Update

The law firm, Lewis Thomason, PC has withdrawn from the related case (3:25-cv-00516), and one lawyer from this firm is still on the record for the appeal.   Judge Varlan recused himself from the related case and cites the withdrawal of Lewis Thomason, PC, one of the subjects of our Section 455(a) recusal.

We have a recusal motion active on the case on appeal, but he has not yet responded to that.  It has to do with a Rule 60 motion we have pending.  As pro se litigants, we don’t know what is going to happen to our Cleland v. Bronson challenge if the Rule 60 motion vacates the orders we flagged.  Rule 60 was placed because during litigation, a lawyer from one of the defense firms was evaluating Magistrate Judge Debra C. Poplin for reappointment to another 8-year term.  We were not notified of this conflict.

Introduction

When Congress enacted the Emergency Medical Treatment and Labor Act (EMTALA), it created a clear, enforceable right: every patient who arrives at a hospital emergency department is entitled to an appropriate medical screening examination.  Yet, across the Sixth Circuit, that right has been eroded by an expanding misapplication of Cleland v. Bronson Health Care Group, Inc. — a 1992 decision that courts have stretched far beyond its original facts to dismiss legitimate failure-to-screen claims before they ever reach a jury.

Our case asks the Sixth Circuit to confront that issue directly.  At its core, this appeal challenges whether Cleland’s judicially crafted standard can be used to override EMTALA’s plain statutory text — and whether patients who were denied the screening Congress guaranteed them can be turned away from court on grounds the statute itself does not authorize.

The answer has consequences not just for us, as plaintiffs, but for every patient in the circuit who walks through an emergency room door and relies on federal law to protect them.

In the Eastern District of Tennessee, the District Court in Knoxville advanced our state and EMTALA claims without having issued a summons so all defendants could be served.   It then manufactured a tolling date based on a document it did not have access to.   After disposing of the state claims using its made up tolling date, the Court advanced the EMTALA claims into discovery.

We either had to comply with the Joint Discovery Plan schedule the Court imposed on us, or lose our EMTALA case.  After we created the Joint Discovery Plan, the Court then set up its plan to dismiss the case after we disclosed our discovery strategy.

EMTALA Failure to Screen (Count 1)

The judged used Cleland v. Bronson and its “improper motive” requirement.   

Cleland’s “improper motive” is not in the EMTALA text, therefore, we are challenging its use to dismiss our screening claim, as one of other key issues on appeal.  

All a hospital has to do at the pleading stage is state they provided adequate screening, or went above the EMTALA requirements and did several tests.  That’s it.  No evidence required.  Just their assertion.   Cleland then provides the judge with a vehicle to resolve the dispute in favor of the hospital and you never get to the discovery stage requiring them to prove their assertions.

Failure to Stabilize (Count 2)

This vehicle to dismiss is more interesting than a straight Cleland-style dismissal. The court’s reasoning moves in three steps:

First, the court actually rules for us on the threshold question — it finds they adequately pled that Tennova North had “actual knowledge” of an emergency medical condition, which is what triggers the stabilization duty in the first place (citing Burd).  So this isn’t dismissed on the same ground as Count 1.

Then the court strips out the legal conclusion.  Plaintiffs alleged Mr. Crawford “remained unstabilized” at discharge — but the court invokes Montgomery v. Huntington Bank to say that is a legal conclusion, not a factual allegation, so it doesn’t have to be accepted as true on a 12(b)(6) motion.  That leaves the court to look at the actual facts pled (not the conclusion) to see if they support stabilization failure.

The factual allegations then run into 42 U.S.C. § 1395dd(b)(2) — the statutory provision that says a hospital satisfies its stabilization obligation if it offers further examination/treatment and the patient refuses it.  The court points to plaintiffs’ own prior allegations (incorporated from the original complaint) that Tennova North ran labs, blood cultures, a urine screen, CT scans, and gave antibiotics — and that Mrs. Crawford declined several additional tests the hospital recommended before discharge.  That refusal is what does the real work: under the statute, an offer-and-refusal counts as stabilization being satisfied, as a matter of law.

