Judge Ralph C. Hofer, Case 23GDCV00358 2023-05-05 Tentative Ruling

Plaintiff Jamie Black alleges that in October of 2022, plaintiff, who had a history of depression, bipolar disorder, ADHD and schizophrenia, for which she had previously been placed on several 5150 involuntary psychiatric holds, went for a walk, and a group of people she encountered noticed she was upset and scared and not acting appropriately and asked if she needed an ambulance, to which plaintiff replied in the affirmative.

Plaintiff alleges that paramedics were summoned, and she was transported to defendant Glendale Adventist Medical Center dba Adventist Health Center (the Hospital). The complaint alleges that when plaintiff arrived at the Hospital, her vital signs showed she was hypersensitive and tachycardic. While in the emergency room, when asked her name, plaintiff identified several names, which were not her correct name, and plaintiff was also unable to provide a valid social security number. Plaintiff alleges that although attempts were made to take plaintiff’s blood and urine, the attempts were not successful.

Plaintiff alleges that she was eventually seen by defendant Alec Bradleigh Freling, M.D., who diagnosed plaintiff with, among other conditions, psychosis due to methamphetamine use, schizoaffective disorder, and PCP use, and concluded that plaintiff appeared in a psychotic state.

Plaintiff alleges that she was given a dose of haloperidol, medication used to treat psychotic patients, and an injection of lorazepam, an anti-anxiety medication. Plaintiff repeatedly requested that the psychiatrist evaluate her, and a request was entered by Dr. Freling for plaintiff to be seen by a psychiatrist. Dr. Freling later re-evaluated plaintiff and noted that she would not provide further information to him because he was a male and had requested to speak with a female behavioral health individual, so that Dr. Freling noted that a female, Tracy, had previously attempted an evaluation during which plaintiff was uncooperative, and that Tracy would attempt to evaluate plaintiff again.

The complaint alleges that plaintiff engaged in behavior such as telling the nursing staff she had been poisoned and requesting an ultrasound because she believed there were drugs inside her uterus, crying loudly, screaming, pulling the curtains on other patient’s beds and screaming and yelling. Plaintiff was asked to write down her social security number, but ultimately said she could not remember it. The complaint alleges that later that evening Dr. Freling noted that Tracy had evaluated plaintiff and that plaintiff had been cleared by the on-call psychiatrist, although there is no record plaintiff was seen or evaluated by a psychiatrist at any time during her presentation. It is alleged that Dr. Freling stated plaintiff was alert and oriented and had normal mood and affect, but there was no physical examination performed at that time to support such a conclusion.

Dr. Freling then indicated that plaintiff would be discharged, and plaintiff requested of the nursing staff that she see someone else, but her request was denied, and she was told to call someone for a ride.

Plaintiff alleges that after some further confusion, plaintiff ultimately called a friend to pick her up, and the nurses escorted plaintiff out of the hospital, essentially throwing her out of the facility, three hours after arriving, when plaintiff had never been seen or evaluated by a psychiatrist and had never had blood or urine work done.

Plaintiff alleges that after many instances of improper behavior in the car and once plaintiff arrived at the friend’s house, plaintiff eventually walked to an overpass above the 15 freeway in Barstow and jumped off the overpass in an attempt to kill herself, as a result of which she suffered serious injuries.

Defendant Glendale Adventist Medical Center dba Adventist Health Glendale (the Hospital) demurs to the second cause of action, arguing that the complaint is devoid of factual allegations upon which to support her EMTALA cause of action, and in fact contains allegations which show plaintiff was provided an appropriate medical screening examination.

In the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits under this subchapter) comes to the emergency department and a request is made on the individual's behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition (within the meaning of subsection (e)(1) of this section) exists.

If any individual (whether or not eligible for benefits under this subchapter) comes to a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either--

(A) within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition, or

“The term “to stabilize” means, with respect to an emergency medical condition described in paragraph (1)(A), to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility, or, with respect to an emergency medical condition described in paragraph (1)(B), to deliver (including the placenta).”

“Under EMTALA, hospitals with emergency departments have two obligations. First, if any individual comes to the emergency department requesting examination or treatment, a hospital must provide for “an appropriate medical screening examination within the capability of the hospital's emergency department.” (42 U.S.C. § 1395dd(a).) Second, if the hospital “determines that the individual has an emergency medical condition,” it must provide “within the staff and facilities available at the hospital” for “such treatment as may be required to stabilize the medical condition” and may not transfer such a patient until the condition is stabilized or other statutory criteria are fulfilled. (Id., § 1395dd(b) & (c).)”

Defendant the Hospital argues that for a patient to show the patient was denied an appropriate medical screening examination to which the patient was entitled, the patient must show that the Hospital had actual knowledge of the condition.

Defendant cites to federal case law in which it was held that the stabilization requirement was not violated where a patient was deemed medically stable by the ED physician for the presenting emergency condition, in that case, pneumonia and asthma, regardless of a subsequent diagnosis of lung abscess and the hospital later requesting the patient to return for further evaluation and ultimate admission to the hospital. See Bryant v. Adventist Health System/West (9th Cir. 2001) 289 F.3d 1162. In connection with the initial emergency room visit in that case, the Ninth Circuit decision was based primarily on its prior holding “that a hospital has a duty to stabilize only those emergency medical conditions that its staff detects.” Bryant, at 1166.

Here, as argued in the opposition, the complaint includes detailed allegations concerning plaintiff’s behavior observed and addressed by staff, and expressly alleges that Dr. Freling diagnosed plaintiff with acute psychosis, noted that plaintiff appeared in a psychotic state, and ordered a psychiatric consult, as well as a battery of lab tests. [Complaint, paras. 18, 19]. Further alarming behavior was observed and reacted to by the staff. [Complaint, paras. 23-31].

Most critically, it is alleged that the discharge ordered was made based on notes that 1) plaintiff had been evaluated by a female health care provider, when that evaluation was allegedly attempted but not able to be completed due to plaintiff’s concerns about the location of the evaluation, the evaluator’s inexperience, and plaintiff’s inability to formulate words, and 2) plaintiff had been cleared by the on-call psychiatrist, when there is no record that plaintiff was actually seen and evaluated by any psychiatrist at any time, and plaintiff alleges such an evaluation never took place. [Complaint, paras. 28, 30, 32, 39, 74, 75].

Defendant argues that the complaint admits that plaintiff was examined by a psychiatric/behavioral health nurse, and that she was discharged only after having been cleared by the on-call psychiatrist, but this argument misconstrues the allegations of the complaint, including the critical allegation that although plaintiff was discharged based on notes that she had been cleared by the psychiatrist, plaintiff did not in fact ever see the psychiatrist. [See Complaint, paras. 32, 39]. These allegations must be accepted as true for purposes of demurrer. See Serrano v. Priest (1971) 5 Cal.3d 584, 591; Del E. Webb Corp. v. Structural Materials Co. (1981, 2nd Dist.) 123 Cal.App.3d 593, 604

The complaint accordingly sufficiently alleges specific facts supporting the claims made in the second cause of action that plaintiff was not appropriately screened as ordered by the physician, and was not appropriately stabilized prior to her discharge, contrary to the representations in the notes, and in violation of the EMTALA. The demurrer is overruled.

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