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Jackson V North Caddo Hospital Service District

              UNITED STATES DISTRICT COURT                           
             WESTERN DISTRICT OF LOUISIANA                           
                 SHREVEPORT DIVISION                                 

CALVIN JACKSON, SR.,                       CIVIL ACTION NO. 22-0171       
INDIVIDUALLY AND ON BEHALF                                                
OF C.J.                                                                   

VERSUS                                     JUDGE S. MAURICE HICKS, JR.    

NORTH CADDO HOSPITAL SERVICE               MAGISTRATE JUDGE HORNSBY       
DISTRICT D/B/A NORTH CADDO                                                
MEDICAL CENTER                                                            

                 MEMORANDUM OPINION                                  
This matter came on for bench trial on March 25, 2024.  See Record Document 
56.  Expert depositions were submitted and Plaintiff Calvin Jackson, Sr. (“Jackson”), 
individually and on behalf of C.J., filed a Post-Trial Memorandum on Damages.  See 
Record Documents 56 & 61.  This litigation presents a claim under the Emergency 
Medical Treatment and Labor Act (“EMTALA”), 42 U.S.C. § 1395dd; thus, this Court has 
subject matter jurisdiction over this case and the claims asserted herein pursuant to 28 
U.S.C. § 1331.  Based on the factual findings and legal conclusions set forth below, the 
Court finds there was no violation of the EMTALA and renders judgment in favor of 
Defendant North Caddo Hospital Service District d/b/a North Caddo Medical Center 
(“NCMC”).1                                                                

1 Also before the Court is a Motion in Limine (Record Document 35) filed by NCMC.  
Jackson did not contest two of the three grounds set forth in the defense motion.  Thus, 
during the final pretrial conference, the Court granted the motion as to those two grounds:  
(1) a $500,000 cap on any potential damages pursuant to La. R.S. 13:5106(B) because 
of NCMC’s status as a political subdivision of the State of Louisiana; and (2) preventing 
Jackson from introducing any evidence at trial that seeks to establish any lost chance of 
survival damages because such damages are permitted only in medical malpractice 
actions under Louisiana law.  See Record Document 50 at 2.                
The remainder of the Motion in Limine addressed the defense position that there 
is  a  $100,000  cap  on  any  possible  damages  pursuant  to  the  Louisiana  Medical 
                   FINDINGS OF FACT                                  
On Sunday, August 9, 2020, at 5:29 pm, Jackson and his 13 year-old son, C.J., 
presented to the emergency room (“ER”) at NCMC because C.J. had been experiencing 
nausea and vomiting for approximately four days.  Prior to arriving at NCMC, Jackson 
testified that C.J. had vomited, was unable to keep any food or water down, was dizzy, 
and was short of breath.  On the Emergency Room Patient Information form, Jackson 
stated  that  the  reason  for  the  C.J.’s  visit  was  “dizziness,  vomiting.”    Exhibit  A  at 

JACKSON005.  In triage, Jackson informed Registered Nurse Rebecca Attaway (“Nurse 
Attaway”) that C.J. had been vomiting for three to four days and had vomited five to six 
times that day.  See id. at JACKSON011 (ED Triage Pediatrics).  Jackson testified that 
he told Nurse Attaway that C.J. felt nauseous, was weak, and could not hold anything 
down.  Nurse Attaway’s triage assessment reflects that she took C.J.’s temperature, 
systolic blood pressure, diastolic blood pressure, peripheral pulse rate, respiratory rate, 
and oxygen level.  See id.  According to Nurse Attaway, C.J.’s respiratory rate and 
oxygen levels were normal.  The triage assessment/emergency documentation also 
reflects C.J.’s height, weight, and BMI.  See id.  Nurse Attaway stated that this was all 

part of her medical screening examination.  Nurse Attaway scored C.J. a tracking acuity 
of 5, indicating he was not critical.  See id.  Nurse Attaway also testified regarding C.J.’s 
medical social history, stating that there were no signs or symptoms of abuse and neglect 

