Delgado-Caraballo et al v. Hospital Pavia Hato Rey, Inc. et al
Filing
125
OPINION AND ORDER granting 66 motion for summary judgment; granting 68 motion for summary judgment; granting 71 motion for summary judgment; and finding as moot 108 Motion to Strike. For the reasons provided herein, the Court GRANTS Hospi tal Pavia Inc.'s Motion for Summary Judgment (Docket No. 71). Plaintiffs' survivorship claim against Hospital Pavia under EMTALA is DISMISSED WITHOUT PREJUDICE; Plainitffs' EMTALA claim against APS Healthcare Inc. is DISMISSED WITH PREJUDICE; and the rest of the Plaintiffs' claims are DISMISSED WITHOUT PREJUDICE. Signed by Judge Daniel R. Dominguez on 3/31/2017. (JM)
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF PUERTO RICO
Yomayra Delgado Caraballo,et al.
Plaintiffs,
v.
Civil No. 14-1738 (DRD)
Hospital Pavia Hato Rey Inc., et al.
Defendants.
OPINION AND ORDER
Juan Ramon Delgado-Caraballo and Yomayra Delgado-Caraballo, personally and on behalf of her
minor children B.O.G.D and M.G.D. (“Plaintiffs”), are seeking damages against Hospital Pavia, Inc., Dr.
Marjorie Acosta-Guillot, Dr. Nilsa Lopez, and APS Healthcare Inc. (”Defendants”). Plaintiffs allege
Defendants violated the Emergency Medical Treatment and Labor Act (“EMTALA”), 42 U.S.C. § 1395dd,
and Articles 1802 and 1803 of the Puerto Rico Civil Code, 31 L.P.R.A. § 5141 and § 5142. Pending before
the Court are Dr. Nilsa Lopez’s Motion for Summary Judgment (Docket No. 66), APS Healthcare Inc.’s
Motion for Summary Judgment (Docket No. 68), and Hospital Pavia’s Motion for Summary Judgment
(Docket No. 71). For the reasons provided below, the Court hereby GRANTS Hospital Pavia’s Motions for
Summary Judgment.
I.
FACTUAL BACKGROUND1
To comply with EMTALA, hospitals must establish internal screening procedures to follow in order
to avoid patient dumping. At Hospital Pavia Hato Rey (“Pavia”), all patients that seek treatment at the
Psychiatric Stabilization Unit (“PSU”) are interviewed by an evaluating physician under strict confidentiality.
The uncontested material facts will be based off Plaintiff’s Objection to Defendant Hospital Pavia Hato Rey's Statement of Uncontested
Material Facts at Docket No. 71-1 (Docket No. 88).
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¶ 26. The physician compiles clinical information both from the patient and any relatives available at the
time of the interview. Id. Generally, Pavia follows the Admission Process Guide to determine if a patient
meets the criteria for admission at the PSU. ¶ 34. Pavia’s Guideline for the Identification and Management
of Patients who Present some Level of Suicidal Risk is used to screen patients with risk of suicide. ¶ 35.
For admission to the PSU, a patient must present at least one or more of the criteria established in section
(A) of Pavia’s Admission Process Guide. ¶ 27.
On October 1, 2012, Natividad Caraballo-Caraballo (“Patient”) arrived at the PSU at Pavia with her
daughter, Plaintiff Yomayra Delgado-Caraballo . ¶ 16-17. The Patient was evaluated by the triage nurse at
6:30 P.M. Id. The nurse noted that Patient was mildly nervous and had not been taking her medications. ¶
18. Additionally, the nurse recorded that the Patient’s visit was voluntary. ¶ 20. Nonetheless, there is an
issue regarding whether Patient was evaluated at Pavia under a Law #408 order.
Dr. Marjorie Acosta-Guillot (“Acosta-Guillot”), the evaluating physician, assessed the patient and
performed the medical screening examination at around 7:00 P.M. ¶ 21. Dr. Acosta-Guillot recorded that
Patient was 53 years old, had a psychiatric history that included a suicide attempt one year before the visit,
and presented “poor compliance or commitment to treatment, exacerbation of depressive symptoms which
included anxiety, isolation. ¶ 22. Dr. Acosta-Guillot also noted that “[patient was] not suicidal, not homicidal,
[and had] no hallucinations”. Id.
