The case involved claims under the Emergency Medical Treatment and Labor Act (EMTALA) concerning the death of Calvin Jackson, Sr.’s minor child, C.J., the Plaintiffs. On August 9, 2020, C.J. received emergency medical care at North Caddo Medical Center (NCMC), the Defendants. Jackson alleged that NCMC failed to provide C.J. with proper medical screening and failed to stabilize C.J. before discharging him, violating EMTALA. C.J. died from diabetic ketoacidosis approximately six days later, on August 15, 2020. NCMC contended it did not breach EMTALA, asserting C.J. received an appropriate medical screening and proper treatments. Both the Plaintiffs and the Defendants provided expert opinions regarding what constituted an appropriate medical screening under the EMTALA, which were extensively addressed in the ensuing Daubert motions. Plaintiffs filed a Daubert Motion to Exclude Testimony/Statements of Jacquelyn White and Defendants filed a Daubert Motion to Exclude or Limit Testimony of Jullette Saussy.
EMTALA was passed by Congress to address worries about hospitals “dumping” patients who lacked insurance or means to pay. The EMTALA mandated that participating hospitals provide the following care to individuals seeking emergency medical attention: (1) an appropriate medical screening, (2) stabilization of a known emergency medical condition, and (3) restrictions on transferring an unstabilized individual to another medical facility.
Section 1395dd(a) of the EMTALA stipulated that if an individual, whether or not eligible for benefits under this subchapter, arrived at a hospital’s emergency department and placed a request for examination or treatment for a medical condition, the hospital had to conduct an appropriate medical screening examination within the department’s capabilities. This examination included ancillary services routinely available to the emergency department, with the aim of determining the presence of an emergency medical condition as defined in subsection (e)(1). Therefore, under the EMTALA, the adequacy of an appropriate medical screening examination was assessed not by diagnostic proficiency but by whether it was conducted fairly in comparison to other patients with similar symptoms.
The EMTALA lacked a specific definition for “appropriate medical screening examination.” An appropriate examination was one that the hospital would have administered to any other patient in a comparable condition with similar symptoms. It was the Plaintiff’s responsibility to demonstrate that the hospital failed to provide an appropriate examination under the EMTALA. This burden could be met by showing either: (1) the hospital did not adhere to its own standard screening procedures; or (2) there were differences between the screening examination that the patient received and examinations that other patients with similar symptoms received at the same hospital; or (3) the hospital offered such a cursory screening that it amounted to no screening at all.
In this case, the NCMC policy outlined that the Medical Screening Examination (MSE) would be conducted by the Emergency Department Physician and customized to suit the presenting complaint and the medical history of any individual seeking care at the Emergency Department. The MSE included, but was not limited to, the following components:
1. Chief complaint and pertinent history
2. Past medical and social history
3. Physical examination
4. Assessment
5. Laboratory and imaging studies, if applicable
Emergency Medicine Expert Witnesses
Dr. Jacquelyn Kibodeaux White, M.D., F.A.C.E.P., a board certified physician in emergency medicine practicing in North Louisiana. She obtained her Bachelor of Science degree from Louisiana Tech University before earning her MD from Louisiana State University Medical Center. Following this, White completed a residency in Emergency Medicine at the University of Arkansas Medical Center. She became board-certified in Emergency Medicine in 1996 and has since then maintained her Active Board status. After 26 years of practice in Emergency Medicine, she is currently working full-time in Primary Care. She has served on several review boards for hospitals and for independent consultants.
Dr. Jullette M. Saussy, M.D., F.A.C.E.P., is a board-certified emergency medicine physician with four years of residency training. She obtained her Bachelor of Arts degree in Sociology from Tulane University and subsequently earned her MD from the Louisiana State University Health Sciences Center and completed her residency at Charity Hospital in New Orleans. Over the course of her 24-year career, she has practiced emergency medicine in a variety of settings, including urban, community, and critical access hospitals.
Discussions by the Court
Jackson attempted to exclude defense expert Jacquelyn White (“White”), contending that her reasoning could not be applied to the facts at issue in this case because she did not read or review NCMC’s EMTALA policies, procedures, or guidelines regarding medical screening examinations. Jackson argued that White’s testimony was irrelevant as it would not aid the trier of fact in determining whether the actions of the treating emergency room physician violated NCMC’s medical screening policy and/or EMTALA.
