St. John’s Health and the doctors and contractors being sued over the death of Ociel Ponce Perez have filed responses denying all allegations of negligence or wrongdoing and arguing that the case should’ve been a state malpractice suit — not a federal constitutional challenge.
The case stems from the death of Perez who sought treatment at the St. John’s Health ER on July 30, 2022. Five days later, he returned to the hospital in much worse condition, dying while being transferred to higher levels of care.
His widow sued the hospital, doctors and contractors in federal court earlier this summer over what she alleges are violations of the federal Emergency Medical Treatment and Labor Act, two clauses within the 14th Amendment and portions of the Wyoming Constitution.
Perez was an uninsured, undocumented immigrant, and his widow Silvia Ruth Sahino Cano argues that’s why he received what she describes as subpar medical assistance.
The defendants responded in four separate filings in recent weeks.
“It is one thing to take issue with the emergency medicine, radiology and general surgery physicians and their medical decision-making on July 30, 2022,” the hospital’s filing from earlier this month stated. “But to suggest this is a case of discrimination under the Fourteenth Amendment to the U.S. Constitution or rising to the level of a patient-dumping claim under EMTALA is not only offensive but disregards the nature and degree of care and treatment provided to Mr. Perez by St. John’s Health and its providers.”
What happened
Perez was 47 when he walked into a Jackson urgent care clinic in 2022. A physician examined him, identifying suspected cellulitis or a perirectal abscess, and sent Perez to the ER at St. John’s Health.
Once there, Dr. Tobin Dennis re-examined the area, ran lab tests and ordered a CT scan, according to defendants’ filings. The scans were then interpreted by radiologist David Bigelow who consulted with general surgeon Eric Wieman. During all of this, Perez was given intravenous hydromorphone to ease the pain.
According to most filings, Bigelow suggested the problem may be a less serious perianal abscess. Then, Wieman diagnosed Perez with a more serious perirectal abscess, which he drained, rinsed and packed with gauze. Doctors then discharged Perez with directions to come back if things got worse and to take “Sitz” baths with warm water up to his hips. Perez left with prescriptions, including antibiotics and painkillers.
This course of treatment was dangerously inadequate, according to the plaintiff’s filing, which accused doctors of missing early signs of a life-threatening infection, failing to consider increased risks from pre-diabetes, releasing Perez without proper stabilization or clear follow-up instructions, and generally not doing enough to save Perez’s life.
Since no “disciplinary or ameliorative action” was taken by St. John’s, the plaintiffs also argue that the subpar treatment of uninsured, undocumented immigrants is part of the hospital’s customs, policies, practices and training.
In their rebuttals, the doctors, a contractor and St. John’s Health deny these allegations.
“[Perez] was provided thorough emergency medical care and treatment,” the hospital’s filing states. “At best, the Complaint states a claim for medical malpractice under state law by second-guessing the medical decision-making of several physicians.”
Five days after St. John’s released Perez, he returned to the urgent care clinic where a provider sent him back to the hospital emergency room. In the interluding days, his health had deteriorated. Doctors diagnosed progressed Fournier’s gangrene, hyponatremia, diabetic ketoacidosis and other major health issues.
He was flown to the Eastern Idaho Regional Medical Center for treatment before dying while waiting for a second transfer to an even higher level of care in Salt Lake City.
Legal argument
Dennis, Wieman and Bigelow — the health care providers named as defendants — argued in their separate filings that they can’t be sued over the Emergency Medical Treatment and Labor Act. The federal law was created to prevent hospitals from dumping or kicking out critical patients over an inability to pay. It can only be applied to hospitals and not individuals, the defendants argue, citing 10th Circuit Court opinions.
St. John’s argued in its filing that the hospital followed the law by stabilizing the patient before releasing him, pointing to the five days that passed before he returned.
“EMTALA does not require hospitals to provide comprehensive healthcare but rather necessary stabilizing treatment for an identified emergency condition,” the filing states. “In short, it requires an emergency department to complete a medical screening examination on a patient within the capabilities of the hospital and stabilization of a patient with an emergency medical condition prior to discharge or transfer.”
The hospital added that there are no requirements to cure or permanently stabilize patients, but to ensure they’re stable during transfer or discharge.
As for the Equal Protection and Due Process clauses of the 14th Amendment, all defendants argued that they don’t apply in this case. Defendants said there is no actual right to healthcare that the hospital infringed upon; that right only applies to those held by the state, like inmates.
Additionally, Perez’s status as an uninsured and undocumented immigrant isn’t in a “suspect” class in the U.S., they said, which may have given him more protections.
“The U.S. Supreme Court held that ‘undocumented aliens cannot be treated as a suspect class because their presence in this country in violation of federal law is not a constitutional irrelevancy,’” the filing states.
Finally, all defendant filings argued that the federal court — where this case was filed — wasn’t the appropriate venue to try the challenges to the Wyoming Constitution (including provisions related to equality, due process and the Wyoming Governmental Claims Act). That’s because, they argued, if the federal arguments are dropped, this should be a state issue. Or even if those arguments stand, defendants say this state constitutional challenge is novel and should be handled by Wyoming courts.
To read coverage of the initial suit and its claims, go here.
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