Adams-Erazo et al v. Hospital San Gerardo
Filing
74
MEMORANDUM AND ORDER re 50 motion for summary judgment. The Court DENIES defendant HSG's motion for summary judgment. Signed by Judge Francisco A. Besosa on 07/24/2015. (brc)
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF PUERTO RICO
MAGDONALD ADAMS-ERAZO, et al.,
Plaintiffs,
v.
Civil No. 13-1918 (FAB)
HOSPITAL SAN GERARDO, et al.,
Defendants.
MEMORANDUM AND ORDER
BESOSA, District Judge.
Before the Court is the motion for summary judgment filed by
defendant Hospital San Gerardo (“HSG”).
(Docket No. 50.)
For the
reasons discussed below, the Court DENIES the motion.
I.
PROCEDURAL BACKGROUND
Plaintiffs, who are surviving family members of Eric AdamsRamos (“Adams”), filed suit against HSG, Dr. Ramon Ochoa-Salcedo,
and SIMED pursuant to the Emergency Medical Treatment and Active
Labor Act (“EMTALA”), 42 U.S.C. § 1395dd, and articles 1802 and
1803 of the Puerto Rico Civil Code, P.R. Laws Ann. tit. 31 §§ 514142.
(Docket No. 1.)
Plaintiffs alleged that defendants failed to
screen, diagnose, stabilize, treat, and transfer Adams adequately
when he arrived at the HSG emergency room with multiple gunshot
wounds.
Id.
Pursuant to a joint stipulation by the parties, (Docket
No. 20), the Court dismissed the claims against SIMED on May 12,
2014, (Docket No. 24).
Default was entered against defendant
Civil No. 13-1918 (FAB)
Dr.
Ramon
Defendant
2
Ochoa-Salcedo
HSG
moved
the
on
May
Court
13,
to
2014.
(Docket
dismiss
No.
plaintiffs’
26.)
claims
pursuant to Federal Rule of Civil Procedure 12(b)(6), arguing that
the facts alleged in the complaint did not state an EMTALA claim
and
that
the
jurisdiction
No. 17.)
Court
over
the
should
decline
Puerto Rico
to
tort
exercise
supplemental
law claims.
(Docket
On October 30, 2014, the Court granted HSG’s motion to
dismiss the EMTALA stabilization claim, but denied dismissal of the
EMTALA screening claim and the supplemental Puerto Rico law claims.
(Docket No. 47.)
Defendant HSG now moves for summary judgment pursuant to
Federal Rule of Civil Procedure 56, arguing that the evidentiary
record establishes that there is no genuine dispute of any material
fact on plaintiffs’ EMTALA screening claim.
Defendant
HSG
again
urges
the
Court
to
(Docket No. 50.)
decline
to
exercise
supplemental jurisdiction over plaintiffs’ Puerto Rico law claims.
Id.
Plaintiffs opposed the motion, (Docket No. 54), and HSG
replied, (Docket No. 59).
II.
SUMMARY JUDGMENT STANDARD
A court will grant summary judgment if the moving party shows,
based on materials in the record, “that there is no genuine dispute
as to any material fact and [she] is entitled to judgment as a
matter of law.”
Fed. R. Civ. P. 56(a).
“A dispute is genuine if
the evidence about the fact is such that a reasonable jury could
Civil No. 13-1918 (FAB)
3
resolve the point in the favor of the non-moving party.
A fact is
material if it has the potential of determining the outcome of the
litigation.”
Farmers Ins. Exch. v. RNK, Inc., 632 F.3d 777, 782
(1st Cir. 2011) (quoting Rodriguez-Rivera v. Federico Trilla Reg’l
Hosp. of Carolina, 532 F.3d 28, 30 (1st Cir. 2008)).
At the summary judgment stage, a court must construe the
entire record in the light most favorable to the nonmoving party,
drawing all reasonable inferences in her favor.
Raffaelly, 424 F.3d 112, 117 (1st Cir. 2005).
DePoutot v.
The court refrains
from making credibility determinations and weighing the evidence.
McGrath v. Tavares, 757 F.3d 20, 25 (1st Cir. 2014).
The court
also disregards conclusory allegations and unsupported speculation.
Id.
III.
EMTALA SCREENING CLAIM
To establish an EMTALA screening violation, a plaintiff must
show that a patient arrived at a hospital emergency department
seeking treatment and that the hospital did not “provide for an
appropriate medical screening examination within the capability of
the hospital’s emergency department, including ancillary services
routinely available to the emergency department, to determine
whether or not an emergency medical condition [existed].”
