Williams v. U.S.

Brief Fact Summary. Williams (P), adminstratrix for the decedent, sued the United States (Defendant) because they refused to provide emergency medical treatment to the decedent which resulted in his death.

Synopsis of Rule of Law. Neither a physician or a private hospital has a duty to provide medical services to every person requesting them.

Facts. The decedent, Berlie White, went to Cherokee Indian Hospital (CIH) suffering from respiratory distress.  CIH, the nearest hospital Mr. White could reach at the time, was an Indian hospital operated on the Cherokee Reservation by the United States Public Health Service.  CIH was operated under the federal Indian Health Care Improvement Act (IHCI Act), which prohibits treatment of non-Indians, except for discretionary treatment in emergency situations.  The federal employees at CIH refused to treat Mr. White and refused to refill his oxygen tank.  Mr. White was referred to another hospital ten miles away.  When he arrived at that hospital, Mr. White was in extreme distress and he died from complications of oxygen deprivation the following day.  Plaintiff, the adminstratrix of Mr. White’s estate, brought suit under various theories claiming the breach of a duty to provide emergency treatment on a non-discriminatory basis.  The district court dismissed and this appeal followed.

Issue. Does either a physician or a private hospital have a duty to provide medical services to every person requesting them?

Held. (Niemeyer, J.)  No.  Neither a physician or private hospital has a duty to provide medical services to every person requesting them.  Four theories are raised by Plaintiff in an effort to establish a duty on the part of health care providers to provide emergency services.  Plaintiff argues: (1) North Carolina General Statutes (NCGS) § 58-65-85 prohibits non-profit hospitals from discriminating on the basis of race, color and natural origin; (2) NCGS § 131A-8 requires all health care facilities that receive state funding be operated to serve and benefit the public in a non-discriminatory manner; (3) the Patients’ Bill of Rights, § 3C.4103, made known after NCGS § 131E-75 requiring that care be provided; and (4) the common-law duty for public utilities providing that once a public institution has held itself out as providing a service, it cannot arbitrarily refuse to provide that service to a member of the public.  The problem with Plaintiff’s theories is that none of the alleged “duties” created by statute authorize any mechanism for their enforcement, and the common-law public utility doctrine has no application toward health care providers in private settings.  At best, the IHCI Act provided for discretionary treatment, which the federal employees refused to provide.  While the circumstances of this case are morally repulsive, the scope of the law is much “narrower than the reach of moral command.”  The court affirms the district court’s dismissal.

Discussion. The casebook author uses this case as an illustration of there being no general duty to provide medical treatment, and no presence of a law to prevent discrimination in allocating treatment.  It should be noted that the procedural posture of this case hinged on the application of the Federal Torts Claim Act (FTCA) in association with the Emergency Medical Treatment and Active Labor Act (EMTALA).  The federal government has sovereign immunity from suit even when violating its own Acts unless, as provided in the FTCA. The liability would exist if the government were acting as a private person in accordance with the law on private parties in the locality where the alleged tort occurred.  Consequently, since Plaintiff was unable to establish any private duty to provide medical treatment in North Carolina, the United States (Defendant) was immune from being sued.  Even though, for the most part, there is no affirmative duty to provide health care, once a decision is made to offer services and a doctor-patient relationship is formed, then traditional medical malpractice negligence law is applicable.  Also, note that if this had been a private hospital receiving federal funds, then EMTALA would have required, at least, stabilization of Mr. White before he was transferred to another facility, and the private hospital would not have immunity from being sued.