ORDER GRANTING DEFENDANTS' MOTION TO DISMISS PLAINTIFF'S SECOND AMENDED COMPLAINT

TILMAN E. SELF, III, District Judge.

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.

INTRODUCTION

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].

FACTUAL BACKGROUND AND PROCEDURAL HISTORY

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 Court3 of Bibb County) that Navicent Health's discharge records were not accurate. [Id. at ¶ 16]. Specifically, Dr. Smith testified:

[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

[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].

DISCUSSION

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 F. App'x 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 review10). 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

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:

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,

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 life threatening." [Id. at ¶¶ 15, 87]. Without a doubt, Plaintiff had every reasonable opportunity to file an EMTALA counterclaim,13 as well as his other state-law claims, against The Medical Center of Central Georgia, Inc., however, he chose not to do so.

Notwithstanding the applicability of Rooker-Feldman's two substantive requirements, the doctrine's true applicability will turn on whether Plaintiff's federal suit meets the remaining procedural requirements pertaining to timing and party identity as outlined in Exxon Mobil. Hoblock, 422 F.3d at 89.

b. The Procedural Rooker-Feldman Requirements

Even if a court, in examining Rooker-Feldman's possible application, finds that a federal plaintiff's suit meets the second and third Rooker-Feldman requirements (that the federal suit complains of state-court judgment and the federal suit seeks or invites review or reversal of the state-court judgment) the inquiry cannot stop there. Because the doctrine "does not automatically bar every federal suit that seeks review and rejection of an injury-creating state decision," federal suits—like this one—must also meet the first and fourth "procedural" Rooker-Feldman requirements: (1) the federal suit must follow the state judgment; and (2) the parties in the state and federal suits must be the same. Id. (citing Exxon Mobil, 544 U.S. at 284).

In this case, the first requirement is straightforward. The Superior Court of Bibb County entered its final order granting The Medical Center of Central Georgia, Inc.'s, request for injunctive relief to discharge Plaintiff on August 31, 2017, and Plaintiff commenced his federal suit on December 28, 2017. [Docs. 1; 33-2]. Thus, Rooker-Feldman's first procedural requirement is unquestionably satisfied. However, the second requirement, common party identity, is less easily determined.

In his federal suit, Plaintiff named 11 other defendants in addition to The Medical Center of Central Georgia, Inc., the original state-court petitioner. Therefore, the Court is left with the question of whether these 11 additional defendants could nonetheless be considered common parties for Rooker-Feldman purposes. See Hoblock, 422 F.3d at 89.

Because the Court finds that Plaintiff's EMTALA claim is non-independent of his state-court suit and because Rooker-Feldman is a doctrine of federal subject-matter jurisdiction, the Court must look to federal law to determine whether the former statecourt petitioner, The Medical Center of Central Georgia, Inc., should be treated, for Rooker-Feldman purposes, as if it and its agents were parties to the state-court suit in which Plaintiff was the respondent. See id. at 89. The Court admits that claim and issue preclusion are distinct from the Rooker-Feldman doctrine, but because Plaintiff's EMTALA claim is non-independent, federal preclusion laws guide the federal jurisdictional issue at hand. Id. at 90.

To help guide lower-courts' decisions on this issue, the United States Supreme Court uses the term "privity" to discuss when "a nonparty may be bound by an earlier judgment." Id. (citing Richards v. Jefferson Cty., 517 U.S. 793, 798 (1996)). Using Richards, the Hoblock court posed the party-identity question this way: "is there sufficient privity, as a matter of federal law, between the [11 additional defendants] and [The Medical Center of Central Georgia, Inc.] that the [11 additional defendants] should be considered parties to, and bound by, [The Medical Center of Central Georgia, Inc.'s] state lawsuit against [Plaintiff]?" Id. In Aerojet Gen. Corp. v. Askew, the Fifth Circuit said, "under the [f]ederal law of res judicata a person may be bound by a judgment even though not a party if one of the parties to the suit is so closely aligned with his interests as to be his virtual representative." 511 F.2d 710, 719 (5th Cir. 1975).14 Going further,

Cotton v. Fed. Land Bank of Columbia, 676 F.2d 1368, 1371 (11th Cir. 1982) (quoting Souffront v. La Compagnie des Sucreries de Porto Rico, 217 U.S. 475, 486-87 (1910)); see also Weitz Co. v. Tremco Inc. of Ohio, No. 10-22409-CIV-JORDAN, 2011 WL 13185725, at *4 (S.D. Fla. Mar. 28, 2011) (same). This Circuit's preclusion standards reflect the longstanding and deeply-rooted principle of American law that a party cannot be bound by a judgment in a prior suit in which it was neither a party nor in privity with a party. EEOC v. Pemco Aeroplex, Inc., 383 F.3d 1280, 1286 (11th Cir. 2004) (citing Martin v. Wilks, 490 U.S. 755, 761-62 (1989)). "`Privity' is a flexible term, comprising several different types of relationships and generally applying when a person, although not a party, has his interests adequately represented by someone with the same interests who is a party." Id. (citation omitted).