Dr. Acosta-Guillot further noted, in the Mental Exam section of the screening sheet, that Patient
had appropriate hygiene, adequate visual contact, and a logical and coherent thought process. ¶ 23.
Patient was also cooperative and oriented, but showed diminished language production, was anxious, and
showed psychomotor retardation. Id.
Dr. Acosta-Guillot diagnosed Patient with major depression according to the Stabilization Unit’s
Evaluation Disposition form. ¶ 24. However, the form contained the conclusion that Patient did not present
the criteria to be admitted at the PSU. Id. This form was signed by both Patient and Plaintiff Yomayra
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Delgado-Caraballo (“Yomayra”). ¶ 31. Dr. Acosta-Guillot testified in her deposition that Patient denied
having suicidal ideas, did not present risk of suicide at the time, and thus, considering Patient’s history and
evaluation, she did not present the criteria for admission at the time of the evaluation. ¶ 32-33. Patient was
discharged with instructions to continue taking her medications and to attend an appointment at the
Defendant APS Healthcare (“APS”) outpatient clinic on October 3, 2012. ¶ 25.
After being discharged from Hospital Pavia, Patient was left alone and slept by herself from
October 1, 2012, to October 3, 2012. ¶ 36. On October 3, 2012, Patient’s mother-in-law, with whom she
had a close relationship, passed away. ¶ 38. The same day, Patient attended her appointment at the APS
outpatient clinic in Caguas. ¶ 37. Patient was attended by Dr. Nilsa Lopez (“Lopez”). After Dr. Lopez
evaluated Patient, Yomayra spoke with the physician and Patient. Patient was released from the APS clinic
and committed suicide the next day. ¶ 39.
II.
PROCEDURAL BACKGROUND
Patient had three children, Yomayra-Delgado Caraballo, Juan Ramon Delgado-Caraballo, and
Vanessa Delgado-Caraballo. The members of the estate of Mrs. Caraballo are Yomayra, Juan Ramon,
Vanessa, and widower Juan Delgado-Gonzalez. In the present complaint, only Yomayra and Juan Ramon
are bringing forth Patient’s survivorship EMTALA action. Juan Ramon and Yomayra, personally and on
behalf of her minor children B.O.G.D and M.G.D., are only seeking personal damages. ¶ 3-6, 9-11.
On September 30, 2014, Plaintiffs filed a Complaint (Docket No. 1) against Defendants alleging
that Pavia failed to give Patient an appropriate medical screening examination and failed to stabilize her
pursuant to the requirements of EMTALA. See 42 U.S.C. §§1395 (a)-(c). Furthermore, Plaintiffs claim that
Hospital Pavia failed to meet the accepted practices of the medical profession by not complying with a Law
408 order2, not documenting the comprehensive risk assessment, not providing the higher level of care
A Law 408 order is required for patients that refuse to let doctors take their vital signs for evaluation when it could be perceived that they
could be a danger to themselves. See 24 L.P.R.A. § 6153.
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required, failing to provide a psychiatric evaluation, not scheduling follow up appointments, and failing to
provide adequate medication.
On April 4, 2016, Dr. Lopez filed a Motion for Summary Judgment (Docket No. 66) claiming that
EMTALA applies exclusively to hospitals that participate in the Medicare program and that it does not
create a cause of action against physicians. Dr. Lopez further avers that Plaintiffs and Defendants lack
complete diversity. Thus, Dr. Lopez argues the Court lacks grounds for jurisdiction.
On June, 24, 2017, Plaintiffs filed a Response in Opposition to Motion for Summary Judgment
(Docket No. 91). Plaintiffs specify that their claims against the individual physicians, Dr. Lopez and Dr.
Acosta, are brought under Article 1802 and 1803 of the Puerto Rico Civil Code. Plaintiffs aver that
supplemental jurisdiction over these claims should be invoked as they have a valid EMTALA claim as well
as diversity jurisdiction.
On April 4, 2016, APS Healthcare Inc. filed a Motion for Summary Judgment (Docket No. 68).
