for Health Professionals by George D. Pozgar (4th Edition).
b. Read the case Nolen v. Boca Raton Community Hospital
c. Find at least two recent articles in the news about issues with EMTALA.
2. Experience the Simulation and Complete Your Role by Answering the Questions in
a Word Document: Watch LearnScapes Episode 3 in Jones & Bartlett LearnScapes for
Health Care Ethics:
“LearnScape 3: Labor and Delivery Services
As part of the ethics committee for a rural 18-bed hospital, the CEO and CFO ask you,
the manager of the Social Services Department, to contribute to the decision on
continuing labor and delivery services in the hospital. You know that historically in your
community, women seek late prenatal care. In discussions, you learn that the Ob/Gyn has
no back-up specialty coverage, that the family practitioner does not want to do obstetric
services, and that the community loves the service. Based on this information, you must
make a recommendation about whether to continue the services. To complicate matters,
and although this discussion should be confidential, somehow word leaks and you receive
many phone calls and emails from concerned citizens.”
3. Complete Written Assignment #2: Reflect on the following questions. Then write a
memo answering the following questions and upload your memo to the Dropbox on D2L
by the due date/time:
Part I: LearnScapes Health Care Ethics: Labor and Delivery
In your Word document to upload on D2L, answer the questions from the episode. (Do
not email the answers to me as indicated in the episode).
c
Part II: Nolen Case
a. From your readings and research, what is the purpose of EMTALA? What are the
basic requirements of EMTALA? Does EMTALA necessarily require good
outcomes? Why or why not?
b. Write out and answer the 7 questions (as listed in the Benson video you watched for
Assignment #1) based on Nolen case.
I hope you enjoy the variety of learning activities. I look forward to hearing about your
experience in the simulation! Sandy Benson, J.D.
c
Page 1
373 F.3d 1151, 17 Fla. L. Weekly Fed. C 677
(Cite as: 373 F.3d 1151)
United States Court of Appeals,
Eleventh Circuit.
Anne Marie NOLEN, individually, and as natural
heir of the Estate of Baby B, and Baby C, PlaintiffAppellant,
v.
BOCA RATON COMMUNITY HOSPITAL, INC., a
Florida corporation, Geoffrey Zann, M.D., Joan
Reinsvold, RN, Susan Slavicek, DefendantsAppellees.
No. 04-10228
Non-Argument Calendar.
June 18, 2004.
Background: The United States District Court for
the Southern District of Florida, No. 02-80410-CVKLR, Kenneth L. Ryskamp, J., granted summary
judgment in favor of hospital on outpatient’s Emergency Medical Treatment and Active Labor Act
(EMTALA) claims, and outpatient appealed.
Holdings: The Court of Appeals held that:
(1) hospital was not required under EMTALA to
have a written emergency screening procedure, and
(2) there was no violation of the EMTALA where
hospital gave to pregnant outpatient the same quality
screening that it would have given a similarly situated outpatient.
Affirmed.
Appeal from the United States District Court for the
Southern District of Florida.
Before CARNES, HULL and PRYOR, Circuit Judges.
PER CURIAM:
Anne Marie Nolen appeals from a summary judgment entered against her. The district court held that
Nolen’s complaint, brought under both the Emergen-
cy Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. section 1395dd, and Florida law,
failed as a matter of law. We affirm; the district court
properly granted summary judgment in favor of the
Boca Raton Community Hospital, Inc. (Hospital).
I. FACTS AND PROCEDURAL HISTORY
Nolen was a pediatric nurse at the Hospital. She was
about twenty-two weeks pregnant with triplets and
had insurance coverage. At approximately 5:00 p.m.
on May 4, 2000, Nolen arrived at the Hospital for a
labor check at the direction of her physician, Dr.
Zann. The Hospital admitted Nolen as an outpatient
about twenty minutes later. She complained of
cramping and a mucous discharge that she feared
signaled the onset of labor.
Nolen was first treated by a Hospital nurse,
Reinsvold, in the labor and delivery unit of the Hospital, One Family Place. Reinsvold undertook preliminary care processes, including the following
measures: taking Nolen’s vital signs, taking Nolen’s
medical history, listening to the unborn babies’ hearts,
conducting a fetal monitor, and giving an initial examination of Nolen’s abdomen. Nolen was attached
to a fetal monitor, which detects uterine contractions
and uterine irritability, for more than an hour.
Reinsvold also paged Dr. Zann to see Nolen shortly
after Nolen’s admission to One Family Place.
After the initial assessment performed by Reinsvold,
Dr. Zann arrived to examine Nolen, who was still on
outpatient status, about an hour and ten minutes after
she was first registered by the Hospital. Dr. Zann
performed a visual exam of Nolen’s cervix, took a
culture of her vagina, and *1153 fully evaluated Nolen’s cervix. Nolen’s cervix was found to be neither
dilated nor thinned. The laboratory results from the
culture were negative. Dr. Zann concluded that Nolen’s lower uterine segment was consistent with what
he expected from a normal pregnancy in this circumstance. Dr. Zann performed an ultrasound to evaluate
each of the three fetal heart rates. He did not order
further testing.
