Hanks v. Ascension St. Vincent's Hospital

UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF ALABAMA

SOUTHERN DIVISION

GEORGETTE HANKS, as the Sole }

Heir of ROSA PARKER HANKS, }

deceased, }

}

Plaintiff, } Case No.: 2:24-cv-821-MHH

}

v. }

}

ASCENSION ST. VINCENT’S }

HOSPITAL, et al., }

}

Defendants. }

MEMORANDUM OPINION AND ORDER

On June 21, 2024, Georgette Hanks filed this action against Ascension St.

Vincent’s Hospital and Noland Hospital Birmingham Downtown in federal court.

Ms. Hanks asserts claims under federal and state law. (Doc. 1). Ms. Hanks filed

with her complaint a motion for leave to proceed in forma pauperis. (Doc. 2). The

magistrate judge to whom this case initially was assigned denied Ms. Hanks’s

motion to proceed in forma pauperis because Ms. Hanks did not demonstrate that

she was indigent. (Doc. 4). Ms. Hanks paid the filing fee and filed two amended

complaints. (Docs. 5, 6).1

1 Because the magistrate judge did not receive consent from all parties to issue dispositive

decisions in this case, the Clerk of Court randomly reassigned the case to the undersigned. (Docs.

13, 14).

In her amended complaints, Ms. Hanks added as defendants several

physicians and a hospital administrator. (Doc. 5, pp. 2–3; Doc. 6, pp. 2–3). Noland

Hospital and Dr. Leland Allen have filed motions to dismiss this case under Rules

12(b)(1), 12(b)(3), 12(b)(4), and 12(b)(6) of the Federal Rules of Civil Procedure.

(Doc. 12, pp. 1, 15–16; Doc. 18, pp. 1, 10–12).2 This opinion resolves these motions.

Because the Court may resolve the motions under Rule 12(b)(6), the Court will not

evaluate the arguments the defendants make under other subsections of Rule 12.

I

Rule 12(b)(6) enables a defendant to move to dismiss a complaint for “failure

to state a claim upon which relief can be granted.” FED. R. CIV. P. 12(b)(6). A Rule

12(b)(6) motion to dismiss tests the sufficiency of a complaint against the “liberal

pleading standards set forth by Rule 8(a)(2).” Erickson v. Pardus, 551 U.S. 89, 94

(2007). Pursuant to Rule 8(a)(2), a complaint must contain “a short and plain

statement of the claim showing that the pleader is entitled to relief.” FED. R. CIV. P.

8(a)(2). A Rule 8(a)(2) statement of a claim “need only ‘give the defendant fair

notice of what the . . . claim is and the grounds upon which it rests.’” Erickson, 551

U.S. at 93 (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2009)).

2 On August 23, 2024, the Clerk of Court issued a summons for all defendants. (Doc. 7). The

Court has not received an executed summons for Dr. Brockington or for Mr. Russell, and these

defendants have not otherwise appeared in this action. (See Doc. 10); see FED. R. CIV. P. 4(l)–(m).

This is particularly true with respect to pro se complaints. Courts must

construe pro se documents liberally. Erickson, 551 U.S. at 94. A district court must

hold a pro se complaint “to less stringent standards than formal pleadings drafted by

lawyers.’” Erickson, 551 U.S. at 94 (quoting Estelle v. Gamble, 429 U.S. 97, 106

(1976)). Still, a district court “may not serve as de facto counsel for a party, or …

rewrite an otherwise deficient pleading in order to sustain an action.” Ausar-El ex.

rel. Small, Jr. v. BAC (Bank of America) Home Loans Servicing LP, 448 Fed. Appx.

1, 2 (11th Cir. 2011) (internal quotations and citations omitted). In addition to her

complaint, Ms. Hanks has described her factual allegations in her responses to the

defendants’ motions to dismiss. Because Ms. Hanks is proceeding pro se, the Court

considers the factual allegations in all of her submissions.3

When evaluating a Rule 12(b)(6) motion to dismiss, a district court accepts as

true the allegations in the complaint and construes the allegations in the light most

3 Ms. Hanks’s responses to the defendants’ motions to dismiss contain details that do not appear

in her original or amended complaints. (Compare Docs. 1, 5, 6 with Docs. 23, 24, 26, 27, 28).

