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Antoine v. Navicent Health Inc.

United States District Court, M.D. Georgia, Macon Division

December 12, 2018




         This matter is before the Court on Defendants' Motion to Dismiss Plaintiff's Second Amended Complaint [Doc. 48]. In their motion, Defendants maintain that Plaintiff's Second Amended Complaint [Doc. 42] is subject to dismissal for a multitude of reasons.


         Defendants contend that the core of Plaintiff's Second Amended Complaint rests on his dissatisfaction with being discharged from the Medical Center of Central Georgia, Inc., [1] and his dissatisfaction with the legal proceedings in the Superior Court of Bibb County, Georgia, permitting his discharge. [Doc. 48-1 at p. 2]. In addition to these central points, Plaintiff's Second Amended Complaint clearly displays his dissatisfaction with the care he received as a patient in Defendants' facility. In this case, Plaintiff asserts an Emergency Medical Treatment and Active Labor Act, 42 U.S.C. § 1395dd (“EMTALA”), claim and medical malpractice claims against the defendant hospital (all of which Defendants argue are barred by res judicata and collateral estoppel) as well as claims for libel and slander; harassment; emotional distress; and invasion of privacy. [Doc. 42 at pp. 27-44]. In his final cause of action Plaintiff seeks to invalidate a lien filed by the Medical Center of Central Georgia, Inc., in relation to Plaintiff's time as a patient at the “[D]efendants' hospital facility.” [Id. at p. 44].


         The Court takes the following facts from Plaintiff's Second Amended Complaint (unless otherwise noted) and assumes them to be true for the purposes of ruling on Defendants' motion. See Bell Atl. Corp. v. Twombly, 550 U.S. 544, 556 (2007).

         Phoebe Putney Memorial Hospital, located in Albany, Georgia, transferred Plaintiff Alter Antoine (“Plaintiff”) to Navicent Health, Inc. (“Navicent Health”), in Macon, Georgia, on March 29, 2017, following his involvement in a motor vehicle accident. [Doc. 42 at ¶¶ 5-6].[2] According to Plaintiff, the nature of the injuries were severe. [Id. at ¶ 7]. The initial admitting diagnosis at Navicent Health included “a traumatic brain injury (“TBI”), a shear injury, intracerebral hemorrhage, grade 4 torn spleen, and grade 4 liver injury as well as numerous fractures, tears and lacerations[, ] and other injuries.” [Id.]. Plaintiff claims that “a TBI is one of the most devastating events and injuries [] a person can endure” and “patients can sustain permanent brain damage without proper neurological care.” [Id. at ¶ 11]. Although Navicent Health supposedly knew of Plaintiff's traumatic brain injury, Plaintiff alleges that Navicent Health never provided neurological care despite him being admitted as a patient for more than five months. [Id. At ¶¶ 9, 12, 23].

         On June 17, 2017, Navicent Health first cleared Plaintiff for discharge. [Id. at ¶¶ 15, 17]. According to Plaintiff, Dr. Smith testified (at a hearing in the Superior Court[3] of Bibb County) that Navicent Health's discharge records were not accurate. [Id. At ¶ 16]. Specifically, Dr. Smith testified:

[Plaintiff] was unable to ambulate on his own, he was a serious risk to fall, [Plaintiff] was still dependent on a PEG feeding tube which had been surgically implanted into his stomach, [Plaintiff] was unable to medicate, unable to hydrate or feed himself, unable to urinate other than into a container thru [sic] a catheter attached to his penis, all while [Plaintiff] was suffering from a severe stage 4 decubitus ulcer [ ], with severe ongoing cognitive deficits affecting his comprehension, speech, memory, and inability to even begin to make important independent decisions for himself.

[Id. (internal record citation omitted)].

