The opinion
UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF OHIO
EASTERN DIVISION
WHITNIE JACKSON, ) CASE NO. 1:25-cv-01227
)
Plaintiff, ) JUDGE BRIDGET MEEHAN BRENNAN
)
v. )
)
CLEVELAND CLINIC FOUNDATION, ) MEMORANDUM OPINION
et al., ) AND ORDER
)
Defendants. )
Before the Court is Defendants’ Motion to Strike Plaintiff’s Amended Complaint or in
the Alternative, Motion to Dismiss Plaintiff’s Amended Complaint. (Doc. 40.) Plaintiff opposed
the motion (Doc. 45), and Defendants replied (Doc. 48). For the reasons stated herein, the
motion to strike is DENIED and the motion to dismiss is GRANTED in part.
I. BACKGROUND
A. Complaint Allegations1
Pro se Plaintiff Whitnie Jackson (“Jackson”) brings this action against Defendants
Cleveland Clinic Marymount Hospital (“Marymount”), Dr. Nathan Eikhoff (“Dr. Eikhoff”), and
John/Jane Doe medical staff (collectively “Defendants”). (Doc. 37 at ¶ 1.) All allegations relate
to the stillborn death of her son, Amir Rodgers (“decedent”), on January 26, 2024. (Id.)
On January 25, 2024, Jackson went to the emergency room at Marymount. (Id.) She was
28 weeks pregnant and experiencing preterm labor. (Id.) She arrived around 11:00 p.m. and was
1 The facts alleged in the amended complaint are summarized here and presumed true for
purposes of this motion. See Cates v. Crystal Clear Techs., LLC, 874 F.3d 530, 534 (6th Cir.
2017).
left to wait in the emergency room for hours. (Id. at ¶¶ 2, 28.) Her water broke in the waiting
area around 3:40 a.m. (Id. at ¶¶ 2, 29.) She was told the fetus was in a footling breech position.
(Id. at ¶ 29.) A nursing note at 3:43 a.m. states Jackson “did not appear in distress.” (Id. at
¶ 69.) Two minutes after that note by the nurse, her heart rate was 112 bpm with an elevated
blood pressure. (Id.)
Jackson generally asserts her condition of preterm labor with a footling breech
presentation and ruptured membranes was “a known obstetric emergency.” (Id. at ¶¶ 1, 29.) She
also characterizes her condition as a “complicated obstetric condition.” (Id. at ¶ 29b.) Jackson
claims Dr. Eikhoff, the attending physician, and Marymount staff recognized she was
experiencing an obstetric emergency. (Id. at ¶¶ 2, 29a.)
Jackson’s condition required immediate consultation with an obstetrician and transfer to a
Level III neonatal intensive care unit per American College of Obstetricians and Gynecologists
(“ACOG”) and Emergency Medical Treatment and Active Labor Act (“EMTALA”) guidelines.
(Id. at ¶ 29.) Marymount is not a Level III neonatal intensive care unit, so it lacked the capability
to effectively screen or stabilize a 28-week neonate. (Id. at ¶ 30.) Marymount staff failed to
follow standards and hospital policy for obstetric emergencies by failing to provide immediate
obstetric consultation and continuous fetal monitoring or timely transfer to a facility with higher-
level care. (Id. at ¶ 29.)
After Jackson’s water broke, she was not provided with an adequate medical screening
examination (“MSE”) as required under EMTALA. (Id. at ¶¶ 2, 55.) There was no obstetrician
on site or an individual qualified to perform the initial MSE. (Id. at ¶¶ 2, 31.) Instead, Dr.
Eikhoff “limited his evaluation to a brief bedside ultrasound/doppler that failed to capture fetal
heart tones[.]” (Id. at ¶¶ 2, 55.) Dr. Eikhoff told her the baby’s position would not allow him to
perform an assessment with the equipment he had. (Id. at ¶ 2.) Dr. Eikhoff’s evaluation failed to
capture fetal “biometry, presentation, or viability.” (Id. at ¶ 55.) No digital cervical exam,
ultrasound confirmation of presentation, continuous fetal monitoring, laboratory work-up, or
consultation with the on-call obstetrician was performed or documented. (Id. at ¶¶ 35, 55.)
The screening Jackson received deviated from Marymount’s obstetric protocol. (Id. at
¶ 55.) “By denying [her] a comprehensive MSE reasonably calculated to identify an obstetric
emergency,” Marymount exposed her and her fetus to “unmanaged and foreseeable peril” in
violation of EMTALA’s screening requirements. (Id. at ¶ 55.) The medical record falsely
suggests sufficient screening was performed, “contradicting Dr. Eikhoff’s own admission that he
was unable to determine fetal heart tones or confirm viability likely because he was not
adequately trained or qualified in obstetric emergencies.” (Id. at ¶ 55.)
Despite the hospital’s lack of obstetric and neonatal intensive care capabilities, the
medical staff proceeded with labor induction without appropriate consultation or transfer to a
facility equipped to handle high-risk deliveries. (Id. at ¶ 1.) “[S]taff express[ed] confusion about
next steps and noted the absence of OB guidance.” (Id. at ¶ 40.) Several nurses told Jackson this
was their “first delivery” and “were visibly excited rather than prepared.” (Id. at ¶ 102.) Dr.
Eikhoff failed to assess cervical dilation adequately but still proceeded with labor. (Id. at ¶ 3.)
No obstetrician was physically present after staff told Jackson to begin pushing. (Id. at ¶ 31.)
After pushing for over an hour, the baby’s head became entrapped. (Id. at ¶ 2.) Dr. Eikhoff
continued with induction medication using Cytotec (misoprostol). (Id. at ¶¶ 2, 32.) “An
unidentified OB, contacted only by telephone” ordered Cytotec. (Id. at ¶ 56.) Cytotec is
contraindicated in such scenarios without obstetric consultation, full cervical evaluation, or
surgical backup. (Id. at ¶¶ 2, 32.) Fetal heart tones were not confirmed prior to Cytotec
administration. (Id. at ¶ 33.)
