April 18, 2016 – Samantha Mikeska v. Las Cruces Regional Medical Center, LLC d/b/a Mountain View Regional Medical Center, No. 33,836

IN THE COURT OF APPEALS OF THE STATE OF NEW MEXICO
Opinion Number:
Filing Date: 	APRIL 18, 2016
NO. 33,836
SAMANTHA MIKESKA,
Plaintiff-Appellant,
v.
LAS CRUCES REGIONAL MEDICAL
CENTER, LLC d/b/a MOUNTAIN VIEW
REGIONAL MEDICAL CENTER,
Defendant-Appellee.
APPEAL FROM THE DISTRICT COURT OF DOÑA ANA COUNTY
Douglas R. Driggers, District Judge
The Pickett Law Firm
Mark L. Pickett
Las Cruces, NM
John Grost
El Paso, TX
for Appellant
Madison & Mroz, P.A.
Ada B. Priest
M. Eliza Stewart
Rebecca S. Kenny
Albuquerque, NM
for Appellee

OPINION
ZAMORA, Judge.
{1} 	Plaintiff Samantha Mikeska (Plaintiff) appeals a judgment entered in favor of
Las 	Cruces 	Regional 	Medical 	Center, 	d/b/a 	Mountain 	View 	Medical 	Center
(Defendant) after a jury trial on Plaintiff’s claim under the Emergency Medical
Treatment and Active Labor Act, 42 U.S.C. § 1395dd (2011) (EMTALA). Plaintiff
argues that the district court erred in allowing expert witness testimony concerning the
purpose and scope of the EMTALA, and the corresponding jury instructions. Plaintiff
also argues that the district court erred in instructing the jury to disregard certain
evidence, particularly evidence that Plaintiff was misdiagnosed. We hold that the
district court erred in allowing an expert witness to testify concerning questions of
law. We further hold that the district court erred in allowing testimony and giving
instructions that misstated the law and interjected a false issue into the trial. Last, we
hold that the district court erred in instructing the jury to disregard evidence that
Plaintiff was misdiagnosed. We reverse and remand.
I. 	FACTUAL AND PROCEDURAL BACKGROUND
{2} 	Plaintiff initially visited Defendant’s emergency room twice on the same day,
and was discharged on both occasions after being misdiagnosed with a ruptured
ovarian cyst. Four days later she once again returned to Defendant’s emergency room

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at which point she was accurately diagnosed with a bowel obstruction. Emergency
surgery to remove a portion of her bowel was ultimately required.
{3} 	Plaintiff 	filed 	suit 	against 	Defendant alleging 	that 	Defendant 	provided
inadequate screening and inappropriately discharged her in an unstable condition after
each of her first two visits to the emergency room, in violation of EMTALA.
Plaintiff’s EMTALA claim proceeded to trial. In anticipation of Dr. Paul Bronston’s
testifying on behalf of Defendant, Plaintiff filed a motion to exclude his testimony, but
later withdrew it. Plaintiff subsequently filed a motion in limine to exclude as
irrelevant, any evidence or argument concerning the purpose of the EMTALA. The
district court heard the parties’ arguments on the motion during a pre-trial hearing.
{4} 	At the pre-trial hearing, Plaintiff’s counsel argued that the initial purpose of the
EMTALA is not relevant in determining whether a violation has occurred, because
under the statute all patients must be appropriately screened and discharged in a stable
condition regardless of the patients’ ability to pay. Defendant’s counsel argued that
the statute’s purpose was relevant to its theory that Plaintiff did not receive disparate
screening or treatment. The following exchange took place between the district court
and Plaintiff’s counsel:
Court: 	[T]he [c]ourt’s ruling is that the statute stands for itself, and
any interpretation of it, the meaning, goes to the evidence to be presented
by the parties or the experts as to how they interpret the statute.

