Indiana Supreme Court Finds Medical Malpractice Claimant’s Right to Amend Timely-Filed Complaint after Statute of Limitations to Add EMTALA Claim Against Hospital Is Not Preempted by EMTALA

The Indiana Supreme Court recently reversed the Indiana Court of Appeals’ denial of a medical malpractice claimant’s request to amend her complaint to allege a violation of 42 U.S.C. § 1395dd, a federal law also known as the Emergency Medical Treatment and Labor Act (“EMTALA”). The claimant, Betty Miller, had sued various health-care providers under medical malpractice theories claiming her mentally ill grandson, Zachary Miller, should not have been released from Community Howard Regional Health Hospital’s (“Community Howard”) emergency room after he had arrived at Community Howard’s emergency room requesting admission for his mental illness and dangerous propensities. She later sought to amend her complaint to include an EMTALA claim.

EMTALA was enacted by Congress to deter hospitals from the practice “dumping” indigent patients. EMTALA provides that a hospital emergency department must screen individuals for “emergency medical condition[s]” and either stabilize the condition or transfer the patient as permitted under the law. However, relevant to the issue presented, any legal claim under the law must be brought no more than two years after the date of the violation.
Federal law can preempt state law either implicitly or explicitly when provisions of the federal and state laws are at odds. EMTALA contains an express preemption provision which provides that “this section does not preempt any State or local law requirement, except to the extent that requirement directly conflicts with a requirement of this section.” 42 U.S.C. § 1395dd(f). A year before Miller, in Williams v. Inglis, the Indiana Court of Appeals had held that EMTALA’s two-year statute of limitations preempted Indiana Trial Rule 15(C)’s provision allowing amendments to timely-filed complaints to relate back to the time the complaint was filed. In, other words, in Williams, the Court of Appeals had held that because EMTALA provided a claim had to be filed within two years after the violation, this conflicted with the otherwise liberal right to amend a complaint under Indiana law and refused to allow an amendment to relate back to add an EMTALA claim after the two years. And, the Indiana Supreme Court had refused to consider Williams’ request for review, so the Court of Appeals had simply followed its past precedent in Miller to deny the same request. Luckily for Miller, unlike in Williams, the Indiana Supreme Court agreed to accept her appeal of the issue in her petition to transfer.

In reviewing the EMTALA preemption issue presented, the Court noted that Trial Rule 15(C) provides that “[w]henever the claim or defense asserted in the amended pleading arose out of the conduct, transaction, or occurrence set forth or attempted to be set forth in the original pleading, the amendment relates back to the date of the original pleading.” Had the EMTALA claim been filed in a federal court, the court would have applied Federal Rule of Civil Procedure 15 in considering whether an amendment should be allowed to relate back to the date of the initial filing. And, in comparing Indiana’s Trial Rule 15 with Federal Rule of Civil Procedure 15, the Court noted there was no conflict, as both rules allow new claims to relate back. The Court noted, “These rules ensure claims comply, rather than conflict, with the statutes of limitations.” In fact, the Court found cases where federal district courts had allowed amendments to complaints to bring EMTALA claims. As such, the Court found no direct conflict between EMTALA and Trial Rule 15 and, therefore, the express preemption clause did not directly conflict.

The Court then examined whether the amendment should be disallowed under the two types of implied preemption: conflict and field. Implied conflict preemption only applies when state law presents an obstacle to achieving Congress’ objectives under a law. Although a statute of limitation serves an important purpose, so too does a rule allowing an amendment after a defendant has been timely notified of allegations that may support a variety of claims, as such a rule is premised upon the notion that “a party is not entitled to the protection of the statute of limitations.” The Court found allowing such an amendment is not an obstacle to Congress’ objectives.

As for field preemption, such preemption only applies “when there is no room for state law because comprehensive federal legislation occupies an entire field of regulation,” thus displacing all the subject matter state law. Because Congress did not restrict EMTALA claims to federal court, the Court found that it had not intended to preempt the field of state law. As such, the Court concluded the claimant’s attempt to amend the complaint was not preempted and should be evaluated by the trial court under Trial Rule 15(C)’s standard of “whether the EMTALA claim arose out of the same conduct set forth or attempted to be set forth in the original complaint, along with other relevant factors.” Read the Court’s opinion here.