PATRICIA LANMAN V KALAMAZOO PSYCHIATRIC HOSP
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STATE OF MICHIGAN
COURT OF APPEALS
PATRICIA LANMAN, Personal Representative of
the Estate of EUGENE H. LANMAN, Deceased,
UNPUBLISHED
January 12, 2006
Plaintiff-Appellee,
v
No. 263665
Court of Claims
LC No. 03-000130-MH
KALAMAZOO PSYCHIATRIC HOSPITAL,
Defendant-Appellant.
Before: Hoekstra, P.J., and Neff and Davis, JJ.
PER CURIAM.
Defendant Kalamazoo Psychiatric Hospital appeals as of right an order denying its
motion for summary disposition on the basis of governmental immunity. We reverse and
remand this case to the trial court for entry of an order granting defendant’s motion for summary
disposition.
Decedent Eugene H. Lanman was initially taken by police to a different hospital, which
found decedent in need of inpatient psychiatric care. The police took decedent to defendant
hospital, where he was found in need of care but capable of giving informed consent. Decedent
signed a voluntary admission form, and defendant hospital admitted him for long-term
psychiatric care, gave him medicine for back pain and placed him in a “quiet room.” Overnight,
decedent became increasingly agitated, eventually culminating in a struggle with defendant’s
staff and injection of a calming drug. Decedent stopped breathing, allegedly as a result of
compression of his breathing capacity by defendant’s staff during the struggle. Defendant’s staff
then performed CPR. Decedent was transported to a general hospital emergency room, where he
remained until his death a little more than two weeks later. Plaintiff filed suit. Relevant to this
appeal, plaintiff alleged a breach of contract claim premised on the voluntary admission form.
Plaintiff also alleged an independent claim under the federal Emergency Medical Treatment and
Active Labor Act (EMTALA), 42 USC 1395dd. The trial court found both claims to be pleaded
in avoidance of governmental immunity and factually supportable at trial.
A grant or denial of summary disposition is reviewed de novo on the basis of the entire
record to determine if the moving party is entitled to judgment as a matter of law. Maiden v
Rozwood, 461 Mich 109, 118; 597 NW2d 817 (1999). We also review de novo questions of
statutory interpretation “to discern and give effect to the Legislature’s intent,” with the
presumption that unambiguous language should be enforced as written. Gladych v New Family
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Homes, Inc, 468 Mich 594, 597; 664 NW2d 705 (2003). Likewise, proper interpretation of a
contract and the applicability of governmental immunity are questions of law subject to review
de novo. Klapp v United Ins Group Agency, Inc, 468 Mich 459, 463; 663 NW2d 447 (2003);
Pierce v Lansing, 265 Mich App 174, 176; 694 NW2d 65 (2005).
Governmental immunity is controlled by the Governmental Immunity Act (GIA), MCL
691.1401 et seq. Under MCL 691.1407(1):
Except as otherwise provided in this act, a governmental agency is immune from
tort liability if the governmental agency is engaged in the exercise or discharge of
a governmental function. Except as otherwise provided in this act, this act does
not modify or restrict the immunity of the state from tort liability as it existed
before July 1, 1965, which immunity is affirmed.
“If a plaintiff successfully pleads and establishes a non-tort cause of action, § 7 will not bar
recovery simply because the underlying facts could have also established a tort cause of action.”
Ross v Consumers Power Co (On Rehearing), 420 Mich 567, 647-648; 363 NW2d 641 (1984).
Plaintiff alleges that one of her claims sounds in contract and is therefore not subject to the
statute. Plaintiff alleges that immunity to the EMTALA claim has been waived.
We first consider the breach of contract claim, which alleges both an express and an
implied contract.
Defendant first argues that the parties did not have an express contract. We disagree, but
we find that the parties’ contract did not include any particular treatment obligations. A breach
of contract claim requires plaintiff to establish all of the elements of a contract. Pawlak v Redox
Corp, 182 Mich App 758, 765; 453 NW2d 304 (1990). “In Michigan, the essential elements of a
valid contract are (1) parties competent to contract, (2) a proper subject matter, (3) a legal
consideration, (4) mutuality of agreement, and (5) mutuality of obligation.” Thomas v Leja, 187
Mich App 418, 422; 468 NW2d 58 (1991). However, a contract’s enforceability is not
dependent on mutuality of obligation so long as one party has given consideration for the other
party’s obligation. Toussaint v Blue Cross & Blue Shield of Michigan, 408 Mich 579, 600; 292
NW2d 880 (1980).