The crucial point to note in this case is federal law's requirement of identity of interests and adequate representation. See, e.g., Hoblock, 422 F.3d at 92. While the 11 additional defendants were not named in the state-court suit, their interests as agents within the hospital were represented by The Medical Center of Central Georgia, Inc., the sole-named, state-court petitioner. Therefore, it is axiomatic that if the state-court judgment had been in Plaintiff's favor, then each of the 11 additional defendants named in this case would undoubtedly be bound by that judgment and thus, could not have discharged Plaintiff from the hospital. Therefore, Plaintiff's case also satisfies the second procedural element of the Rooker-Feldman doctrine.

In consideration of the foregoing, it is clear that to permit Plaintiff's EMTALA claim to continue, a claim that alleges that The Medical Center of Central Georgia, Inc., should not have discharged him in the manner it did, would be a fundamental desecration of federalism. See Lance v. Dennis, 546 U.S. 459, 463 (2006) (per curiam) (holding that the Rooker-Feldman doctrine prevents the lower federal courts from exercising appellate jurisdiction over cases brought by "state-court losers" effectively challenging "state-court judgments rendered before the district court proceedings commenced"). Any attempt by Plaintiff to unwind the superior court's ruling, due to his dissatisfaction with those proceedings and the outcome from the superior court, must have been brought in the appropriate appellate court. See Casale, 558 F.3d at 1260 ("The Rooker-Feldman doctrine makes clear that federal district courts cannot review [state-court] final judgments because that task is reserved for state appellate courts or, as a last resort, the United States Supreme Court.").

In light of this analysis, Rooker-Feldman principles defeat federal jurisdiction under 28 U.S.C. § 1331 in this case, and Plaintiff's EMTALA claim is barred. Consequently, the Court is not required to address the parties' substantive contentions regarding Plaintiff's EMTALA claim.

c. Ordinary Principles of Preclusion

However, in order to ensure the soundness and completeness of its ruling, the Court now turns to whether Plaintiff's EMTALA claim is barred by ordinary principles of preclusion. Exxon Mobil explains that the narrow Rooker-Feldman inquiry is distinct from the question of whether res judicata (claim preclusion) or collateral estoppel (issue preclusion) will also defeat a plaintiff's suit. Thus, if by some fashion Plaintiff's EMTALA claim could be characterized as an independent claim, an analysis apart from Rooker- Feldman is warranted and the Court looks to state-preclusion law to determine whether Plaintiff's claims would nonetheless be barred. Hoblock, 422 F.3d at 92-93. Because the Full Faith and Credit Act, 28 U.S.C. § 1738, requires federal courts to accord state judgments the same preclusive effect those judgments would have in the courts of the rendering state, Georgia preclusion law applies. Id.

i. Res Judicata (Claim Preclusion)

First, under Georgia law, "[t]he doctrine of res judicata prevents the re-litigation of all claims which have already been adjudicated, or which could have been adjudicated, between identical parties or their privies in identical causes of action." Smith v. Bell, 816 S.E.2d 698, 701 (Ga. Ct. App. 2018) (quoting Setlock v. Setlock, 688 S.E.2d 346, 347 (Ga. 2010)). While res judicata began as a common law rule in Georgia, the Georgia Supreme Court has held that Ga. Code Ann. § 9-12-40 is a codification of Georgia's basic common law rule of res judicata. Coen v. CDC Software Corp., 816 S.E.2d 670, 672 (Ga. 2018). This code section provides:

Id.

As Plaintiff aptly states, Georgia's highest court has explained that in regards to "cause of action" terminology, factual linkage in the subject matter between two cases does not mean that that the second lawsuit will automatically be barred by Ga. Code Ann. § 9-12-40. Coen, 816 S.E.2d at 674; see also [Doc. 61 at p. 5]. "For [res judicata] to act as a bar, `the cause of action in each suit must be identical.'" Coen, 816 S.E.2d at 674 (citations omitted). The Georgia Supreme Court defines "cause of action" as being

Id. (alterations in original) (emphasis added). Specifically, Georgia law looks to the "entire set of facts which give rise to an enforceable claim to determine whether res judicata has been triggered." Id. (internal quotations omitted). Ultimately under Georgia law, to solidify res judicata's applicability, "three prerequisites must be satisfied—(1) identity of the cause of action, (2) identity of the parties or their privies, and (3) previous adjudication on the merits by a court of competent jurisdiction." Id. at 675.

Taking these three requirements into consideration, the same parties (or their privies) are undoubtedly at play in both the state-court action and this case, and the second prong of Georgia's res judicata requirements is satisfied. Id.; see Section (C)(1)(b), supra. Furthermore, the Superior Court of Bibb County, Georgia, is unquestionably "a court of competent jurisdiction." Coen, 816 S.E.2d at 675. As a superior court, it has the authority "[t]o exercise the powers of a court of equity" and as such is vested with the authority to hear injunctive claims of the kind presented in the state-court proceeding as well as "all causes, both civil and criminal." Ga. Code Ann. § 15-6-8; see also Ga. Const. Art. VI, § 1, ¶ 4 ("Each court may exercise such powers as necessary in aid of its jurisdiction or to protect or effectuate its judgments; but only the superior and appellate courts shall have the power to issue process in the nature of mandamus, prohibition, specific performance, quo warranto, and injunction. Each superior court, state court, and other courts of record may grant new trials on legal grounds.").