Malpractice Act, (“LMMA”), specifically La. R.S. 40:1231.2(B)(2).  See Record Document 
35 at 5-9.  Jackson opposed the motion on this ground.  See Record Document 39.  
Resolution of this issue was deferred to trial.  See Record Document 50 at 2.  Because 
this Court has found no violation of the EMTALA and rendered judgment in favor of 
NCMC, there is no need to reach the contested issue of whether the LMMA’s $100,000 
damages cap applies in this instance.  NCMC’s Motion in Limine (Record Document 35) 
is terminated as MOOT.                                                    
and  C.J.  had  never  smoked,  used  electronic  cigarettes,  or  vaped.    See  id.  at 
JACKSON013.  She further testified that C.J. was alert, his behavior was appropriate, 
and he was calm and cooperative.                                          
C.J. was then moved to an examination room and seen by Dr. John Chandler 
(“Dr. Chandler”), a family practice physician who worked in the emergency room at 
NCMC.  See id. at JACKSON006.  Dr. Chandler testified that he had been practicing as 
an emergency medicine physician since 2016 and was tendered as an expert physician 

in emergency medicine.  Dr. Chandler explained that as the ER physician, he took his 
own medical history and did his own medical screening of C.J, including cardiovascular, 
respiratory, and psychiatric.  See id.  Additionally, he reviewed the triage information for 
C.J. and noted two things:  his heart rate was up a little bit and his diastolic blood 
pressure was up.  Dr. Chandler testified this could be indicative of hypertension or from 
C.J. being in the emergency room, which can be an anxiety provoking situation.   
Dr. Chandler recalled at trial that he considered C.J.’s chief complaints to be 
nausea, vomiting, and a rash on his penis.  In his ED Note, Dr. Chandler wrote: 
History of Present Illness                                           
     The patient presents with rash.  The onset was about a week.  The 
course/duration of symptoms is constant.  Location:  foreskin of penis.  The 
character of symptoms is itching.  . . .  Additional history:  Pt is a 13 year old 
AA male with MR who presents to ED and initially reports that he was 
nauseated, but on further questioning his main reason for presenting is a 
rash on his penis.  He states that his appetite is normal and denied any N/V 
to me.                                                               

Id.2  Dr. Chandler testified that he got this medical history from C.J.  Dr. Chandler recalled 
that Jackson relayed C.J. had been short of breath, but C.J. did not report this.  See id.  

2 At trial, Dr. Chandler clarified that “MR” referred to mentally retarded.  He testified that 
C.J. did not tell him he was mentally retarded, but Jackson implied it.  When asked how 
Jackson implied it, Dr. Chandler explained that Jackson told him C.J. was not right.  Dr. 
Chandler interpreted this to mean C.J. was a child with special needs.  The defense 
Notwithstanding, Dr. Chandler listened with his stethoscope and found C.J.’s heart to 
have a regular rate and rhythm.  See id. at JACKSON007.  Additionally, C.J.’s lungs 
were clear, respiration was non-labored, and breath sounds were equal.  See id.  Dr. 
Chandler further testified that he ordered a chest X-ray due to the shortness of breath 
and an EKG because of the elevated heart rate.  As to C.J.’s skin examination, Dr. 
Chandler found “skin of the distal penile foreskin is slightly swollen with white exudative 
material around the glans.”  Id.  Dr. Chandler also explained that C.J.’s social history was 

tailored to the 13 year-old patient, specifically noting there was no history of smoking, 
use of electronic cigarettes, or vaping.                                  
The results of the chest X-ray were “normal.”  See id. at JACKSON031.  The EKG 
was read as “prob[ably] normal for age.”  Id. at JACKSON022.  Dr. Chandler testified 
that C.J.’s vital signs at 8:20 p.m. had all improved.  See id. at JACKSON026.  Dr. 
Chandler diagnosed C.J. with a yeast infection and prescribed nystatin topical cream.  
C.J. was discharged at 8:23 pm.  After C.J. was discharged, he returned home with 
Jackson and went to sleep.                                                
The next morning, Monday, August 10, 2020, Jackson’s fiancé, Jessica Jackson, 

found C.J. on the floor barely breathing.  She testified that she called 911.  Bossier Parish 
Emergency Medical Service (“EMS”) arrived and, while in route to Willis Knighton – 
Bossier, C.J. went into cardiopulmonary arrest.  See Exhibit B at JACKSON007.  The 
Emergency  Medical  Technicians  (“EMTs”)  intubated  C.J.,  he  was  given  a dose of 

