Negron-Colon et al v. Hospital Episcopal San Lucas et al

Filing 72

OPINION AND ORDER GRANTING 56 MOTION for Summary Judgment filed by Hospital Episcopal San Lucas; GRANTING 64 MOTION to Dismiss/Lack of Jurisdiction as to Felix Ruben Negron-Colon, Evelyn Collazo-Gonzalez, Conjugal Partnership Negron-Collazo, Feli x R. Negron-Collazo, Evelyn Negron-Collazo, Linnette Negron-Collazo, filed by Luis Hernandez-Ortiz. We DISMISS Plaintiffs' complaint in its entirety as to all Defendants. Judgment shall enter accordingly. Signed by Chief Judge Jose A Fuste on 8/30/2010.(mrj)

Negron-Colon et al v. Hospital Episcopal San Lucas et al

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U N IT E D STATES DISTRICT COURT D IS T R IC T OF PUERTO RICO F É L IX RUBÉN NEGRÓN-COLÓN, et al., P la in tif f s , v. H O S P IT A L EPISCOPAL SAN LUCAS, e t al., D e f e n d a n ts .

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O P I N I O N AND ORDER P la in tif f s , Félix Rubén Negrón-Colón, Evelyn Collazo-González, their conjugal p a rtn e rs h ip , and their three children, Félix R., Evelyn, and Linnette Negrón-Collazo, bring this a c tio n against Defendants, Hospital Episcopal San Lucas ("HESL"); Dr. Luis Hernández-Ortiz, L u z E. Cruz-Torres, and their conjugal partnership; Seguros Triple S, Inc.; Puerto Rico E m e rg e n c y Group; Caribbean Emergency Group; and various unknown parties, alleging v io la tio n s of the Emergency Medical Treatment and Active Labor Act ("EMTALA"), 42 U.S.C. § 1395dd, and personal injury claims under Puerto Rico law, 31 L.P.R.A. § 5141 (1993). (D o c k e t No. 33.) Defendant HESL moves for summary judgment. (Docket No. 56.) Plaintiffs o p p o s e (Docket No. 62), and HESL replies (Docket No. 67). Plaintiffs surreply. (Docket N o . 68.) Defendant Dr. Hernández-Ortiz moves to dismiss supplemental claims against him. (D o c k e t No. 64.)

Dockets.Justia.com

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I. F a c tu a l and Procedural Summary W e derive the following facts from the parties' motions, statements of uncontested m a te ria l facts, and exhibits. (Docket Nos. 56; 57; 62; 63; 67; 68.) A t 5:45 p.m. on January 20, 2007, Félix Rubén Negrón-Colón arrived at the emergency ro o m of HESL in Ponce, Puerto Rico, suffering from a week-long headache. Shortly after N e g ró n -C o ló n 's arrival, nurse triage established that he had a blood pressure of 204/97. At 6 :0 5 p.m., he was evaluated by Dr. Hernández-Ortiz, and a CT scan was ordered, with a n e g a tiv e result. At this time, his blood pressure was listed again as 204/97. Dr. HernándezO rtiz made a preliminary diagnosis of headache and high blood pressure. He prescribed m e d ic a tio n and a reevaluation of blood pressure. At 9:00 p.m., Negrón-Colón's blood pressure w a s measured at 223/94. Dr. Hernández-Ortiz prescribed additional medication. Sometime b e tw e e n 11 and 11:20 p.m., Negrón-Colón's blood pressure was measured for a third time and re c o rd e d as 190/85. He was then discharged. O n the following night, Negrón-Colón returned to HESL's emergency room and was d ia g n o s e d with a hypertensive crisis and admitted into the intensive care unit by Dr. María V a le n tín . Negrón-Colón was eventually diagnosed with oculomotoral paralysis. P la in tif f s filed suit in January 2008, alleging that the care Negrón-Colón received from H E S L on January 20, 2007, violated EMTALA and Puerto Rico law. (Docket No. 1.) An a m e n d e d complaint followed. (Docket No. 33.) On March 2 and 6, 2009, HESL deposed

