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Anestis v. United States

United States District Court, E.D. Kentucky, Central Division, Lexington

December 3, 2014

TIFFANY ANESTIS, Individually, and as Administratrix of the ESTATE OF CAMERON ANESTIS, deceased, and as Mother and Next Friend of I.A., an infant Plaintiffs,


DAVID L. BUNNING, District Judge.

On September 30, 2014, this Court entered its Memorandum Opinion and Order (Doc. # 164) granting Plaintiffs' Partial Motion for Summary Judgment (Doc. # 153) and denying both Defendant's Motion to Dismiss for Lack of Subject-Matter Jurisdiction (Doc. # 151) and Defendant's Motion for Summary Judgment (Doc. # 152). Pursuant to Federal Rule of Civil Procedure 54(b), Defendant now moves this Court to reconsider that part of its Order "granting partial summary judgment for Plaintiffs on the questions of duty and breach" (Doc. # 173). Plaintiff having filed her response (Doc. # 191), and Defendant having failed to file a reply within the allotted time period, this matter is ripe for the Court's review. For reasons set forth herein, Defendant's Motion is hereby denied.


Pursuant to Federal Rule of Civil Procedure 54(b), "any order or decision, however designated, that adjudicates fewer than all the claims or the rights and liabilities of fewer than all the parties does not end the action as to any of the claims or parties and may be revised at any time before the entry of a judgment adjudicating all the claims and the parties' rights and liabilities." The Sixth Circuit has recognized that this rule allows district courts "to reconsider interlocutory orders and reopen any part of a case before final judgment." Rodriguez v. Tenn. Laborers Health & Welfare Fund, 89 F.Appx. 949, 959 (6th Cir. 2004)(citing Mallory v. Eyrich, 922 F.2d 1273, 1281 (6th Cir. 1991)). However, district courts typically reconsider interlocutory orders in the following circumstances only: (1) there is an intervening change of controlling law; (2) new evidence has become available; (3) there is a need to correct a clear error or prevent manifest injustice[1]. Id.


1. The VA had a duty to treat Cameron Anestis

Under Kentucky law, hospitals generally do not have a duty to treat or admit patients without a physician's order. Richard v. Adair Hosp. Found. Corp., 566 S.W.2d 791, 793 (Ky. App. 1978). However, courts have "carved from the general no-duty-to-admit rule a view that where a hospital refuses care in an emergency situation, liability may be predicated upon such refusal." Id .; see also Noble v. Sartori, 799 S.W.2d 8, 10 (Ky. 1990) (holding that, in some circumstances, a doctor has a duty to treat medical emergencies). Case law suggests that this duty only applies to hospitals that have emergency facilities. See Adair, 566 S.W.2d at 791; Nunsuch ex rel. Nunsuch v. United States, 221 F.Supp.2d 1027, 1033 (D. Ariz. 2001) (holding that a hospital can avoid the duty to provide medical care by showing "that the hospital is not obligated (or capable) under its state license to provide the necessary emergency medical care."); 35 A.L.R.3d 841 (surveying state law approaches to the duty to provide emergency care).

Applying the above-cited case law, this Court recently concluded that the VA had a duty to treat Cameron because he presented to the Leestown clinic with a mental health emergency on August 17, 2009. (Doc. # 164 at 7-9). The Court imposed this duty despite the fact that the Leestown clinic did not have emergency facilities, reasoning that "[t]he VA cannot escape the duty to treat because Cameron Anestis showed up at the wrong place." ( Id. at 11).

Defendant challenges the Court's duty analysis on two grounds. (Doc. # 173). First, Defendant sets forth expert opinions and mental health records to show that Cameron was not in an emergency state when he arrived at the Leestown facility. ( Id. at 4-9). Second, Defendant argues that the Court expanded Kentucky law too far by ruling that a non-emergency facility had a duty to treat individuals with medical emergencies. ( Id. at 9-11). The Court will consider each of these arguments in turn.

a. Cameron presented to the Leestown clinic with a mental health emergency on August 17, 2009

As this Court noted in its latest Memorandum Opinion and Order, intake clerk Carole McIntosh "could not have been more clear that Cameron Anestis faced a medical emergency" when he arrived at the Leestown facility on August 17, 2009. (Doc. # 164 at 8). Cameron repeatedly told McIntosh that he "needed help, " prompting her to take him aside and speak privately with him about his mental health concerns. (Doc. # 88-3 at 22). He was visibly upset and teary-eyed throughout the conversation. ( Id. at 25-26). McIntosh felt like she had to "talk him down" and "baby him." ( Id. at 22-24). She even worried that he may be suicidal, as he spoke about being "at the end of the rope." (Doc. # 88-4 at 2).

Although McIntosh later offered conflicting statements about Cameron's potential for suicide, the Court decided that it "need not conclude that Cameron was suicidal to conclude that he did, in fact, suffer from a medical emergency." (Doc. # 164 at 8). "Indeed, when the only live question is whether McIntosh felt that Cameron was actually suicidal or just very emotionally troubled, the Court cannot avoid concluding that Cameron faced a mental health emergency." ( Id. ). Finding the Court's approach to be too forgiving, Defendant now argues that such an emergency is only present if there is an "imminent risk that the person will take action based on those emotions and harm themselves." (Doc. # 173-1 at 8). Thus, the following question takes center stage on Defendant's Motion for Reconsideration: What constitutes a medical emergency for purposes of Kentucky's duty to provide emergency care?

In determining that Cameron's troubled state constituted a mental health emergency, the Court partially relied upon EMTALA's definition of "medical emergency, " which includes all medical conditions that could place an individual's health in "serious jeopardy."[2] See 42 U.S.C. ยง 1395dd(e)(1)(A)(I). Defendant now suggests that this interpretation of "medical emergency" is irrelevant, as it "is not aware of any law in Kentucky adopting this definition outside of the context of a lawsuit under EMTALA." (Doc. # 173-1 at 8 n. 5). While Defendant is technically correct, the Court is likewise unaware of Kentucky case law adopting any definition of a medical emergency, for purposes of the duty to provide emergency care. Thus, the Court properly looked elsewhere for guidance, and because EMTALA imposes a similar duty to provide emergency care upon Medicare-participating hospitals, the Court found EMTALA to be the best available resource.

EMTALA's definition may not be directly on point, but it is more than Defendant can offer in support of their interpretation of a medical emergency. Without citing to any case law, Defendant insists that "very emotionally troubled" is insufficient, thus drawing the focus back to suicidal tendencies. Perhaps Defendant believes that this interpretation is clearer and easier to apply, but in the Court's view it also has the potential to be quite underinclusive. After all, health care providers faced with possible medical emergencies must quickly decide whether or not to treat, often without all relevant information before them. Surely this task is even more difficult in the case of a mental health emergency, as it is impossible to delve into an individual's thoughts. Defendant's approach practically requires ...

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