expert, Jacquelyn White, MD, also testified at trial that Dr. Chandler’s belief may have 
been based, in part,  on C.J.’s speech impediment.                        
Dr. Chandler admitted during his trial testimony that he must have been mistaken 
about C.J.’s perceived mental deficiencies in light of the trial testimony of C.J.’s seventh 
grade English teacher, Leslie Ilgenfritz (“Ilgenfritz”).  Dr. Chandler stated that, given the 
testimony of Ilgenfritz, Jackson was likely implying that something was acutely “not right” 
during the time frame Jackson brought C.J. to the ER.                     
Epinephrine and Sodium Bicarbonate, and the EMTs performed chest compressions.  
See id. at JACKSON007-009.  The EMTs performed a glucose check, which showed 
C.J.’s blood sugar level was 460 mg/dl.  See id.  C.J. was without a pulse when he arrived 
at Willis Knighton – Bossier.  See id.  He regained rhythm after additional CPR.  See id. 
at JACKSON008.  Dr. Bryant Boyd examined C.J. and ordered blood work, which 
showed his blood sugar had increased to 1103 mg/dl and he had elevated potassium 
and creatinine levels.  See id. at JACKSON 009-011.                       

C.J. was transferred via EMS and admitted to Willis Knighton – South Pediatric 
Intensive Care Unit.  See Exhibit C.  Upon examination, Dr. Minh Tran found that C.J. 
was unresponsive, tachycardic, and in diabetic ketoacidosis (“DKA”) with hypovolemic 
shock versus cardiogenic shock versus septic shock.  See id.  Despite medical treatment, 
the providers were unable to control C.J.’s blood sugar or otherwise reverse his DKA.  
See id.  C.J. passed away on August 15, 2020, and his death certificate listed the cause 
of death as DKA.  See id.; see also Exhibit E.                            
                 CONCLUSIONS OF LAW                                  
Congress did not intend the EMTALA to be a federal malpractice statute.  See 

Marshall v. East Carroll Parish Hosp. Serv. Dist., 134 F.3d 319, 322 (5th Cir. 1998).  Its 
purpose is to prevent “patient dumping,” i.e., the practice of refusing to treat patients who 
are unable to pay.  Id.3  The EMTALA “requires that participating hospitals give the 
following care to an individual who is presented for emergency medical care: (1) an 
appropriate medical screening, (2) stabilization of a known emergency medical condition, 
and (3) restrictions on transfer of an unstabilized individual to another medical facility.”  
Battle ex rel. Battle v. Mem’l Hosp. at Gulfport, 228 F.3d 544, 557 (5th Cir. 2000), citing 

3 There is no allegation of patient dumping in this case.                 
42 U.S.C. § 1395dd(a)-(c).  Jackson submits that there was a violation of the EMTALA 
in this case because (1) neither Nurse Attaway nor Dr. Chandler asked about C.J.’s 
medical or social history as part of the medical screening examination; and (2) the 
medical screening examination was cursory and not tailored to C.J.’s chief presenting 
complaint.  Thus, the first requirement – an appropriate medical screening – is the key 
issue in this case.4                                                      
Section 1395dd(a) of the EMTALA provides:                            

In the case of a hospital that has a hospital emergency department, if any 
individual . . . comes to the emergency department and a request is made 
on  the  individual’s  behalf  for  examination  or  treatment  for  a  medical 
condition,  the  hospital  must  provide  for  an  appropriate  medical 
screening examination within the capability of the hospital’s emergency 
department,  including  ancillary  services  routinely  available  to  the 
emergency  department,  to  determine  whether  or  not  an  emergency 
medical condition (within the meaning of subsection (e)(1)) exists.  

