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Morales v. Palomar Health

United States District Court, S.D. California

August 12, 2014

YARET MORALES, as next friend of ESTELA LOREDO MORALES, the real party in interest, Plaintiff,


GONZALO P. CURIEL, District Judge.


Before the Court is defendant Rady Children's Hospital San Diego's ("RCHSD") Motion to Dismiss Plaintiff's First Amended Complaint, (ECF No. 24, "FAC"). (ECF No. 28, "Motion to Dismiss.") Plaintiff filed an opposition to the Motion to Dismiss, (ECF No. 40), and RCHSD filed a reply, (ECF No. 44). Based on a review of the briefs, supporting documentation, and the applicable law, the Court GRANTS IN PART AND DENIES IN PART RCHSD's Motion to Dismiss.


Plaintiff alleges she developed meningococcal bacteremia on or about February 16, 2013, after having contracted a meningococcal infection on or about February 15, 2013. (FAC ¶ 11.) Plaintiff alleges that, on February 17, 2013, she was examined by a nurse practitioner in the RCHSD emergency department. (FAC ¶ 29.) Plaintiff alleges that, during this visit, RCHSD staff learned Plaintiff had a temperature of 105°F in the previous three days; she had been febrile for three days; she had vomited five times that day; she was listless; Plaintiff's parents were sufficiently concerned about her condition that they had already taken her to health care providers twice in the previous 24 hours; and her respiratory rate was 44/minute. (Id.) Plaintiff alleges these symptoms, signs, and history were indicative of a potentially emergent medical condition, and a screening examination that would have demonstrated the presence or absence of an emergency medical condition would have included a physical examination by a physician; laboratory testing, including a complete blood count and serum chemistries; and a lumbar puncture. (FAC ¶ 30.) Plaintiff alleges RCHSD's emergency department had the capabilities to perform these procedures. (Id.) Plaintiff alleges RCHSD did not have her examined by a physician, perform laboratory testing, or perform a lumbar puncture at this visit. (FAC ¶ 31.)

Plaintiff alleges she had no medical insurance when she was seen on February 17, 2013. (FAC ¶ 33.) Plaintiff alleges RCHSD failed to provide her with a minimally adequate medical screening examination to determine whether she had an emergent medical condition based on her presenting signs, symptoms, and history in the same manner as the hospital provides other patients with the same or similar signs and symptoms who are insured. (Id.)

Plaintiff alleges that, on February 19, 2013, she was again admitted to RCHSD and was diagnosed with meningococcal bacteremia and meningitis. (FAC ¶ 14.) Plaintiff alleges that, prior to developing meningococcal bacteremia and meningitis, she was a normal one-year-old and was walking and speaking with an age-appropriate vocabulary. (Id.) Plaintiff alleges that, when she was discharged from RCHSD, she was deaf, not walking, and not speaking. (Id.)

Based on the foregoing, Plaintiff alleges two causes of action against RCHSD: (1) violation of the Emergency Medical Treatment and Active Labor Act ("EMTALA"), 42 U.S.C. § 1395dd(a); and (2) medical negligence. RCHSD now moves to dismiss both causes of action. Defendants Kelly Pretorius (erroneously sued as "Kelly Pretorious") and Children's Specialists of San Diego, A Medical Group, Inc. join RCHSD's Motion to Dismiss. (ECF No. 37.)


A motion to dismiss under Federal Rule of Civil Procedure 12(b)(6) tests the sufficiency of a complaint. Navarro v. Block , 250 F.3d 729, 732 (9th Cir. 2001). Dismissal is warranted under Rule12(b)(6) where the complaint lacks a cognizable legal theory. Robertson v. Dean Witter Reynolds, Inc. , 749 F.2d 530, 534 (9th Cir. 1984); see Neitzke v. Williams , 490 U.S. 319, 326 (1989) ("Rule12(b)(6) authorizes a court to dismiss a claim on the basis of a dispositive issue of law."). Alternatively, a complaint may be dismissed where it presents a cognizable legal theory yet fails to plead essential facts under that theory. Robertson , 749 F.2d at 534.

While a plaintiff need not give "detailed factual allegations, " a plaintiff must plead sufficient facts that, if true, "raise a right to relief above the speculative level." Bell Atlantic Corp. v. Twombly , 550 U.S. 544, 545 (2007). "To survive a motion to dismiss, a complaint must contain sufficient factual matter, accepted as true, to state a claim to relief that is plausible on its face.'" Ashcroft v. Iqbal , 556 U.S. 662, 678 (2009) (quoting Twombly , 550 U.S. at 547). A claim is facially plausible when the factual allegations permit "the court to draw the reasonable inference that the defendant is liable for the misconduct alleged." Id . In other words, "the non-conclusory factual content, ' and reasonable inferences from that content, must be plausibly suggestive of a claim entitling the plaintiff to relief." Moss v. U.S. Secret Service , 572 F.3d 962, 969 (9th Cir. 2009). "Determining whether a complaint states a plausible claim for relief will... be a context-specific task that requires the reviewing court to draw on its judicial experience and common sense." Iqbal , 556 U.S. at 679.

In reviewing a motion to dismiss under Rule 12(b)(6), the court must assume the truth of all factual allegations and must construe all inferences from them in the light most favorable to the nonmoving party. Thompson v. Davis , 295 F.3d 890, 895 (9th Cir. 2002); Cahill v. Liberty Mut. Ins. Co. , 80 F.3d 336, 337-38 (9th Cir. 1996). Legal conclusions, however, need not be taken as true merely because they are cast in the form of factual allegations. Ileto v. Glock, Inc. , 349 F.3d 1191, 1200 (9th Cir. 2003); W. Mining Council v. Watt , 643 F.2d 618, 624 (9th Cir. 1981).

Generally, on a motion to dismiss, courts limit review to the contents of the complaint and may only consider extrinsic evidence that is properly presented to the court as part of the complaint. See Lee v. City of L.A. , 250 F.3d 668, 688-89 (9th Cir. 2001) (court may consider documents physically attached to the complaint or documents necessarily relied on by the complaint if their authenticity is not contested). However, a court may take notice of undisputed "matters of public record" subject to judicial notice without converting a motion to dismiss into a motion for summary judgment. Id . (citing Fed.R.Evid. 201; MGIC Indem. Corp. v. Weisman , 803 F.2d 500, 504 (9th Cir. 1986)). Under Federal Rule of Evidence 201, a district court may take notice of facts not ...

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