         Plaintiff alleges that a video, taken four days after Navicent Health cleared Plaintiff for discharge, shows that Plaintiff still required assistance from hospital employees to help reduce Plaintiff's risk of falling. [Id. at ¶ 17]. All in all, despite Plaintiff's allegations that he was nowhere near ready for discharge, Navicent Health still “wanted [Plaintiff] to be out their door.” [Id. at ¶¶ 22, 23]. Plaintiff contends that beginning on June 17, 2017, and continuing through “and beyond” August 9, 2017, Navicent Health conspired to evict Plaintiff. [Id. at ¶ 24].

         On August 9, 2017, Navicent Health deemed Plaintiff safe for discharge for a second time, a decision that, Plaintiff argues, was based on false grounds. [Id. at ¶¶ 32, 33]. According to Plaintiff, nursing and assisting staff conspired, and without direction from a medical doctor, wheeled Plaintiff out of his hospital room “all the way down to Navicent's discharged patient pick-up area and dumped him there.” [Id. at ¶ 34]. In doing so, Plaintiff contends that Defendants “recklessly and wantonly created a living nightmare for Plaintiff.” [Id. at ¶ 39].[4] Plaintiff states that he “was returned to the hospital as a patient because the hospital feared publicity from a news reporter who was on her way to Navicent having heard about what Navicent had done to [Plaintiff].” [Id. at ¶ 48].

         Plaintiff claims that Defendants' “stunningly reckless” and “uncaring” attitude “permeated” each Defendant to the extent that they all “made significant effort” to “illegally discharge [Plaintiff].” [Id. at ¶ 26]. For example, Plaintiff states that Navicent Health did not contact Plaintiff's brother before discharge, which, according to Dr. Smith's testimony (at the superior-court hearing), was not appropriate since Plaintiff's brother was “supposed to be the one helping him.” [Id. at ¶¶ 30, 31].

         Eventually, given Plaintiff's refusal to leave, Navicent Health sought an injunction from the Superior Court of Bibb County to remove Plaintiff on the grounds of criminal trespass. [Id. at ¶¶ 54-56, 60]. In what Plaintiff calls an “attempt to double down on [Navicent Health's] insatiable desire to lock [Plaintiff] out, ” Navicent Health presented a “false set of legal papers” for immediate review by the court system. [Id. at ¶¶ 54-55]. According to Plaintiff, Navicent not only sought court intervention, but also “proudly” and “maliciously accused [Plaintiff] of being a criminal trespasser by remaining at Navicent.” [Id. at ¶¶ 56, 74].

         Plaintiff asserts that Navicent Health's “slanderous injunction case was a manipulation of the court system . . . so that [Plaintiff] would leave the hospital.” [Id. at ¶ 62]. Specifically, Plaintiff now claims that the injunction application “did not contain a scintilla of records, evidence[, ] nor medical statements to support their allegation of irreparable harm, because there was none.” [Id. at ¶ 79]. To that end, Plaintiff concludes that the motive behind evicting Plaintiff was purely out of financial concern. [Id. at ¶ 78].

         In light of these events, Plaintiff takes issue with Navicent Health's removal of “their traumatic brain injured patient” from his hospital room to the exit with “no medication, ” “nowhere to go, ” and “no one to pick him up.” [Id. at ¶ 59]. Plaintiff characterizes Navicent Health's actions as “grotesque” and “an outrageous Goliath attempt to stomp out this 33[-]year[-]old man and to cover up their willful neglect and abuse.” [Id. at ¶¶ 59, 61]. According to Plaintiff, Dr. Smith testified on several occasions at the superior-court injunction hearing that this particular conduct was “wrong, ” “reprehensible, ” and “unacceptable negligence.” [Id. at ¶¶ 66, 67].

         On August 15, 2017, Navicent Health brought Dr. Smith into Plaintiff's hospital room for what Plaintiff argues was a means to “cook up” three lines in the record that Plaintiff was “supposedly safe for discharge to Hemlock Street or out to a Macon homeless shelter. [Id. at ¶¶ 81, 86]. Later, however, Plaintiff contends Dr. Smith recanted on cross-examination and stated that his previous decision authorizing discharge was “totally improper, dangerous, and life threatening.” [Id. at ¶ 87].