42 U.S.C.A. § 1395dd(a) (emphasis added).  Thus, under the EMTALA, an appropriate 
medical screening examination is not judged by proficiency in diagnosis, but rather by 
whether  it  was  performed  equitably  in  comparison  to  other  patients  with  similar 
symptoms.  See Marshall, 134 F.3d at 322.  The statute does not specifically define 
“appropriate medical screening examination.”  Id. at 323.  An appropriate examination is 
one that the hospital would have provided “to any other patient in a similar condition with 
similar symptoms.” Id. The plaintiff has the burden of demonstrating that the hospital 
failed to provide an appropriate examination under the EMTALA.  See id. at 323–24.  
The plaintiff may carry this burden by showing that either: (1) the hospital failed to follow 
its  own  standard  screening  procedures;  (2)  there  were  “differences  between  the 
screening examination that the patient received and examinations that other patients 

4 Jackson has not alleged failure to stabilize a known emergency medical condition or 
any restriction on the transfer of C.J. to another medical facility.      
with similar symptoms received at the same hospital”; or (3) the hospital offered “such a 
cursory screening that it amounted to no screening at all.” Guzman v. Mem’l Hermann 
Hosp. Sys., 409 Fed.Appx. 769, 773 (5th Cir. 2011).  Jackson submits that he has met 
his burden under two of the aforementioned options, that is, NCMC failed to follow its 
own EMTALA policy and C.J.’s screening was cursory.                       
“Negligence in the screening process or providing a faulty screening or making a 
misdiagnosis, as opposed to refusing to screen or providing disparate screening, does 

not violate EMTALA, although it may violate state malpractice law.”  Guzman v. Mem’l 
Hermann Hosp. Sys., 637 F. Supp. 2d 464, 482 (S.D. Tex. 2009), aff’d, 409 F. App’x 769 
(5th Cir. 2011).  Additionally, while a hospital violates Section 1395dd(a) when it does 
not follow its own standard procedures, “this . . . does not mean that any slight deviation 
by a hospital from its standard screening policy violates EMTALA.”  Repp v. Anadarko 
Mun. Hosp., 43 F.3d 519, 522–23 (10th Cir. 1994).  “Mere de minimus variations from 
the hospital’s standard procedures do not amount to a violation of hospital policy.”  Id.  
The  statute  was not meant  to  “impose  liabilities  on hospitals  for  purely  formalistic 
deviations when the policy had been effectively followed.”  Id.           

The Court will now consider Jackson’s contentions that the medical screening in 
this case did not include C.J.’s medical or social history, was cursory, and/or was not 
tailored to C.J.’s chief presenting complaint(s).  The starting point is NCMC’s EMTALA 
Medical Screening Exam and Stabilization Policy (MSE), which provides:    
Scope: The Medical Screening Examination will be performed [by] the  
Emergency Department Physician and tailored to the presenting complaint 
and the medical history of any individual who comes to the Emergency 
Department seeking care. The MSE examination and/or treatment will not 
be delayed in order to inquire about the individual’s insurance or payment 
status. All MSE’s will include the following, but are not limited to: 

     1. Chief complaint and pertinent history                        
     2. Past medical and social history                              
     3. Physical examination                                         
     4. Assessment                                                   
     5. Laboratory and imaging studies if appliable                  

Exhibit D at 7.5  NCMC’s policies and procedures further state that “a medical screening 
will be performed on all patients that present to the emergency department for care and 
treatment by the physician on duty.”  Id. at 4.                           
C.J.’s Past Medical and Social History                                    
Jackson asserts neither Nurse Attaway nor Dr. Chandler asked about C.J.’s past 
medical history or social history.  More specifically, Jackson points to the complete lack 
of questions relating to C.J.’s family medical history.  Jackson contends that if questions 
had  been  asked  about  C.J.’s  family  medical  history,  then  Nurse  Attaway  and  Dr. 
Chandler would have learned that C.J.’s mother died in 2017 from complications of 
diabetes, indicating a family history of diabetes.                        
As set forth above, past medical and social history is a requirement of NCMC’s 
MSE policy.  Conversely, the Court notes there is no reference to family history in the 
NCMC’s MSE policy.  Nurse Attaway testified at trial that there is a difference between 
a family history and a social history.  Dr. Chandler admitted he did not he did take a 
family history, but testified he did get C.J.’s medical and social history.   
The parties have submitted expert depositions in support of their positions.  Dr. 
Juliette Saussy (“Dr. Saussy”) gave deposition testimony on behalf of Jackson, and Dr. 
Jacquelyn White (“Dr. White”) gave expert testimony on behalf of NCMC.6  Both experts 