Given Ms. Hanks’s status as a pro se litigant, the Court treats Ms. Hanks’s responses to the

defendants’ motions as motions to amend her complaint. See Newsome v. Chatham Cnty. Det.

Ctr., 256 Fed. Appx. 342, 344 (11th Cir. 2007) (construing a pro se plaintiff’s response to a

magistrate judge’s report and recommendation as a motion to amend the complaint where the pro

se plaintiff alleged new facts in the response). Consistent with Rule 15 of the Federal Rules of

Civil Procedure, the Court permits the amendment. Rule 15 authorizes a district court to freely

grant a plaintiff leave to amend her complaint when justice so requires. FED. R. CIV. P. 15(a)(2).

The decision to grant a party leave to amend is within the sound discretion of the court. Abramson

v. Gonzalez, 949 F.2d 1567, 1582 (11th Cir. 1992). The amendment will not cause delay, and the

defendants will not be prejudiced by this amendment because the Court could order Ms. Hanks to

amend her complaint again to include in the complaint the factual details she provides in her

opposition to the defendants’ motions to dismiss. See FED. R. CIV. P. 15(a).

favorable to the plaintiff. See Brophy v. Jiangbo Pharms. Inc., 781 F.3d 1296, 1301

(11th Cir. 2015). Therefore, in deciding the defendants’ motions to dismiss, the

Court views Ms. Hanks’s factual allegations in her complaints in the light most

favorable to her.

II

Ms. Hanks’s claims concern treatment her mother, Rosa Hanks, received

before Rosa passed away.4 Accepting Ms. Hanks’s allegations as true for purposes

of this opinion, St. Vincent’s Hospital admitted Ms. Hanks’s mother on December

13, 2021. (Doc. 26, p. 5). While there, Rosa Hanks was diagnosed with

pseudomonas and klebsiella in December 2021 and January 2022. (Doc. 1, p. 6;

Doc. 26, pp. 3–4). The hospital’s infectious disease specialist, Dr. Allen, knew that

Ms. Hanks’s mother had contracted infections and that Ms. Hanks’s mother was

exhibiting symptoms that indicated the presence of those infections in June 2022.

(Doc. 26, pp. 3–4). Ms. Hanks asked Dr. Allen whether her mother needed further

treatment for her infections, and Dr. Allen said no. (Doc. 26, p. 3). St. Vincent’s

discharged Rosa Hanks on June 23, 2022. (Doc. 26, p. 5). Ms. Hanks asserts that

Dr. Allen provided inaccurate information to her mother’s primary care physician,

and the misinformation led to her mother’s death. (Doc. 26, pp. 2–4). Ms. Hanks

4 The Court expresses its condolences to Ms. Hanks for her loss.

also alleges that her mother had five infections and a clogged feeding tube when St.

Vincent’s discharged her mother. (Doc. 1, pp. 4-5; Doc. 3, pp. 11-13; Doc. 6, pp. 4-

6).

Brookwood Hospital admitted Ms. Hanks’s mother on June 25, 2022, and

diagnosed her with five infections. (Doc. 26, p. 6). Ms. Hanks’s mother died in

Brookwood Hospital on August 9, 2022. (Doc. 26, p. 6). Rosa Hanks’s death

certificate identifies colitis as a cause of death. (See Doc. 26, pp. 3–4). Ms. Hanks

contends that her mother’s colon was inflamed because of infections that St.

Vincent’s Hospital did not stabilize before the hospital discharged her mother. (Doc.

3, pp. 15-16; Doc. 26, p. 4).

Ms. Hanks filed this action on June 21, 2024, on behalf of Rosa Hank’s estate.