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Counsel for Plaintiff: 	And why would the [c]ourt allow an expert to
come in and interpret the law? Isn’t that the position and function of the
[j]udge? I’ve never been in a trial, ever, in which someone came in and
said, [t]his is what the law is, and explained to the jury what the law is.
The jury is there to answer questions.
Court: 	Right.
. . . .
Court: 	I like my ruling. All right. Next.
Counsel for Plaintiff: 	Judge, the fourth point is that [D]efendant[] listed two
witnesses, expert witnesses, who we believe will come in and discuss [the]
EMTALA and what [the] EMTALA requires[.]
Court: 	I thought your co-counsel said that wasn’t the responsibility of the
experts; it was the responsibility of the [c]ourt.
Counsel for Plaintiff: 	Well, I think that’s true.
Court: 	Are you changing your tune?
Counsel for Plaintiff: 	No.
Ultimately, Plaintiff’s motion in limine was denied. 	The district court informed
counsel that Dr. Bronston would be allowed to testify. Defendant presented the expert
testimony of Dr. Paul Bronston concerning the purpose and scope of the EMTALA.
{5} 	In the course of trial, Plaintiff’s counsel reiterated her objection to any evidence
of the patient’s ability to pay or the prohibition of discrimination and questioned the
relevancy of this information in an EMTALA claim. Specifically, at Defendant’s
request and over Plaintiff’s objection, the district court instructed the proposed jury,

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as well as the empaneled jury, on the issue of discrimination based on Plaintiff’s
ability to pay. The district court also instructed the jury, over Plaintiff’s objection, that
medical negligence was not an issue in this case, stating “[y]ou are not to concern
yourselves with [evidence that Plaintiff was misdiagnosed], nor should it have any
bearing on your verdict in this case.” The jury found that Defendant did not violate
the EMTALA in screening or treating Plaintiff during her first two visits to its
emergency room. Plaintiff filed a motion for new trial contending that Dr. Bronston’s
testimony on the history and purpose of EMTALA regarding the ability to pay was
irrelevant. She also argued that Dr. Bronston misled the jury when he testified that
the emergency room doctors’ medical negligence was not to be relied upon in
determining an EMTALA claim. The motion was denied. This appeal followed.
II. 	DISCUSSION
{6} 	On appeal, Plaintiff argues that the district court erred in allowing Dr. Bronston
to express his legal opinions to the jury about the purpose and scope of the EMTALA,
and the legal significance of insurance coverage under the EMTALA. Defendant
argues that Plaintiff either failed to object to Dr. Bronston’s testimony or waived any
objection to the evidence of payment or ability to pay, thereby failing to preserve this
first issue on appeal. While it may have been best practices to raise her objection again
during Dr. Bronston’s testimony, we find that Plaintiff properly preserved this issue

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on appeal and invoked a ruling by the trial court by filing her second motion in limine
to exclude any evidence of the purpose of the EMTALA; objecting to Defendant’s
contentions in the statement of the case instruction about ability to pay; objecting to
Defendant’s proposed instruction on the purpose of EMTALA; and by filing a motion
for new trial. See Benz v. Town Ctr. Land, LLC, 2013-NMCA-111, ¶ 24, 314 P.3d 688
(“To preserve an issue for review on appeal, it must appear that appellant fairly
invoked a ruling of the trial court on the same grounds argued in the appellate
court.”(internal quotation marks and citation omitted)). Plaintiff also contends that the
district court erred in instructing the jury on the elements of an EMTALA claim and
by giving erroneous and misleading instructions on the significance of evidence that
was admitted at trial. We discuss the purpose and scope of the EMTALA, and then
each of Plaintiffs’ contentions in turn.
A. 	The EMTALA
{7} 	The EMTALA was enacted to prevent hospitals from patient “dumping,” that
is “refusing to treat patients who do not have health insurance or are otherwise unable
to pay for services.” Godwin v. Mem’l Med. Ctr., 2001-NMCA-033, ¶ 17, 130 N.M.
434, 25 P.3d 273. It applies to hospitals receiving federal funding from Medicare and
that operate an emergency care department. See § 1395dd(e)(2) and 42 U.S.C.
§ 1395cc (2015). Under the EMTALA, participating hospitals have two primary