Defendant APS claimed that they were not subject to the EMTALA statute as they are a Managed
Behavioral Healthcare Organization and not a hospital. On June 26, 2016, Plaintiffs filed a Response in
Opposition to Motion for Summary Judgment (Docket No. 94) where they conceded that Defendant APS is
not a hospital and not subject to the EMTALA provisions.
On April 4, 2016, Defendant Pavia filed a Motion for Summary Judgment (Docket No. 71). Dr.
Acosta-Guillot, Dr. Lopez, and APS Healthcare Inc. all joined Pavia’s motion. Defendant Pavia claimed that
they complied with the screening, stabilization, and transfer provisions of EMTALA. Furthermore,
Defendant Hospital Pavia avers that EMTALA allows state law to govern inherited causes of action and
thus the survivorship claim should be summarily dismissed since Plaintiffs did not join Vanessa Delgado
Caraballo and Juan Delgado-Gonzalez, who are indispensable parties under Puerto Rico law. Defendant
Pavia further avows that minors B.O.G.D. and M.G.D. were both domiciled in Puerto Rico and thus there is
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no jurisdiction under 28 U.S.C. §1332. Defendant Pavia concludes that, since the Court lacks original
jurisdiction, it should dismiss all claims under supplemental jurisdiction.
On June 20, 2016, Plaintiffs filed a Response in Opposition to Motion for Summary Judgment
(Docket No. 87) and stated that, although Defendant Hospital Pavia screened Patient, the screening
provided was not consistent with that of other similarly situated patients. Plaintiffs claim that although
EMTALA does allow state law to govern inherited causes of action, the law in Puerto Rico permits
survivorship actions to be brought by any heir and does not require that all heirs be included in the action.
On August 8, 2016, Defendant Hospital Pavia filed a Reply to response to Motion to Summary
Judgment (Docket No. 117) requesting that Plaintiffs’ EMTALA claim be dismissed since they admitted that
Mrs. Caraballo was indeed screened at Hospital Pavia. Defendant avers that state jurisprudence regarding
the issue has stated that all members of an estate are indispensable parties whenever the estate is party to
a claim. Defendant also claims that even though diversity jurisdiction is sought in the alternative, not even
the minors B.O.G.D. and M.G.D. can claim diversity as they only lived in Massachusetts temporarily.
III.
STANDARD OF REVIEW FOR SUMMARY JUDGMENT MOTIONS
Rule 56 of the Federal Rules of Civil Procedure provides that summary judgment should be
entered where “the pleadings, depositions, answers to interrogatories, and admissions on file, together with
the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is
entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(c); see Celotex Corp. v. Catrett, 477 U.S. 317,
324-325 (1986). Pursuant to the clear language of the rule, the moving party bears a two-fold burden: it
must show that there is “no genuine issue as to any material facts,” as well as that it is “entitled to judgment
as a matter of law.” Veda-Rodriguez v. Puerto Rico, 110 F.3d 174, 179 (1st Cir. 1997). A fact is “material”
where it has the potential to change the outcome of the suit under governing law. See Anderson v. Liberty
Lobby, Inc., 477 U.S. 242, 248 (1986). A fact is “genuine” where a reasonable jury could return a verdict
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for the nonmoving party based on the evidence. Id. Thus, it is well settled that “the mere existence of a
scintilla of evidence” is insufficient to defeat a properly supported motion for summary judgment. Id.
After the moving party meets this burden, the onus shifts to the non-moving party to show that
there still exists “a trial worthy issue as to some material facts.” Cortes-Irizarry v. Corporación Insular, 11
F.3d 184, 187 (1st Cir. 1997).
At the summary judgment stage, the trial court examines the record “in the light most flattering to
the non-movant and indulges in all reasonable references in that party’s favor. Only if the record, viewed in
this manner and without regard to credibility determinations, reveals no genuine issue as to any material
fact may the court enter summary judgment.” Cadle Co. v. Hayes, 116 F.3d 957, 959-60 (1st Cir. 1997).