ACOG recommends against vaginal delivery for a footling breech presentation with
preterm labor due to the high risk of complications. (Id. at ¶ 6.) Instead, ACOG recommends
cesarean delivery to minimize risks. (Id.) The decision to proceed with Jackson’s labor
induction without obstetric consultation or surgical backup deviated from established standards.
(Id.) Jackson asserts expert medical testimony will confirm the failure to consult with an
obstetrician and transfer to an appropriate facility deviates from accepted emergency obstetric
protocols. (Id. at ¶ 7.)
No one intervened when Dr. Eikhoff deviated from obstetric protocol and the staff’s
“inexperience and failure to escalate care show a systemic lack of training and supervision.” (Id.
at ¶ 102.) Jackson’s fetus died in front of her, still partially entrapped, while staff congratulated
themselves on delivering their first baby. (Id. at ¶¶ 81, 84.) Had competent staff been hired and
properly trained, her fetus would have received competent care. (Id. at ¶ 105.) These failures
were a foreseeable and proximate cause of her fetus’ stillbirth. (Id.)
The conduct of Marymount and its staff failed to adhere to established medical standards.
(Id. at ¶ 9.) Dr. Eikhoff and the nursing staff specifically breached their duty of care by failing to
perform a cervical digital exam before directing her to push; ignoring the need for immediate
obstetric consultation and surgical backup for a footling breach; administering Cytotec despite
guidelines contraindicating induction agents in active breech labor; and pulling on the fetus’ legs
without an operating team on standby resulting in head entrapment and irreversible hypoxia. (Id.
at ¶ 59.) “These departures from the standard of care were the proximate cause of my son’s
death and my own physical and emotional injuries.” (Id. at ¶ 60.) Cleveland Clinic knew, or
should have known, its emergency triage and obstetric protocols were dangerously deficient. (Id.
at ¶ 63.)
“As a Black uninsured woman, [Jackson] was subjected to substandard care due to
implicit bias and systemic disparities known to exist in emergency maternal health settings.” (Id.
at ¶ 12.) She references studies establishing racial disparities in maternal health outcomes and
claims these disparities were evident in her treatment. (Id.) Jackson also references an instance
from 2015 where federal regulators cited the Cleveland Clinic for patient safety violations due to
record keeping and procedural deficiencies. (Id. at ¶¶ 10, 54.) “On information and belief,”
Cleveland Clinic has a practice of deprioritizing maternal and fetal emergencies involving Black
women and Medicaid patients. (Id. at ¶ 101.)
After Dr. Eikhoff identified a footling breech presentation with ruptured membranes,
EMTALA required Marymount to provide stabilizing treatment within its capabilities or arrange
appropriate transfer. (Id. at ¶ 56.) Instead, staff proceeded with labor. (Id. at ¶ 56.) This
conduct destabilized the situation and led to the deterioration of Jackson’s and her fetus’
condition. (Id. at ¶ 56.) Despite Marymount’s lack of on-site obstetric and neonatal intensive
care support, staff failed to stabilize her or her fetus before continuing active delivery. (Id. at
¶ 56.) Jackson was not transferred until later. (Id. at ¶ 56.) “Hillcrest Hospital’s subsequent
documentation of ‘fetal demise prior to arrival’ underscores Marymount’s mismanagement
during the critical window of care[.]” (Id. at ¶ 60.)
Defendants failed to comply with EMTALA and Ohio law by refusing to “transfer
[Jackson] to a higher-level facility despite [her] preterm status and complicated presentation.”
(Id. at ¶ 57.) She asked to be transferred to University Hospitals, but Dr. Eikhoff denied her
request. (Id. at ¶¶ 3, 29b.) He told her there was no available ambulance. (Id. at ¶ 3.) There is
no documentation that a qualified obstetrician determined transfer was unsafe or there was
inadequate time to transfer prior to delivery. (Id. at ¶ 57.) Marymount also failed to document
any call to emergency medical services or to University Hospitals. (Id. at ¶ 58.) Marymount
staff falsely represented to Jackson no ambulance was available, an obstetrician was monitoring
her case, and she was being placed on continuous fetal monitoring. (Id. at ¶ 89.) In reliance on
those assurances, she remained at Marymount instead of arranging her own transfer to University
Hospitals. (Id. at ¶ 89.) Jackson’s chart was backdated to indicate she refused transfer. (Id. at
¶ 90.) She was eventually transferred to Hillcrest Hospital. (Id. at ¶¶ 56, 60.)
B. Procedural Background
On June 11, 2025, Jackson filed the initial complaint. (Doc. 1.) She alleged fourteen
claims: violations of EMTALA, 42 U.S.C. § 1395dd (Counts One-Three); a denial of due
process under 42 U.S.C. § 1983 (Count Seven); a wrongful death claim under Ohio Revised
Code § 2125.01 (Count Five); and Ohio common law claims for medical negligence/malpractice,
spoliation of evidence, negligent infliction of emotional distress, intentional infliction of
emotional distress, fraudulent misrepresentation and concealment, breach of fiduciary
duty/special relationship, civil conspiracy, negligent supervision and training, and negligent
retention and credentialing (Count Four, Six, Eight-Fourteen). (Id. at 9-22.)2
In response, Defendants moved for judgment on the pleadings. (Doc. 17.) On August
22, 2025, Jackson moved for leave to amend the complaint and/or substitute parties. (Doc. 21.)
In her motion, Jackson referenced that Defendants raised a standing issue regarding the wrongful
death claim and her ability to represent the decedent’s estate pro se. (Id. at 239.)
2 For ease and consistency, record citations are to the electronically stamped CM/ECF document
and PageID# rather than any internal pagination.
On September 24, 2025, the Court granted Jackson’s motion for leave to amend and
denied the motion for judgment on the pleadings as moot. (9/24/2025 Non-Document Order.)