6
obligations. See Ingram v. Muskogee Reg’l Med. Ctr., 235 F.3d 550, 551 (10th Cir.
2000). The hospital must first conduct a medical screening examination “to determine
whether the patient is suffering from an emergency medical condition.” Phillips v.
Hillcrest Med. Ctr., 244 F.3d 790, 796 (10th Cir. 2001); see §1395dd(a). When an
emergency medical condition exists, the hospital must “stabilize the patient before
transporting him or her elsewhere.” Phillips, 244 F.3d at 796; see §1395dd(b)(1)(A),
(B). “[A t]ransfer includes [a] discharge.” See Godwin, 2001-NMCA-033, ¶ 20
(internal quotation marks and citation omitted); see also § 1395dd(e)(4).
{8} 	The EMTALA’s private right of action permits recovery in damages where
hospitals fail to comply with these obligations. See § 1395dd(d)(2)(A). Although the
EMTALA was “originally intended to cure the evil of dumping patients who could not
pay for services, the rights guaranteed under EMTALA apply equally to all
individuals whether or not they are insured.” Phillips, 244 F.3d at 796; see Collins v.
DePaul Hosp., 963 F.2d 303, 308 (10th Cir. 1992) (stating that the plaintiff’s ability
to pay did not preclude his action under the EMTALA); see also Summers v. Baptist
Med. Ctr. Arkadelphia, 91 F.3d 1132, 1137 (8th Cir. 1996) (en banc) (“The
[EMTALA] clearly applies to ‘any individual,’ whether insured or not, and, therefore,
the fact that [the defendant’s] motivation in this particular case was obviously not to

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dump an uninsured or indigent patient does not defeat the plaintiff’s action.” (citation
omitted)).
{9} 	The goal of the medical screening examination required by § 1395dd(a) “is to
determine whether a patient with acute or severe symptoms has a life threatening or
serious medical condition.” Godwin, 2001-NMCA-033, ¶ 47 (internal quotation marks
and citation omitted). “[T]he hospital must develop a screening procedure designed
to identify such critical conditions that exist in symptomatic patients and to apply that
screening procedure uniformly to all patients with similar complaints.” Id. (internal
quotation marks and citation omitted). In Godwin, this Court rejected the defendant’s
argument that in order to prove a § 1395dd(a) violation, a plaintiff must present
evidence that the hospital treated him differently in its screening process from other
patients with similar conditions. Godwin, 2001-NMCA-033, ¶¶ 59-60. We held that
“a plaintiff’s proof of the existence of a standard screening procedure for a person
presenting a medical condition, and of a deviation from that standard screening
procedure with respect to that person, is a prima facie showing of inappropriate
screening.” Id. ¶ 59. A plaintiff is not required to prove that he received disparate
treatment. See Gatewood v. Wash. Healthcare Corp., 933 F.2d 1037, 1041 (D.C. Cir.
1991) (“[A] hospital fulfills the appropriate medical screening requirement when it

8
conforms in its treatment of a particular patient to its standard screening procedures.”
(internal quotation marks omitted)).
{10} 	If a hospital determines that a patient 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.
§ 1395dd(b)(1)(A), (B). The United States Supreme Court has held that under
§ 1395dd(b)(1), a plaintiff is not required to show improper motive on the part of the
hospital in order to establish that the hospital failed to provide the necessary
stabilizing treatment for his emergency medical condition. See Roberts v. Galen of
Va., Inc., 525 U.S. 249, 253-54 (1999) (per curiam) (reversing a decision by the Court
of Appeals for the Sixth Circuit, which held that proof of improper motive was
necessary for recovery under § 1395dd(b)’s stabilization requirement). In sum, neither
proof of disparate treatment, nor proof of a hospital’s improper motive is required to
show a violation of § 1395dd of the EMTALA.
B. 	Bronston Testimony
{11} 	Plaintiff argues that the district court erred in allowing Bronston to “misinform”
the jury that the EMTALA is only about providing access to emergency medical care