“Credibility determinations, the weighing of the evidence, and the drawing of legitimate inferences from the
facts are jury functions, not those of a judge.” Reeves v. Sanderson Plumbing Prod., 530 U.S. 133, 150
(2000)(quoting Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 250-51, 106 S.Ct. 2505 (1986)). Summary
judgment is inappropriate where there are issues of motive and intent as related to material facts. See
Poller v. Columbia Broad. Sys., 369 U.S. 470, 473, 82 S.Ct. 486 (1962)(summary judgment is to be issued
“sparingly” in litigation “where motive and intent play leading roles”); see also Pullman-Standard v. Swint,
456 U.S. 273, 288, 102 S.Ct. 1781 (1982)(“findings as to design, motive and intent with which men act [are]
peculiarly factual issues for the trier of fact.”); see also Dominguez-Cruz v. Suttle Caribe, Inc., 202 F.3d
424, 433 (1st Cir. 2000)(finding that “determinations of motive and intent . . . are questions better suited for
the jury”). “As we have said many times, summary judgment is not a substitute for the trial of disputed
factual issues.” Rodríguez v. Municipality of San Juan, 659 F.3d 168, 178-179 (1st Cir. 2011)(internal
quotations and citations omitted). Conversely, summary judgment is appropriate where the nonmoving
party rests solely upon “conclusory allegations, improbable inferences and unsupported speculation.”
Ayala-Gerena v. Bristol Myers-Squibb Co., 85 F.3d 86, 95 (1st Cir. 1996). However, while the Court
“draw[s] all reasonable inferences in the light most favorable to [the non-moving party] . . . we will not draw
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unreasonable inferences or credit bald assertions, empty conclusions or rank conjecture.” Vera v. McHugh,
622 F.3d 17, 26 (1st Cir. 2010)(internal quotations and citation omitted). Moreover, “we afford no
evidentiary weight to conclusory allegations, empty rhetoric, unsupported speculation, or evidence which, in
the aggregate, is less than significantly probative.” Tropigas De P.R. v. Certain Underwriters at Lloyd’s of
London, 637 F.3d 53, 56 (1st Cir. 2011)(internal citations omitted).
Further, the Court will not consider hearsay statements or allegations presented by parties that do
not properly provide specific reference to the record. See Garside v. Osco Drug, Inc., 895 F.2d 46, 50 (1st
Cir. 1990)(“Hearsay evidence, inadmissible at trial, cannot be considered on a motion for summary
judgment.”).3 See also D.P.R. Civ. R. 56(e)(“The [C]ourt may disregard any statement of fact not supported
by a specific citation to the record material properly considered on summary judgment. The [C]ourt shall
have no independent duty to search or consider any part of the record not specifically referenced.”);
Morales v. A.C. Orssleff’s EFTF, 246 F.3d 32, 33 (1st Cir. 2001)(finding that, where a party fails to buttress
factual issues with proper record citations, judgment against that party may be appropriate).
If a defendant fails to file an opposition to the motion for summary judgment, the district court may
consider the motion as unopposed and disregard any subsequently filed opposition. Velez v. Awning
Windows, Inc., 375 F.3d 35, 41 (1st Cir. 2004). Furthermore, the district court must take as true any
uncontested statements of fact. Id. at 41-42; see D.P.R.R. 311.12; see Morales, 246 F.3d at 33 (“This case
is a lesson in summary judgment practice …. [P]arties ignore [Rule 311.12] at their own peril, and … failure
to present a statement of disputed facts, embroidered with specific citations to the record, justifies deeming
the facts presented in the movant’s statement of undisputed facts admitted.”)(internal citations and
quotations omitted); see also Euromodas, Inc. v. Zanella , Ltd., 368 F.3d 11, 14-15 (1st Cir. 2004).
D.P.R. CIV. R. 56(b), often referred to as the anti-ferret rule, requires the party moving for summary judgment to submit a “separate, short, and
concise statement of material facts, set forth in numbered paragraphs, as to which the moving party contends there is no genuine issue of
material fact.” Similarly, the non-moving party is required to submit a counter-statement “admit[ing], deny[ing] or qualify[ing] the facts by
reference to each numbered paragraph in the moving party’s statement of material facts and unless a fact is admitted, shall support each
denial or qualification by record citation.” D.P.R. CIV. R. 56(c).
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However, this does not mean that summary judgment will be automatically entered on behalf of the moving
party when there is no opposition by the non-moving party, as the court “still has the obligation to test the
undisputed facts in the crucible of the applicable law in order to ascertain whether judgment is warranted.”