(Doc. 1). For the estate, Ms. Hanks asserts claims against the defendants under the

Emergency Medical Treatment and Labor Act, 42 U.S.C. § 1395dd; the Age

Discrimination Act, 42 U.S.C. § 6101; and state laws. (Doc. 5, pp. 12–16; Doc. 6,

pp. 5–9).5

III

As a threshold issue, the defendants argue that Ms. Hanks cannot represent

the estate of Rosa Hanks because a pro se litigant may not file a lawsuit on behalf of

5 The Court understands Ms. Hanks’s “Age Discrimination” claim to arise under 42 U.S.C. § 6101;

see Molina v. Aurora Loan Servs., LLC, 710 Fed. Appx. 837, 840–41 (11th Cir. 2017).

another party. (Doc. 12, pp. 11–13; Doc. 18, pp. 13–14). There is a narrow

exception to that general rule; the sole heir of an estate with no creditors may

represent the estate. Iriele v. Griffin, 65 F.4th 1280, 1284–85 (11th Cir. 2023).

In her amended complaint, Ms. Hanks states that she is the “sole heir of the

Estate of Rosa Hanks.” (Doc. 6, p. 1; see also Doc. 26, p. 5). She has provided

letters of administration naming her as the personal representative of Rosa Hanks’s

estate. (Doc. 5, p. 17).6 Though Ms. Hanks has properly alleged that she is the sole

heir of her mother’s estate, Ms. Hanks has not indicated whether the estate has

outstanding creditors. Therefore, Ms. Hanks has not established that she may

proceed in this case pro se.

IV.

Even if Ms. Hanks may proceed pro se in this case, Ms. Hanks has not asserted

a viable claim under federal law. Ms. Hanks’s attempt to assert a claim for the estate

under EMTALA misunderstands the scope of EMTALA, the Emergency Medical

Treatment and Active Labor Act, 42 U.S.C. § 1395dd. As the Eleventh Circuit Court

of Appeals has explained, “EMTALA was not intended to establish guidelines for

patient care, to replace available state remedies, or to provide a federal remedy for

6 The Court may consider the letters of administration without converting the defendants’ motions

to dismiss into motions for summary judgment because the Court may take judicial notice of these

legal documents. FED. R. EVID. 201; U.S. ex rel. Osheroff v. Humana, Inc., 776 F.3d 805, 811 n.4

(11th Cir. 2015) (first citing FED. R. EVID. 201; then citing Lozman v. City of Riviera Beach, 713

F.3d 1066, 1075 n.9 (11th Cir. 2013)).

medical negligence.” Harry v. Marchant, 291 F.3d 767, 773 (11th Cir. 2002) (en

banc). Instead, EMTALA “was intended to prevent ‘patient dumping,’ the practice

of some hospital emergency rooms turning away or transferring indigents to public

hospitals without prior assessment or stabilization treatment.” Marchant, 291 F.3d

at 772. EMTALA establishes “minimal standards for screening and transferring

patients, but not for patient care outside these two narrowly defined contexts.”

Marchant, 291 F.3d at 774. EMTALA provides for “a private cause of action against

hospitals, but not individual physicians.” Lane v. Calhoun-Liberty Cnty. Hosp.

Ass’n, Inc., 846 F. Supp. 1543, 1548 (N.D. Fla. 1994); see also Ashton v. Florala

Memorial Hosp., Case No. 06-cv-226-ID, 2006 WL 2864413, at * 12 (M.D. Ala.

Oct. 5, 2006).

Accordingly, Ms. Hanks may not assert an EMTALA claim against Dr. Allen,

Dr. Brockington, Dr. Rahim, Dr. Smith, or Mr. Russell. With respect to St. Vincent’s

and Noland, Ms. Hanks must properly allege that one or both hospitals violated the

statute’s screening or stabilization requirement.

The screening provision requires hospitals with an emergency room to

provide “an appropriate medical screening examination” to determine whether an

indigent patient has “an emergency medical condition.” 42 U.S.C. § 1395dd(a).