The Court ordered: “Plaintiff has until 10/3/2025 to file an amended complaint and/or substitute
parties.” (Id.)
Jackson timely filed her amended complaint. (Doc. 37.) The amended complaint
substituted parties, but it also removed some causes of action and added others. (Compare Doc.
1, with Doc. 37.) In addition to Jackson’s EMTALA claims (Counts One-Three), her amended
complaint brings claims for wrongful death and survivorship of the decedent as Representative
of the Estate of Amir Rodgers under Ohio Revised Code § 2125.01 (Count Five). (Doc. 37 at
¶¶ 8, 64-66.) She also brings Ohio common law claims for medical negligence/malpractice,
spoliation of evidence, negligent and intention infliction of emotional distress, fraudulent
misrepresentation and concealment, breach of fiduciary duty, civil conspiracy, negligent
supervision and training, and battery (Counts Four, Six-Thirteen). (Id. at ¶¶ 59-63, 67-113.)
On October 9, 2025, Defendants moved to strike the amended complaint for exceeding
the Court’s order granting leave to amend, or in the alternative, to dismiss the amended
complaint. (Doc. 40.) The motion is fully briefed.3 (Docs. 45, 48.)
3 Defendants also moved for a protective order, or alternatively, to stay discovery pending a
ruling on the motion to strike/motion to dismiss. (Doc. 41.) Defendants asserted Jackson, a pro
se plaintiff, had no standing to represent the decedent’s estate. (Id.) Magistrate Judge Greenberg
granted the motion for a protective order or motion to stay discovery in part. (See Doc. 58.)
Discovery was stayed and an evidentiary hearing was set on the estate representation issue. (Id.
at 583.) While Magistrate Judge Greenberg issued a Report and Recommendation (“R&R”) on
the estate representation issue after the hearing (Doc. 70), in light of the fact that the Court
declines to exercise supplemental jurisdiction over Jackson’s state-law claims, the Court need
not address the R&R and related filings.
II. MOTION TO STRIKE AMENDED COMPLAINT OR IN THE ALTERNATIVE,
MOTION TO DISMISS AMENDED COMPLAINT
A. Motion to Strike
“The Court may strike from a pleading an insufficient defense or any redundant,
immaterial, impertinent, or scandalous matter.” FED. R. CIV. P. 12(f). The decision to strike an
affirmative defense is discretionary. Operating Eng’rs Local 325 Health Care Plan v. G&W
Constr. Co., 783 F.3d 1045, 1050 (6th Cir. 2015) (citing Dassault Systemes, SA v. Childress, 663
F.3d 832, 846 (6th Cir. 2011)). But “[m]otions to strike are viewed with disfavor and are not
frequently granted.” Id. (citations omitted).
Leave to file an amended complaint should be “freely” given “when justice so requires.”
FED. R. CIV. P. 15(a)(2). Courts have stricken amendments pursuant to Rule 12(f) that exceed
the scope of leave granted. See In re Keithley Instruments, Inc., 599 F. Supp. 2d 908, 911-16
(N.D. Ohio 2009); Patterson v. HG Ohio Emp. Holding Corp., No. 23-cv-681, 2024 U.S. Dist.
LEXIS 82557, 2024 WL 2022088, at *2-3 (N.D. Ohio May 7, 2024) (collecting cases).
Defendants move to strike Jackson’s amended complaint as exceeding the Court’s order
granting leave to amend. (Doc. 40 at 384-86, 388-89.) To Defendants, Jackson moved to amend
her complaint only to substitute parties to overcome standing issues for her wrongful death
claim. (Id.; Doc. 21 at 239.) Although her motion for leave to amend states the claims would
not change, her amended complaint added additional claims for battery, lack of informed
consent, and negligence per se, removed her § 1983 and negligent retention claims, changed
original allegations in places, and added new allegations. (Doc. 40 at 385-86 (citing Doc. 37 at
¶¶ 1, 19, 20, 27, 29, 30, 41, 57, 61, 66, 67, 73, 81, 107-113).) Jackson’s amended complaint
exceeded the Court’s Order granting leave to amend because she did more than substitute parties,
Defendants urge. (Doc. 40 at 386, 388-89.)
But the Court’s Order was not as limited as Defendants suggest. Jackson was given leave
“to file an amended complaint and/or substitute parties.” (9/24/2025 Non-Document Order.)
The amended complaint does not exceed the scope of the Cour’s Order. The motion to strike is
denied and the Court will assess the alternative arguments presented in the motion to dismiss.
B. Motion to Dismiss
Under Rule 12(b)(6), a court must dismiss a complaint if it fails “to state a claim upon
which relief can be granted.” FED. R. CIV. P. 12(b)(6). To state a claim, 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). To survive a Rule 12(b)(6) motion, the complaint must make out a
plausible legal claim, meaning the complaint’s factual allegations must be sufficient for a court
“to draw the reasonable inference that the defendant is liable.” Ashcroft v. Iqbal, 556 U.S. 662,
678, 129 S. Ct. 1937, 173 L. Ed. 2d 868 (2009) (quoting Bell Atl. Corp. v. Twombly, 550 U.S.
544, 570, 127 S. Ct. 1955, 167 L. Ed. 2d 929 (2007)). Plausibility does not require any specific
probability of success, but it does demand “more than a sheer possibility that a defendant has
acted unlawfully.” Id.
When evaluating a motion to dismiss, the Court must accept all factual allegations as true
and draw all reasonable inferences in the plaintiff’s favor. Cates v. Crystal Clear Techs., LLC,
874 F.3d 530, 534 (6th Cir. 2017) (quoting Bickerstaff v. Lucarelli, 830 F.3d 388, 396 (6th Cir.
2016)). But the court “‘need not accept as true legal conclusions or unwarranted factual
inferences, and conclusory allegations or legal conclusions masquerading as factual allegations
will not suffice.’” D’Ambrosio v. Marino, 747 F.3d 378, 383 (6th Cir. 2014) (quoting Terry v.