See Velez, 375 F.3d at 42. See also Aguiar-Carrasquillo v. Agosto-Alicea, 445 F.3d 19, 25 (1st Cir. 2006)
(when scrutinizing an unopposed motion for summary judgment, “the district court [is] still obliged to
consider the motion on its merits, in light of the record as constituted, in order to determine whether
judgment would be legally appropriate.”) (citing Mullen v. St. Paul Fire and Marine Ins. Co., 972 F.2d 446,
452 (1st Cir. 1992) and López v. Corporación Azucarera de Puerto Rico, 938 F.2d 1510, 1517 (1st Cir.
1991)); Fontanez-Nunez v. Janssen Ortho LLC, 447 F.3d 50, 55 (1st Cir. 2006) (citing Torres–Rosado v.
Rotger–Sabat, 335 F.3d 1, 4 (1st Cir. 2003)).
IV.
ANALYSIS
APS Healthcare Inc.’s liability under EMTALA
EMTALA was enacted by Congress to ensure that hospitals would not turn away or discharge
patients that could not afford healthcare. See Correa v. Hosp. San Francisco, 69 F.3d 1184, 1189-90 (1st
Cir. 1995). EMTALA established minimal screening and stabilization requirements to prevent the practice of
patient dumping. See Reynolds v. Maine General Health, 218 F.3d 78, 83-84 (1st Cir. 2000). The statute
covers hospitals that enter into provider agreements, such as the federal Medicare program. See 42
U.S.C. § 1395 (e)(2). It is important to note that “EMTALA does not apply to all health care facilities; it
applies only to participating hospitals with emergency departments.” Rodríguez v. American International
insurance Co., 402 F3d 45, 49 (1st Cir. 2005) (emphasis ours).
APS Healthcare provides outpatient services and does not provide inpatient or emergency hospital
services. Additionally, Plaintiffs conceded that “APS Clinics Caguas is not a hospital and not subject to the
EMTALA provisions”. See Plaintiffs Response In Opposition to Defendant APS Healthcare Motion for
Summary Judgment Docket No. 94 Pg. 8 (emphasis ours). Accordingly, based on the uncontested facts
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and Plaintiffs’ own admission, the Court hereby DISMISSES WITH PREJUDICE Plaintiffs’ EMTALA claim
against APS Healthcare Inc.
Indispensable Party
Prior to reaching the merits of Plaintiff’s claim, the Court must determine whether Plaintiffs failed to
join an indispensable party to the suit. An indispensable party is one “(1) without whom the court cannot
accord complete relief; or (2) who claims an interest relating to the subject of the action and is situated such
that disposing of the action in the person's absence may as a practical matter impair or impede the
person's ability to protect the interest; or (3) whose claimed interest in the subject of the action would leave
defendants subject to substantial risk of incurring multiple or otherwise inconsistent obligations.” Cruz–
Gascot v. HIMA–San Pablo Hosp. Bayamón, 728 F.Supp.2d 14, 26–27 (D.P.R. 2010) (citing Fed. R. Civ. P.
19(a)). After taking all of this into account, “[i]f the court finds that party is anything less than indispensable,
the case proceeds without her. If, on the other hand, the court finds that the litigation cannot proceed in the
party's absence, the court must dismiss the case”. Jiménez v. Rodríguez–Págan, 597 F.3d 18, 23 (1st Cir.
2010) (referring to B. Fernandez & Hnos, Inc. v. Kellogg USA, Inc., 516 F.3d 18, 23 (1st Cir. 2008))
(emphasis ours).
Decedent’s estate is compiled of Yomayra Delgado Caraballo, Juan Ramon Ramon Delgado
Caraballo, Vanessa Delgado Caraballo, and widower Juan Delgado Gonzalez. However, the instant
EMTALA claim was brought by Yomayra and Juan Ramon. There is no doubt that the absent heirs interest
might be affected or prejudiced by the decision reached by this Court. Additionally, any relief acquired
through the survivorship claim may not be adequate and the absent heirs may be compelled to file a state
suit if they were not in accord with the remedy given. Notwithstanding, Plaintiffs claim that standing Puerto
Rico law has determined that individual heirs can individually bring suits in name of the estate. The Court
strongly disagrees and explains.