         According to Plaintiff, the superior court ruled that Navient Health “could not throw [Plaintiff] out the door.” [Id. at ¶ 93 (emphasis added)].[5] After having heard testimony from only two witnesses and after determining that the hospital's case “had to stop, ” the superior court judge nevertheless granted Navicent Health's injunctive relief permitting Plaintiff's discharge, but told “the hospital that they could not discharge [Plaintiff] without the proper care in place.” [Id. at ¶¶ 105, 106 (emphasis omitted)]. Navicent Health had “to provide and pay for months of in-patient rehabilitation care at Navicent Health's own expense.” [Id. at ¶¶ 93-94]. Specially, the superior court ordered that

[i]n order to provide a safe place for [Plaintiff] to continue his next level of outpatient treatment after his discharge from The Medical Center, Navicent Health, is ordered to pay up to $400.00 per day, or $12, 000.00 per month, for up to a maximum of one hundred (100) days for [Plaintiff] to be admitted to a skilled nursing facility of [Navicent Health's] choice for the purpose of providing safe lodging and nutrition for [Plaintiff] as he transitions from an acute care hospital.

         [Doc. 33-2 at pp. 5-6]. After 160 days, [6] Navicent discharged Plaintiff on September 5, 2017. [Doc. 33-3]. But, in an attempt “to stick it to [Plaintiff] one more time, ” Plaintiff alleges that Navicent “secretly filed a purported lien for their alleged billing, ” never letting Plaintiff know of their plans. [Doc. 42 at ¶ 114].

         Following his discharge, Plaintiff filed the instant lawsuit in the United States District Court for the Southern District of New York on December 28, 2017. [Doc. 1]. The next day, after receiving filing errors, Plaintiff re-filed his initial Complaint [Doc. 1] against Defendants. See [Doc. 3]. Before its service, Plaintiff attempted to amend his initial Complaint on January 29, 2018, but once again received a filing error with instructions regarding how to properly label and file what would become his First Amended Complaint [Doc. 26]. See [Doc. 24]. However, before correcting his filing errors the following day, Plaintiff's attorney, Mr. David Panitz, filed a letter dated January 29, 2018, and addressed to the Southern District of New York district court judge assigned to his client's case. [Doc. 25]. In his letter, Mr. Panitz asked that Court “in lieu of a more formal application to voluntarily transfer this case pursuant to 28 U.S.C. § 1404, from the District Court for the Southern District of New York to the District Court for the Middle District of Georgia.” [Id. at p. 1]. Then, on January 30, 2018, Plaintiff filed his First Amended Complaint. [Doc. 26].

         On January 31, 2018, the District Court for the Southern District of New York ordered that “th[is] action be transferred to the U.S. District Court for the Middle District of Georgia.” [Doc. 27 at p. 2]. Having been served, [7] Defendants filed a Motion to Dismiss [Doc. 33] Plaintiff's First Amended Complaint on March 5, 2018. On March 26, 2018, exactly 21 days after Defendants' service of their motion under Federal Rule of Civil Procedure 12(b), Plaintiff filed a Second Amended Complaint [Doc. 42]. However, Plaintiff failed to seek leave of court regarding his second attempt to amend his complaint. See Fed. R. Civ. P. 15. Plaintiff's purported Second Amended Complaint could not be an amendment as a matter of right because he previously filed his First Amended Complaint on January 30, 2018, thereby exhausting Rule 15's right to amend “once as a matter of course.” Fed.R.Civ.P. 15(a)(1) (emphasis added); Stephens v. Atlanta Indep. Sch. Sys., No. 1:13-cv-978-WSD, 2013 WL 6148099, at *2 (N.D.Ga. Nov. 22, 2013).

         In an effort to clarify the controlling pleading in this case, the Court held a telephone conference during which Defendants “consent[ed] that the Plaintiff may amend his Complaint by the filing of this Second Amended Complaint, such already being filed of record on March 26, 2018.” [Doc. 50 at p. 1]. Defendants now seek dismissal of Plaintiff's Second Amended Complaint in their re-filed Motion to Dismiss [Doc. 48].