Dr. Zann concluded that Nolen was not dilated and
© 2009 Thomson Reuters. No Claim to Orig. US Gov. Works.
Page 2
373 F.3d 1151, 17 Fla. L. Weekly Fed. C 677
(Cite as: 373 F.3d 1151)
that she had only one conclusive episodic contraction, which occurred at 5:32 p.m. Another potential
episodic contraction occurred at 6:04 p.m., but it was
inconclusive because Nolen was being repositioned
when the fetal monitor registered that movement.
Satisfied that Nolen had been adequately diagnosed
and stabilized, Dr. Zann discharged her from the
Hospital at 6:48 p.m. He ordered Nolen to keep her
scheduled appointment with her perinatologist, Dr.
Scott, the next morning.
After leaving the Hospital, Nolen’s condition changed
for the worse. She testified at deposition that she began cramping after leaving the Hospital. She made no
effort to contact Dr. Zann or the Hospital after this
change in condition.
When she reached Dr. Scott’s office the next morning, Nolen fully described the events of the previous
day. Nolen also told Dr. Scott of the change in condition she experienced after leaving the Hospital. Dr.
Scott examined Nolen and concluded that she may
have been entering pre-term labor on that day because the partial effacement and dilation of her cervix. Dr. Scott determined that Nolen could not have
been entering pre-term labor on the previous day
when she was at the Hospital in the care of Dr. Zann.
Dr. Scott sent Nolen back to the Hospital to suppress
her pre-term labor. Nolen stayed there until May 7,
2000, when she was transferred to Broward General
Hospital because it had a superior neonatal care unit.
Nolen went into pre-term labor. Her first baby was
stillborn, and her other two babies were born alive.
Neither of her two live births survived past May 24,
2000, however.
ment after the close of discovery. The district court
granted the motions made by the Hospital and the
other defendants on all three counts under the EMTALA and the remaining state law claim. Nolen does
not address the grant of summary judgment by the
district court on her state law claim in her brief before this Court, so any arguments on that claim are
waived. Farrow v. West, 320 F.3d 1235, 1242 (11th
Cir.2003); Kelliher v. Veneman, 313 F.3d 1270, 1274
n. 3 (11th Cir.2002); Greenbriar, Ltd. v. City of Alabaster, 881 F.2d 1570, 1573 n. 6 (11th Cir.1989).
II. STANDARD OF REVIEW
Summary judgment is only appropriate if “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*1154 fact and that the moving party is entitled to a
judgment as a matter of law.” Fed.R.Civ.P. 56(c);
Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247,
106 S.Ct. 2505, 2510, 91 L.Ed.2d 202 (1986) (quoting Fed.R.Civ.P. 56(c)). Summary judgment should
be granted when, after an adequate time for discovery, a party fails to make a showing sufficient to establish the existence of an essential element of that
party’s case. Celotex Corp. v. Catrett, 477 U.S. 317,
322, 106 S.Ct. 2548, 2552, 91 L.Ed.2d 265 (1986).
“We review the district court’s rulings on motion for
summary judgment de novo, applying the same legal
standards that bound the district court.” Carter v.
Galloway, 352 F.3d 1346, 1348 (11th Cir.2003).
III. ANALYSIS
Nolen filed a complaint under 42 U.S.C. section
1395dd on May 3, 2002, and alleged that the Hospital
(1) did not provide her with an adequate screening
examination, (2) did not stabilize her labor condition
adequately, and (3) discharged her in violation of the
EMTALA. Nolen received leave from the district
court to amend her complaint to include six counts of
medical malpractice under Florida law. Dr. Zann,
Reinsvold, and Slavicek, another nurse from the
Hospital, were added as defendants on those claims.
The district court declined to exercise jurisdiction
over all but one of the state law claims.
Nolen asserts two grounds on which the district court
erred in holding that the Hospital gave her an appropriate screening when she entered as an outpatient on
May 4, 2000. First, she contends that the Hospital did
not have a standard written screening procedure or,
alternatively, that the Hospital did not follow its
screening procedure, either of which, she contends,
violated the EMTALA. Second, Nolen argues that the
district court should not have considered the evidence
submitted by the Hospital that proved Nolen was not,
in fact, in pre-term labor when she was examined at
the Hospital on May 4, 2000, by her personal physician, Dr. Zann. Each of these arguments is addressed
and rejected below.
Both parties filed cross-motions for summary judg-
[1][2][3] As we have previously stated,
© 2009 Thomson Reuters. No Claim to Orig. US Gov. Works.