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P la in tif f s ' expert witness, Dr. Edwin Miranda-Aponte. In his deposition, Dr. Miranda-Aponte a g re e d with HESL's definition of "hypertensive crisis" as requiring a blood pressure greater th a n 220/120 and "usually diastolic over 140." (Docket No. 57-4 at 15, 18.) After reviewing th e three blood pressure readings listed in Negrón-Colón's patient record for January 20, 2007, D r. Miranda-Aponte agreed with HESL's assertion that Negrón-Colón did not suffer from an e m e rg e n c y medical condition on that night. (Id. at 27­28.) This assessment was supported by Dr. María Valentín's deposition. Addressing the " n e u ro lo g ic a l deficit" experienced by Negrón-Colón on January 21, Dr. Valentín agreed that th is deficit was a "change in the clinical picture that the patient had the previous day" and " m a n if e s te d itself after discharge and while the patient was at his house during January 21st." (D o c k e t No. 67-7 at 6.) P la in tif f s ' deposition testimony regarding Negrón-Colón's blood pressure on the night o f January 20 does not contradict HESL's patient record. Negrón-Colón stated that his blood p re s s u re was taken three times that night, with a final reading of 190/85 at 11:20 p.m. (Docket N o . 67-8 at 3.) The deposition of his son, Félix Negrón-Collazo, corroborates this sequence: " [ W ]h e n I left they had taken his blood pressure again around 9:30, 10:00 or 11:00. I really d o n 't remember the time very well, but it had come down from two hundred and twenty s o m e th in g to 190 by then." (Docket No. 67-9 at 2.) Furthermore, the deposition of his d a u g h te r, Evelyn Negrón-Collazo, states that the last blood pressure reading taken was 190. (D o c k e t No. 67-10 at 2.)

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H E S L sent an e-mail to Plaintiffs on May 6, 2009, transmitting a transcript of D r. Miranda-Aponte's deposition, as had been stipulated prior to the deposition. HESL moved f o r summary judgment on September 17, 2009 (Docket No. 56), and Plaintiffs opposed (Docket N o . 62). HESL replied to Plaintiffs' opposition (Docket No. 67), and Plaintiffs surreplied (D o c k e t No. 68). Dr. Hernández-Ortiz filed a separate motion to dismiss the supplemental c la im s against him. (Docket No. 64.) II. S u m m a r y Judgment Under Rule 56(c) W e grant a motion for summary judgment "if the pleadings, the discovery and disclosure m a te ria ls on file, and any affidavits show that there is no genuine issue as to any material fact a n d the movant is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(c). A factual d isp u te is "genuine" if it could be resolved in favor of either party and "material" if it potentially a f f e c ts the outcome of the case. Calero-Cerezo v. U.S. Dep't of Justice, 355 F.3d 6, 19 (1st Cir. 2 0 0 4 ). T h e movant carries the burden of establishing that there is no genuine issue as to any m a te ria l fact. Celotex Corp. v. Catrett, 477 U.S. 317, 325 (1986). The movant does not need to produce evidence to prove the absence of a genuine issue of material fact but may instead p o in t to a lack of evidence supporting the nonmovant's case. Id. In evaluating a motion for s u m m a ry judgment, we must view the record in the light most favorable to the nonmovant, and w e must consider the entire record of admissible evidence. See Reeves v. Sanderson Plumbing

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P ro d s ., 530 U.S. 133, 150­51 (2000). "Once the moving party has made a preliminary showing th a t no genuine issue of material fact exists, the nonmovant must produce specific facts, in s u ita b le evidentiary form, to establish the presence of a trialworthy issue." Clifford v. Barnhart, 4 4 9 F.3d 276, 280 (1st Cir. 2006) (internal quotation marks omitted). The nonmovant "may not re ly merely on allegations or denials in its own pleading; rather, its response must . . . set out s p e c if ic facts showing a genuine issue for trial." Fed. R. Civ. P. 56(e)(2). III. A n a ly s is

P la in tif f s allege that HESL violated EMTALA by providing an inadequate medical s c re e n in g and failing to stabilize Negrón-Colón before discharging him. E M T A L A requires hospital emergency rooms to conduct an "appropriate medical s c re e n in g examination . . . to determine whether or not an emergency medical condition . . . e x is ts ." 42 U.S.C. § 1395dd(a). An "appropriate medical screening" under § 1395dd(a) is one " re a s o n a b ly calculated to identify critical medical conditions that may be afflicting symptomatic p a tie n ts and provides that level of screening uniformly." Correa v. Hosp. San Francisco, 69 F .3 d 1184, 1192 (1st Cir. 1995). EMTALA, however, is not a cause of action for medical m a lp ra c tic e . Id. While either a refusal to screen or a policy that results in a disparate screening v io la te s EMTALA, a flawed medical screening, standing alone, does not. See id. at 1192­93.