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The First Circuit recently noted that the Puerto Rico District Court is split on whether joinder of all
heirs to a survivorship claim under Puerto Rico law is necessary. See Cason v. Puerto Rico Elec. Power
Authority, 770 F. 3d 971 (1st Cir. 2014)4. The first view is that all heirs to an estate are not indispensable
since any judgement in favor of one of the heirs benefits all of them, “while any adverse judgment is only
prejudicial to the individual or individuals who filed the lawsuit”. Betancourt v. U.S., 2014 WL 5846745
(citing inter alia, Cintrón v. San Juan Gas, 79 F.Supp.2d 16 (D.P.R. 1999) (Casellas, J.); Martínez-Álvarez
v. Ryder Mem'l Hosp., Civ. No. 09–2038(JP), 2010 WL 3431653, at *15 (D.P.R. Aug. 31, 2010) (Pieras, J.);
Ruiz–Hance v. P.R. Aqueduct & Sewer Auth., 596 F.Supp.2d 223, 229–30 (D.P.R. 2009) (Pérez–Giménez,
J.); Arias–Rosado v. González–Tirado, 111 F.Supp.2d 96, 99 (D.P.R. 2000) (Gierbolini, J.)).
“The contrary view focuses on ‘the unitary nature of the succession, which all of the heirs together
represent ....,’ reasoning that the heirs to a succession are indispensable because ‘their interests could be
prejudiced by the proceedings to which they were not parties.’” Id. (citing, inter alia, Cruz–Gascot, 728
F.Supp.2d 14 (Besosa, J.); Pagán–Ortiz v. Carlo–Domínguez, 977 F.Supp.2d 106 (D.P.R. 2013) (Gelpí,
J.)); see also Reyes–Ortíz v. HIMA San Pablo–Bayamón, No. 11–1273(PAD) (D.P.R. June 16, 2014)
(Delgado–Hernández, J.); and Jiménez–Franceshini, No. 12–1504 (ADC) (D.P.R. March 31, 2014)
(Delgado–Colón, J.).
If one were to side with the first view, then “it appears that the federal suit here is something of a
free shot for the non-diverse heirs. Success inures to their benefit while failure is costless”. Jimenez v.
Rodriguez-Pagan, 597 F. 3d 18 (1st Cir. 2010). However, the First Circuit in Jimenez was not convinced
Compare, e.g., Reyes–Ortíz v. HIMA San Pablo–Bayamón, No. 11–1273 (D.P.R. June 16, 2014); Segura–Sanchez v. Hosp. Gen. Menonita,
Inc., 953 F.Supp.2d 344, 348 (D.P.R.2013); Casillas–Sanchez v. Ryder Mem'l Hosp., Inc., No. 11–2092, 2013 WL 3943517, at *1 (D.P.R. July
30, 2013); Pagán–Ortíz v. Carlo–Dominguez, 977 F.Supp.2d 106 (D.P.R.2013); Pino–Betancourt v. Hosp. Pavía Santurce, 928 F.Supp.2d 393,
396 (D.P.R.2012), (cases holding that all heirs are required and indispensable parties to a wrongful death suit asserting a survivorship action),
with Rodríguez v. Integrand Assur. Co., No. 10–1476, 2011 WL 3439260 at *3 (D.P.R. Aug. 5, 2011); Muñiz–Mercado v. Hosp. Buen
Samaritano, No. 09–1829, 2010 WL 923 at *1 (D.P.R. Oct. 26, 2010); Martínez–Alvarez v. Ryder Mem'l Hosp., Inc., No. 09–2038, 2010 WL
3431653 at *18 n. 9 (D.P.R. Aug. 31, 2010); Ruiz–Hance v. Puerto Rico Aqueduct & Sewer Auth., 596 F.Supp.2d 223, 229–30 (D.P.R.2009);
Rodríguez–Rivera v. Rivera Ríos, No. 06–1381, 2009 WL 564221, at *3. (D.P.R. Mar. 5, 2009); Arias–Rosado v. González Tirado, 111
F.Supp.2d 96, 99 (D.P.R.2000); Cintrón v. San Juan Gas, Inc., 79 F.Supp.2d 16, 19 (D.P.R.1999) (cases holding that survivorship actions can
be brought on behalf of the estate without joining all heirs as parties);.