         A. Standard of Review

         Defendants seek to dismiss Plaintiff's action against them for failure to state a claim pursuant to Federal Rule of Civil Procedure 12(b)(6). When ruling on a 12(b)(6) motion, district courts must accept the facts set forth in the complaint as true. Twombly, 550 U.S. at 572. A complaint survives a motion to dismiss only if it alleges sufficient factual matter (accepted as true) that states a claim for relief that is plausible on its face. McCullough v. Finley, 907 F.3d 1324, 1333 (11th Cir. 2018) (citing Ashcroft v. Iqbal, 556 U.S. 662, 678-79 (2009). In fact, a well-pled complaint “may proceed even if it strikes a savvy judge that actual proof of those facts is improbable, and that a recovery is very remote and unlikely.” Twombly, 550 U.S. at 556 (citations omitted).

         Although Federal Rule of Civil Procedure 8 does not require detailed factual allegations, it does require “more than [ ] unadorned, the-defendant-unlawfully-harmed-me accusation[s].” McCullough, 907 F.3d at 1333 (citation omitted); see also n.4, supra. To decide whether a complaint survives a motion to dismiss, district courts are instructed to use a two-step framework. Id. The first step is to identify the allegations that are “no more than mere conclusions.” Id. (quoting Iqbal, 556 U.S. at 679). “Conclusory allegations are not entitled to the assumption of truth.” Id. (citation omitted). After disregarding the conclusory allegations, the second step is to “assume any remaining factual allegations are true and determine whether those factual allegations ‘plausibly give rise to an entitlement to relief.'” Id. (quoting Iqbal, 556 U.S. at 679).

         Furthermore, a complaint attacked by a 12(b)(6) motion is subject to dismissal when it fails to “give the defendant fair notice of what the . . . claim is and the grounds upon which it rests.” Twombly, 550 U.S. at 555 (citation omitted). “A plaintiff must plead more than labels and conclusions or a formulaic recitation of the elements of a cause of action.” McCullough, 907 F.3d at 1333 (internal quotations omitted); see also Twombly, 550 U.S. at 555. “To be sure, a plaintiff may use legal conclusions to structure his complaint, but legal conclusions ‘must be supported by factual allegations.'” McCullough, 907 F.3d at 1333 (quoting Iqbal, 556 U.S. at 679). While courts, in ruling on a motion to dismiss, must take all of the factual allegations in the complaint as true; they are not bound to accept a legal conclusion couched as a factual allegation. Iqbal, 556 U.S. at 678. Courts must “identify conclusory allegations and then discard them-not ‘on the ground that they are unrealistic or nonsensical' but because their conclusory nature ‘disentitles them to the presumption of truth.'” McCullough, 907 F.3d at 1333 (quoting Iqbal, 556 U.S. at 681).

         The issue to be decided when considering a motion to dismiss is not whether the claimant will ultimately prevail, but “whether the claimant is entitled to offer evidence to support the claims.” Scheuer v. Rhodes, 416 U.S. 232, 236 (1974), overruled on other grounds by Davis v. Scheuer, 468 U.S. 183 (1984). The factual allegations in a complaint “must be enough to raise a right to relief above the speculative level” and cannot “merely create[] a suspicion [of] a legally cognizable right of action.” Twombly, 550 U.S. at 545, 555 (second alteration in original). Finally, complaints that tender “‘naked assertion[s]' devoid of ‘further factual enhancement'” will not survive against a motion to dismiss. Iqbal, 556 U.S. at 678 (quoting Twombly, 550 U.S. at 557) (alteration in original). Stated differently, the complaint must allege enough facts “to raise a reasonable expectation that discovery will reveal evidence” supporting a claim. Twombly, 550 U.S. at 556. With the foregoing standard in mind, and taking the facts asserted in Plaintiff's Second Amended Complaint as true, the Court rules on Defendants' Motion to Dismiss.