9
for patients who cannot afford it, and to prevent discrimination. Plaintiff also contends
that Bronston interjected a false issue by improperly referencing her health insurance
coverage. “We review the admission or exclusion of evidence for abuse of discretion.”
Progressive Cas. Ins. Co. v. Vigil, 2015-NMCA-031, ¶ 13, 345 P.3d 1096 (internal
quotation marks and citation omitted), cert. granted, 2015-NMCERT-003, 346 P.3d
1163. “An abuse of discretion will be found when the trial court’s decision is clearly
untenable or contrary to logic and reason.” State ex rel. King v. B & B Inv. Grp., Inc.,
2014-NMSC-024, ¶ 28, 329 P.3d 658 (internal quotation marks and citation omitted).
“Such discretion . . . is a legal discretion to be exercised in conformity with the law.”
Id. (internal quotation marks and citation omitted). When a district court exercises its
discretion in admitting evidence based on a misapprehension of the law, it abuses its
discretion, see State v. Jaramillo, 2012-NMCA-029, ¶ 17, 272 P.3d 682, and our
review is de novo. See State v. Duran, 2015-NMCA-015, ¶ 11, 343 P.3d 207.
1. 	Bronston Testimony Concerning Questions of Law Is Inadmissible
{12} 	Rule 11-702 NMRA provides that an expert witness “who is qualified as an
expert by knowledge, skill, experience, training, or education may testify in the form
of an opinion or otherwise if the expert’s scientific, technical, or other specialized
knowledge will help the trier of fact to understand the evidence or to determine a fact
in issue.” An expert witness “may give his opinion on matters pertaining to his field[,]

10
which concern questions of fact.” Beal v. S. Union Gas Co., 1960-NMSC-019, ¶ 29,
66 N.M. 424, 349 P.2d 337. “Testimony of expert witnesses is, in general, confined
to matters of fact, as distinguished from matters of law.” Id. ¶ 30 (internal quotation
marks and citation omitted).
{13} 	In the present case, Bronston was accepted, without objection, as an expert in
emergency medicine and medical quality management. The focus of his testimony was
on EMTALA and the interpretive guidelines for that federal statute. He gave
appropriate expert testimony interwoven with impermissible legal conclusions.
Bronston testified concerning the history of the EMTALA as an anti-dumping statute.
He explained that EMTALA advances fair and equal treatment for patients, and
requires the hospitals’ screening procedures to be the same for all patients with the
same symptoms. He also discussed how medical practitioners define and apply
EMTALA related terms such as “emergency medical condition” and “reasonable
clinical confidence.”
{14} 	Bronston also testified that the purpose of the EMTALA is to prevent hospitals
from denying emergency medical care to patients without health insurance. According
to Bronston, the EMTALA was enacted to address access to emergency care, not to
address medical malpractice or negligence because there are “other laws and
regulations that were already in place to deal with that.” Bronston repeatedly asserted

11
that the EMTALA is geared toward providing access to care and does not apply to
negligence or malpractice.
{15} 	Bronston also testified that the EMTALA “is . . . about” access to emergency
medical treatment for patients without health insurance and requires uniform
screening for patients with similar symptoms, “regardless of the individual’s ability
to pay.” He repeatedly emphasized that the EMTALA requires physicians not to
screen patients differently based on whether or not they have health insurance. At one
point Bronston commented, “[i]n this case, the patient had insurance anyway[].” On
cross examination, Bronston admitted that the EMTALA protects “any individual”
seeking emergency medical treatment and that the statute does not include any
language concerning the patients’ ability to pay.
{16} 	Concerning his involvement in the present case, Bronston testified that he was
hired to determine if there had been EMTALA violations, and whether Plaintiff had
access to medical care such that she could be evaluated for an emergency condition.
Regarding the deviation in procedure from Plaintiff’s first visit to Defendant’s
emergency room to her second visit, Bronston stated that it was not necessary to
perform the same level of screening on the second visit. Bronston did not testify
regarding Defendant’s medical screening policies or procedures. Nor did Bronston
testify as to whether Defendant deviated from its screening policies and procedures

12
in treating Plaintiff. In fact, Bronston was not familiar with Defendant’s EMTALA
policy at all. Bronston testified that there was no evidence to suggest that Plaintiff did
not receive fair and equal access to medical care. Nevertheless, he concluded that
there was no violation of EMTALA.
{17} 	Plaintiff argues that Bronston’s interpretation of the EMTALA is inaccurate and
misleading to the jury. Plaintiff’s argument illustrates the difficulty with allowing
witnesses to testify to their own interpretation of the law. It has been long established
that opinion testimony seeking to set forth a legal conclusion is inadmissible. See
Beal, 1960-NMSC-019, ¶¶ 30, 32 (“Testimony of expert witnesses is, in general,
confined to matters of fact, as distinguished from matters of law . . . [f]rom a number
of given facts an expert witness may give his opinion as to what may or could have
caused a certain result. For example, a medical expert may state as an opinion that a
certain wound or cut could have been inflicted by a knife or by a rock, but he cannot,
even as an expert, state that a certain individual or group is [or is not] responsible for
what happened.” (internal quotation marks and citation omitted)); see also State v.
Clifford, 1994-NMSC-048, ¶ 20, 117 N.M. 508, 873 P.2d 254 (noting that the district
court has the exclusive province and responsibility of telling the jury whether conduct
is or is not legal); Flagstar Bank, FSB v. Licha, 2015-NMCA-086, ¶ 22, 356 P.3d
1102 (holding that an affidavit in which the affiant made legal conclusions was