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that this represented the state of Puerto Rico law regarding the issue and decided that it was not equipped
to resolve said issue due to the “unsettled state of governing Puerto Rico law.” Id. at 26. Nonetheless, the
Court in Jimenez entertained a hypothetical scenario where a plaintiff in federal court secured monetary
damages that were less than they originally sought and questioned whether that would “constitute a
successful judgment sufficient to bind the non-diverse heirs . . . or . . . an adverse judgment that would
leave those heirs free to double down in the second suit[.]”Id. at 27. There being no binding resolution, the
Court must then go with the most persuasive and reasonable legal judgment.
There is no doubt that a suit brought only by one heir in representation of the estate may affect the
absent heirs of said estate. There exists no such thing as a free shot in bringing a suit against a defendant.
Further, “a ‘sucesion’ is not an entity distinct and separate from the persons composing it” and “does not
have existence by itself as a juridical person or entity.” Pino-Betancourt v. Hospital Pavia Santurce 928 F.
Supp. 2d 393 (D.P.R. 2013) (citing Cruz–Gascot 728 F.Supp.2d at 19). The Court then agrees with the
latest case law in this District Court that a lawsuit brought by only one or some of the heirs could prejudice
the rights of others in the succession, rendering such parties necessary to the survivorship action. See
Cruz–Gascot, 728 F.Supp.2d at 24–26; Gonzalez v. Presbyterian Community Hosp., Inc. 103 F. Supp. 3d
198 (D.P.R. 2015); Betancourt, 2014 WL 5846745; Pino-Betancourt, 928 F. Supp. 2d at 393. Moreover,
and most importantly, the Puerto Rico Supreme Court has affirmed the indispensability of all heirs to an
estate when the same is a party to a claim. See Vilanova et al. v. Vilanova et al., 184 D.P.R. 824, 839–840
(2012) (“Since the beginning of the past century, the Court has left it completely clear that an estate is not a
legal entity separated from the members that compose it. Then, for an estate to be able to sue or substitute
a deceased plaintiff, all members of the estate must be brought to the suit”.) Furthermore, the Court in
Vilanova stated that members to an estate are indispensable parties since without their presence the claim
cannot be attended since any sentence against or in benefit of the estate will undoubtedly affect their
interests. Id at 844.
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Notwithstanding that Plaintiffs are arguing against standing Puerto Rico law, they still have one last
gasp attempt at maintaining the survivorship claim. “[I}f the court determines that someone is a necessary
party under Rule 19(a) but one that cannot be feasibly joined, then the court proceeds under Rule 19(b) to
determine ‘whether, in equity and good conscience, the action should proceed among the existing parties
or should be dismissed.’” Id. (citing Fed. R. Civ. P. 19(b); In re Cambridge Biotech Corp., 186 F.3d 1356,
1372 (Fed.Cir.1999)). To answer that question, the district court must consider four factors specified in the
Rule:
(1) the extent to which a judgment rendered in the person's absence might prejudice that
person or the existing parties; (2) the extent to which any prejudice could be lessened or
avoided by (A) protective provisions in the judgment; (B) shaping the relief; or (C) other
measures; (3) whether a judgment rendered in the person's absence would be adequate;
and (4) whether the plaintiff would have an adequate remedy if the action were dismissed
for nonjoinder.
Jimenez, 597 F.3d at 25 (citing Fed. R. Civ. P. 19(b)). The Court discusses these factors seriatim.
One cannot expect that absent heirs would not suffer the consequences of the dismissal of the
survivorship claim. If the survivorship claim is dismissed with prejudice, the absent heirs would not be able
to bring their own federal claim representing the estate against the same particular defendant. Furthermore,
allowing the survivorship claim to continue would open up Defendants of possibly having to incur in liability
both in the federal and state court. Thus, if the decision reached by this Court affects the heirs’ ability to
bring a suit in favor of the estate, a suit brought by other heirs in representation of said estate does in fact
deprive them of a certain right. Specifically to this case, the only remaining federal claim under EMTALA is
the survivorship claim and deciding the merits of said claim without permitting all the heirs of the estate to
exercise their rights would be unfair to the absent heirs and also to the Defendants.