         B. Defendants' Motion to Dismiss [Doc. 48]

         Defendants' Brief in Support of its dismissal motion sets forth ten arguments regarding Plaintiff's claims. See generally [Doc. 48-1]. The first and third arguments are based on procedural grounds-namely a lack of diversity jurisdiction, res judicata, and collateral estoppel. [Id. at pp. 7, 10]. Defendants' second argument, however, discusses Plaintiff's only federal law claim, his EMTALA claim against the defendant hospital. [Id. at p. 9]. In that argument, Defendants assert that EMTALA, in regards to this case, is inapplicable on the basis that EMTALA “does not apply to [the] discharge of a non-emergent, stable patient.” [Id.]. Next, as additional grounds for dismissal of Plaintiff's medical malpractice claims, Defendants argue that Plaintiff failed to file the accompanying medical affidavit as required by Ga. Code Ann. § 9-11-9.1. [Id. at p. 12]. And, finally, Defendants' remaining arguments as to Plaintiff's medical malpractice; libel and slander; harassment; emotional distress; invasion of privacy; invalidation of a hospital lien; and attorney's fees claims all incorporate the traditional motion-to-dismiss standard of failure to state a claim under Federal Rule of Civil Procedure 12(b)(6). See generally [id.].

         C. Jurisdiction

         The Court must determine whether it has subject-matter jurisdiction over this case before it can address any substantive arguments presented by the parties as to Plaintiff's claims. Henderson ex rel. Henderson v. Shinseki, 562 U.S. 428, 435 (2011) (“[F]ederal courts have an independent obligation to ensure that they do not exceed the scope of their jurisdiction, and therefore they must raise and decide jurisdictional questions that the parties either overlook or elect not to press.”). The claims presented in this case potentially invoke two avenues by which a case may be filed in federal court: federal-question jurisdiction and diversity jurisdiction.

         1. Federal Question Jurisdiction Under 28 U.S.C. § 1331

         As a preliminary matter, the Court rules on Plaintiff's EMTALA claim before discussing Defendants' diversity of citizenship concerns and their other jurisdictional and procedural arguments as to Plaintiff's remaining state-law claims.

         As previously alluded to, Plaintiff's EMTALA claim is his only claim invoking federal-question jurisdiction under 28 U.S.C. § 1331, [8] which would normally give the Court original jurisdiction over this case. In light of this Court's duty to undertake an independent inquiry as to its jurisdiction, it finds that it lacks federal-question jurisdiction as to Plaintiff's EMTALA claim under Rooker v. Fidelity Trust Co., 263 U.S. 413 (1923) and D.C. Court of Appeals v. Feldman, 460 U.S. 462 (1983). See Pate v. Chilton Cty. Bd. of Educ., 853 F.Supp.2d 1117, 1128 (M.D. Ala. Jan. 4, 2012) (citing Ebrahimi v. City of Huntsville Bd. of Educ., 114 F.3d 162, 165 (11th Cir. 1997) (“Federal courts have an independent duty to determine whether they have jurisdiction and to police the boundaries of their jurisdiction.”)); see also Hoblock v. Albany Cty. Bd. of Elections, 422 F.3d 77, 83 (2d Cir. 2005) (“The district court raised Rooker-Feldman sua sponte . . . .”).

         “Where a federal suit follows a state suit, the former may be prohibited by the so-called Rooker-Feldman doctrine in certain circumstances.” Hoblock, 422 F.3d at 83. The United States Supreme Court has observed that the Rooker-Feldman doctrine “recognizes that [while] 28 U.S.C. § 1331 is a grant of original jurisdiction, [it] does not authorize district courts to exercise appellate jurisdiction over state-court judgments, which Congress has reserved to th[e] [United States Supreme Court].” Sophocleus v. Ala. Dep't of Transp., 170 Fed.Appx. 608, 610 (11th Cir. 2005) (citing Exxon Mobil Corp. v. Saudi Basic Indus. Corp., 544 U.S. 280, 292 (2005)); see also 28 U.S.C. § 1257(a). After due consideration and for the reasons that follow, the Court finds the Rooker-Feldman doctrine controls so that it does not have federal subject-matter jurisdiction over Plaintiff's EMTALA claim.