5 NCMC’s EMTALA Medical Screening Exam and Stabilization Policy will be shortened 
to NCMC’s “MSE policy.”                                                   
6 Dr. Saussy is a board certified emergency medicine physician with privileges at Baton 
Rouge General in Baton Rouge, Louisiana and Covington Trace ER & Hospital in 
Mandeville, Louisiana.  By stipulation, she was tendered as an expert in emergency 
medicine.  Dr. White is also a board certified emergency medicine physician.  She is the 
testified that C.J.’s medical records indicate at least some social history was taken.  The 
medical records reflect inquiries from Nurse Attaway and/or Dr. Chandler and responses 
indicating no domestic concerns; no signs or symptoms of abuse or neglect; that C.J. 
had no history of tobacco use (cigarettes), use of electronic cigarettes, or vaping; there 
was no need to call an interpreter; no ED homicide ideations; and C.J. was not feeling 
down, depressed, irritable, or hopeless.  See Exhibit A at JACKSON012-JACKSON013.  
Dr. Saussy testified there was no adequate social history, and she believed Dr. Chandler 

simply  reviewed  the  triage  notes  and  did  not  ask  or  explore  C.J.’s  social  history.  
Conversely, Dr. White testified that there was an appropriate social history taken, which 
was tailored to the pediatric patient.                                    
As to medical history,  Dr. Chandler explained that he got a medical history, noting 
his  ED  Note discussing  “history  of  present  illness”  and  “additional  history.”  Id.  at 
JACKSON006.  Dr. Chandler further testified that Jackson had reported C.J. having 
shortness of breath, which Dr. Chandler considered to be part of C.J.’s medical history 
because C.J. did not make such a report to Dr. Chandler.  The medical records also 
reflect the date of C.J.’s last tetanus shot, that his immunizations were current, and he 

had no known allergies.  See id. at JACKSON006, JACKSON012.  Dr. Chandler’s entries 
indicate no active or resolved past medical history and no active surgical procedure 
history.  See id. at JACKSON006.                                          
Dr. Saussy opined that there was no adequate past medical history documented 
in the medical records.  Other than entries reflecting no known allergies/medications, 
and the MR notation, she saw no past medical history in the medical records.  She 


Medical Director of Health Hut and does contract work with LaSalle Corrections.  Without 
objection, she was tendered as an expert in emergency medicine.           
believes Dr. Chandler neither asked nor explored C.J.’s medical history.  Conversely, Dr. 
White testified she believed there was an appropriate medical history tailored to the 
pediatric patient.  She stated that date of last tetanus shot, immunizations being current, 
and no known allergies are all considered to be part of C.J.’s medical history.  The past 
medical history was documented in the medical chart, and Dr. White explained Dr. 
Chandler is ultimately responsible for the nursing documentation in the chart as well.  
According to Dr. White, other than medications and allergies, there was simply no real 

past medical history for C.J.                                             
After considering all of the evidence, this Court finds that the medical screening 
examination of C.J. included an appropriate past medical and social history.  The medical 
records reflect that Nurse Attaway obtained medical and social history.  Moreover, in 
addition to what he had learned from the triage nurse, Dr. Chandler talked to both C.J. 
and Jackson.  His ED Notes demonstrate information about C.J.’s medical and social 
history.  The testimony of both experts likewise supports the conclusion that some level 
of a past medical and social history was taken.  NCMC’s MSE policy required past 
medical and social history.  See Exhibit D at 7.  It did not specifically reference family 

history.  See id.  Nurse Attaway testified that there was a difference between a family 
history and a social history.  Jackson has not provided any evidence that a family history 
was required under NCMC’s MSE policy.  Moreover, even if this Court were to hold that 
the failure to ask about C.J.’s mother was a deviation from NCMC’s MSE policy or was 
negligence, it would be insufficient to prove a violation of the EMTALA.  While the 
circumstances surrounding the past family history and C.J.’s death in this case are tragic, 
the Court does not believe that any deviation in relation to past medical or social history 
was a material deviation.  De minimus variations from a hospital’s standard procedures 
or negligence in the screening process do not, by themselves, constitute an EMTALA 
violation.  See Guzman, 637 F. Supp. 2d at 481; Repp, 43 F.3d at 523.     
Medical Screening – Was it Cursory?  Was it Tailored to C.J.’s Chief Presenting 
Complaint(s)?                                                             