Tyson Farms, Inc., 604 F.3d 272, 275-76 (6th Cir. 2010)). A pleading that offers “labels and
conclusions, and a formulaic recitation of the elements of a cause of action will not do.” Id.
(quoting Republic Bank & Tr. Co. v. Bear Stearns & Co., Inc., 683 F.3d 239, 246-47 (6th Cir.
2012)). Nor does a complaint suffice if it “tenders naked assertions devoid of further factual
enhancement.” Iqbal, 556 U.S. at 678 (quotations and citations omitted).
Pro se pleadings are liberally construed. Boag v. MacDougall, 454 U.S. 364, 365, 102 S.
Ct. 700, 70 L. Ed. 2d 557 (1982) (per curiam); see also Pilgrim v. Littlefield, 92 F.3d 413, 416
(6th Cir. 1996); Garrett v. Belmont Cnty. Sheriff’s Dep’t, 374 F. App’x 612, 614 (6th Cir. 2010)
(quoting Haines v. Kerner, 404 U.S. 519, 520, 92 S. Ct. 594, 30 L. Ed. 2d 652 (1972)).
“However, this lenient treatment has limits . . . .” Pilgrim, 92 F.3d at 416 (citation omitted).
Liberal construction for pro se litigants does not “abrogate basic pleading essentials.” Wells v.
Brown, 891 F.2d 591, 594 (6th Cir. 1989).
A plaintiff may plead herself out of federal court if the allegations presented demonstrate
a bar to relief. Cataldo v. U.S. Steel Corp., 676 F.3d 542, 547 (6th Cir. 2012) (“sometimes the
allegations in the complaint affirmatively show that the claim” is deficient or disallowed as a
matter of law); Riverview Health Inst. LLC v. Med. Mut. of Ohio, 601 F.3d 505, 512 (6th Cir.
2010); Southfield Educ. Ass’n v. Southfield Bd. of Educ., 570 F. App’x 485, 487 (6th Cir. 2014)
(“A complaint will be dismissed pursuant to Rule 12(b)(6) if no law supports the claim made, if
the facts alleged are insufficient to state a claim, or if the face of the complaint presents an
insurmountable bar to relief.”) (citing Twombly, 550 U.S. at 561-64); see also O’Gorman v. City
of Chicago, 777 F.3d 885, 889 (7th Cir. 2015) (“A complainant can plead himself out of court by
including factual allegations that establish that the plaintiff is not entitled to relief as a matter of
law.”).
A plaintiff, including a pro se plaintiff, who fails to respond to a motion to dismiss a
claim is deemed to have abandoned the claim. See Humphrey v. United States AG Office, 279 F.
App’x 328, 331 (6th Cir. 2008) (“where . . . [a] plaintiff has not raised arguments in the district
court by virtue of his failure to oppose defendants’ motions to dismiss, the arguments have been
waived”); Scott v. Tennessee, 878 F.2d 382 (unpublished table decision) (6th Cir. 1989) (“if a
plaintiff fails to respond or to otherwise oppose a defendant’s motion, then the district court may
deem the plaintiff to have waived opposition to the motion”); Weatherby v. Fed. Express, 454 F.
App’x 480, 490 (6th Cir. 2012) (“[t]hough this court provides some leeway to pro se litigants,
Plaintiff must still make some effort at argumentation or presentation of facts” and absent such
effort, Plaintiff’s claims are waived); see also Bryant v. McDonough, No. 20-cv-726, 2021 U.S.
Dist. LEXIS 221273, 2021 WL 5359182, at *9 (N.D. Ohio Nov. 17, 2021), aff’d, 72 F.4th 149
(6th Cir. 2023) (dismissing pro se plaintiff’s claim on motion to dismiss where she failed to
address the defendant’s arguments in opposition), abrogated on other grounds by Kellar v.
Yunion, Inc., 157 F.4th 855 (6th Cir. 2025); Viola v. Ohio AG, No. 20-cv-765, 2021 U.S. Dist.
LEXIS 26701, 2021 WL 510746, at *23 (N.D. Ohio Feb. 11, 2021) (same).
1. EMTALA Claims
EMTALA was enacted after “highly publicized incidents where hospital emergency
rooms allegedly, based only on a patient's financial inadequacy, failed to provide a medical
screening that would have been provided a paying patient, or transferred or discharged a patient
without taking steps that would have been taken for a paying patient.” Cleland v. Bronson
Health Care Grp., Inc., 917 F.2d 266, 268 (6th Cir. 1990). “Congress intended this legislation to
prevent hospitals from dumping patients who suffered from an emergency medical condition
because they lacked insurance to pay the medical bills.” Est. of Lacko v. Mercy Hosp., Cadillac,
829 F. Supp. 2d 543, 548 (E.D. Mich. 2011) (citing Cleland, 917 F.2d at 268; Thornton v. Sw.
Detroit Hosp., 895 F.2d 1131, 1134 (6th Cir. 1990)). The statute was not intended to establish
standards for patient care, provide a suit for medical negligence, or substitute for a medical
malpractice claim. Moses v. Providence Hosp. and Med. Ctrs., Inc., 561 F.3d 573, 578 (6th Cir.
2009).
Defendants argue Jackson’s EMTALA claims should be dismissed for failure to state a
claim. (Doc. 40 at 387, 398-402.) In response, Jackson simply states “Defendants’ assertions of
immunity under the PREP Act and Ohio tort reform statutes do not bar my federal EMTALA
claims[.]” (Doc. 45 at 439.) On reply, Defendants note they did not raise an immunity defense
and assert Jackson failed to provide any relevant argument opposing dismissal of her EMTALA
claims. (Doc. 48 at 496-97.)
