Rivera-Romero et al v. INSPIRA Behavioral Care et al

Filing 85

OPINION AND ORDER denying 74 Joint MOTION in Limine to Preclude the Opions & Testimony of Dr. Santiago Noa. Signed by US Magistrate Judge Camille L. Velez-Rive on 1/23/2020. (ari) Modified on 1/24/2020 to correct document type (gmm).

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF PUERTO RICO
BLANCA RIVERA ROMERO, et. al.,
Plaintiffs,
v.

CIVIL NO. 16-2721 (CVR)

INSPIRA BEHAVIORAL CARE, et. al.,
Defendants.

OPINION AND ORDER
INTRODUCTION
Before the Court is a “Joint Motion in Limine to Preclude the Opinions and
Testimony of Plaintiffs’ Expert Dr. Víctor Santiago Noa” filed by co-Defendants Hospital
Metropolitano Dr. Pila and Inspira Behavioral Care (collectively “Defendants”).
Defendants aver that Plaintiffs’ expert Dr. Víctor Santiago Noa (“Dr. Santiago Noa”)
should not be allowed to testify at trial because his report fails to conform to the
requirements of Fed. R. Civ. P. 26. In addition, they contend that his report and testimony
are not reliable under Federal Rule of Evidence 702 and the landmark case of Daubert v.
Merrell Dow Pharm., Inc., 509 U.S. 579, 113 S. Ct. 2786 (1993). (Docket No. 74).
Plaintiffs proffer a variety of reasons in opposition to Defendants’ Motion in
Limine. (Docket No. 83).
For the reasons explained below, the Court DENIES Defendants’ Motion in
Limine.

Blanca Rivera Romero, et al. v. Inspira Behavioral Care, et al.
Opinion and Order
Civil 16-2721 (CVR)
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ANALYSIS
Federal Rule of Evidence 702 states that:
A witness who is qualified as an expert by knowledge, skill, experience, training, or
education may testify in the form of an opinion or otherwise if:
(a) the expert's scientific, technical, or other specialized knowledge will help the
trier of fact to understand the evidence or to determine a fact in issue;
(b) the testimony is based on sufficient facts or data;
(c) the testimony is the product of reliable principles and methods; and
(d) the expert has reliably applied the principles and methods to the facts of the
case. Fed. R. Evid. 702.
A review of the case law after Daubert shows that the rejection of expert testimony
is the exception, rather than the rule. The Daubert case did not work a “seachange over
federal evidence law,” and “the trial court’s role as gatekeeper is not intended to serve as
a replacement for the adversary system.” United States v. 14.38 Acres of Land Situated
in Leflore County, Mississippi, 80 F.3d 1074, 1078 (5th Cir. 1996). “Vigorous crossexamination, presentation of contrary evidence, and careful instruction on the burden of
proof are the traditional and appropriate means of attacking shaky but admissible
evidence.” Daubert, 509 U.S. at 595.
Furthermore, it has been established that “Daubert does not require that a party
proffering expert testimony convince the court that the expert’s assessment of the
situation is correct, but rather, [a]s long as an expert’s scientific testimony rests upon
good grounds it should be tested by the adversary process-competing expert testimony
and active cross-examination-rather than excluded from jurors’ scrutiny for fear that they

Blanca Rivera Romero, et al. v. Inspira Behavioral Care, et al.
Opinion and Order
Civil 16-2721 (CVR)
Page 3
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will not grasp its complexities or satisfactorily weigh its inadequacies.” United States v.
Perocier, 269 F.R.D. 103, 107 (D.P.R. 2009) (citing Ruiz-Troche v. Pepsi Cola of Puerto
Rico Bottling Co., 161 F.3d 77, 85 (1st Cir. 1998)). Therefore, the Court’s analysis must be
flexible, not rigid, and must ensure that expert testimony is relevant. Daubert, 509 U.S.
at 592. Besides establishing relevancy, the Court must also ensure that the expert opinion
is sufficient and reliable. Carrelo v. Advanced Neuromodulation Sys., Inc., 777 F. Supp.
2d 315, 318 (D.P.R. 2011).
Turning to the case at bar, Defendants argue that Dr. Santiago Noa allegedly failed
to establish the proper standard of care in his report. However, after a review of the
reports of the expert witnesses for all parties, it is noted that Plaintiffs’ expert witness and
those of Defendants do address the standard of care and they do so in the same way. Thus,
what is good for the goose is good for the gander.
Dr. Santiago Noa’s report states that “in this case, it was identified that the patient
was at risk of elopement”, 1 a fact clearly stated in the record and an undeniable conclusion
reached by that all experts in this case, including those for Defendants. All three experts,
in addressing the standard of care, conclude that special care must be taken by the
institution in cases where patient elopement is a possibility. Dr. Santiago Noa then goes
on to detail how Dr. Pila Hospital, breached said requirement, a conclusion which Dr. Pila
Hospital naturally does not agree with. Therefore, Defendants’ contention that the report
does not detail the standard of care and that they cannot “properly prepare for rebuttal or
cross examination at trial” regarding this issue falls short.