Decedent and one of defendant’s doctors signed a “voluntary admission form,” which
plaintiff argues is a contract for specific types of treatment based on the Michigan Mental Health
Code, MCL 330.1001 et seq. We disagree. The particular form in this case only constitutes an
offer stating the applicant’s desire to be admitted to the hospital in exchange for certain
promises. See Eerdmans v Maki, 226 Mich App 360, 364; 573 NW2d 329 (1997). In relevant
part, decedent agreed to consent to treatment and to facilitate payment for any treatment
received. Defendant agreed to follow certain procedures in the event it decided to admit
decedent or provide certain kinds of treatment against his will. We presume that this offer was
accepted by defendant’s decision to admit decedent, which did establish an express contract.
Otherwise, the contract based on this form only authorizes treatment, it does not require it.
Defendant next argues that the parties did not have an implied contract. We agree. An
implied contract may arise where circumstances and the parties’ conduct and language imply that
the parties intended to contract, but where they did not explicitly put that intent into words.
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Featherston v Steinhoff, 226 Mich App 584, 589; 575 NW2d 6 (1997). There is no elemental
difference between an implied contract and an express contract other than “the character of the
evidence necessary to establish the contract.” Borg-Warner Acceptance Corp v Dep’t of State,
169 Mich App 587, 590; 426 NW2d 717 (1988), rev’d on other grounds 433 Mich 16 (1989).
Relevant to this appeal, an implied contract still depends on consideration. Lowery v Dep’t of
Corrections, 146 Mich App 342, 359; 380 NW2d 99 (1985). “[I]t is well settled that doing what
one is legally bound to do is not consideration for a new promise.” Yerkovich v AAA, 461 Mich
732, 740-741; 610 NW2d 542 (2000).
We have addressed an argument similar to plaintiff’s “that the admission application
signed by the decedent constituted an implied agreement between defendants and the decedent to
provide appropriate care and treatment for the decedent.” Freiburger v Dep’t of Mental Health,
161 Mich App 316, 318; 409 NW2d 821 (1987). At the time, MCL 330.1810 provided that
“[n]o person shall be denied services because of an inability to pay for such services on the part
of the individual, the spouse, or the parents.” See 1974 PA 258. That statute imposed a
preexisting duty “to provide services to all persons in need of mental health services, regardless
of their ability to pay,” so there was no consideration for the alleged contract. Freiburger, supra.
The statute now reads “an individual shall not be denied services because of the inability of
responsible parties to pay for the services.” MCL 330.1810. This is only a stylistic change. See
In re Marin, 198 Mich App 560, 563; 499 NW2d 400 (1993). We reach the same result today as
we did in Freiburger. On these facts, plaintiff’s breach of contract claim is “a tort case.”
Freiburger, supra at 320. Consequently, the trial court erred in denying summary disposition of
plaintiff’s contract claims.
Next, we address whether the facts of this case support an EMTALA claim. EMTALA
imposes two primary requirements on participating hospitals.1 First, it requires that a
participating hospital afford an appropriate medical screening to all persons who come to its
emergency room seeking medical assistance. 42 USC 1395dd(a). Second, it requires that if an
emergency medical condition is found to exist, the participating hospital must render those
services that are necessary “to stabilize” the patient’s condition. See 42 USC 1395dd(b)(1)(a).2
In her complaint, plaintiff alleged that defendant violated EMTALA when, “despite
recognizing the existence of an emergency medical condition,” its staff “did nothing to stabilize
[decedent’s] emergency medical condition, or to prevent his condition from deteriorating further
to the point that he became a danger to others as well as himself.” However, even if accepted as
true, plaintiff’s allegations in this regard do not support an EMTALA claim under the facts of
this case.
1
EMTALA defines a “participating hospital” as a “hospital that has entered into a provider
agreement under section 1395cc of this title.” 42 USC 1395dd(e)(2). Neither party disputes that
KPH is a participating hospital.
2
As an enforcement mechanism for these requirements, the EMTALA creates a private right of
action for violations of the act. See 42 USC 1395dd(d)(2).
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In Harry v Marchant, 291 F3d 767, 770 (CA 11, 2002) (en banc), the Eleventh Circuit
Court of Appeals addressed the issue whether “EMTALA requires a hospital to provide
stabilization treatment to a patient with an emergency medical condition who is not transferred.”