Page 3
373 F.3d 1151, 17 Fla. L. Weekly Fed. C 677
(Cite as: 373 F.3d 1151)
In 1986, Congress enacted EMTALA in response
to widely publicized reports of emergency care
providers transferring indigent patients from one
hospital to the next while the patients’ emergency
medical conditions worsened. EMTALA was designed specifically to address this important societal concern; it was not intended to be a federal
malpractice statute. Under EMTALA, hospital
emergency rooms are subject to two principal obligations, commonly referred to as the appropriate
medical screening requirement and the stabilization
requirement…. The appropriate medical screening
requirement obligates hospital emergency rooms to
provide an appropriate medical screening to any
individual seeking treatment in order to determine
whether the individual has an emergency medical
condition…. If an emergency medical condition exists, the hospital is required to provide stabilization
treatment before transferring the individual.
Harry v. Marchant, 291 F.3d 767, 770 (11th
Cir.2002) (en banc).
[4] First, we address Nolen’s contention that the Hospital was required to have a written screening procedure. A similar argument was rejected by the Eighth
Circuit. Summers v. Baptist Med. Ctr. Arkadelphia,
91 F.3d 1132, 1140 (8th Cir.1996) (en banc). The
Eighth Circuit held that a hospital with emergency
screening procedures that were unwritten, in whole or
in part, did not violate the EMTALA. Id. (stating that
“the hospital did have a screening procedure, even if
unwritten in part, and the statute makes no additional
requirement”). Nolen’s argument that the Hospital
was required to have a written screening procedure
also fails because a written procedure is not required
by the terms of section 1395dd(a).
[5] Nolen alternatively contends that the Hospital did
not follow its policies for screening patients in preterm labor situations. Nolen relies on several policies
propagated by the Hospital to create doubt about the
quality of screening she received. As long as the
Hospital screened *1155 Nolen in a manner consistent with the screening that any other patient in the
care of a private physician would have received, there
can be no liability under the EMTALA. The Hospital
presented undisputed evidence that Reinsvold performed exactly the type of screening that would have
been given to any other outpatient in Nolen’s position
according to the only policy that applied to Nolen’s
case. Because the Hospital met its initial burden of
disproving the applicability of the EMTALA, the
burden shifts back to Nolen to show the existence of
a genuine issue of material fact. Hammer v. Slater, 20
F.3d 1137, 1141 (11th Cir.1994). Nolen did not meet
that burden.
[6] The undisputed record shows that Nolen, if anything, received superior care from the Hospital.
Reinsvold promptly summoned Dr. Zann to perform
an in-person exam of Nolen, which only 6 percent of
similarly situated patients receive. The uncontroverted evidence showed that 94 percent of other patients
who came to the Hospital for a labor check did not
receive as extensive a screening as the one Nolen
received. As the Fourth Circuit has explained, a hospital has every right to tailor its screening procedures
to a patient to account for her condition, stated symptoms, and the determinations made by her personal
physician. Baber v. Hosp. Corp. of Am., 977 F.2d
872, 879 n. 6 (4th Cir.1992); see also Baker v. Adventist Health, Inc., 260 F.3d 987, 995 (9th Cir.2001)
(“Hospitals are not required to provide patients presenting different symptoms with identical screenings.”). Nolen’s treatment was provided primarily by
her private physician, who was in a better position to
provide care beyond the screening mandated by the
EMTALA. So long as the Hospital gave to Nolen the
same quality screening that it would have given a
similarly situated outpatient, there is no violation of
the EMTALA. Harry, 291 F.3d at 770.
Second, we turn to Nolen’s argument that the district
court impermissibly weighed evidence and usurped
the function of a jury. We disagree. The Hospital
proffered evidence from experts and the principals
that confirmed that Nolen received an adequate
screening. It was Nolen’s responsibility then to present evidence of a genuine issue of material fact,
which would have precluded summary judgment.
Celotex, 477 U.S. at 322-24, 106 S.Ct. at 2552-54.
Nolen did not satisfy that burden, and the district
court properly granted summary judgment.
Baber is also instructive on this point. The Fourth
Circuit held in Baber that one cursory affidavit from
a physician was insufficient to create a genuine issue
of material fact as to the adequacy of the screening
that the patient received. 977 F.2d at 881-82. Nolen
has failed to present even a single affidavit of a phy-
© 2009 Thomson Reuters. No Claim to Orig. US Gov. Works.
Page 4
373 F.3d 1151, 17 Fla. L. Weekly Fed. C 677
(Cite as: 373 F.3d 1151)
sician to dispute the adequacy of the screening provided by the Hospital.
Accordingly, the summary judgment entered by the
district court is
AFFIRMED.
C.A.11 (Fla.),2004.
Nolen v. Boca Raton Community Hosp., Inc.
373 F.3d 1151, 17 Fla. L. Weekly Fed. C 677
END OF DOCUMENT
© 2009 Thomson Reuters. No Claim to Orig. US Gov. Works.

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