1

Docket 74, Exhibit 1, p. 4.

Blanca Rivera Romero, et al. v. Inspira Behavioral Care, et al.
Opinion and Order
Civil 16-2721 (CVR)
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Defendants also aver that Dr. Santiago Noa’s report violated the Federal Rules
because he changed his expert opinion during his deposition, offering opinions of alcohol
withdrawal that were not originally included in his report. Plaintiffs’ main contention,
however, is that Dr. Pila Hospital failed to properly supervise Julio Mayol while there, and
he eloped. Facts and conclusions as to this specific matter are clearly detailed in the
report. That Dr. Santiago Noa failed to include in his report an opinion regarding alcohol
withdrawal does not deviate from Plaintiffs’ main assertion, to wit, that Dr. Pila Hospital
had a duty toward a patient in this case, failed to comply with it, and was therefore
negligent in the treatment provided to him. This is precisely the kind of issue that falls
squarely within the jury’s province. See Carrelo 777 F. Supp. 2d at 318-19 (a challenge to
the factual underpinnings of an expert opinion is a matter that affects the weight and
credibility of the testimony and is a jury question) citing United States v. Vargas, 471 F.3d
255, 264 (1st Cir. 2006) and Int’l Adhesive Coating Co. v. Bolton Emerson Int’l, Inc., 851
F.2d 540, 544-545 (1st Cir. 1988)) (“The burden is on opposing counsel through crossexamination to explore and expose any weaknesses in the underpinnings of the expert’s
opinion”).
This reasoning also applies to Defendants’ argument that Dr. Santiago Noa never
worked in hospital administration and is not an expert in emergency room medicine or
internal medicine. Whether these facts may ultimately help Defendants during the trial
is not for this Court to determine at this stage, but is a matter entrusted to the jury as part
of its fact-assessment duty. All these arguments go to the weight of Dra. Santiago Noa’s
testimony, not its admissibility. Defendants are free to voire dire and cross-examine the
doctor on the stand, and the jurors will give his testimony the probative value they see fit.

Blanca Rivera Romero, et al. v. Inspira Behavioral Care, et al.
Opinion and Order
Civil 16-2721 (CVR)
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Regarding the reliability of principles and methods under Daubert and its progeny,
some types of expert testimony will be more objectively verifiable, and subject to the
expectations of falsifiability, peer review, and publication, than other, non-scientific
testimony. Indeed, some types of expert testimony will not rely on anything like a
scientific method, and will thus have to be evaluated by reference to other standard
principles attendant to the particular area of expertise. It is therefore the job of the trial
judge to determine whether proffered expert testimony is properly grounded, wellreasoned, and not speculative before it can be admitted. See e.g., American College of
Trial Lawyers, Standards and Procedures for Determining the Admissibility of Expert
Testimony after Daubert, 157 F.R.D. 571, 579 (1994) (“[W]hether the testimony concerns
economic principles, accounting standards, property valuation or other non-scientific
subjects, it should be evaluated by reference to the ‘knowledge and experience’ of that
particular field.”).
In the instant case, Dr. Santiago Noa is qualified as an expert because of his
knowledge, skill, and experience and training, as his deposition testimony clearly
established. He has further rendered services in several cases as an expert, both for
plaintiffs and defendants. That he has a psychiatry specialization is undeniably relevant
to the case at hand, insofar as Julio Mayol, the decedent, had a mental condition at the
time the events in this case took place. 2 As such, Dr. Santiago Noa’s testimony will
certainly help the trier of fact better understand the relevant issues in this case.

2 Co-Defendant Inspira Behavioral Care is a specialized psychiatric hospital that serves adult patients with mental
conditions and substance dependence. (Docket No. 37, p. 2).

Blanca Rivera Romero, et al. v. Inspira Behavioral Care, et al.
Opinion and Order
Civil 16-2721 (CVR)
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Additionally, as an expert in psychiatry, Dr. Santiago Noa offered his conclusions
as to the cause of the elopement and death, after evaluating the totality of the evidence
before him. The Court cannot say that his conclusions are irrelevant or unreliable, insofar
as they seem properly grounded, well-reasoned, and are clearly based on the evidence he
examined and his knowledge and long experience in this field. At this stage, that is all
the Court needs to analyze as part of its gatekeeping function. Whether or not Dr.
Santiago Noa’s opinions and conclusion, as to any negligence by Defendants and the cause
of death, will ultimately sway a jury remains a matter to be assessed at trial by the trier of
fact.
CONCLUSION
In view of the above, Defendants’ Motion in Limine is DENIED. (Docket No. 74).
IT IS SO ORDERED.
In San Juan, Puerto Rico, on this 23rd day of January 2020.

S/CAMILLE L. VELEZ-RIVE
CAMILLE L. VELEZ RIVE
UNITED STATES MAGISTRATE JUDGE