Notwithstanding Jackson’s abandonment of her EMTALA claims for failing to respond
to the challenges raised in Defendants’ motion to dismiss, the three claims fail on the merits.
a. Screening
Under 42 U.S.C. § 1395dd(a):
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) of this section) exists.
In Cleland v. Bronson Health Care Grp., the Sixth Circuit “interpret[ed] the vague phrase
‘appropriate medical screening’ to mean a screening that the hospital would have offered to any
paying patient, and the vague phrase “emergency medical condition” to mean a condition within
the actual knowledge of the doctors on duty or those doctors that would have been provided to
any paying patient.” 917 F.2d at 268-69. The Cleland court rejected the plaintiffs’ argument
that the term “appropriate medical screening” “denote[d]…the full panoply of state malpractice
law.” Id. at 271.
[W]hether a hospital administered an “appropriate” screening refers not only to the
hospital’s standards, but also to the motives with which a hospital acts.” Est. of Lacko, 829 F.
Supp. 2d at 549 (citing Cleland, 917 F.2d at 272). “If a hospital acts in the same manner as it
would have for the usual patient, then the screening provided is appropriate.” Id. A plaintiff
must provide “evidence of disparate treatment based on improper motive” to succeed on an
EMTALA screening claim. Id. (citations and quotations omitted); see also Romine v. St. Joseph
Health Sys., 541 F. App’x 614, 620 (6th Cir. 2013) (“an EMTALA plaintiff . . . must adduce
some evidence that her screening differed in some way from that given to other patients, and the
difference was improperly motivated”).
Defendants assert Jackson fails to allege she was treated differently than any other patient
or that any difference in treatment was precipitated by an improper motive. (Doc. 40 at 399-
400.) As to disparate treatment, Jackson alleges Dr. Eikhoff limited his evaluation to a brief
bedside ultrasound/doppler that failed to capture fetal heart tones, biometry, presentation, or
viability. (Doc. 37 at ¶ 55.) She was not given a formal obstetric ultrasound, continuous fetal
monitoring, a pelvic digital exam, or a laboratory work-up. (Id.) No obstetrician was summoned
despite hospital policy requiring consultation for breech or preterm presentations. (Id.) Jackson
contends, “[t]his perfunctory screening departed from the hospital’s customary obstetric
protocol[.]” (Id.) “By denying [her] a comprehensive MSE reasonably calculated to identify an
obstetric emergency,” Marymount violated the EMTALA screening requirement, she urges.
(Id.) In accepting Jackson’s factual allegations as true and drawing all reasonable inferences in
her favor, as the Court must, Jackson has plausibly alleged the disparate treatment prong of her
screening claim. See Est. of Lacko, 829 F. Supp. 2d at 550.
As to improper motive, Jackson alleges “[a]s a Black uninsured woman, [she] was
subjected to substandard care due to implicit bias and systemic disparities known to exist in
emergency maternal health settings.” (Doc. 37 at ¶ 12.) She generally references studies
establishing racial disparities in maternal health outcomes and claims these disparities were
evident in her treatment. (Id.) Jackson also references an instance from 2015 where federal
regulators cited the Cleveland Clinic for patient safety violations due to record keeping and
procedural deficiencies. (Id. at ¶¶ 10, 54.) She further asserts, “[o]n information and belief,”
Cleveland Clinic has a practice of deprioritizing maternal and fetal emergencies involving Black
women and Medicaid patients. (Id. at ¶ 101.)
Here, although Jackson references her status as a Black and uninsured woman, she fails
to allege facts supporting that her race or insurance motivated Marymount’s conduct. See Est. of
Lacko, 829 F. Supp. 2d at 550-51 (dismissing screening claim where despite alleging plaintiff
was on Medicaid, plaintiff alleged no facts to support his treatment would have been different
had he not been on Medicaid); see also Broughton v. St. John Health Sys., 246 F. Supp. 2d 764,
769 (E.D. Mich. 2003) (dismissing screening claim where plaintiff failed to allege hospital’s
failure to conduct tests was due to an impermissible motive); Elmhirst v. McLaren N. Mich., No.
17-cv-374, 2017 U.S. Dist. LEXIS 112431, 2017 WL 4535714, at *4 (W.D. Mich. July 19,
2017) (dismissing screening claim where plaintiff “formulaically allege[d]” hospital acted based
on her lack of insurance without any support facts that staff knew about her lack of insurance),
aff’d, 726 F. App’x 439 (6th Cir. 2018), cert. denied, 586 U.S. 919, 139 S. Ct. 325, 202 L. Ed. 2d
221 (2018); Huber v. Mia. Valley Hosp., Inc., No. 20-cv-294, 2022 U.S. Dist. LEXIS 176980,
2022 WL 4540180, at *4 (S.D. Ohio Sept. 28, 2022) (dismissing screening claim for failure to
allege improper motive where plaintiff failed to allege facts she was treated based on appearance
of inability to pay for services).
Other than Jackson’s general references to a difference in maternal health outcomes
involving Black and Medicaid patients, “[t]here is nothing to suggest that anyone at Defendant’s
hospital took that information into consideration or, because of that information, altered or failed
to administer any tests, procedures, or diagnoses that would have otherwise been made or done.”
Est. of Lacko, 829 F. Supp. 2d at 551. Even in viewing the amended complaint in a light most
favorable to Jackson, she does not allege facts to establish Dr. Eikhoff or anyone at Marymount
was aware of Jackson’s lack of insurance or financial status or took her race into consideration.
Instead, she alleges Dr. Eikhoff “was not adequately trained or qualified in obstetric
emergencies” and Marymount “lacked the capability to effectively screen” her. (Doc. 37 at
¶¶ 30, 55.) Jackson’s allegations are not enough where “the facts do not permit the Court to infer
more than a possibility that there was an improper motive.” Est. of Lacko, 829 F. Supp. 2d at
551 (citing Iqbal, 556 U.S. at 678). Jackson fails to state an improper screening claim in
Count 1.
b. Stabilization
Under 42 U.S.C. § 1395dd(b),
If any individual . . . comes to a hospital and the hospital determines that the
individual has an emergency medical condition, the hospital must provide either-
(A) within the staff and facilities available at the hospital, for such further medical
examination and such treatment as may be required to stabilize the medical
condition, or (B) for transfer of the individual to another medical facility in
accordance with subsection (c) of this section.