13
properly excluded); State v. Elliott, 2001-NMCA-108, ¶ 22, 131 N.M. 390, 37 P.3d
107 (recognizing that opinion testimony is inadmissible when it seeks to state a legal
conclusion); G & G Servs., Inc. v. Agora Syndicate, Inc., 2000-NMCA-003, ¶ 46, 128
N.M. 434, 993 P.2d 751 (holding that testimony concerning insurance law in general,
offered by the insurer’s expert witness, who was an attorney, was properly excluded
because that testimony would have violated rule prohibiting opinion testimony that
states legal conclusion). An expert witness permitted to testify to the meaning and
application of a statute conveys what may be an erroneous legal standard to the jury
and invades the court’s province in determining and instructing the jury on the
applicable law. See Beal, 1960-NMSC-019, ¶ 33 (“Whatever liberality may be
allowed in calling for the opinions of experts or other witnesses, they must not usurp
the province of the court . . . by drawing conclusions of law[.]” (internal quotation
marks and citation omitted)). Accordingly, we conclude that the district court abused
its discretion in allowing Bronston to give his expert opinion on the purpose and scope
of the EMTALA.
2. 	Bronston’s Testimony on the Purpose and Scope of the EMTALA
Conveyed an Erroneous Legal Standard to the Jury
{18} 	Plaintiff argues that by repeatedly testifying that the purpose of the EMTALA
is to provide access to care for uninsured or indigent patients, and that the EMTALA

14
is not applicable to claims of negligence or malpractice, Bronston conveyed an
erroneous and irrelevant legal standard to the jury. We agree.
{19} 	In Godwin, this Court recognized that, “in regard to screening, liability must be
based on more than a mere misdiagnosis.” 2001-NMCA-033, ¶ 64 (internal quotation
marks and citation omitted). However, we also recognized that “[a] failure to examine
or test pursuant to a standard screening procedure might support a medical malpractice
claim under [s]tate law and at the same time also constitute evidence [sufficient] to
support a claim for failure to give an ‘appropriate medical screening’ under [the
EMTALA].” Id. (internal quotation marks and citation omitted). “The spheres of
medical malpractice and failure to provide an appropriate medical screening may
overlap.” Id. ¶ 66. Following the logic of Godwin, evidence of negligence or medical
malpractice may also constitute evidence of a failure to stabilize an emergency
condition, under § 1395dd(b)(1). Thus, evidence of negligence or malpractice may
also be evidence of an EMTALA violation under § 1395dd(a) and (b), and such
evidence cannot be entirely disregarded as irrelevant to an EMTALA claim. See, e.g.,
Godwin, 2001-NMCA-033, ¶ 65 (noting that “if a hospital acts consistently with its
standard screening procedures it is not liable even if those procedures are deficient
under state medical malpractice law” (alteration, internal quotation marks, and citation
omitted)).

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{20} 	Bronston testified that the EMTALA is only applicable to patients that have
been denied access to care, that negligence and medical malpractice are completely
separate from EMTALA claims, and are addressed by separate statutes and
regulations. Bronston’s expert testimony as to his interpretation of the statute
potentially confused and misled the jury about the applicable legal standard and what
evidence was relevant to Plaintiff’s EMTALA claim.
3. 	Bronston Improperly Raised the Issue of Plaintiff’s Insurance Coverage
{21} 	Plaintiff argues that Bronston improperly raised the issue of her insurance
coverage. Bronston testified concerning appropriate medical screening for an
emergency medical condition under the EMTALA, explaining that the determination
as to whether an emergency medical condition exists is within the discretion of the
physician, and that the EMTALA requires that the determination be made “in a
nondiscriminatory way. In other words, not to judge it differently because people have
insurance or don’t have insurance.” As noted earlier, Bronston then commented, “[i]n
this case, the patient had insurance anyway[].”
{22} 	As 	previously 	discussed, 	in 	order 	to 	make 	a 	prima 	facie 	showing 	of
inappropriate screening, the plaintiff must show “the existence of a standard screening
procedure for a person presenting a medical condition, and of a deviation from that
standard screening procedure with respect to that person.” Godwin, 2001-NMCA-033