Under the stabilization provision, if “the hospital determines that the individual has

an emergency medical condition,” then EMTALA requires the hospital to stabilize

an indigent patient if the patient will be transferred. Marchant, 291 F.3d at 771

(“Reading the statute in its specifically defined context, it is evident EMTALA

mandates stabilization of an individual only in the event of a ‘transfer’ as defined in

the statute.”); see also 42 U.S.C. § 1395dd(b).

To plead a plausible EMTALA failure-to-screen claim, a plaintiff must allege

that the hospital had an emergency department, the patient came to the emergency

department and requested examination or treatment, and the emergency department

failed to provide an appropriate medical screening. 42 U.S.C. § 1395dd(a).

EMTALA “does not define ‘appropriate medical screening,’” but a hospital satisfies

its statutory obligation by providing to an indigent patient a medical screening that

is “similar to one which [the hospital] would provide any other [paying] patient.”

Holcomb v. Monahan, 30 F.3d 116, 117 (11th Cir. 1994) (brackets added).

Ms. Hanks does not allege that Noland had an emergency department or that

Rosa Hanks sought an examination or treatment in an emergency department at

Noland Hospital. To the contrary, Ms. Hanks alleges that Noland Hospital is an

acute care facility. (Doc. 3, p. 12).7 Ms. Hanks has also not alleged that Rosa Hanks

7 Noland is a “long-term acute care hospital.” See NOLAND HOSPITALS,

https://nolandhospitals.com/ [https://perma.cc/P7V2-NMFR] (last visited Sept. 12, 2025).

Alabama does not require a “Long Term [Acute] Care Hospital” like Noland to have an emergency

department. ALA. ADMIN. CODE r. 420-5-7-.03(2)(c)(14). Noland is “housed in the same facility

as St. Vincent’s Hospital,” which has its own emergency department. (Doc. 6, p. 5; see also 23-

1, p. 7). If Noland does not have its own emergency department, then it is not subject to

EMTALA’s screening requirement.

was indigent or that, because she was indigent, Noland failed to provide the medical

screening that Noland would have provided to a paying patient. See Holcomb, 30

F.3d at 117. Therefore, Ms. Hanks has not stated an EMTALA claim as to Noland

Hospital. As to St. Vincent’s, Ms. Hanks alleges, among other things, that St.

Vincent’s failed to treat her mother’s medical condition and did not provide physical

therapy to her mother during her mother’s six-month stay at the hospital. (Doc. 23-

1, p. 8). These allegations cannot support a failure-to-screen claim because Ms.

Hanks has not alleged that Rosa Hanks was indigent or that St. Vincent’s failed to

provide appropriate medical screening because of her indigency. See Holcomb, 30

F.3d at 117. Therefore, Ms. Hanks has not plausibly pleaded an EMTALA failure-

to-screen claim against Noland or St. Vincent’s.

To plead a plausible EMTALA failure-to-stabilize claim, a plaintiff must

allege “that the patient had an emergency medical condition, the hospital knew of

the condition, the patient was not stabilized before being transferred, and the hospital

neither obtained the patient’s consent to transfer nor completed a certificate

indicating the transfer would be beneficial to the patient and was appropriate.”

Holcomb, 30 F.3d at 117. Therefore, “the stabilization requirement only sets forth

standards for transferring a patient in either a stabilized or unstabilized condition.

By its own terms, the statute does not set forth guidelines for the care and treatment

of patients who are not transferred.” Marchant, 291 F.3d at 771 (italics in

Marchant). EMTALA defines “transfer” as “‘the movement (including the

discharge) of an individual outside of a hospital’s facilities.’” Marchant, 291 F.3d

at 768 n.1 (quoting 42 U.S.C. § 1395dd(e)(4)).

Ms. Hanks alleges that her mother had an emergency condition because of

serious infections. (Doc. 6, p. 5). Ms. Hanks also alleges that the infectious disease

specialist at St. Vincent’s Hospital knew that her mother had been diagnosed with

multiple infections and discharged her without stabilizing the infections. (Doc 26,

pp. 4–5). But EMTALA governs only emergency care. See 42 U.S.C. § 1395dd.