Lastly, and what seems to be the most contested prong of res judicata's prerequisites, is an examination of "identity of the cause of action." Coen, 816 S.E.2d at 675. Where some of the operative facts between two cases "are different," the second suit is not founded upon the same cause of action as the first, despite the possibility that the two cases arose from the same transaction and contain identical subject matter. Id. at 674 (emphasis added).

Here, the facts presented in Plaintiff's federal suit are not different from the facts presented in the state-court proceeding, despite Plaintiff's contention to the contrary. See [Doc. 61 at p. 6]. Succinctly put, Plaintiff, in both cases argues that discharge is improper. His Second Amended Complaint presents nothing different from what occurred in the state-court case. In fact, as discussed above, see Section (C)(1)(a), supra, Plaintiff clearly presented EMTALA-based arguments in an attempt to prevent his discharge in the earlier state-court proceeding. There is simply nothing different from the operative facts presented in this action when compared to the operative facts previously litigated in state court. Under Georgia law, the cause of action in both suits is identical and, this latter suit is barred by res judicata.15

Furthermore, Georgia's codification of its basic common law rule of res judicata provides additional support and guidance on this narrow preclusion issue. Plaintiff's EMTALA claim is one "which under the rules of law might have been put in issue." Ga. Code Ann. § 9-12-40 (emphasis added). Accordingly, his EMTALA claim is also barred as a compulsory counterclaim that he was required to bring in the state-court proceeding to preserve it. See Bell, 816 S.E.2d at 702. The Georgia Civil Practice Act provides in pertinent part:

Ga. Code Ann. § 9-11-13(a).

In support of his argument, Plaintiff argues that res judicata should not apply because he was "denied the opportunity to submit a responsive pleading, . . . denied the opportunity to testify, . . . denied the chance to present witnesses, . . . and denied discovery." [Doc. 61 at p. 6]. He contends that the state proceeding was "so limited and streamlined" that he could not "have even begun to assert affirmative claims." [Id.]. However, as Defendants point out, Plaintiff cannot show and offers nothing to support that he ever attempted to serve any subpoena, attempted to serve formal discovery, filed a motion to compel the allegedly requested discovery,16 or ever sought a continuance from the state-court proceedings to prepare his "affirmative claims." [Doc. 63 at p. 3]. Clearly, by his own argument, Plaintiff, at the time of the state-court proceeding had certain "affirmative claims" to present. [Doc. 61 at p. 6].

While the Court lacks sufficient knowledge to determine what transpired in the state-court proceeding (aside from the transcript excerpts throughout Plaintiff's Second Amended Complaint), it is clear that Plaintiff had the unequivocal ability and absolute right to bring his EMTALA claim as an "affirmative claim" in the earlier state-court proceeding. In fact, the Second Amended Complaint presents Dr. Smith's testimony demonstrating Plaintiff's arguments against his discharge on EMATALA grounds. See [Doc. 42 at pp. 15-17]. By Plaintiff's own admission, "[a]n EMTALA violation occurs when a hospital discharges a patient in a manner which exposes the patient to imminent material deterioration in their condition." [Doc. 61 at p. 3 (citing Quinney v. Phoebe Putney Mem. Hosp., Inc., 751 S.E.2d 874, 881 n.8 (Ga. Ct. App. 2013) (citing 42 U.S.C. § 1395dd(e)(3)(A)))]. While it is true that Plaintiff did not formally raise an EMTALA violation as a defense, he certainly made countless arguments surrounding this standard. Plaintiff's own filings demonstrate that the state court in no way prevented him from arguing and presenting certain defenses or denied him the opportunity to file any counterclaims. But, even if such scenario is in fact true, Plaintiff's remedy is not in a federal district court, but rather in the appropriate state appellate court or the United States Supreme Court.17

Consequently, assuming that Plaintiff's EMTALA claim is not barred by the Rooker-Feldman doctrine, it is nonetheless clearly a compulsory counterclaim because it involves the same "cause of action" and "transaction or occurrence that [wa]s the subject matter of the opposing party's [(The Medical Center of Central Georgia, Inc.)] claim." Coen, 816 S.E.2d at 674; Ga. Code Ann. § 9-11-13(a). As such, Plaintiff was required to address his alleged EMTALA violation in state court given that the actions he complained about arose from the transaction or occurrence that was the subject of the state-court proceeding.

ii. Collateral Estoppel (Issue Preclusion)

Having determined that res judicata, under Georgia law, and Georgia's compulsory counterclaim statute both apply to bar Plaintiff's EMTALA claim, the Court must determine whether the related doctrine of collateral estoppel (issue preclusion) also applies. The doctrine of collateral estoppel

Salem Crossing Townhomes Homeowners Ass'n, Inc. v. Wagner, ___ S.E.2d ___, 2018 WL 4998235, at *2-3 (Ga. Ct. App. 2018) (quoting Fulton Cty. Tax Comm'r v. Gen. Motors Corp. 507 S.E.2d 772, 778-79 (Ga. Ct. App. 1998)). Going further, Georgia case law provides that collateral estoppel applies to "those issues that actually were litigated and decided in the previous action, or that necessarily had to be decided in order for the previous judgment to have been rendered." Salem Crossing, 2018 WL 4998235, at *3 (citation omitted).