         Rooker stands for the proposition that “a United States District Court has no authority to review final judgments of a state court in judicial proceedings.” Wood v. Orange Cty., 715 F.2d 1543, 1546 (11th Cir. 1983) (quoting D.C. Court of Appeals v. Feldman, 460 U.S. 462, 467 (1983)). Cases are subject to the Rooker-Feldman doctrine if: (1) the federal-court plaintiff lost in state court; (2) the federal-court plaintiff complains of injuries caused by a state-court judgment; (3) the plaintiff's federal suit invites district-court review and rejection of the state-court judgment; and, (4) the state-court judgment was “rendered before the [district-court] proceedings commenced.”[9] Hoblock, 422 F.3d at 85. Despite Plaintiff's clear allegation that Navicent Health's actions violated EMTALA, such a claim raised in this Court (a United States District Court)-in light of the circumstances surrounding Plaintiff's state and federal cases-“complain[s] of [an] injury [caused] by” the Superior Court of Bibb County (a state court) and prompts a Rooker-Feldman analysis. Id. at 88.

         a. The Substantive Rooker-Feldman Requirements

         At the outset, and in order to ensure Rooker-Feldman's applicability to Plaintiff's EMTALA claim, the Court first details the doctrine's substantive requirements. Embedded in the Rooker-Feldman doctrine is the principle, expressed by Congress in 28 U.S.C. § 1257, that within the federal judicial system, only the United States Supreme Court may review state-court decisions (aside from habeas review[10]). Id. at 85; see also Casale v. Tillman, 558 F.3d 1258, 1260 (11th Cir. 2009) (per curiam), infra. This principle “animates the two substantive requirements for Rooker-Feldman's application outlined in Exxon Mobil: [(1)] the federal plaintiff must complain of injury from a state-court judgment; and [(2)] the federal plaintiff must seek federal-court review and rejection of the state-court judgment.” Hoblock, 422 F.3d at 85.

         The Second Circuit Court of Appeals in Hoblock

points out that 28 U.S.C. § 1257 (and thus Rooker-Feldman) does not deprive a district court of subject-matter jurisdiction simply because a party attempts to litigate in federal court a matter previously litigated in state court. If a federal plaintiff ‘present[s] some independent claim, albeit one that denies a legal conclusion that a state court has reached in a case to which he was a party . . ., then there is jurisdiction and state law determines whether the defendant prevails under principles of preclusion.'

Id. at 86 (quoting Exxon Mobil, 544 U.S. at 293) (alteration in original) (emphasis added). Stated differently, if the federal plaintiff presents an independent claim then the court can exercise subject-matter jurisdiction and Rooker-Feldman cannot bar the claim. Independent claims are outside of Rooker-Feldman's reach even if they involve the identical subject matter and parties as the previous state-court suit. Id. Nevertheless, the defendant may still prevail, but state law will determine whether the plaintiff's federal suit is subject to preclusion. Id.; see also Section (C)(1)(c)(i) and (ii), infra.

         By that same token, if the plaintiff presents, in federal court, a non-independent claim, then Rooker-Feldman will, subject to the doctrine's procedural requirements, bar the plaintiff's suit due to a lack of jurisdiction. See Hoblock, 422 F.3d at 86-87. A claim's status as either independent or non-independent is adjudicated using the “inextricably intertwined”[11] standard. Id. “A claim is inextricably intertwined if it would effectively nullify the [state-court] judgment, or if it succeeds only to the extent that the state court wrongly decided the issues.” Antoine v. Vernin, No. 18-10645, F. App'x, 2018 WL 3860477, at *2 (11th Cir. Aug. 14, 2018) (citing May v. Morgan Cty., 878 F.3d 1001, 1005 (11th Cir. 2017)).