For a hospital to be liable for failure to stabilize a patient, the hospital must (1)
“determine[] that the individual has an emergency medical condition” and (2) the hospital must
have failed to stabilize the patient before transferring or discharging the patient. See Cleland,
917 F.2d at 268; Est. of Lacko, 829 F. Supp. 2d at 552.
“[T]o trigger further EMTALA obligations, the hospital physicians must actually
recognize that the patient has an emergency medical condition; if they do not believe an
emergency medical condition exists because they wrongly diagnose the patient, EMTALA does
not apply.” Moses v. Providence Hosp. & Med. Ctrs., Inc., 561 F.3d 573, 585 (6th Cir. 2009)
(citing Roberts ex rel. Johnson v. Galen of Virginia, Inc., 325 F.3d 776, 786 (6th Cir. 2003)).
“Only actual knowledge of an emergency medical condition [by Defendant]—not simply the
existence of facts that should have put Defendant on notice—triggers a duty to stabilize a patient
pursuant to § 1395dd(b) of EMTALA.” Burd v. Lebanon HMA, Inc., 756 F. Supp. 2d 896, 906
(M.D. Tenn. 2010). In Estate of Lacko, the Court noted negligence claims alleging a hospital
failed to detect an emergency condition and claims requiring actual knowledge, such as
EMTALA stabilization claims, are not compatible. 829 F. Supp. 2d at 553.
Defendants argue Jackson fails to allege Marymount had actual knowledge of her
emergency medical condition. (Doc. 40 at 401.) In her screening claim, she alleges she was
denied “a comprehensive MSE reasonably calculated to identify an obstetric emergency. (Id.
(citing Doc. 37 at ¶ 55).) Jackson’s claim that Marymount’s employees would have known
about her emergency medical condition had they provided a better screening is incompatible
with EMTALA’s actual knowledge requirement, Defendants urge. (Id.) Defendants maintain
Jackson’s amended complaint concedes actual knowledge was lacking and there are no facts to
plausibly allege Dr. Eikhoff had actual knowledge of her condition. (Id. at 401-02.)
Jackson claims Dr. Eikhoff and Marymount staff recognized she was experiencing an
obstetric emergency. (Id. at ¶ 29a.) The Court must consider whether Jackson has plausibly
alleged facts to support this conclusion. See Iqbal, 556 U.S. at 678.
Jackson alleges her condition of preterm labor with a footling breech presentation and
ruptured membranes was “a known obstetric emergency.” (Id. at ¶¶ 1, 29.) Elsewhere she
characterizes her condition as a “complicated obstetric condition.” (Id. at ¶¶ 29b, 57.) She
asserts ACOG recommends against vaginal delivery for a footling breech presentation with
preterm labor due to the high risk of complications. (Id. at ¶ 6.)
Jackson asserts Marymount lacked obstetric and neonatal intensive care capabilities. (Id.
at ¶ 1.) A nursing note from 3:43 a.m. states Jackson “did not appear in distress” after her water
broke. (Id. at ¶ 69.) She contends there was no obstetrician on site or an individual qualified to
perform the initial MSE. (Id. at ¶¶ 2, 31.) Instead, Dr. Eikhoff’s perfunctory evaluation failed to
confirm fetal heart tones, biometry, presentation, or viability. (Id. at ¶¶ 2, 55.) Dr. Eikhoff
admitted he was unable to do so “likely because he was not adequately trained or qualified in
obstetric emergencies.” (Id. at ¶ 55.) She also alleges “staff express[ed] confusion about next
steps,” nurses told her this was their “first delivery,” and they “were visibly excited rather than
prepared.” (Id. at ¶¶ 40, 102.) Jackson claims the staff’s “inexperience and failure to escalate
care show a systemic lack of training and supervision.” (Id. at ¶ 102.)
She further alleges had competent staff been hired and properly trained, her fetus would
have received competent care. (Id. at ¶ 105.) These failures were a foreseeable and proximate
cause of her fetus’ stillbirth, Jackson argues. (Id. at ¶ 105.) “By denying [her] a comprehensive
MSE reasonably calculated to identify an obstetric emergency,” Marymount exposed her and her
fetus to “unmanaged and foreseeable peril.” (Id. at ¶ 55.)
On balance, these allegations cannot be squared with Jackson’s conclusory assertion that
Dr. Eikhoff and Marymount staff were aware of her emergency condition. See Elmhirst, 726 F.
App’x 439, 444-45 (6th Cir. 2018) (affirming dismissal of stabilization claim where complaint
alleged no facts to plausibly support inference hospital actually knew plaintiff was suffering
from an emergency medical condition; plaintiff’s core allegation was hospital failed to detect her
emergency medical condition), cert. denied, 586 U.S. 919, 139 S. Ct. 325, 202 L. Ed. 2d 221
(2018); Est. of Lacko, 829 F. Supp. 2d at 552-54 (plaintiff alleged emergency condition existed
but fell short of alleging defendant knew of emergency condition where complaint explicitly
alleged defendant failed to determine and diagnose emergency condition); Burd v. Lebanon
HMA, Inc., 756 F. Supp.2 d 896, 906 (M.D. Tenn. 2010) (because hospital diagnosed the patient
with acute anxiety and determined he was stable, it did not have actual knowledge of an
emergency medical condition); Perry v. Owensboro Health, Inc., No. 14-CV-00046, 2015 U.S.