The Court suspects Plaintiffs seek to attain remedy through the EMTALA statute in an attempt to
attain federal jurisdiction. Based on the present facts of the case, Plaintiffs claim appear more like medical
malpractice rather than a failure to screen under EMTALA. Thus, dismissing Plaintiffs survivorship claim
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would not adversely affect them since they have similar available remedies for their survivorship claim in
state court. Plaintiffs would also be able to refile their claim in the federal court with all the indispensable
parties. Consequently, the survivorship claim brought by plaintiffs under EMTALA is DISMISSED
WITHOUT PREJUDICE.5 We look now to see if diversity jurisdiction exists for the Court to attain
supplemental jurisdiction over the personal claims brought by Plaintiffs.
Diversity Jurisdiction6
Plaintiffs claim that they have attained diversity jurisdiction since minors B.O.G.D. and M.G.D. lived
in Massachusetts for a few years for educational purposes. In deciding whether diversity jurisdiction is
attained in the present case, this argument is irrelevant. “Diversity jurisdiction exists only when there is
complete diversity, that is, when no plaintiff is a citizen of the same state as any defendant.” Gabriel v.
Preble, 396 F.3d 10, 13 (1st Cir. 2005) (referring to Strawbridge v. Curtiss, 7 U.S. (3 Cranch) 267, 267, 2
L.Ed. 435 (1806)); Am. Fiber & Finishing, Inc. v. Tyco Healthcare Group, LP, 362 F.3d 136, 139 (1st Cir.
2004); see also Connectu LLC v. Zuckerberg, 522 F.3d 82, 91 (1st Cir. 2008). There is no doubt in this
case that diversity jurisdiction fails since Plaintiffs Yomayra Delgado Caraballo and Juan Ramon Delgado
Caraballo are both from Puerto Rico as are Defendants Hospital Pavia, APS Healthcare, Dr. Acosta, and
Dr. Lopez.
Local Law Claims
As no federal claim survives and there is no diversity jurisdiction, all that remain are supplemental state
law claims under Articles 1802 and 1803 of the Puerto Rico Civil Code. Under 28 U.S.C. § 1367(c), a
district court “may decline to exercise supplemental jurisdiction” when “all claims over which it has original
jurisdiction” have been “dismissed.” See also United Mine Workers of Am. v. Gibbs, 383 U.S. 715, 726
Even though the parties made no such argument, the Court emphasizes that the Eerie doctrine would not affect the ultimate outcome of this
case. Whether the indispensable party issue is a matter that should be governed by federal procedural rules or substantive state law, the Court
would reach the same determination.
6 A Motion to Strike a Post Summary Judgment Affidavit (Docket No. 93-12) regarding facts about the citizenship of minors B.O.G.D and M.G.D
is DENIED as MOOT.
5
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(1966) (“Certainly, if the federal claims are dismissed before trial, even though not insubstantial in a
jurisdictional sense, the state claims should be dismissed as well.”); Rodríguez v. Doral Mortg. Corp., 57
F.3d 1168, 1177 (1st Cir. 1995) (stating "[t]o be sure, the exercise of supplemental jurisdiction in such
circumstances is wholly discretionary."). Here, all of Plaintiff's local law claims arise from the same set of
alleged acts as Plaintiff's federal law claims. Since all pertinent federal claims have been dismissed and in
order to conserve judicial resources, the Court rejects Plaintiff’s invitation to exercise its discretionary
supplemental jurisdiction and DISMISSES WITHOUT PREJUDICE the local law claims.
V.
CONCLUSION
For the reasons provided above, the Court GRANTS Hospital Pavia Inc.’s Motion for Summary
Judgment (Docket No. 71). Plaintiffs’ survivorship claim against Hospital Pavia under EMTALA is
DISMISSED WITHOUT PREJUDICE; Plainitffs’ EMTALA claim against APS Healthcare Inc. is DISMISSED
WITH PREJUDICE; and the rest of the Plaintiffs’ claims are DISMISSED WITHOUT PREJUDICE.
IT IS SO ORDERED.
In San Juan, Puerto Rico, this 31st day of March, 2017.
S/ DANIEL R. DOMÍNGUEZ
DANIEL R. DOMÍNGUEZ
U.S. District Judge
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