U.S.C. § 1395dd.
42
The First Circuit Court of Appeals defines a
hospital’s EMTALA screening duty as follows:
A hospital fulfills its statutory duty to screen patients
in its emergency room if it provides for a screening
Civil No. 13-1918 (FAB)
4
examination reasonably calculated to identify critical
medical conditions that may be afflicting symptomatic
patients and provides that level of screening uniformly
to
all
those
who
present
substantially
similar
complaints.
Correa v. Hosp. San Francisco, 69 F.3d 1184, 1192 (1st Cir. 1995).
The essence is that there is “some screening procedure” and that it
is “administered even-handedly.”
Id.
A hospital’s screening protocols play a central role in its
EMTALA screening duty.
“When a hospital prescribes internal
procedures for a screening examination, those internal procedures
‘set the parameters for an appropriate screening.’” Cruz-Queipo v.
Hosp. Espanol Auxilio Mutuo de Puerto Rico, 417 F.3d 67, 70 (1st
Cir.
2005)
hospital’s
(quoting
Correa,
69
existing
screening
F.3d
at
protocol
1193).
was
“Whether
followed
in
a
a
circumstance where triggering symptoms were identified by hospital
emergency room staff is thus a touchstone in gauging uniform
treatment.”
Cruz-Vazquez v. Mennonite Gen. Hosp., Inc., 717 F.3d
63, 69 (1st Cir. 2013); accord Correa, 69 F.3d at 1192 (“[A
hospital’s] refusal to follow regular screening procedures in a
particular instance contravenes [EMTALA].”); Battle ex rel. Battle
v. Mem’l Hosp. at Gulfport, 228 F.3d 544, 558 (5th Cir. 2000)
(“Evidence
that
a
hospital
did
not
follow
its
own screening
procedures can support a finding of EMTALA liability for disparate
treatment.”).
Civil No. 13-1918 (FAB)
5
In Cruz-Vazquez, the First Circuit Court of Appeals found that
a trialworthy issue existed as to the plaintiff’s EMTALA screening
claim where the plaintiff presented vaginal bleeding in her third
trimester and the defendant hospital did not perform testing
requirements set forth in the hospital’s “Gravid with 3rd Trimester
protocol.1
Bleeding”
717
F.3d
at
69-71.
Similarly,
in
Cruz-Queipo, the court of appeals found that the defendant hospital
was not entitled to summary judgment for an EMTALA screening claim
where
the
hospital’s
triage
policy
required
that
a
patient
complaining of chest pain be assigned a triage Category II and the
hospital assigned plaintiff to triage Category IV despite his chest
pain complaint.2
417 F.3d at 70-71.
The court reasoned that the
error in triage category assignment “marked a departure from the
hospital’s standards, which ‘set the parameters for an appropriate
screening.’”
Id. at 71 (quoting Correa, 69 F.3d at 1193).
Here, HSG has a protocol for screening patients with gunshot
wounds.
See Docket No. 55-3.
The emergency room triage form
identifies gunshot wounds as Adams’s principal complaint, see
1
The defendant hospital in Cruz-Vazquez stipulated that it failed
to activate or follow the applicable protocol, including the
protocol’s requirement that certain laboratory tests be performed.
717 F.3d at 66.
2
The defendant hospital’s triage policy in Cruz-Queipo required
the classification of emergency room patients into one of four
categories, where “Category I encompasses the most serious
conditions” and “Categories II, III, and IV encompass progressively
less serious conditions.” 417 F.3d at 68.
Civil No. 13-1918 (FAB)
6
Docket No. 55-5 at p. 4, and triggers HSG’s gunshot wound protocol.
HSG,
however,
requirements.
failed
to
perform
a
number
of
the
protocol’s
For example, the protocol provides that the gunshot
wound patient “should be completely undresse[d] to observe the
perforations.”
(Docket No. 55-3 at p. 2.)
There is no indication
in Adams’s medical records that HSG personnel removed his clothing.
See Docket No. 55-5. The protocol also requires examination of the
patient to determine the “exact location of the point of entry,”
the “size of the wound,” and “the depth of the wound.”
No. 55-3 at p. 1.)
(Docket
Adams’s medical records indicate that HSG
personnel identified the locations of six gunshot wounds on Adams’s
face, shoulders, back, abdomen, and hand.