Dist. LEXIS 93688, 2015 WL 4450900, at *6-8 (W.D. Ky. July 20, 2015) (dismissing
stabilization claim where plaintiffs failed to plead factual allegations defendant had actual
knowledge of unstable emergency condition when discharged); Huber, 2022 WL 4540180, at *5
(S.D. Ohio Sept. 28, 2022) (dismissing stabilization claim where complaint alleged hospital
failed to detect plaintiff’s emergency medical condition despite her exhibiting symptoms that
should have made it aware of the condition).
Although Jackson makes the bare assertion Dr. Eikhoff and Marymount staff knew a
footling breech presented an emergency medical condition, there are no supporting facts, even
when viewed in a light most favorable to Jackson, that make actual knowledge plausible. Her
complaint centers on Dr. Eikhoff’s allegedly negligent treatment and that Marymount did not
have anyone equipped to handle her treatment. Staff were confused and inadequately trained in
obstetric emergencies. She explicitly alleges she was denied a comprehensive screening
“reasonably calculated to identify an obstetric emergency.” (Doc. 37 at ¶ 55.) These allegations
demonstrate a bar to federal relief. See Cataldo, 676 F.3d at 547; Riverview Health Inst, 601
F.3d at 512; Southfield Educ. Ass’n, 570 F. App’x at 487. She cannot plausibly allege actual
knowledge of an emergency condition. Jackson fails to state a stabilization claim in Count 2.
c. Transfer
Under 42 U.S.C. § 1395dd(c), “[i]f an individual at a hospital has an emergency medical
condition which has not been stabilized . . ., the hospital may not transfer [or discharge] the
individual unless . . . [certain conditions have been satisfied].” § 1395dd(c)(1). Accordingly, a
“failure-to-transfer theory” is “more accurately characterized as a discharge-before-stabilization
theory.” Elmhirst, 2017 WL 4535714, at *5, aff’d 726 F. App’x 439 (6th Cir. 2018), cert.
denied, 586 U.S. 919 (2018). Like the stabilization requirement in § 1395dd(b), liability for an
EMTALA transfer claim is predicated on the hospital’s actual knowledge of an emergency
medical condition. Id. (citing Cleland, 917 F.2d at 268); see also Broughton, 246 F. Supp. 2d at
772-75.
Defendants argue Jackson’s failure to plead sufficient facts establishing actual knowledge
of her emergency condition means her EMTALA transfer claim also fails. (Doc. 40 at 402.) The
Court agrees. As discussed above, Jackson failed to establish that Marymount had “actual
knowledge” of her emergency medical condition. See Elmhirst, 2017 WL 4535714, at *5
(dismissing transfer claim where plaintiff failed to plead sufficient facts to establish hospital had
actual knowledge of her emergency medical condition); Broughton, 246 F. Supp. 2d at 775
(dismissing transfer claim where hospital did not determine plaintiff had an emergency medical
condition). Accordingly, she failed to state a transfer claim under EMTALA in Count 3.
In sum, Jackson’s EMTALA claims (Counts 1-3) are dismissed for failure to state a
claim. Jackson did not request to amend her complaint in response to Defendants’ motion to
dismiss. (See Doc. 45.) Despite her pro se status, she is familiar with the procedure for
requesting leave to amend, has already amended her EMTALA allegations, and was on notice of
the asserted deficiencies with her federal claims. (See Docs. 21, 40, 75.) “EMTALA was
enacted to prevent hospital emergency rooms from dumping patients that could not afford
treatment. It was not intended to provide a suit for medical negligence or substitute for a medical
malpractice claim.” Est. of Lacko, 829 F. Supp. 2d at 555. Here, Jackson’s claims sound in
medical negligence, and her “allegations do not support a case that EMTALA was intended to
cover. Consequently, granting further leave to amend would be futile.” Perry, 2015 WL
4450900, at *9.
2. Supplemental Jurisdiction Over State-Law Claims
Section 1367 provides that “in any civil action of which the district courts have original
jurisdiction, the district courts shall have supplemental jurisdiction over all other claims that are
so related to claims in the action within such original jurisdiction that they form part of the same
case or controversy under Article III of the United States Constitution.” 28 U.S.C. § 1367(a).
However, a district court may decline supplemental jurisdiction if:
(1) the claim raises a novel or complex issue of State law,
(2) the claim substantially predominates over the claim or claims over which the district
court has original jurisdiction,
(3) the district court has dismissed all claims over which it has original jurisdiction, or
(4) in exceptional circumstances, there are other compelling reasons for declining
jurisdiction.
28 U.S.C. § 1367(c)(1)-(4). Relevant here is § 1367(c)(1)-(3).
Before declining jurisdiction, “a district court should consider and weigh several factors,
including the values of judicial economy, convenience, fairness, and comity.” Gamel v. City of
Cincinnati, 625 F.3d 949, 951 (6th Cir. 2010) (citations and quotations omitted); see also
Landefeld v. Marion Gen. Hosp., Inc., 994 F.2d 1178, 1182 (6th Cir. 1993) (“district court
should consider the interests of judicial economy and the avoidance of multiplicity of litigation
and balance those interests against needlessly deciding state law issues”) (citing Aschinger v.
Columbus Showcase Co., 934 F.2d 1402, 1412 (6th Cir. 1991)). “When all federal claims are
dismissed before trial, the balance of considerations usually will point to dismissing the state law
claims.” Stanley v. W. Mich. Univ., 105 F.4th 856, 867 (6th Cir. 2024). The presumption in
favor of dismissal “grows even stronger when the court has dismissed the federal claims on a
motion to dismiss.” Cotterman v. City of Cincinnati, No. 21-3659, 2023 U.S. App. LEXIS
28781, 2023 WL 7132017, at *7 (6th Cir. Oct. 30, 2023) (citing Musson Theatrical, Inc. v. Fed.
Exp. Corp., 89 F.3d 1244, 1255 (6th Cir. 1996) (“After a 12(b)(6) dismissal, there is a strong
presumption in favor of dismissing supplemental claims.”)).