In that case, an on-call physician acting on behalf of a patient’s primary care provider refused to
authorize the patient’s admission into the defendant hospital’s intensive care unit (ICU), despite
the emergency room physician’s recommendation that she be admitted for treatment of
pneumonia. Id. at 768. Several hours later, the patient’s regular primary care physician
examined and admitted the patient into the ICU. Id. at 768-769. Shortly thereafter, the patient
lapsed into respiratory and cardiac failure and died. Id. at 769. The personal representative of
the patient’s estate brought suit against the hospital and its emergency room personnel, alleging
that the defendants violated EMTALA by failing to stabilize and treat the patient’s emergency
medical condition. Id. In reversing an earlier panel decision finding that the plaintiff’s
complaint supported an EMTALA claim for failure to stabilize the patient’s condition, the court,
sitting en banc, noted that the term “to stabilize” was expressly defined by EMTALA. Id. at 770.
Specifically, the court noted that
[u]nder EMTALA, the term “to stabilize” means “with respect to an emergency
medical condition . . . [a hospital must] provide such medical treatment of the
condition as may be necessary to assure, within reasonable medical probability,
that no material deterioration of the condition is likely to result or occur during
the transfer of the individual from a facility.” [Id. at 770-771, quoting 42 USC
1395dd(e)(3)(A) (emphasis added).]
Addressing the language emphasized above, the court reasoned that “[c]onstruing
EMTALA to mandate stabilization treatment irrespective of a transfer renders the words ‘during
the transfer,’ contained in the statutory definition of the term ‘to stabilize,’ superfluous.” Id. at
771-772. Thus, the court found that “[t]o give effect to the clear language of the statute, [it] must
conclude that the triggering mechanism for stabilization treatment under EMTALA is transfer,”
and that, therefore, “EMTALA mandates stabilization of an individual only in the event of a
‘transfer’ as defined in EMTALA.”3 Id.
In reaching this conclusion, the court noted that the legislative history and purpose of
EMTALA was consistent with such a construction:
EMTALA’s main objective was to prevent the practice of “patient dumping,” [i.e,
the practice of some hospital emergency rooms turning away or transferring
indigents to public hospitals without prior assessment or stabilization treatment.]
By mandating treatment only in the context of a patient transfer, the stabilization
requirement addresses Congress’ concern regarding rejection of patients without
converting EMTALA into a federal malpractice statute. In prescribing minimal
standards for screening and transferring patients, but not for patient care outside
3
The term “transfer” is defined by the act as “the movement (including the discharge) of an
individual outside of a hospital’s facilities at the direction of any person employed by (or
affiliated or associated, directly or indirectly, with) the hospital.” 42 USC 1395dd(e)(4).
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these two narrowly defined contexts, Congress confined EMTALA solely to
address its concerns and, at the same time, avoided supplanting state malpractice
and tort remedies. [Id. at 773-774.]
Absent a conflict among the various federal appellate circuits, we are bound by the
holding of a federal appellate court concerning interpretation of a federal statute. Abela v
General Motors Corp, 257 Mich App 513, 526; 669 NW2d 271 (2003). We are aware of no
conflict with the en banc decision of the court in Harris, supra, and, in any event, agree that the
EMTALA stabilization requirement is unambiguous, and plainly applies only to those instances
where a patient treated for an emergency medical condition is transferred or discharged. See
Gladych, supra. Consequently, because plaintiff’s decedent was neither transferred nor
discharged, but rather admitted to the defendant hospital for long term treatment of his
psychiatric condition,4 the requirements of EMTALA are inapplicable and summary disposition
of her EMTALA claim is required.5
Reversed and remanded for entry of an order granting defendant’s motion for summary
disposition. We do not retain jurisdiction.
/s/ Joel P. Hoekstra
/s/ Janet T. Neff
4
We acknowledge that decedent was transferred to another hospital that was better equipped to
treat his physical condition resulting from the fact that he stopped breathing during the struggle
with defendant’s staff members. However, plaintiff does not complain of a lack of stabilization
relative to decedent not breathing prior to the transfer. Rather, she alleges a failure “to stabilize .
. . or prevent his [psychiatric] condition from deteriorating further to the point that he became a
danger to others as well as himself.” Consequently, the transfer after the struggle is immaterial
to whether plaintiff may maintain her EMTALA claim.
5
Because we find plaintiff’s EMTALA claim to be factually untenable, we need not consider
defendant’s claim of governmental immunity.
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