         Initially, a federal claim-like EMTALA-may seem independent because Plaintiff did not assert such claim during his state-court proceedings. However, just presenting a legal theory to a federal court that was not raised in state court cannot insulate the plaintiff's federal suit from Rooker-Feldman if the federal suit complains of injury resulting from a state-court judgment and effectively seeks to have that state-court judgment reversed. Hoblock, 422 F.3d at 86. “[S]uch federal [] claims, even if not raised in state court, are ‘inextricably intertwined' with the challenged state-court judgment . . . and therefore a federal district court lacks jurisdiction over such claims because ‘the district court is in essence being called upon to review the state-court decision.'” Id. (citing Feldman, 460 U.S. at 483-84 n.16). To that end, the Court is tasked with deciding whether Plaintiff's federal suit seeks “review and reversal” of the state-court judgment. Id. at 87. In one sense, no: Plaintiff does not seem to want the Court to evaluate the state court's reasoning or review the substance of the state court's ultimate decision permitting his discharge from the hospital. See Id . However, as explained above, a federal suit is not free from Rooker-Feldman's bar simply because the suit proceeds on legal theories not addressed in state court. Id. at 87.

         Even if what Plaintiff seeks is not a strict “review” of the state court's final order, he does-by virtue of the federal claim enumerated in his Second Amended Complaint- effectively seek reversal. See id; see also [Doc. 42 at ¶ 79 (“The hospital's injunction application of August 9[th], 2017[, ] did not include a scintilla of records, evidence[, ] nor medical statements to support their allegation of irreparable harm, because there was none.”)]. The state court ordered that Plaintiff could be discharged, and now Plaintiff ostensibly wants the federal court to rule that The Medical Center of Central Georgia, Inc. (the petitioner in the earlier superior court case), violated EMTALA because it followed the state-court order. Clearly, The Medical Center of Central Georgia, Inc., could not comply with both the state-court order and Plaintiff's desired federal-court ruling-that he has sufficiently stated an EMTALA claim to withstand a motion to dismiss. Thus, the relief sought in Plaintiff's Second Amended Complaint, “if granted, would seem to ‘reverse' the state-court judgment.” Hoblock, 422 F.3d at 87.

         On the other hand, Hoblock notes that an independent and, therefore, non-barred claim may “den[y] a legal conclusion” reached by a state court. Id. (citing Exxon Mobil, 544 U.S. at 293). The Hoblock court stresses that “[p]recisely what [‘deny a legal conclusion'] means is not clear” from either Exxon Mobil or GASH Ass'ns v. Village of Rosemont, 995 F.2d 726, 728 (7th Cir. 1993) (the original source of the language), “but it suggests that a plaintiff who seeks in federal court a result opposed to the one he achieved in state court does not, for that reason alone, run afoul of Rooker-Feldman.” Id. In hopes of clarifying this phrase, and by extension clarifying the doctrine's applicability, Hoblock tells us that “the key to resolving this uncertainty lies in the second substantive Rooker-Feldman requirement: that federal plaintiffs are not subject to the Rooker-Feldman bar unless they complain of an injury caused by a state judgment.” Id. (second emphasis in original).

         First, this requirement answers why a federal plaintiff cannot escape the Rooker-Feldman bar simply by relying on a legal theory not raised in the state court. Hoblock provides the perfect illustration:

Suppose a state court, based purely on state law, terminates a father's parental rights and orders the state to take custody of his son. If the father sues in federal court for the return of his son on grounds that the state judgment violates his federal substantive due-process rights as a parent, he is complaining of an injury caused by the state judgment and seeking its reversal. This he may not do, regardless of whether he raised any constitutional claims in state court, because only the Supreme Court may hear appeals from state-court judgments.