(Docket No. 55-5 at
p.
that
4.)
There
is
no
evidence,
however,
HSG
personnel
determined the size or depth of these wounds. Furthermore, Adams’s
autopsy report reveals that he actually had nine gunshot wounds,
see Docket No. 52-2 at pp. 2-4, thus HSG personnel failed to locate
three
of
his
wounds.
Plaintiffs’
proposed
expert,
Dr.
Ian
Cummings, stated during his deposition that one of the three wounds
missed by HSG personnel was the wound on Adams’s buttock, which was
the wound that killed him.
(Docket No. 55-2 at pp. 80-81.)
HSG’s gunshot wound protocol also requires that a history be
taken of “the time of the accident,” the “distance, direction,
[and] number of bullets shot,” the “position of the patient upon
falling,”
the “time
that
[the]
last
meal
was
ingested,”
and
Civil No. 13-1918 (FAB)
7
“immunizations - Tetanus.”
(Docket No. 55-3 at p. 1.)
Adams’s
medical records reveal that none of this information was recorded,
see Docket No. 55-5, and no evidence otherwise indicates that HSG
personnel ascertained this history.
Despite these uncontested failures to adhere to the gunshot
wound protocol when screening Adams, defendant HSG argues that
there is no dispute that it satisfied its EMTALA screening duty
because it “substantially complied” with the protocol.
No. 52 at p. 7.)
(Docket
HSG contends that it performed “a great majority”
of the protocol’s requirements and the “few that were not done
either could wait until the patient was sufficiently stable . . .
or simply could not be done [due] to the severity of the condition
of the patient.”
Id. at p. 14.
but that is not the issue.
that
it
routinely
or
That may or may not be correct,
HSG does not present evidence, however,
uniformly
disregards
these
protocol
requirements - or that a different procedure is in place - when it
screens patients who present complaints substantially similar to
those Adams presented.
That is the issue.
Because HSG did not remove Adams’s clothing and failed to find
three of his nine gunshot wounds, including the one that killed
him, a reasonable jury could conclude that HSG did not provide
Adams
with
a
screening
examination
“reasonably
identify critical medical conditions.”
1192.
calculated
to
See Correa, 69 F.3d at
Even more, in light of the fact that HSG only partially
Civil No. 13-1918 (FAB)
followed
its
gunshot
8
wound
protocol
when
screening
Adams,
a
reasonable jury could find that HSG did not provide Adams with a
screening examination uniform to the screening it provides patients
presenting substantially similar complaints. See Cruz-Vazquez, 717
F.3d at 69; Cruz-Queipo, 417 F.3d at 70-71; Correa, 69 F.3d at
1192-93.
There is thus a genuine dispute of material fact as to
whether HSG provided Adams with an appropriate medical screening
examination.
Accordingly, defendant HSG’s motion for summary
judgment on plaintiffs’ EMTALA screening claim is DENIED.
IV.
PUERTO RICO LAW CLAIMS
When a district court has original jurisdiction over a claim,
it also has supplemental jurisdiction over state law claims that
form part of the same case or controversy.
28 U.S.C. § 1367(a).
Because plaintiffs’ EMTALA screening claim remains, the Court may
exercise supplemental jurisdiction over state law claims that
“derive from a common nucleus of operative fact.”
Workers v. Gibbs, 383 U.S. 715, 725 (1966).
United Mine
A court should
consider “the values of judicial economy, convenience, fairness,
and comity in order to decide whether to exercise jurisdiction over
a case brought in that court involving [supplemental] state-law
claims.”
(1988).
Carnegie–Mellon Univ. v. Cohill, 484 U.S. 343, 350
In
light
of
these
factors,
as
well
as
plaintiffs’
remaining EMTALA screening claim to ground jurisdiction, the Court
will exercise its supplemental jurisdiction over plaintiffs’ Puerto
Civil No. 13-1918 (FAB)
Rico law claims.
9
Accordingly, defendant HSG’s motion to dismiss
plaintiffs’ Puerto Rico law claims is DENIED.
V.
CONCLUSION
For the reasons explained above, the Court DENIES defendant
HSG’s motion for summary judgment, (Docket No. 50).
IT IS SO ORDERED.
San Juan, Puerto Rico, July 24, 2015.
s/ Francisco A. Besosa
FRANCISCO A. BESOSA
UNITED STATES DISTRICT JUDGE
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