While the text of EMTALA does not “restrict the scope of the stabilization

requirement to a maximum number of minutes, hours or days after a person with an

emergency medical condition presents at a hospital,” Ms. Hanks alleges that her

mother was hospitalized for six months. The Ninth Circuit has held “that

EMTALA’s stabilization requirement ends when an individual is admitted for

inpatient care.” Bryant v. Adventist Health Sys./W., 289 F.3d 1162, 1168 (9th Cir.

2002). The Eleventh Circuit has affirmed the Southern District of Alabama’s

application of the Ninth Circuit’s rule. See Morgan v. N. Miss. Med. Ctr., Inc., 403

F. Supp. 2d 1115, 1128–30 (S.D. Ala. 2005), aff’d without opinion, 225 Fed. Appx.

828 (11th Cir. 2007).8

8 “If a patient demonstrates in a particular case that inpatient admission was a ruse to avoid

EMTALA’s requirements, then liability under EMTALA may attach.” Bryant, 289 F.3d at 1169;

see also Morgan, 403 F. Supp. 2d at 1129. The Southern District of Alabama noted that the text

St. Vincent’s admitted Rosa Hanks for inpatient care on December 13, 2021,

and discharged her six months later on June 23, 2022. (Doc. 26, pp. 5–6). Ms.

Hanks complains about the treatment that her mother received over that six-month

period, but she does not contend that St. Vincent’s admitted Rosa Hanks in bad faith.

Therefore, Ms. Hanks has not alleged a viable EMTALA failure-to-stabilize claim.

Similarly, Ms. Hanks has not alleged facts to support a claim under the Age

Discrimination Act of 1975, 42 U.S.C. § 6101. (Doc. 6, p. 7). The Court has not

located factual allegations concerning Rosa Hanks’s age or a lapse in treatment that

Ms. Hanks’s attributes to her mother’s age. Even if Ms. Hanks had alleged these

facts, she has not alleged that she has exhausted her administrative remedies before

bringing her age discrimination claim, and she has not provided EEOC

documentation to establish that she exhausted administrative remedies before filing

this suit. See 42 U.S.C. § 6104(f); 34 C.F.R. § 110.39(a).9 Therefore, Ms. Hanks’s

ADA claim appears to be premature.

of EMTALA’s implementing regulations supports Ninth Circuit’s rule; the regulations provide

that after a hospital screens a patient, identifies her emergency medical condition, and “admits that

individual as an inpatient in good faith in order to stabilize the emergency medical condition, the

hospital has satisfied” EMTALA’s requirements. Morgan, 403 F. Supp. 2d at 1129 n.14 (quoting

42 C.F.R. § 489.24(d)(2)(i)) (italics in Morgan).

9 Administrative exhaustion typically is a requirement for discrimination lawsuits under federal

law. See, e.g., Wilkerson v. Grinnell Corp., 270 F.3d 1314, 1317 (11th Cir. 2001) (discussing the

requirement of administrative exhaustion under Title VII); Brown v. Gen. Servs. Admin., 425 U.S.

820, 828–29, 832 (1976) (describing the requirement of administrative exhaustion as a

“precondition[]” of a plaintiff’s right to bring suit in federal court under Title VII); Patton v.

Anniston Army Depot, No. 20-cv-00441, 2020 WL 6273738, at *2–3 (N.D. Ala. Oct. 26, 2020)

(discussing the requirement that the plaintiff exhaust her administrative remedies before she sues

Because Ms. Hanks has not asserted a viable claim against the defendants

under federal law, the Court declines to exercise jurisdiction over Ms. Hanks’s state-

law claims. When a federal district court has original jurisdiction over an action

because the action includes a viable claim under federal law, the district court may

exercise supplemental jurisdiction over the plaintiff’s state-law claims, 28 U.S.C. §

1367(a), but a district court does not have to exercise supplemental jurisdiction, 28