422 F.3d at 87. This hypothetical scenario is markedly similar to the proceedings involved in this case. “In effect, [Plaintiff], ” by filing his EMTALA claim, “seeks to challenge collaterally the state . . . court proceedings” that gave The Medical Center of Central Georgia, Inc., the authority to discharge him, and this he may not do because “federal courts are not a forum for appealing state[-]court decisions.” Staley v. Ledbetter, 837 F.2d 1016, 1017-18 (11th Cir. 1988) (per curiam); see also Wood, 715 F.2d at 1546 (“[F]ederal review of [state-court] decisions is entrusted solely to the Supreme Court, [the lower federal courts] may not decide federal issues that are raised in state proceedings and ‘inextricably intertwined' with the state court's judgment. Feldman, moreover, indicates that the Rooker bar also operates where the plaintiff fails to raise his federal claims in state court.”) (internal citation omitted)).

         Further, by focusing on the requirement that the state-court judgment be the source of the injury, it is clear how a suit potentially asking a federal court to “den[y] a legal conclusion” could be deemed “independent, ” and therefore unfit for Rooker-Feldman adjudication. Hoblock, 422 F.3d at 87. Assuredly, the Court recognizes “[t]he fact that the state court chose not to remedy the injury does not transform the subsequent federal suit on the same matter into an appeal, [which is] forbidden by Rooker-Feldman, of the state-court judgment.” Id. at 88. However, it does seem obvious that a federal plaintiff cannot avoid Rooker-Feldman simply by clever pleading, such as alleging that actions taken pursuant to a court order violate his rights without ever challenging the state-court order itself. Id. Revisiting Hoblock's child-custody scenario just discussed,

if the state has taken custody of a child pursuant to a state judgment, the parent cannot escape Rooker-Feldman simply by alleging in federal court that he was injured by the state employees who took his child rather than by the judgment authorizing them to take the child. The example shows that in some circumstances, federal suits that purport to complain of injury by individuals in reality complain of injury by state-court judgments.

Id. Still the question remains: when does a federal suit complain of an injury caused by a state-court judgment?

         A federal suit complains of a state-court judgment even if it appears to only claim a purported violation by a third party's actions-in this case, The Medical Center of Central Georgia, Inc.-when in fact, the third party's actions were produced by the state-court judgment. Id. “Where a state-court judgment causes the challenged third-party action, any challenge to that third-party action is necessarily the kind of challenge to the state judgment that only the Supreme Court can hear.” Id.[12]

         As briefly discussed above, presenting a legal theory in the federal suit that was not raised in state court cannot insulate the federal plaintiff's suit from Rooker-Feldman when the federal suit complains of an injury from a state-court's judgment. Id. at 87. In this case, Plaintiff cannot escape Rooker-Feldman by alleging, via EMTALA, that he was injured by hospital personnel (the party who actually discharged him) rather than by the state-court judgment that permitted his discharge. See Id . at 88. Plaintiff had every reasonable opportunity to raise his alleged EMTALA violation during the fervid state court proceedings. May, 878 F.3d at 1005 (“[Rooker-Feldman] does not apply, however, where a party did not have a reasonable opportunity to raise his federal claim in state proceedings.”).

         In fact, a reasonable reading of Plaintiff's Second Amended Complaint shows that Plaintiff clearly made EMTALA arguments in the superior court. For example, Plaintiff claims that The Medical Center of Central Georgia, Inc., “kn[ew] they had already illegally discharged and forced [Plaintiff] out” and that “[i]t was only [Plaintiff], not Navicent, who had the emergency need for court intervention as a result of Navicent's wrongful discharge . . . .” [Doc. 42, at ¶¶ 55, 58]. Secondly, Plaintiff himself unequivocally alleged that “defendants carelessly and without concern for [his] care, sabotaged [his] personal circumstances, knowing that [he] would suffer irreparable harm by what they were doing to him.” [Id. at ¶ 76 (emphasis added)]. Lastly, Plaintiff, at the time of the proceedings in the Superior Court of Bibb County, even presented testimony in which Dr. Matthew C. Smith, M.D., “conceded . . . that [the June 17, 2017, ] discharge of [Plaintiff] was totally improper, dangerous, and ...

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