Accordingly, even though Plaintiff did not bring his EMTALA claim in the state-court proceeding, it is clear that the state-court judge found sufficient cause to permit Plaintiff's conditional discharge. See generally [Doc. 33-2]. The Second Amended Complaint presents relevant excerpts from the state-court hearing for the court to determine that the "issue" of EMTALA "was decided in the previous action." See, e.g., [Doc. 42 at pp. 3-11, 15-23]; see also Salem, supra. As Defendants argue and Plaintiff admits, and considering the available excerpts, it is clear that the state-court judge "was concerned about what had happened" and "gave wide latitude for [P]laintiff to assert claims relating to his discharge." [Doc. 63 at p. 3]; see also [Doc. 42 at ¶ 89].18 Taking into consideration what Plaintiff could have conceivably presented in his defense at the state-court hearing or in his post-hearing brief, the state-court judge still ruled in favor of The Medical Center of Central Georgia, Inc., but with the certain conditions as outlined above. Thus, the state-court decision clearly contains issues that show an EMTALA issue "necessarily had to be decided" in order for the state-court judge to even render a decision as to the injunctive relief sought by The Medical Center of Central Georgia, Inc. Salem Crossing, 2018 WL 4998235, at *3 (citation omitted). Again, to permit Plaintiff's EMTALA claim to proceed in this federal lawsuit could invite potential reversal of the state-court decision. In order to reach his ruling, the state-court judge effectively "decided" that any discharge would not violate EMTALA, and Plaintiff, dissatisfied with that judgment, now seeks a different ruling in federal court. Salem Crossing, 2018 WL 4998235, at *3 (citation omitted). This simply is not allowed.

Moreover, Plaintiff (as the defendant/respondent in the state-court proceeding) could have filed his EMTALA counterclaim and then, given the presence of a federal question, removed The Medical Center of Central Georgia, Inc.'s, case to federal court. This he did not do, and as stated numerous times, if Plaintiff felt he had been wronged by the state court's decision, his relief rested with state appellate courts or the United States Supreme Court—not the lower federal courts. See Casale, 558 F.3d at 1260. In addition to the doctrine of res judicata, the issue of an EMTALA claim "was determined in the previous action," thus, collateral estoppel's appositeness under Georgia law, further shows that Plaintiff's EMTALA claim is barred. Salem Crossing, 2018 WL 4998235, at *3 (citation omitted).

In light of the foregoing, the Court rules that Rooker-Feldman defeats the Court's exercise of federal-question jurisdiction. See Wood, 715 F.2d at 1546, supra, Section (C)(1). Additionally, Plaintiff's EMTALA claim is also subject to the procedural bars related to the ordinary principles of preclusion under Georgia law regarding res judicata and collateral estoppel. Accordingly, the Court must DISMISS Plaintiff's EMTALA claim, and thus, need not consider the parties' additional substantive arguments regarding Plaintiff's EMATALA claim pursuant to the traditional standard under Federal Rule of Civil Procedure 12(b)(6).

2. Diversity Jurisdiction Under 28 U.S.C. § 1332

Having determined that the Court cannot exercise federal-question jurisdiction over this case, the Court must consider Defendants' certain jurisdictional concerns related to diversity of citizenship between the parties as to Plaintiff's remaining state-law claims. [Docs. 48-1; 63]. Defendants contend that "it would be appropriate for the Court to conduct a factual inquiry to confirm the existence of facts establishing Plaintiff's domicile in New York." In light of these concerns and because "it is fundamental that parties may not stipulate to federal jurisdiction," the Court held a telephone conference19 inquiring into Plaintiff's domicile. Travaglio v. Am. Exp. Co., 735 F.3d 1266, 1269-70 (11th Cir. 2013); [Doc. 48-1 at pp. 8-9]; [Doc. 38].

Under 28 U.S.C. § 1332:

28 U.S.C. § 1332(a)(1)-(2). The Eleventh Circuit has held that

McCormick v. Aderholt, 293 F.3d 1254, 1257 (11th Cir. 2002) (internal citations omitted); see also Scoggins v. Pollock, 727 F.2d 1025, 1026 (11th Cir. 1984). During the telephone conference, Plaintiff's counsel stated that Plaintiff is not a natural-born citizen of the United States, but he also assured both the Court and opposing counsel that Plaintiff had met the requirements for consideration as an individual "lawfully admitted for permanent residence in the United States." 28 U.S.C. § 1332(a)(2). Plaintiff further stated that he has a residence in New York as reflected by an address listed on this case's civil cover sheet [Doc. 2 at p. 2]. Given that Defendants' counsel took Plaintiff's counsel at his word and offered nothing to refute or disprove the proffered statements, Defendants, as well as the Court, accepted Plaintiff's contentions regarding his resident alien status. Accordingly, the Court found that Plaintiff's domicile20 lies in New York. As such, there is complete diversity among the parties in this case and the Court possesses diversity jurisdiction to rule on Plaintiff's state-law claims.