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If a patient is found to have an emergency medical condition, a hospital must stabilize th e condition prior to transfer, subject to certain exceptions. § 1395dd(b)­(c). An "emergency m e d ic a l condition" is one that "manifest[s] itself by acute symptoms of sufficient severity . . . s u c h that the absence of immediate medical attention could reasonably be expected to result in -- (i) placing the health of the individual . . . in serious jeopardy, (ii) serious impairment to b o d ily functions, or (iii) serious dysfunction of any bodily organ or part." § 1395dd(e)(1)(A). 1. A d e q u a te Screening

P la in tif f s ' complaint broadly alleged that the medical screening provided by HESL was in a d e q u a te . (Docket No. 33.) HESL has argued that there is no evidence of disparate treatment o r a refusal to treat. (Docket No. 56 at 10­11.) Plaintiffs failed to respond with any evidence d e m o n s tra tin g that HESL refused to follow established screening procedures or applied those p ro c e d u re s disparately. We, therefore, find no genuine issue of material fact as to whether N e g ró n -C o ló n received an appropriate medical screening within the meaning of § 1395dd(a). S e e Correa, 69 F.3d at 1192. 2. Emergency Medical Condition

P la in t i f f s allege that Negrón-Colón's emergency medical condition was not properly s ta b iliz e d before his discharge on January 20, 2007. (Docket No. 33.) HESL presents evidence th a t Negrón-Colón did not exhibit an emergency medical condition, much less a condition that H E S L failed to stabilize. (Docket No. 56.) HESL relies, in part, on Negrón-Colón's hospital re c o rd and the testimony of Plaintiffs' expert witness, Dr. Miranda-Aponte, for the proposition

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th a t Negrón-Colón's blood pressure never reached the point of "hypertensive crisis" before his d isc h a rg e on January 20. Thus, HESL argues, Negrón-Colón's condition was not an emergency m e d ic a l condition under § 1395dd(e)(1)(A). (Docket No. 56 at 11­12.) I n opposition, Plaintiffs argue that HESL's evidence for the lack of an emergency m e d ic a l condition is inadmissible and, therefore, the existence of such a condition remains a tria b le issue. Plaintiffs claim HESL's evidence is inadmissible because: (1) the medical record a p p e n d e d to HESL's motion for summary judgment was possibly tampered with; and (2) the d e p o s itio n transcript of Plaintiffs' expert, Dr. Miranda-Aponte, was not sent to the expert for h is review, as stipulated prior to the deposition, and Plaintiffs were denied an opportunity to c ro s s -e x a m in e him. (Docket No. 63.) F o r the reasons stated below, we find neither of Plaintiffs' arguments meritorious. In lig h t of the evidence before us, we find no genuine issue of material fact as to whether NegrónC o ló n suffered an emergency medical condition on January 20, 2007, and, therefore, HESL is e n title d to summary judgment as to Plaintiffs' EMTALA claim. a. Spoliation of the Medical Record

P la in tif f s first call into question the accuracy of the medical record HESL relies on in its s u m m a ry-ju d g m e n t motion (Docket No. 57-2), when compared to the copy of the medical re c o rd initially provided to Plaintiffs (Docket No. 62-2). The records differ in two ways. First, p a g e two of HESL's patient record contains additional writing under the "Consulted Physician" h e a d in g . Under this heading, both Plaintiffs' and HESL's respective copies contain a blood

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p re s s u re measurement of 190/85. (Docket Nos. 57-2 at 4; 62-2 at 2.) HESL's copy, however, c o n ta in s additional notations next to this measurement providing a time, appearing to be either " 1 1 0 0 pm" or "1120 pm," and an illegible scribble. (Docket No. 57-2 at 4.) Also, HESL's copy in c lu d e s a page, missing from Plaintiffs' copy, titled "Physician's Progress Notes," containing w h a t seem to be Dr. Hernández-Ortiz' handwritten notes. (Docket No. 57-2 at 6.) Plaintiffs c la im that this "substantial suspicious discrepancy" between the two medical records indicates a spoliation of the record submitted by HESL. (Docket No. 62 at 3­4.) W h i le Plaintiffs have raised a suspicion of spoliation, this is not a genuine issue of m a te ria l fact. Even if we were to disregard the suspect portions of the medical record as having b e e n tampered with, additional evidence in the record before us independently supports the p ro p o s itio n that Negrón-Colón was not suffering from a medical emergency on January 20. S p e c if ic a lly, Plaintiffs' own deposition testimony establishes Negrón-Colón's blood pressure re a d in g s on January 20 with a third and final reading of 190/85. (See Docket Nos. 67-8; -9; 1 0 .) b. E x p e r t Deposition

P la in tif f s next challenge the admissibility of their expert witness' deposition on two g ro u n d s : (1) HESL's alleged failure to send Dr. Miranda-Aponte a transcript of his deposition; a n d (2) the denial of an opportunity to cross examine Dr. Miranda-Aponte. (Docket No. 62.) P la in tif f s , however, have waived their right to object to the admissibility of this deposition on e ith e r ground.

