Pauly v. Stanford Health Care

District Court, N.D. California·Decided September 29, 2022·No. 3:18-cv-05387·Unknown

Opinion

1 2 3 4 UNITED STATES DISTRICT COURT 5 NORTHERN DISTRICT OF CALIFORNIA 6 7 MAKENZIE PAULY, Case No. 18-cv-05387-SI

8 Plaintiff, ORDER ON MOTIONS FOR 9 v. SUMMARY JUDGMENT

10 STANFORD HEALTH CARE, Re: Dkt. Nos. 163, 175 11 Defendant.

12 13 Before the Court are defendant Stanford Health Care’s (SHC) motion for summary 14 judgment and plaintiff Makenzie Pauly’s cross-motion for summary judgment. Dkt. Nos. 163, 15 175. This lawsuit arises out of defendant’s alleged failure to screen and treat plaintiff in violation 16 of the Emergency Medical Treatment & Labor Act (EMTALA), 42 U.S.C. § 1395dd. Dkt. No. 1 17 at 4. For the reasons discussed below, the Court GRANTS defendant’s motion for summary 18 judgment and DENIES plaintiff’s cross-motion for summary judgment. 19 20 BACKGROUND A. Factual Background 21 22 On November 7, 2008, when Pauly was approximately ten years old, she saw Dr. Gates at 23 Sutter Hospital (Sutter) for abdominal pain she had been suffering for two months. Id.; Dkt. No. 24 165-6 at 5. She had received a “significant workup” including ultrasound, colonoscopy, 25 esophagogastroduodenoscopy, and CT scan, all of which were negative. Id. at 5–6. After a 26 physical examination, id. at 6, Dr. Gates performed a diagnostic laparoscopy and removed Pauly’s 27 appendix. Id. at 239–40. Dr. Gates reported no complications. Id. at 241. An MRI was 1 259. On November 11, 2008, Pauly was discharged from Sutter with medication and instructions 2 to follow up in 7–10 days. Id. at 179–80. Her record noted that the family planned to call SHC 3 “to see if they can be evaluated by their team.” Id. at 179–80. 4 On November 14, 2008, Pauly’s mother took Pauly to the SHC emergency room for 5 abdominal pain after the surgery. Dkt. No. 165-1 at 3–8. Her medical history was obtained, her 6 vitals were taken by nursing, and she saw Dr. Stephanie Doniger for a physical exam. Id. at 6–9. 7 Dr. Doniger made a differential diagnosis “includ[ing] but not limited to post-op abscess (s/p neg 8 appendectomy) vs gallbladder pathology (cholecystitis/cholelithiasis) vs UTI vs functional AP vs 9 constipation vs abdominal migraines vs post-op pain.” Id. at 9. Pauly was given morphine and 10 was evaluated with several labs and an ultrasound. Id. at 11–18. The ultrasound showed a small 11 amount of gallbladder sludge but was otherwise normal. Id. at 16–21. Pauly was given more pain 12 medication later that night. Id. at 22–23. She left in stable condition with a prescription for 13 Vicodin and instructions to return in the case of persistent vomiting, intolerance to liquids, or 14 unbearable pain not controlled with Vicodin. Id. at 5, 31. On November 17 a nurse spoke with 15 Pauly’s mother about a positive urine culture and a doctor sent a prescription for Augmentin. Id. 16 at 6. 17 On December 4 Pauly returned to Sutter reporting “persistent abdominal pain … different 18 in nature from the pain she originally presented with.” Dkt. No. 165-2 at 16. She again saw Dr. 19 Gates, who treated her on December 5 with a bupivacaine injection that “caused her excruciating 20 pain.” Id. 12. Dr. Gates sought a consultation by Dr. Falco, whose assessment notes indicate 21 “nonspecific abdominal pain that despite a very extensive workup has no organic etiology” and a 22 normal heart rate despite high pain levels. Id. at 18–19. Dr. Falco recommended “more intensive 23 psychiatric therapy” and “agree[d] with getting a pain consultation from UC Davis and/or 24 transferring her to Stanford where there is a more extensive pain/psychiatric service.” Id. A 25 consult was also performed by Dr. McDonald, who noted an “extremely extensive workup” with 26 all labs and testing negative. Id. at 20–21. Dr. McDonald assessed Pauly as having “chronic 27 abdominal pain,” recommended an MRI of the spine in case of a tumor, and noted Pauly’s mother 1 pain was “inconsistent” with her abdominal examination and heart rate and suggested a 2 “nonorganic etiology for her abdominal pain.” Id. at 14–15. 