a. Plaintiff's State-Law Tort Claims

In addition to his EMTALA claim, Plaintiff brings a litany of state-law claims. First, Plaintiff asserts two causes of action (Counts 2 & 3) involving alleged medical malpractice against various medical professionals. [Doc. 42 at pp. 30-34]. The remaining state-law claims include: libel and slander; harassment; emotional distress; and invasion of privacy. [Doc. 42 at pp. 35, 37, 40-42]. However, while these state-law claims arguably do not "complain of a state-court judgment" and therefore, may not prompt a Rooker-Feldman analysis, they most certainly complain of tortious actions allegedly committed by Defendants that arose from the same set of operative facts that gave rise to the previous state-court proceedings. As such, these claims—brought against Defendants in this federal suit—present comparable procedural complexities.

Given the lack of federal-question jurisdiction in this case, the Court (sitting in diversity as to these remaining state-law claims) must apply federal procedural law to determine the claims' preclusive effect. Esfeld v. Costa Crociere, S.P.A., 289 F.3d 1300, 1306 (11th Cir. 2002) ("A federal court sitting in diversity must apply state substantive law and federal procedural law."). Federal procedural law provides the same points as those contained in Georgia's Civil Practice Act. Specifically,

Fed. R. Civ. P. 13(a).

This circuit's predecessor, the Fifth Circuit Court of Appeals, "adopted the `logical relationship' test for determining whether a counterclaim was compulsory. Republic Health Corp. v. Lifemark Hosps. of Fl., Inc., 755 F.2d 1453, 1455 (11th Cir. 1985) (citation omitted). "Under this test, there is a logical relationship [between the opposing party's claim and a potential counterclaim] when `the same operative facts serve as the basis of both claims or the aggregate core of facts upon which the claim rests activates additional legal rights, otherwise dormant, in the [counterclaimant].'" Id. (citation omitted).

1. Medical Malpractice

First, Defendants seek dismissal of Plaintiff's medical malpractice claims (Counts 2 & 3) on the grounds that he failed to file the affidavit required by Ga. Code Ann. § 9-11-9.1. "In federal courts, `state law governs substantive issues, . . . while federal law governs pleading requirements.'" Durden v. Newton Cty., No. 1:14-CV-01163-RWS, 2015 WL 71446, at *2 (N.D. Ga. Jan. 5, 2015) (quoting Brown v. Nichols, 8 F.3d 770, 773 (11th Cir. 1993)). Because the Georgia affidavit requirement for medical malpractice claims is a procedural vehicle, and "not substantive state law," it does not apply in federal courts. Id. (citation omitted). Thus, the Court rejects this argument as a basis for dismissal.

However, it is of vital importance to note that Plaintiff's medical malpractice claims only surround allegations that occurred during the 160-day period he was admitted as a patient. Nothing in Plaintiff's Second Amended Complaint could reasonably be construed as a medical malpractice claim against Defendants, or another third party (such as the skilled nursing facility to which Plaintiff was purportedly discharged) for that matter, after the date of his discharge. Consequently, Plaintiff's allegations that Defendants breached "the[ir] duty under federal law, the law[s] of Georgia, and other applicable laws and medical standards" all arose from the "occurrence" that was the subject matter of The Medical Center of Central Georgia, Inc.'s, original claim in state court. Fed. R. Civ. P. 13(a); [Doc. 42 at p. 30].

Therefore, Plaintiff should have sought to pause the state-court case against him, requested a continuance, regrouped, and then asserted in state court the two medical malpractice claims he now seeks to bring in this lawsuit because they involved "the same operative facts" as those presented in state court. Republic Health Corp., 755 F.2d at 1455; Fed. R. Civ. P. 13(a). Accordingly, the Court DISMISSES Plaintiff's medical malpractice claims (Counts 2 & 3) against Defendants on the grounds that they should have been asserted in state court and are therefore barred as compulsory counterclaims.

2. Libel, Slander, and Harassment

Second, Plaintiff's Second Amended Complaint sets forth claims of libel and slander (Counts 5 & 8, presumably) and a claim of harassment (Count 4). [Doc. 42 at pp 35-40, 42-44]. As structured, Plaintiff's Second Amended Complaint intermingles each of these actions (plus "further emotional distress") within Counts 4, 5, and 8. [Id.]. Specifically, Plaintiff complains that Defendants "maliciously accused [Plaintiff] of being a criminal trespasser" and that Defendants actions "publicly smear[ed] [Plaintiff] as a means to "harass and embarrass" him. [Id. at ¶¶ 166-67]. However, as Plaintiff states, the accusations labeling Plaintiff as a "criminal trespasser" were asserted in The Medical Center of Central Georgia, Inc.'s, state-court petition. [Id. at ¶ 74 ("In their baseless petition, the hospital proudly called [Plaintiff] a criminal trespasser, . . . ." (italics in original))]. Irrespective of Plaintiff's "buzzword-pleading," it is clear that the accusations contained within these claims enjoy absolute privilege21 because they were allegedly made within the course of a legal proceeding. Williams v. Stepler, states:

490 S.E.2d 167, 171 (Ga. Ct. App. 1997) (citing Ga. Code Ann. § 51-5-8). In response, Plaintiff stresses that "privilege extends only to allegations `which are pertinent and material to the relief sought.'" [Doc. 61 at p. 17, n.13 (citing Vito v. Paley, 604 S.E.2d 620, 621 (Ga. Ct. App. 2004)]. However, notwithstanding Plaintiff's argument that Defendants' reliance on Vito is misplaced and that Plaintiff's doctors testified that Plaintiff "was just trying to get better," Plaintiff fails to articulate any reason why such accusations were not "pertinent and material" to the issues presented in the earlier state-court pleadings. 604 S.E.2d at 621; see also [Docs. 33-1; 61 at p. 17 n.13]. Plaintiff's claims include accusations made by The Medical Center of Central Georgia, Inc., that were undoubtedly made within "official court documents" or include "acts of `legal process.'" Stepler, 490 S.E.2d at 171 (citations omitted).

Furthermore, Plaintiff was fully aware of The Medical Center of Central Georgia, Inc.'s, accusations in the earlier proceeding, and under the rules of compulsory counterclaims outlined above, he must have addressed these claims in state court because "the same operative facts serve as the basis" of any claim he should have brought in state court and the claims he currently brings in this action. Republic Health Corp., 755 F.2d at 1455; Fed. R. Civ. P. 13(a). Therefore, the Court finds that Defendants' accusations, including their labeling Plaintiff as a "criminal trespasser," are deemed privileged and, as an additional and alternative basis, barred as compulsory counterclaims. Accordingly, the Court DISMISSES Plaintiff's libel and slander claims (Counts 5 & 8, presumably) as well as his claim for harassment22 (Count 4) given that such claim cannot stand absent some other legally recognized claim.

3. Emotional Distress

Third, Plaintiff's Second Amended Complaint sets forth a claim for emotional distress (Count 6). [Doc. 42 at p. 40]. Notably, this count only makes allegations related to Defendants' alleged "failure to exercise due care" and their knowledge that such a level of care "would cause Plaintiff to suffer severe emotional distress . . . ." [Id. at ¶ 173]. Plaintiff clearly states that "[a]s direct and proximate result of said conduct [he] was caused to sustain serious[] permanent, personal injuries and suffering, including pain, suffering, progressive cognitive decline, distress, depression, mental anguish, humiliation, and other physical and personal losses." [Id. at ¶ 174].

Additionally, it is worth noting that Plaintiff's emotional distress claim stems from, what he describes as a "4-prong conspiracy." [Doc. 61 at p. 13]. Plaintiff argues that

[Id. (emphasis in original)]. To support his four-pronged conspiracy theory, Plaintiff directs the Court to Crisp Reg'l Nursing & Rehab. Ctr. v. Johnson, for the proposition that "displacing [a] patient out of [his] room" constitutes a "[h]ospital staff['s] deliberate disregard for a patient's basic needs and concerns [and] support[s] a finding of intentional infliction of emotional distress." 574 S.E.2d 650 (Ga. Ct. App. 2002). While the court in Crisp Reg'l. found that whether such outrageous conduct caused severe and emotional distress was for determination by "[a] reasonable jury," Defendants, in reply argue that their conduct was "not outrageous" and therefore is not subject to jury determination. Id. at 655; [Doc. 63 at p. 9].

Specifically, Defendants contend that their conduct does not fall within the ambit of the disapproving conduct discussed in Crisp Reg'l. because "[Navicent Health] took the reasonable step of seeking [c]ourt intervention when [Plaintiff] refused discharge plans that the staff presented." [Doc. 63 at p. 9]. As to Plaintiff's first prong—five months of neurological oversight—Defendants show that "[w]hether [Plainitff] needed additional specialists or tests was addressed by [the state court]" which "[would] not substitute its own judgment for that of the medical providers caring for [Plaintiff]." [Id. quoting [Doc. 33-2 at p. 8]]. Taking this into consideration, it appears that the state-court judge already passed ruling as to Plaintiff's emotional distress claim regrading Defendants' purported "failure to exercise due care." [Doc. 42 at p. 40]. Thus, Plaintiff's request of asking this Court to deny dismissal of his emotional distress claim, once again treads the waters of Rooker-Feldman and cannot be adjudicated here as federal district courts cannot exercise appellate jurisdiction over state-court judgments. Sophocleus, 170 F. App'x at 610 (citing Exxon Mobil Corp., 544 U.S. at 292); see also 28 U.S.C. § 1257(a).

Crucially, Plaintiff's allegations, regarding his emotional distress claim like his other tort claims against Defendants, do not present any facts occurring after the discharge itself. In other words, Plaintiff only pleads that what occurred in the events leading up to the discharge created a viable emotional distress claim. Therefore, this state-court claim, like the others, would have been an appropriate counterclaim in the state-court action given that "the same operative facts serve as the basis" for any emotional distress claim, whether asserted in the earlier state-court proceeding, or here. Republic Health Corp., 755 F.2d at 1455; Fed. R. Civ. P. 13(a). Accordingly, the Court DISMISSES Plaintiff's emotional distress claim (Count 6).