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Federal Rule of Civil Procedure 30(e) states that, when requested, a deponent must be a llo w e d thirty days to review his deposition transcript and sign a statement listing any changes to his testimony and the reasons for them. A deponent's signature on the deposition is required o n ly where review was requested and changes were made. See Fed. R. Civ. P. 30 advisory c o m m itte e 's note to 1993 amendments. Objections to the transmittal of a transcript are waived " u n le ss a motion to suppress is made promptly after the error or irregularity becomes known or, w ith reasonable diligence, could have been known." Fed. R. Civ. P. 32(d)(4). H E S L completed its deposition of Dr. Miranda-Aponte on March 6, 2009. HESL did n o t move for summary judgment until September 17, 2009. If the transcript had not been tra n s m itte d to Plaintiffs,1 reasonable diligence surely would have uncovered this irregularity w ith in six months. Thus, any objection on this ground by Plaintiffs is waived under Rule 3 2 (d )(4 ). P la in tif f s next argue that they did not have an opportunity to cross-examine Dr. MirandaA p o n te , and that it is improper for us to consider his deposition. (Docket No. 62 at 2.) HESL c o n te n d s that the deposition was cut short because Plaintiffs insisted they had run out of time, a n d it notes that Plaintiffs had ample time to schedule another deposition of their witness or to h a v e him produce an amended report. (Docket No. 67 at 2­3.)

HESL's submissions demonstrate that its attorney e-mailed Plaintiffs' attorney on May 6, 2009, attaching a copy of the transcript of Dr. Miranda-Aponte's deposition. (Docket No. 67-6.) Plaintiffs have not challenged the authenticity of HESL's e-mail. If Dr. Miranda-Aponte was unable to review the transcript of his deposition, it seems the fault lies with Plaintiffs' attorney.

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F e d e ra l Rule of Civil Procedure 32(d)(3)(B) provides that objections to errors or irre g u la ritie s relating to "the manner of taking the deposition . . . or other matters that might h a v e been corrected at that time" are waived if not made during the deposition itself. A s s u m in g that there is a right to cross-examination in pretrial depositions,2 we find that P la in tif f s have waived any objection based on such a right. Reviewing the full text of D r. Mirada-Aponte's deposition (see Docket Nos. 67-2; -3; -4; -5), we find no objection by P la in tif f s to a deprivation of their right to cross-examine the witness. By failing to object during th e deposition, Plaintiffs have waived any potential objection for lack of cross-examination. S e e Fed. R. Civ. P. 32(d)(3)(B). P la in tif f s raise no other objections to the substance or form of Dr. Miranda-Aponte's d e p o s itio n , nor do they present evidence to contradict his determination that Negrón-Colón did n o t suffer from an emergency medical condition on January 20, 2007. B. S u p p le m e n ta l Claims P la in tif f s allege supplemental claims under Puerto Rico tort law against all Defendants. (D o c k e t No. 33.) As we dismiss Plaintiffs' only federal claim, we decline to consider their s u p p le m e n ta l claims. See 28 U.S.C. § 1367(c)(3); González-De-Blasini v. Family Dept., 377 F .3 d 81, 89 (1st Cir. 2004) (stating that a "district court may decline to exercise supplemental

It is unclear whether a right to cross-examination exists at pretrial deposition. We need not decide this question, however, as we resolve the present dispute on other grounds.

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ju ris d ic tio n " if "the district court has dismissed all claims under which it has original ju ris d ic tio n " ). IV . C o n c lu s io n F o r the reasons stated above, we hereby GRANT both HESL's summary-judgment m o tio n (Docket No. 56) and Dr. Hernández-Ortiz' motion to dismiss supplemental claims (D o c k e t No. 64). We DISMISS Plaintiffs' complaint (Docket No. 33) in its entirety as to all D e f e n d a n ts . I T IS SO ORDERED. S a n Juan, Puerto Rico, this 30th day of August, 2010. s/José Antonio Fusté JOSE ANTONIO FUSTE Chief U.S. District Judge