Catala-Velez v. Metro Santurce Inc, d/b/a Hospital Pava Santurce et al

Filing 72

OPINION AND ORDER denying 31 Motion to Dismiss. Signed by US Magistrate Judge Marcos E. Lopez on 6/19/13. (Lopez, Marcos)

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF PUERTO RICO
FRANK G. CÁTALA VÉLEZ,
Plaintiff,
v.

CIVIL NO.: 12-1923 (MEL)

METRO SANTURCE, INC., et al.,
Defendants.

OPINION AND ORDER
Pending before the court is a motion to dismiss under Federal Rule of Civil Procedure
12(b)(6), filed by defendant Dr. Aida L. Blasini Torres (“Dr. Blasini” or “defendant”). (D.E.
31). Plaintiff filed a response in opposition to the pending motion. (D.E. 38). For the reasons
set forth below, defendant’s motion is denied.
Defendant argues under Rule 12(b)(6) that the allegations against him are insufficient to
support a claim of medical malpractice. When considering a motion to dismiss under Federal
Rule 12(b)(6), the court must limit its focus to the allegations of the complaint. Litton Indus.,
Inc. v. Colón, 587 F.2d 70, 74 (1st Cir. 1978). The inquiry is whether the allegations, accepted
as true, show “a plausible entitlement” to the relief requested. Bell Atl. Corp. v. Twombly, 550
U.S. 544, 559 (2007). To avoid dismissal, a plaintiff must “set forth factual allegations, either
direct or inferential, regarding each material element necessary to sustain recovery under some
actionable legal theory.” Gooley v. Mobil Oil Corp., 851 F.2d 513, 515 (1st Cir. 1988).
Determining whether a complaint makes out a plausible entitlement to relief involves two
steps. See Ocasio Hernández v. Fortuño Burset, 640 F.3d 1, 11-12 (1st Cir. 2011) (citing
Ashcroft v. Iqbal, 556 U.S. 662, 679 (2009)). First, the court should separate a complaint’s

factual allegations from any “legal conclusions couched as fact or threadbare recitals of the
elements of a cause of action,” and disregard the latter. Id. at 12 (quoting Iqbal, 556 U.S. at 678)
(internal quotations omitted). The court then treats non-conclusory factual allegations as true,
“even if seemingly incredible.” Id. Second, the court must determine if the factual content,
taken as a whole, admits of “the reasonable inference that the defendant is liable for the
misconduct alleged.” Id. (quoting Iqbal, 556 U.S. at 678). Only if it does will the complaint
survive a motion to dismiss under Rule 12(b)(6).
Because jurisdiction in this case is based on 28 U.S.C. § 1332 diversity of citizenship,
state law provides the relevant substantive law. Under Puerto Rico law, three elements comprise
the prima facie case for medical malpractice: “the duty owed, the occurrence of an act or
omission constituting a breach of that duty, and a sufficient causal nexus between the breach and
some resultant harm.” Martínez Serrano v. Quality Health Servs. of P.R., Inc., 568 F.3d 278,
285 (1st Cir. 2009) (citing Rolón Alvarado v. Mun’y of San Juan, 1 F.3d 74, 77 (1st Cir. 1993)).
Although the elements of a prima facie case can be “used as a prism to shed light upon the
plausibility of the claim,” a plaintiff does not have to plead facts sufficient to establish a prima
facie case in her complaint. Rodríguez Reyes v. Molina Rodríguez, 711 F.3d 49, 54 (1st Cir.
2013). Therefore the elements of the prima facie case are used here only as a framework in
evaluating plaintiff’s allegations, not as a determinative tool.
Although a significant portion of the complaint’s allegations contain boilerplate and
conclusory language, there are sufficient non-conclusory allegations to survive defendant’s
motion to dismiss. The complaint alleges that defendant evaluated and treated plaintiff’s father
in the emergency department of Pavía Hospital on December 10, 2011. (D.E. 6, ¶¶ 11, 34).
Among the allegations made of Dr. Blasini and the other three named physicians is that

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“[t]he…doctors that treated the patient failed to conduct an adequate physical examination and
assessment of the patient’s condition, including medication he was taking (Coumadin), which
was causing the coagulopathy and bleeding, as demonstrated in the widespread bruising of his
back, left leg and cyanotic tongue.” (D.E. 6, ¶ 27). Additionally, the complaint alleges that
“[d]efendant doctors negligently and carelessly failed to provide Frank Cátala, Sr. with proper
attention and medical care despite the fact that patient Cátala, Sr. had a serious hemorrhage
requiring emergency intervention, including immediate blood and/or plasma transfusions.” (D.E.
6, ¶ 67). In Puerto Rico, a physician’s duty owed to a patient is “[t]hat [level of care] which,
recognizing modern means of communication and education, . . . meets the professional
requirements generally acknowledged by the medical profession.” Morales v. Monagas, 723 F.
Supp. 2d 411, 415 (D.P.R. 2010) (quoting Lama v. Borras, 16 F.3d 473, 478 (1st Cir. 1994)).
Defendant’s motion correctly notes that the complaint does not indicate what the accepted
standard of care is in Dr. Blasini’s specialty (D.E. 31 at 11). Nevertheless, in determining the
sufficiency of pleadings, reviewing courts are asked to “draw on [their] judicial experience and
common sense.” Ocasio Hernández, 640 F.3d at 17 (citing Sánchez v. Pereira Castillo, 590 F.3d
31, 50 (1st Cir. 2009)); Iqbal, 556 U.S. at 679. A reasonable inference can be drawn that a
physician’s duty to a patient in an emergency department includes assessing what medications
have been taken that may contribute to the patient’s symptoms. Similarly, a reasonable inference
can be made that a physician’s duty in treating an individual with “a serious hemorrhage
requiring emergency intervention” may plausibly include such steps as immediate blood or
plasma transfusions. (D.E. 6, ¶ 67). Even though no individual allegation establishes the duty of
physicians in similar circumstances to Dr. Blasini, a reading of the complaint in toto points to

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what that duty is; “[t]here need not be a one-to-one relationship between any single allegation
and a necessary element of the cause of action.” Rodríguez Reyes, 711 F.3d at 55.
The facts alleged also set forth the breach of such a duty and establish a sufficient causal
nexus between the breach and the resultant harm. Alleging that the patient’s death was because
of defendant’s failure to assess the medications taken (e.g., Coumadin) or to order timely blood
or plasma transfusions is enough for this claim to cross from the realm of possibility to that of
plausibility.
Time will tell whether the allegations against Dr. Blasini have merit, but it is improper to
dismiss them at this juncture. Because plaintiff has alleged specific facts that would “plausibly
give rise to an entitlement to relief,” Iqbal, 556 U.S. at 679, defendant’s motion to dismiss (D.E.
31) is hereby DENIED.
IT IS SO ORDERED.
In San Juan, Puerto Rico, this 19th day of June, 2013.
s/Marcos E. López
U.S. Magistrate Judge

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