Recently, the Sixth Circuit addressed the exercise of supplemental jurisdiction when
§ 1367(c) applies. See Williams v. Addison Cmty. Schs., 168 F.4th 791 (6th Cir. 2026). There, it
reversed the district court’s exercise of supplemental jurisdiction because Michigan state courts
had not yet spoken to whether a private cause of action exists for claims pursued under the Fair
and Just Treatment clause of Michigan’s constitution. Id. at 796. For this reason, comity
mandated dismissal of the state-law claim without prejudice.4 Id.
4 Notably, the opinion cautioned that “district courts should not read this opinion to restrict the
broad exercise of supplemental jurisdiction . . . .” Williams, 168 F.4th at 796-97.
Because dismissal of Jackson’s EMTALA claims (Counts 1-3) is warranted, Defendants
assert the Court could decline to exercise supplemental jurisdiction over the remaining state-law
claims (Counts 4-13) and dismiss them without prejudice under § 1367(c)(3). (Doc. 48 at 497.)
While Jackson asserted supplemental jurisdiction under 28 U.S.C. § 1367, she does not address
this position. (See Doc. 37 at ¶ 14.)
Defendants raise two issues with Jackson’s Ohio statutory wrongful death claim (Count
Five) and nine Ohio common law claims (Counts Four, Six-Thirteen): (1) Jackson cannot bring a
pro se statutory wrongful death claim on behalf of the decedent’s estate; and (2) Jackson’s Ohio
law claims are time-barred under the one-year statute of limitation for medical claims. (See Doc.
40 at 387, 390-98; Doc. 48 at 494-96.)
As to the estate representation issue, Defendants argue Jackson cannot represent the
decedent’s estate pro se because there are other statutory next of kin under Ohio Rev. Code
§ 2125.02(A). (See Doc. 40 at 396-98.) Jackson responds she can represent the decedent’s
estate pro se because she is the estate’s sole beneficiary and there are no creditors. (See Doc. 45
at 437-39.) In other filings, the parties dispute the relevance of the 2023 amendments to Ohio
Rev. Code § 2125.02(B) and whether “other next of kin” under the statute were required to
preserve their interest in any wrongful death action. (See Docs. 71-73, 75-77.)
As to whether the state-law claims are time-barred, Ohio Rev. Code § 2305.113(A)
provides a one-year statute of limitations for medical claims. “Medical claims” are defined by
§ 2305.113(E)(3). Defendants assert the Ohio law claims all medical claims based on medical
care Jackson received at Marymount on January 25-26, 2024, and are time-barred. (See Doc. 40
at 390-93 (collecting cases); see also Doc. 48 at 494-95 (same).) Jackson maintains that due to
Defendants’ concealment, incomplete record production, and spoliation of evidence, any statute
of limitations is tolled by the discovery rule and equitable tolling under Ohio law. (Doc. 45 at
438; see also Doc. 37 at ¶ 19.)
Overall, the § 1367(c) factors favor declining supplemental jurisdiction over Jackson’s
state-law claims. Jackson’s only federal claims (Counts 1-3) are dismissed pursuant to Rule
12(b)(6). See 28 U.S.C. § 1367(c)(3). The presumption in favor of dismissal at this stage is
strong. See Cotterman, 2023 WL 7132017, at *7; Musson Theatrical, Inc., 89 F.3d at 1255. Ten
of Jackson’s thirteen total claims (Counts 4-13) are based on Ohio law and relate to Defendants’
alleged negligence and misconduct. (See Doc. 37.) These claims predominate over her three
EMTALA claims. See 28 U.S.C. § 1367(c)(2). And where discovery has been stayed pending
the resolution of the motion to dismiss, the interests of judicial economy, fairness, and the
avoidance of multiplicity of litigation are outweighed by the interest against needlessly deciding
state-law issues. (See Doc. 58 at 583; see also Landefeld, 994 F.2d at 1182.)
Further, while not dispositive of the Court’s overall analysis, it appears declining
supplemental jurisdiction over Jackson’s state-law claims is consistent with Williams and the
interest of comity because she raises novel and complex issues of Ohio law, that being whether
her status as the sole beneficiary of the decedent’s estate under the Ohio wrongful death statute
allows here to appear on behalf of the estate despite her pro se status. See 168 F.4th at 796; see
also 28 U.S.C. § 1367(c)(1). It does not appear that Ohio courts have addressed the issue of
when a pro se plaintiff is the sole beneficiary for a wrongful death action post-amendment of the
applicable Ohio statue. And whether Jackson’s state-law claims are all medical claims under
§ 2305.113 and the related limitations period raise other complex and novel issues under Ohio
law. See, e.g., Everhart v. Coshocton Cnty. Mem’l Hosp., 176 Ohio St. 3d 91, 247 N.E.3d 101,
109 (2023) (“[the Ohio Supreme Court] court has never considered whether that statute of
limitations [for medical claims in § 2305.113(A)] applies to wrongful-death claims based on
medical care”). The Court therefore declines to exercise supplemental jurisdiction over
Jackson’s state-law claims.’ Counts 4 through 13 are dismissed without prejudice.
I. CONCLUSION
For the reasons stated herein, Defendants’ Motion to Strike Plaintiff’'s Amended
Complaint (Doc. 40) is DENIED. Defendants’ alternative Motion to Dismiss Plaintiff's
Amended Complaint (Doc. 40) is GRANTED in part. Counts One through Three are
DISMISSED. The Court declines to exercise supplemental jurisdiction over Plaintiff's
remaining state-law claims, which are DISMISSED without prejudice. Accordingly, all pending
motions are DENIED as moot.
IT IS SO ORDERED.
Date: August 20, 2026 Load san
BRIDGET MEEHAN- BRENNAN
UNITED STATES DISTRICT JUDGE
> The Court does not reach the merits of Defendants’ arguments regarding dismissal of the state-
law claims.