16
¶ 59. “The question is not whether a plaintiff has insurance, or whether he was refused
screening because of lack of insurance, but, rather, whether he was afforded an
appropriate medical screening examination.” Summers, 91 F.3d at 1137 (internal
quotation marks omitted). Thus, a patient’s ability to pay for emergency medical care
and the question of whether Mikeska did or did not have health insurance was of no
consequence to her EMTALA claim. Bronston’s testimony regarding patients’ ability
to pay and regarding Plaintiff’s health insurance coverage was irrelevant to Plaintiff’s
EMTALA claim and interjected a false issue into the trial.
C. 	Jury Instructions
{23} 	Plaintiff challenges three of the district court’s instructions to the jury. We
review the district court’s instructions to the jury de novo. See Benavidez v. City of
Gallup, 2007-NMSC-026, ¶ 19, 141 N.M. 808, 161 P.3d 853 (“We review jury
instructions de novo to determine whether they correctly state the law and are
supported by the evidence introduced at trial.” (internal quotation marks and citation
omitted)). We review jury instructions to determine whether a reasonable juror would
have been confused or misdirected by the instruction. See Chamberland v. Roswell
Osteopathic Clinic, Inc., 2001-NMCA-045, ¶¶ 15-16, 130 N.M. 532, 27 P.3d 1019.
1. 	Instruction 19

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{24} 	Instruction 19 reads: “This is a claim of a violation of the [EMTALA], which
is a federal law that prevents participating hospitals from declining treatment to
patients based on an inability to pay or based upon race, gender[,] or national origin.”
Defendant argues that the instruction misstates the law and interjects the false issue
of a patient’s ability to pay into the trial. We agree.
{25} 	The EMTALA is a federal law that requires a hospital emergency department
to provide an appropriate medical screening examination to any individual seeking
emergency medical treatment. See § 1395dd(a). It also requires that any individual
suffering from an emergency medical condition be stabilized before being discharged
or transferred from the emergency department. See § 1395dd(b). The initial purpose
of the EMTALA, the hospitals’ motivation for any improper screening, and the
patients’ ability to pay are not reflected in the language of the statute and as we
previously discussed, are not relevant to the determination of whether an EMTALA
violation has occurred. Therefore, an instruction to the jury that the function of the
EMTALA is to prevent the denial of care based on the ability to pay, among other
things, is neither justified by evidence nor by theory and led to “the interjection of a
false issue into the trial.” See Torres v. El Paso Elec. Co., 1999-NMSC-029, ¶ 22, 127
N.M. 729, 987 P.2d 386 (internal quotation marks and citation omitted), overruled on
other grounds by Herrera v. Quality Pontiac, 2003-NMSC-018, 134 N.M. 43, 73 P.3d

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181; Archibeque v. Homrich, 1975-NMSC-066, ¶ 9, 88 N.M. 527, 543 P.2d 820 (“We
have held that it is error to instruct on issues which are unsupported by the evidence
or which present a false issue.”); State ex rel. State Highway Comm’n v. Atchison,
Topeka & Santa Fe Ry. Co., 1966-NMSC-146, ¶ 4, 76 N.M. 587, 417 P.2d 68 (“It is
well established that it is error to instruct on a proposition of law not supported by the
evidence, or which presents a false issue.”). We conclude that Instruction 19 misstates
the law and is not relevant to the determination of whether an EMTALA violation
occurred. Accordingly, we conclude that its usefulness is outweighed by its potential
to confuse and misdirect the jury. See Chamberland, 2001-NMCA-045, ¶¶ 15-16.
2. 	Instructions 21 and 22
{26} 	Plaintiff contends that Instructions 21 and 22 served to mislead the jury about
which evidence they could consider in determining whether an EMTALA violation
occurred. Instruction 21 states:
This case is related solely to [P]laintiff’s claims of EMTALA violations.
The medical negligence case against the physicians was a separate case
that was decided by another jury. This is not a medical malpractice
action or a claim for medical negligence against the physicians.
Defendant . . ., denies these claims and contends that [Plaintiff] was
appropriately screened under EMTALA on December 28, 2006[,] and
treated by emergency department physicians who did not diagnose an
emergency medical condition and thereafter appropriately discharged
[Plaintiff] home in a stable condition. (Emphasis added.)

