7th Circuit: Bloomington hospital complied with federal law before patient’s death

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A widower who sued a Bloomington hospital for failure to operate following his wife’s death did not find relief at the 7th Circuit Court of Appeals, which ruled that the facility had complied with its requirements under the Emergency Medical Treatment and Labor Act.

In January 2017, Jody Martindale arrived at the emergency room at Indiana University Health Bloomington Hospital with severe abdominal pain. IUHB doctors determined she needed emergency surgery to remove a dying portion of her intestine, which they thought was a problem that stemmed from a gastric bypass surgery she had undergone 10 years earlier.

Jody was recommended to a bariatric surgeon at another hospital instead of IUHB’s on-call general surgeon. But poor weather delayed the transfer by helicopter, so Jody was transported via ambulance.

The bariatric surgeon who performed the bypass determined there was a dying intestine, as predicted. However, the surgeon found “absolutely no sign of any bariatric etiology for Mrs. Martindale’s ischemia,” revealing that IUHB had been mistaken in its belief that Jody’s condition stemmed from her prior procedure.

Jody underwent the second surgery but began experiencing sepsis and multiple organ failure. Two days later, she died at age 50.

Kenneth Martindale, Jody’s surviving husband, sued IUHB and invoked the federal Emergency Medical Treatment and Labor Act. Martindale asserted IUHB failed to satisfy its statutory obligation to “stabilize” Jody when it decided to transfer her without first performing a laparotomy and removing the ischemic portions of her intestine.

But the Southern Indiana District Court never answered the question whether IUHB had successfully stabilized Jody within the meaning of the Treatment Act. Instead, it entered summary judgment for IUHB on alternative grounds.

Judge Richard L. Young explained that even “assuming she was not stabilized” at the time of transfer, no reasonable jury could find that IUHB had not satisfied the Treatment Act’s provisions expressly permitting it to transfer her prior to stabilization.

Martindale argued on appeal that IUHB violated 42 U.S.C. § 1395dd(c) by failing to stabilize Jody prior to transferring her, but the 7th Circuit was reluctant to decide the case based on waiver. It noted that Martindale’s brief presented a more structural argument about the meaning of the Treatment Act — namely, that a hospital may never transfer a patient prior to stabilization on facts like the ones in Jody’s case.

But the court found that position to be “untenable,” ruling that no reasonable jury “could conclude that IUHB did not satisfy” one of the two triggering conditions of the Treatment Act: a written request by the patient or a certification signed by a doctor.

“The information available to Dr. (Francis) Karle at the time — the results of the CT scan — seemed to indicate that Jody’s ischemia was related to her history of gastric bypass surgery,” Judge Michael Scudder wrote. “On that understanding, the on-call surgeon Dr. (Terrence) Greene believed he could not safely operate on Jody.

“Martindale does not suggest that Dr. Karle completed this certification in bad faith,” Scudder wrote. “… And absent some evidence corroborating such an allegation, the Treatment Act does not permit us to second guess Dr. Karle’s decision.”

As to whether Jody’s transfer was “appropriate” within the meaning of § 1395dd(c)(2), the 7th Circuit noted inconsistencies if Martindale’s reasoning was adopted.

“The laparotomy and resection procedures Martindale now argues were required to ‘minimize the risks’ under § 1395dd(c)(2)(A) are the very same surgeries he says were needed to ‘stabilize’ Jody under § 1395dd(c)(1) and (e)(3)(B),” Scudder wrote.

The court also found no basis for Martindale’s reading that “when the evidence shows the hospital could have stabilized the patient, pre-stabilization transfer could never be deemed ‘appropriate.’” As such, it rejected Martindale’s sole argument about the phrase’s meaning.

“Beyond that, Martindale makes no claim — and there is no indication in the summary judgment record — that IUHB carried out the transfer itself in an unsafe manner,” the judge wrote. “Accordingly, he has not presented evidence permitting a reasonable jury to conclude that IUHB failed to provide medical care within its capacity to minimize the risks of Jody’s transfer to Community Health. The transfer was thus ‘appropriate,’ 42 U.S.C. § 1395dd(c)(1)(B), and summary judgment for the hospital was proper.

“… The facts of this case are tragic. But we are left to apply the Treatment Act as Congress enacted it,” he concluded. “If Martindale has a claim against IUHB, it is one under state rather than federal law. We express no views on the merits of such a claim.”

The case is Kenneth Martindale, Individually and as Personal Representative of the Estate of Jody Martindale, Deceased v. Indiana University Health Bloomington, Inc., d/b/a IU Health Bloomington Hospital, 21-3015.

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