4. Invasion of Privacy

Last, Plaintiff brings an invasion of privacy claim (Count 7). [Doc. 42 at pp. 41-42]. The presentment of this claim states that Defendants violated both "Georgia and federal privacy laws" but, as Defendants note, fails to identify neither the state nor the federal law upon which Plaintiff rests his claim. [Id. at p. 42]. As stated above, in the Court's Standard of Review, see Section (A), supra, 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.

It is true that a Plaintiff may certainly use legal conclusions such as, "the [D]efendants did invade and violate [Plaintiff's] privacy rights," and "th[e] conduct by the [D]efendants was specious in violation of both Georgia and federal privacy laws," to structure his complaint, but he must support such conclusions with factual allegations. McCullough, 907 F.3d at 1333 (quoting Iqbal, 556 U.S. at 679). Because Plaintiff's Second Amended Complaint fails to assert on which state and/or federal privacy laws he brings his invasion of privacy claim, it is subject to dismissal under Federal Rule of Civil Procedure 12(b)(6).

Furthermore, as with Plaintiff's other state-tort claims, his invasion of privacy claim should have also been brought as a counterclaim in the earlier state-court proceeding given that it arises from "the same operative facts" under which The Medical Center of Central Georgia, Inc., asserted its claims. Republic Health Corp., 755 F.2d at 1455; Fed. R. Civ. P. 13(a). Therefore, Plaintiff's invasion of privacy claim is subject to dismissal not only because it fails to give Defendants fair notice of what law, either state or federal, they are charged with violating and the factual bases upon which the alleged violation rests (and thereby fails to state a claim under Federal Rule of Civil Procedure 12(b)(6)), but also because the claim is a compulsory counterclaim under Federal Rule of Civil Procedure 13(a). Accordingly, the Court DISMISSES Plaintiff's invasion of privacy claim (Count 7).

b. Plaintiff's Arguments Regarding the Hospital Lien Filed in Bibb, Dougherty,23 and Worth Counties

In his Second Amended Complaint, Plaintiff's ninth cause of action seeks to invalidate a hospital lien "asserting purported claims upon causes of action accruing to the Plaintiff on account of injuries caused by unnamed third parties who caused Plaintiff[] to need care in the [D]efendants' hospital facility." [Doc. 42 at p. 44]. This ninth cause of action rests on the premise that the lien should be invalidated because notice was not provided as required by statute. [Doc. 48-1 at p. 19]. Plaintiff's Second Amended Complaint makes no mention of the county or counties in which The Medical Center of Central Georgia, Inc., filed its lien. However, Defendants, for the sake of clarity—in the instant motion—referenced "Exhibit C," from their first Motion to Dismiss [Doc. 33] Plaintiff's Amended Complaint [Doc. 26]. [Doc. 48-1 at p. 19], In that exhibit, the "Notice of Filing of Hospital Lien" indicates that the liens are filed in Bibb, Dougherty, and Worth counties. [Doc. 33-3].

To start, The Medical Center of Central Georgia, Inc., "provided notice of its intent to claim a lien" "[a]s provided in" Ga. Code Ann. § 44-14-470, on September 19, 2017. [Doc. 33-1 at p. 1]. However, Plaintiff argues that The Medical Center of Central Georgia, Inc., failed to provide written notice to him, and therefore, failed to follow the requirements for perfection of the lien as outlined in Ga. Code Ann. § 44-14-471(a). [Doc. 61 at p. 17]. The method of perfecting an existing lien is as follows:

Ga. Code Ann. § 44-14-471 (2006) (emphasis added).

The Medical Center of Central Georgia, Inc., undoubtedly filed its lien within 75 days of Plaintiff's discharge (Sept. 5, 2017) in Bibb (Oct. 24, 2017), Dougherty (Oct. 23, 2017), and Worth (Oct. 24, 2017) counties. [Doc. 33-3]. Plaintiff's issue is that The Medical Center of Georgia, Inc., "never provided written notice of said or any lien as required by said statute." [Doc. 42 at p. 44]. However, despite the scarce case law regarding validity of hospital liens, the Court concludes that Plaintiff's argument is somewhat misguided and, therefore, premature.

Plaintiff is undoubtedly correct that the lien statute clearly necessitates that "written notice" "shall" be given "to the patient" and "to . . . the persons, firms, corporations, and their insurers claimed by the injured person or the legal representative of the injured person to be liable for damages arising from the injuries." Ga. Code Ann. § 44-14-471(a)(1) (emphasis added). A plain reading of this portion of the statute clearly shows that notice must be given to two different sets of people: the patient and those who may be liable for Plaintiff's injuries. Id. Plaintiff contends that Defendants never gave him notice, and the lien is therefore unenforceable.