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{27} 	The first part of Instruction 21 appropriately instructs the jury that their
attention should be directed at whether there were violations of EMTALA, not
whether there was medical malpractice or medical negligence. However, our concern
lies with the indistinct denial of “these claims.” This ambiguity not only opens the
door for potentially conflicting considerations, but also sends conflicting messages to
the jury.
{28} 	Throughout the trial, the jury was discouraged from considering evidence of
medical negligence. Prior to jury selection, over Plaintiff’s objection, the jury panel
was instructed that “this is not a medical negligence case against the physicians[, t]he
medical negligence case against the physicians was a separate case that was decided
by a different jury[, and t]he sole issue for [the] jury to decide in this case is whether
the hospital is in violation of the [EMTALA].” Bronston was permitted to testify
numerous times that the EMTALA is not applicable to medical negligence or medical
malpractice.
{29} 	As 	previously 	discussed, 	evidence 	of 	medical 	negligence 	or 	medical
malpractice may overlap with evidence of inappropriate screening or failure to
stabilize an emergency medical condition under § 1395dd(a) and (b). However, the
distinction between evidence of negligence or malpractice and evidence of EMTALA
violations was misstated and overemphasized throughout the trial, creating the

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potential for the jury to be confused and misled concerning the evidence that they
could properly consider.
{30} 	Instruction 22 is also misleading and misdirects the jury. It states:
You have heard evidence that [Plaintiff] was misdiagnosed[.] You are
not to concern yourselves with this information nor should it have any
bearing on your verdict in this case. If [Plaintiff] was appropriately
screened but misdiagnosed in the context of an [EMTALA] claim, it
does not mean a violation occurred.
Beginning with the second sentence, the instruction is in direct conflict with Godwin.
See Godwin, 2001-NMCA-033, ¶ 64 (“[F]ailure to examine or test pursuant to a
standard screening procedure might support a medical malpractice claim under [s]tate
law and at the same time also constitute evidence of differential treatment sufficient
to support a claim for failure to give an appropriate medical screening under the
[EMTALA].” (alteration, internal quotation marks, and citation omitted)). The jury
is allowed to consider evidence of the misdiagnosis, but only to the extent, if any, that
it applies to the issues of whether Plaintiff received the appropriate medical screening
examination, or whether Defendant failed to stabilize Plaintiff before her discharge.
{31} 	We conclude that Instruction 21 with Instruction 22 should not have been given.
See Atchison, Topeka & Santa Fe Ry. Co., 1966-NMSC-146, ¶ 6 (“Instructions[,]
which are repetitious[,] or which unduly emphasize certain portions of the case should
not be given.”); see also Dunleavy v. Miller, 1993-NMSC-059, ¶ 22, 116 N.M. 353,

21
862 P.2d 1212 (holding that an instruction that was “unnecessary and potentially
confusing and serves to overemphasize one portion of the case” was improperly
given).
III. 	CONCLUSION
{32} 	In conclusion, we hold that the district court erred in allowing an expert witness
to testify concerning questions of law. We further hold that the district court erred in
allowing testimony and instructing the jury concerning the EMTALA’s initial purpose
and patients’ ability to pay, and by allowing testimony and instructing the jury to
disregard evidence of medical malpractice or medical negligence on Plaintiff’s
misdiagnosis. For these reasons, we reverse and remand for further proceedings.
{33} 	IT IS SO ORDERED.
M. MONICA ZAMORA, Judge
WE CONCUR:
MICHAEL E. VIGIL, Chief Judge
J. MILES HANISEE, Judge