U.S.C. § 1367(c); Palmer v. Hosp. Auth. of Randolph Cnty., 22 F.3d 1559, 1566

(11th Cir. 1994). A district court may decline to exercise supplemental jurisdiction

over state-law claims if the court “has dismissed all claims over which it has

jurisdiction.” 28 U.S.C. § 1367(c)(3); see Palmer, 22 F.3d at 1569 (“Under the

language of section 1367, whenever a federal court has supplemental jurisdiction

under Title VII or the ADEA, and concluding that she did not do so); cf. Brune v. Wal-Mart Stores

E. LP, No. 17-cv-00845, 2017 WL 4621790, at *2–3 (N.D. Ala. Oct. 16, 2017) (holding that a

Title VII plaintiff successfully exhausted her administrative remedies by filing a charge of

discrimination with the EEOC, but that she was entitled to sue only on the grounds of the types of

discrimination that she specifically alleged in her EEOC charge).

The Eleventh Circuit has not addressed the question whether exhaustion is a jurisdictional

requirement under the ADA. See McGhee v. Ala. Stat Univ., Case No. 2:09-cv-0092-MEF, 2009

WL 1684604, at *2 & n.1 (M.D. Ala. June 12, 2009) (first citing Williams v. Trevecca Nazarene

College, 162 F.3d 1162 (6th Cir. 1998) (unpublished); then citing Simmons v. Middle Tenn. State

Univ., 117 F.3d 1421 (6th Cir. 1997) (unpublished)) (“In the two unpublished opinions cited in the

body, the Sixth Circuit concluded that exhaustion is a jurisdictional requirement under the Age

Discrimination Act. The Fifth Circuit did not reach the issue. The Eleventh Circuit has not

addressed the question.”); see also Ali v. Univ. of Louisville, Case No. 3:17-cv-00638-RGJ, 2019

WL 539098, at *7 (W.D. Ky. Feb. 11, 2019) (“In order for the district court to have jurisdiction

under the ADA, plaintiffs must exhaust their administrative remedies.” (quoting Simmons, 117

F.3d at 1421)).

under section 1367(a), that jurisdiction should be exercised unless section 1367(b)

or (c) applies.”).

Here, the Court is dismissing the claims over which it has original jurisdiction,

Ms. Hanks’s EMTALA claim and her Age Discrimination Act claim. Because this

case is in its initial pleadings phase, the Court declines to exercise jurisdiction over

Ms. Hanks’s state law claims in the interests of judicial economy and convenience.

Palmer, 22 F.3d at 1569. Alabama’s state circuit courts are well-versed in the law

that governs Ms. Hanks state-law claims, and those claims may be tried together in

state court. Therefore, this Court will not exercise jurisdiction over Ms. Hanks’s

state-law claims.

Accordingly, the Court dismisses Ms. Hanks’s federal claims for failure to

state a claim and declines to exercise supplemental jurisdiction over Ms. Hanks’s

state-law claims.10 The Court dismisses this action without prejudice.

The Clerk of Court shall please mail to Ms. Hanks via certified mail a copy of

this order and close this case. The parties shall review 28 U.S.C. §1367(d) for

10 To the extent that Ms. Hanks alleged claims against “Dr. John Doe,” fictitious party pleading

generally is not allowed in federal court. FED. R. CIV. P. 10(a) (“The title of the complaint must

name all the parties.”); see also Estate of West v. Smith, 9 F.4th 1361, 1368 n.6 (11th Cir. 2021)

(“As a general matter, fictitious-party pleading is not permitted in federal court.”) (quoting

Richardson v. Johnson, 598 F.3d 734, 738 (11th Cir. 2010)). Ms. Hanks will have more latitude

to pursue claims against fictitious defendants in state court.

information concerning the period of limitations for claims that Ms. Hanks may

refile in state court pursuant to this order.

DONE and ORDERED this September 24, 2025.

MADELINE HUGHES HAIKALA

UNITED STATES DISTRICT JUDGE

14