3 Dr. Gates’ notes also indicate he sought an inpatient referral to SHC’s pain clinic, “but 4 they refused admission unless she failed their outpatient pain management service.” Id. at 14–15. 5 Notes from December 7 indicate Pauly was “awaiting bed avail – Sford” but “no bed avail today” 6 and stated intent to transfer “to Stanford as soon as bed avail.” Id. at 68. Notes from December 8 7 again mention a possible “transfer to Stanford peds.” Id. Notes from December 9 indicate an 8 attempt to transfer her to SHC: “try to get her to Stanford pain clinic.” Id. at 67. Notes from 9 December 10 indicate that doctors at Sutter were trying to transfer Pauly to SHC when a bed 10 became available: “cont [illegible] bed avail @ Stanford,” id. at 65; “Waiting for Stanford pain 11 clinic,” id.; “cont. @ current Doc. Tx to Stanford when bed avail,” id. at 66; “P awaiting bed @ 12 Stanford.” Id. 13 Notes from SHC’s transfer log show that they had no beds available on December 7 but 14 recommended calling back the next day. Dkt. No. 166-6 at 3. Notes from December 8 note no 15 beds available “and not sure if they want to take pt.” Id. Notes from December 10 state, “There is 16 nothing that LPCH has to offer at this time bed control is aware.” Id. 17 On December 10, after Pauly was discharged from Sutter, her mother took her to SHC’s 18 emergency room. Dkt. No. 165-1 at 44. Pauly reported her pain was a 10/10 and a procedure at 19 Sutter had made the pain worse. Id. at 47. Nursing notes indicate Pauly had been in pain for a 20 month and been seen at numerous hospitals for pain control without relief. Id. at 48. 21 Nurses triaged Pauly and then performed a nursing assessment. Id. at 60–62. Topical 22 cream and morphine were administered. Id. at 58–59. Pauly’s vitals were taken again. 23 Pauly was seen by Dr. Grant Lipman, who received a medical history from Pauly’s mother. 24 Id. at 50. The medical history included her laparoscopy in November and hospitalization at Sutter. 25 Id. Dr. Lipman noted the pain “started at the end of August and continued despite negative 26 workup.” Id. Dr. Lipman noted “severe” pain not relieved by anything but “no anorexia, no 27 diarrhea, no hematuria, no fever, no nausea, no vaginal bleeding, no cough, no vomiting, no 1 noted Pauly was seen by “psych at Sutter Hospital to [rule out] somatoform disorder.” Id. 2 Dr. Lipman conducted a physical examination including palpation of Pauly’s abdomen. Id. 3 at 51–52. He consulted pain services, which said they would not “admit/consult unless medically 4 indicated or seen as outpatient first.” Id. at 52. He made a differential diagnosis of “Chronic pain 5 symptom v neuropathic pain v abdominal migraines v malingering.” Id. His notes on patient 6 progress and condition on discharge state: “Stable 8:17 PM.” Id. He also noted Pauly’s mother 7 was uncomfortable with leaving and would follow up as an outpatient with pain services. Id. at 8 53. He noted at 9:10 p.m. that the patient was refusing to sign discharge papers, was “demanding 9 admission for diagnostics” despite over 5 weeks of similar symptoms, and had a “good” follow-up 10 scheduled in the morning. Id. 11 From Pauly’s perspective, the visit was stressful and perfunctory. Pauly submitted a 12 declaration stating that she was “in severe pain” and unable to walk at the emergency department 13 and that the doctors were angry she had come and refused to admit her or treat her pain. Dkt. No. 14 175-1 ⁋⁋ 12–14. She states that the examination was rude and harsh and Dr. Lipman “treated [her] 15 like a nuisance.” Id. ⁋ 15. She states that on-call specialists refused to come in and she was 16 discharged without stabilizing treatment despite her mother’s insistence that she stay for the night. 17 Id. ⁋⁋ 15–18. She was traumatized by the experience and in severe pain for five more weeks. Id.

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