There was no dispute regarding White’s qualifications as a board-certified physician in emergency medicine practicing in North Louisiana. The Court deemed White qualified as an expert to provide opinions on appropriate medical screening examinations based on general standards of the medical community. White clarified in her deposition why she didn’t deem it necessary to review NCMC’s medical screening exam and stabilization document, since she believed it would not have altered her evaluation of the chart to determine if the patient had undergone an adequate medical screening exam. White expressed confidence in her ability to assess the adequacy of medical screening exams based on her extensive experience reviewing charts over the years and familiarity with EMTALA policies, which she found to be consistent across various institutions.
Upon close examination of White’s deposition, it appeared that Jackson’s assertion that White categorically stated no social or medical history was recorded was not supported. The Court found that White sufficiently provided the factual basis for all her opinions. Both parties agreed that experts should not testify as to the legal conclusion that EMTALA was violated with this determination was reserved for the jury. The Court citing Chevron TCI, Inc. v. Capitol House Hotel Manager, LLC, No. CV 18-00776-BAJ-RLB (M.D. La. June 25, 2021), emphasized that the validity or correctness of an expert’s conclusions are matters for the jury to decide after the Daubert analysis. The Court concluded that Jackson’s challenges to White’s expert testimony pertained to credibility rather than admissibility. Therefore, challenges to the factual basis of White’s opinion were best addressed through cross-examination instead of Daubert motions. Consequently, Plaintiff’s Daubert motion to exclude the testimony of White was denied.
Defendant NCMC moved to exclude Plaintiff’s expert, Jullette Saussy, contending that she did not meet the requirements of an expert under Rule 702. The Defendant argued that Saussy’s deposition testimony contained conflicting statements and inconsistencies regarding medical screening examinations and stabilization requirements, indicating a lack of accurate understanding of EMTALA elements. Defendant pointed out Saussy’s lack of prior involvement in EMTALA cases and absence of specialized training in EMTALA, questioning the reliability of her opinions. Additionally, the Defendant asserted that Saussy improperly conflated EMTALA claims with general medical negligence, suggesting her testimony would confuse the jury.
After thoroughly reviewing the arguments presented in the motion, the Court determined that Saussy possessed extensive knowledge, skill, experience, training, and education, making her qualified to serve as an expert witness in the case. Being board certified in emergency medicine and having acquired knowledge about EMTALA, Saussy was deemed capable of reviewing NCMC’s EMTALA policies, procedures, and C.J.’s medical records to form opinions regarding appropriate medical screening examinations and stabilization requirements. The Court considered any concerns regarding conflicting statements and inconsistencies in EMTALA standards as matters of credibility and weight, rather than expertise and admissibility. It was acknowledged that there could be overlap between the objective test of local malpractice law (general medical negligence) and the subjective test of the adequacy of a hospital’s screening under EMTALA. The defense retained the right to challenge the weight given to Saussy’s testimony through vigorous cross-examination and presentation of contrary evidence during the adversarial trial setting. Consequently, Defendant’s Daubert motion to exclude or limit testimony of Saussy was denied.
Held
The Court denied Plaintiff’s Daubert motion to exclude testimony of Jacquelyn White. Additionally, the Court also denied Defendant’s Daubert motion to exclude or limit testimony of Jullette Saussy.
The Court has not arrived on an outcome for this case since the remaining issues involved in this case still await resolution.
Key Takeaways
In this medical malpractice action, both Plaintiffs and Defendants provided expert opinions on what constituted appropriate medical screening under EMTALA, leading to Daubert motions regarding the admissibility of both their emergency medicine experts’ testimony. Despite challenges raised against both the experts Jacquelyn White and Jullette Saussy, the Court deemed both qualified to provide opinions on medical screening examinations. While White’s testimony faced scrutiny over her familiarity with NCMC’s policies, her extensive experience and understanding of EMTALA standards were deemed sufficient. Similarly, Saussy’s expertise was upheld, despite challenges to her understanding of EMTALA elements and conflating an EMTALA claim with general medical negligence. The Court emphasized the role of the jury in determining the validity of expert conclusions after a thorough Daubert analysis. The decisions underscored the importance of expert testimony in navigating complex medical standards under EMTALA.
Case Details
| Case Caption | Jackson v. N. Caddo Hosp. Serv. Dist. |
| Docket Number | 5:22cv171 |
| Court | United States District Court, Louisiana Western |
| Citation | 2024 U.S. Dist. LEXIS 29044 |
| Order Date | February 20, 2024 |
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