Additionally, Jackson contends that C.J.’s medical screening was cursory and not 
tailored to C.J.’s chief presenting complaints of nausea and vomiting.  While the past 
medical and social history provision was discussed above, NCMC’s MSE policy further 
states that the medical screening exam will include the chief complaint and pertinent 
history,  physical  examination,  assessment,  and  laboratory  and  imaging  studies  if 
applicable.  See Exhibit D at 7.                                          
As stated supra, one of the ways Jackson may carry his burden of showing that 
NCMC failed to provide an appropriate medical screening is that the hospital offered 
“such a cursory screening that it amounted to no screening at all.”  Guzman, 409 
Fed.Appx. at 773.  Jackson has offered no proof that NCMC, Nurse Attaway, or Dr. 
Chandler treated C.J. differently from any other pediatric patients.  Nurse Attaway 
performed an ED triage pediatrics assessment, which included taking C.J.’s vital signs.  
She assigned C.J. a tracking acuity of 5.7  Dr. Chandler testified that the medical 
screening in this case was “pretty involved” for the ER.  He explained that C.J.’s 
screening was more in depth than a patient who presented only with a rash.  C.J. was in 
the ER for almost three hours.  Dr. Chandler physically examined C.J., including listening 
to C.J.’s breathing and heart rate/rhythm with a stethoscope.  Dr. Chandler also ordered 
a  chest  X-ray  and  an  EKG,  which  required  transport  to  an  X-ray  room  and  the 


7 Again, a tracking acuity of 5 means C.J.’s vital signs and other presentations indicated 
he was not critical.  Dr. White testified that a DKA patient would have pretty severely 
abnormal vital signs.                                                     
involvement of respiratory and radiology technicians.  These facts simply do not support 
a finding that C.J.’s screening was so cursory that it amounted to no screening at all.   
Next, Jackson argues that C.J.’s medical screening was not tailored to the chief 
presenting  complaints  of  nausea  and  vomiting.    The  Emergency  Room  Patient 
Information form listed “dizziness, vomiting” as the reason for C.J. visit to the ER.  See 
Exhibit A at JACKSON005.  Jackson also told Nurse Attaway in triage that C.J. was 
nauseous, weak, and could not hold anything down.  The triage note provided:  “Chief 

Complaint pt reports that he has been vomiting x3-4 days and has vomited 5-6x today.”  
Id. at JACKSON006.  In Dr. Chandler’s ED Note, he stated that C.J. presented with a 
rash on the foreskin of his penis.  See id.  As additional history, Dr. Chandler entered the 
following:                                                                
Pt is a 13 year old AA male with MR who presents to ED and initially reports 
that he was nauseated, but on further questioning his main reason for 
presenting is a rash on his penis.  He states that his appetite is normal and 
denied any N/V to me.                                                

Id.  Dr. Chandler further averred that Jackson related C.J. had been short of breath, but 
C.J. did not report this to him.  See id.  During his testimony, Dr. Chandler acknowledged 
that there was some confusion regarding the primary reason for C.J.’s ER visit – nausea, 
vomiting, and/or the rash.  Yet, the record contains testimony from both Dr. Chandler and 
Dr. White – two witness this Court finds to be credible – that it is possible for patients to 
have more than one chief complaint.  In fact, it was Dr. White’s opinion that C.J.’s chief 
complaint to the triage nurse was the nausea and vomiting and his chief complaint to Dr. 
Chander was the rash.                                                     
Dr. White testified that in her opinion, the medical screening examination in this 
case did not violate the EMTALA.  Her testimony was based – among other things – on 
her review of the medical records.  She noted that Nurse Attaway asked C.J. questions 
in triage that were tailored to his age (pediatrics) and the chief complaint of vomiting.  Dr. 
Saussy stated that she believed Dr. Chandler focused only on the rash and discounted 
the triage note regarding nausea and vomiting and the reports of shortness of breath.  
Yet,  Dr.  Chandler  specifically  referenced  the  nausea  and  vomiting  in  his additional 
history.8  Thus, while Dr. White does not dispute that Dr. Chandler focused more on the 
rash, she testified that this was likely because his examination was tailored more to the 
chief complaint given to him by C.J., not the triage note(s).  Additionally, the medical 