However, subsection (b) provides that "[t]he filing of the claim or lien shall be notice thereof to all persons, firms, or corporations liable for the damages, whether or not they received the written notice provided for in [subsection (a)]." Ga. Code Ann. § 44-14-471(b). This subsection acts as somewhat of a saving grace for the lien as to those "persons, firms, or corporations" who may be liable for the damages, but, based on the plain text of the statute, this savings clause does not provide a safe harbor for a hospital's failure to notify the patient of its intent to file a lien.

Moreover, even if it is true that Defendants never provided Plaintiff notice of the lien, there is currently no cause of action against which the lien would operate. Effectively, Plaintiff is asking the Court invalidate a hospital lien that is merely sitting idle with no sign of enforceability on the horizon.24 Because Plaintiff seeks a declaratory judgment that the hospital lien "and any other lien" is invalid (as to him) given Defendants failure to provide written notice to him under Ga. Code Ann. § 44-14-471(a)(1), "[s]trict application of the ripeness doctrine prevents federal courts from rendering impermissible advisory opinions and wasting resources through review of potential or abstract disputes." Nat'l Advertising Co. v. City of Miami, 402 F.3d 1335, 1339 (11th Cir. 2005); [Doc. 42 at p. 44]. Accordingly, for the reasons stated above and until such time as the hospital actually attempts to enforce its lien against a pending settlement between Plaintiff and one liable to him for his damages, the Court is constrained to leave the question of whether Plaintiff has a direct cause of action to invalidate the lien for a later date.25

Therefore, as it stands now, because no such resolute action has been taken, and until such time as The Medical Center of Central Georgia, Inc., seeks to enforce the lien against those who may be liable for damages, its mere filing constitutes notice to those "persons, firms, or corporations" and that is all that is required at this point. Ga. Code Ann. § 44-14-471(b). To put a finer point on the Court's decision, there is simply no "case or controversy" between the Plaintiff and Defendants regarding the validity of the hospital lien because there is no settlement or judgment against which the hospital could attempt to enforce its lien. Thus, Plaintiff's declaratory judgment count is not ripe, assuming that he has a direct cause of action to contest the lien's validity.

In Response to Defendants' attempt to uphold the validity of the hospital lien, Plaintiff argues that "[i]f the defense of res judicata argument has merit, it would bar . . . [D]efendants' own counterclaim for payment of their hospital bill. Under [their] own argument, . . . [D]efendants would be barred from ever litigating their alleged unpaid bill since [they] did not pursue payment in the state court in 2017." [Doc. 61 at p. 9]. This argument, especially considering the contents of this order, merits discussion.

To this point, it is axiomatic that a hospital lien may not be filed until "after the person has been discharged from the facility." Ga. Code Ann. § 44-14-471(a)(2)(A). Clearly, The Medical Center of Central Georgia, Inc., could not have filed its lien at the time of the state-court proceeding based on the fact that Plaintiff had not yet been discharged. As a result, there is nothing to support a res judicata-based argument that Defendants should have litigated the hospital bills in the earlier proceeding.

As explained above, the Court DISMISSES Plaintiff's demand for a declaratory judgment (Count 9) that the hospital lien is invalid because it is not yet ripe.

c. Plaintiff's Claims Regarding Attorney's Fees, Punitive Damages, and Treble Damages

Given the Court's ruling on Defendants' motion, Plaintiff's claims for attorney's fees, punitive damages, and treble damages are likewise due to be dismissed because they are derivative of his underlying Georgia tort law claims. See Love v. WEECCO(TM), No. 1:18-CV-540-TWT, 2018 WL 5044639, at *3 n.28 (N.D. Ga. Oct. 17, 2018) (citing Perkins v. Thrasher, 701 F. App'x 887, 891 (11th Cir. 2017)); see also Lilliston v. Regions Bank, 653 S.E.2d 306, 311 (Ga. Ct. App. 2007) (explaining that dismissal of underlying substantive claims warrants dismissal of derivative claims for punitive damages); Gilmour v. Gates, McDonald & Co., 382 F.3d 1312, 1316 (11th Cir. 2004) (per curiam) (establishing that a claim for attorney's fees under Ga. Code Ann. § 13-6-11 requires an underlying claim). Therefore, Plaintiffs' claims for punitive damages, treble damages, and attorney's fees are also dismissed in light of the Court's ruling.

CONCLUSION

Based on the reasoning described above, the Court DISMISSES Plaintiff's EMTALA claim on the grounds that it is barred by the Rooker-Feldman doctrine and, in the alternative, the doctrines of res judicata and/or collateral estoppel. Furthermore, the Court GRANTS26 Defendants' Motion to Dismiss [Doc. 48] Plaintiff's Second Amended Complaint [Doc. 42] and DISMISSES Plaintiff's state-law claims for medical malpractice; libel and slander; harassment; emotional distress; and invasion of privacy on the grounds that they are barred as compulsory counterclaims under Federal Rule of Civil Procedure 13(a). Finally, Plaintiff's claim to invalidate the lien filed in Bibb, Dougherty, and Worth counties is DISMISSED without prejudice as it is not yet ripe. Consequently, the Court DIRECTS the Clerk of Court to ENTER JUDGMENT for all Defendants and CLOSE this case.

SO ORDERED.