The truth is, those test facts came from us pleading from evidence we got when Tennova North faxed limited records to Methodist Medical Center.   What the court ignored is that I, Colleen Crawford, was refusing tests that had nothing to do with testing my husband for food poisoning.  I refused other tests and the hospital even documented their knowledge of why I suspected food poisoning.

EMTALA is broad, but what the court failed to include is that CMS clarifies what an appropriate screening is.  It is based on the chief complaint.  So, if I took my husband to ER to have him tested for food poisoning, and he shows the commonly known symptoms of food poisoning, then their obligation was to screen him for food poisoning.  Instead, they did exactly what CMS tells them not to do. They screened him for things that had nothing to do with his complaint of food poisoning.  Those are the tests I refused.  

CMS also includes that the physicians’ observations plus the patient’s chief complaint is how they determine what is an appropriate screening.  My husband could not speak for himself.  He was dependent on me telling them what his chief complaint was.  Interesting enough, the physicians identified symptoms specific to Shiga toxin food poisoning, and still would not screen him for food poisoning, and instead, wanted expensive tests done instead of a $26 E. coli lab kit test done.

The court’s stabilization dismissal leaned heavily on the idea that Mrs. Crawford “declined ‘several expensive tests'” [Doc. 1 ¶¶ 63, 72], and used that refusal to trigger § 1395dd(b)(2)’s safe harbor — treating the offer-and-decline as satisfying the stabilization duty.

But if the test in question was the lumbar puncture to rule out meningitis — a different suspected condition, not food poisoning — that’s a real problem for how the court applied the statute.  I was asked for permission for them to do a lumbar puncture to rule out meningitis.  I agreed.  I was waiting for them to get my husband so they could test him for meningitis.  Instead, they cancelled the test.

The evidence we pleaded in the complaint (yes, I know now that plaintiffs don’t have to plead evidence) was that they cancelled the LP, yet applied meningitis drugs for stabilization for an emergency medical condition (EMC) that didn’t exist, while documenting their knowledge of a ‘food intoxication’ EMC.  Without an appropriate screening to rule out the food poisoning EMC, they administered the wrong stabilization treatment, created a new EMC of renal failure to the point of near death, at risk of death, and then concealed all of the records.

I had to take my husband to another facility to test him for food poisoning because Tennova North refused to do it.   He had Shiga toxin-producing E. coli and C. diff infections. 

The court knew this.  They knew we pleaded all of this, but instead of allowing the case to advance to discovery, they forced us to turn over our discovery strategy and then dismissed the case. 

Section 1395dd(b) is about stabilizing the emergency medical condition that was actually identified — here, the food-poisoning/STEC condition. A declined test aimed at ruling out an unrelated conditions doesn’t obviously satisfy the stabilization duty for the food-poisoning EMC.  That’s a legitimate, specific argument: the “refusal” the court relied on wasn’t a refusal of stabilizing treatment for the condition at issue — it was a separate workup for a different suspected condition entirely that only based on ‘suspicions.’  I approved two tests.  Food poisoning and meningitis.  They did neither.   Instead, I turned down multiple unrelated tests they wanted to do, and when I said we had to pay cash for everything and I wanted him tested for food poisoning, they said no, and discharged my husband.

So the vehicle is still Rule 12(b)(6) — but the dispositive tool is the statutory safe-harbor in § 1395dd(b)(2) combined with disregarding the conclusory “unstabilized” allegation, rather than a Cleland-style “this is really malpractice” reasoning (though the court does gesture at that theme too).

Failure to Transfer (Count 3)

This one isn’t independently analyzed at all. The court dismisses it purely derivatively: the transfer obligation under § 1395dd(c) only kicks in “if an individual ha[d] an emergency medical condition which has not been stabilized.” Since the court already concluded (for 12(b)(6) purposes) that plaintiffs failed to plausibly plead a stabilization failure, the transfer claim has no predicate to attach to — it fails as a matter of statutory logic, not because the court separately evaluated any transfer-specific facts.