records  demonstrate  that  Dr.  Chandler  also  focused  on  the  complaints  regarding 
shortness of breath, as the EKG and chest X-ray performed in this matter were tailored 
to that complaint.9  Likewise, the social history screening questions regarding the use of 
tobacco, electronic cigarettes, and/or vaping were also tailored to a pediatric patient with 
shortness of breath.                                                      
In sum, this Court finds that the facts of this case fall short of establishing a 
violation of the EMTALA.  The statute is not a federal malpractice statute.  See Marshall, 
134 F.3d at 322.  An appropriate medical screening examination is not judged by 
proficiency  in  diagnosis  or  a  physician’s  misdiagnosis.    Even  if  those  facts  could 

constitute  negligence  or  medical  malpractice,  a  lack  of  proficiency  and  a  missed 
diagnosis do not necessarily create an EMTALA claim.  See id.; see also Guzman, 637 

8 Dr. Chandler’s notes reflect “no abdominal pain, no nausea, no vomiting.”  Exhibit A at 
JACKSON006.  Dr. White explained this meant C.J. was currently not having any 
abdominal pain, nausea, or vomiting.  C.J. had reported the vomiting in triage, but not to 
Dr. Chandler.                                                             
9  Dr.  Chandler testified  that  if  he had  suspected  diabetes,  he would  have  ordered 
bloodwork/lab work.  Likewise, Dr. White stated in all likelihood if Dr. Chandler had 
suspected DKA, he would have checked C.J.’s blood sugar by doing an Accu-Chek 
pinprick on his finger.  She noted that such a test is much easier to do and takes less 
resources than either an EKG or an X-ray.                                 
F. Supp. 2d at 482.  Dr. Chandler’s actions may have risen to level of state medical 
malpractice, but they did not violate the EMTALA.  With the benefit of hindsight, it is 
apparent that all NCMC medical professionals involved in this case would have liked 
another chance and a different outcome with respect to C.J.’s ER visit.  Dr. Chandler 
testified that he wished he had done more of a screening and expressed that he actually 
settled a medical malpractice complaint related to the facts of this case, partially because 
he did not like the outcome.  Dr. Saussy was also critical of the medical screening in this 

matter because there was what she called a material deterioration of the patient after 
discharge.  She expressed that she believed there should have been more questions 
asked; a full workup to evaluate for dehydration; and bloodwork to consider an underlying 
infection and kidney function.  She added that she would have performed a urinalysis 
and taken the glucose level of a 13 year-old boy with a significant candidal (yeast) rash.  
She believes there should have been a much wider differential than just a rash on C.J.’s 
penis.  But her treatment deficiencies and Jackson’s arguments are a critique of Dr. 
Chandler’s missed diagnosis of diabetes.  There may well have been negligence in the 
screening process and there was certainly a missed diagnosis, but there was not a 

refusal to screen, a cursory screening, or any evidence of a disparate screening.  There 
may have been a violation of state malpractice law, but there was no violation of the 
EMTALA.  See Guzman, 637 F. Supp. 2d at 482.                              
                     CONCLUSION                                      
Based on the factual findings and legal conclusions set forth above, the Court 
holds that Nurse Attaway and Dr. Chandler performed an appropriate medical screening 
of C.J. under the EMTALA.  There was sufficient medical and social history taken, the 
medical screening examination was not cursory, and the medical screening examination 
was tailored to C.J.’s chief presenting complaints.  While the missed diabetes diagnosis 
is tragic, there was no violation of the EMTALA.  Judgment in favor of NCMC is hereby 
rendered. 
 THUS  DONE AND SIGNED in  Shreveport,  Louisiana on this 23rd  day of July, 
2025. 

                                       United States District Judge 

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