Robles-Figueroa v. Presbyterian Community Hospital, Inc. et al
Filing
171
OPINION AND ORDER denying 103 Motion In Limine To Exclude Jocelyn Holt's Testimony As An Expert. See attached. Signed by Judge Gina R. Mendez-Miro on 1/27/2025. (GMN)
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF PUERTO RICO
Keila Robles-Figueroa
on behalf of her minor daughter Civil. No. 22-cv-01361(GMM)
Kamila
Plaintiff,
v.
Presbyterian Community Hospital,
Inc., et al.,
Defendants
OPINION AND ORDER
On July 29, 2022, a minor, Kamila, who is represented by her
mother Keila Robles Figueroa (“Plaintiff” or “Mrs. Robles”), filed
a Complaint against Dr. Juan C. Castañer, Presbyterian Community
Hospital,
Inc.
(“the
Hospital”)
and
to
Hospital
Pediátrico
Universitario alleging claims of medical malpractice under Puerto
Rico state law. (Docket No. 1). Pending before the Court is the
Motion In Limine To Exclude Jocelyn Holt’s Testimony As An Expert
Witness In Life Care Planning. (Docket No. 103). For the reasons
stated below, the Motion in Limine is DENIED.
I.
RELEVANT FACTUAL AND PROCEDURAL HISTORY
This is a medical malpractice case in which Plaintiff alleges
that Dr. Juan C. Castañer (“Dr. Castañer”), the Hospital and the
Hospital
Pediátrico
Universitario
(collectively
“Defendants”)
deviated from the standards of care. The allegations of negligence
Civil No. 22-1361 (GMM)
Page -2-
are centered on the medical care provided to Mrs. Robles and her
baby during her pregnancy, delivery, and the neonatal care of her
premature infant.
Relevant here, the Court issued a Case Management Order on
October 3, 2022, which set discovery to conclude on May 3, 2023.
(Docket No. 22). On March 31, 2023, the parties filed a Joint
Motion for Leave to Extend Discovery Deadline and to File a
Discovery Plan, which was granted by the Court. (Docket Nos. 35,
37). Thereby the Court extended discovery until July 31, 2023, and
adopted
the
parties’
discovery
plan.
(Docket
No.
35).
This
discovery plan included July 20, 2023 as the deadline to produce
Defendants’
expert
reports
and
no
additional
deadline
was
established as to Plaintiff’s experts, since they had already
produced their reports.
On September 5, 2023, the Court set Jury Trial for September
23, 2024. (Docket No. 61). On August 22, 2024, the Parties filed
their Joint Proposed Pretrial Order. (Docket No. 62). On the same
date they filed an Amended Joint Proposed Pretrial Order. (Docket
No. 64). On August 22, 2024, Dr. Castañer filed a Motion for
Continuance seeking to move the trial dates. (Docket No. 69). After
the
matter
was
briefed,
the
Court
granted
the
Motion
for
Continuance and sanctioned Dr. Castañer and his counsel with the
payment of reasonable fees and costs incurred. (Docket No. 75).
Civil No. 22-1361 (GMM)
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On August 30, 2024, the Hospital filed a series of motions in
limine. On September 3, 2024, the Jury Trial was reset to commence
on February 3, 2025. (Docket No. 96). On September 10, 2024, after
the Court granted an extension of time, the Hospital filed the
Motion In Limine that is now before the Court. (Docket No. 103).
On September 16, 2024, Dr. Castañer filed a Motion for Joinder as
to this Motion In Limine filed by the Hospital. (Docket No. 108).
On October 7, 2024, Plaintiff filed Plaintiff’s Opposition to
Codefendant’s Motion In Limine At Docket No. 103. On November 18,
2024, the Hospital filed Reply to Plaintiff’s Opposition To The
Hospital’s Motion In Limine At Docket No. 103 (Docket No. 143). On
November 25, 2024, Dr. Castañer filed a Motion for Joinder as to
motions filed by the Hospital at Docket Nos. 139, 140, 141, 142
and 143. (Docket No. 149). On December 5, 2024, Plaintiff filed
Plaintiff’s Sur-Reply to Codefendant’s Replies at Docket No. 143
(Docket No. 154).
II.
A.
APPLICABLE LAW
Rule 702: The Admissibility of Expert Witness
Fed. R. Evid. 702 controls the admissibility of expert witness
testimony. See Crow v. Marchand, 506 F.3d 13, 17 (1st Cir. 2007)
(“The touchstone for the admission of expert testimony in federal
court litigation is Federal Rule of Evidence 702.”). The Rule
dictates:
Civil No. 22-1361 (GMM)
Page -4-
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. Fed. R. Evid. 702 assigns a “gatekeeping role
for the judge” to ensure that the expert is “sufficiently qualified
to assist the trier of fact” and “that an expert’s testimony both
rests on a reliable foundation and is relevant to the task at
hand.” Daubert v. Merrell Dow Pharm., 509 U.S. 579, 597 (1993);
Kumho Tire Co. v. Carmichael, 526 U.S. 137, 147-49 (1999) (holding
that Daubert applies to all expert testimony). A trial court “must
have considerable leeway in deciding in a particular case how to
go
about
determining
whether
particular
expert
testimony
is
reliable.” Kumho Tire Co., 526 U.S. at 152. To aid trial judges in
their role as gatekeepers, the Daubert Court set forth several
factors that may be taken into consideration, none of which are
determinative: (i) whether a theory or technique can and has been
tested; (ii) whether the theory or technique has been subjected to
peer
review
and
publication;
(iii)
whether
the
particular
scientific technique has a known or potential rate of error; and
Civil No. 22-1361 (GMM)
Page -5-
(iv) the “general acceptance” of a theory or technique.
See
Daubert, 509 U.S. at 593-94.
To determine that an expert’s evidence rests of reliable
foundation the district court considers whether “the testimony is
based on sufficient facts or data”; whether “the testimony is the
product of reliable principles and methods”; and whether “the
expert has reliably applied the principles and methods to the facts
of the case.” Smith v. Jenkins, 732 F.3d 51 (1st Cir. 2013) (citing
Fed. R. Evid. 702). Where, as here, the factual basis of an
expert’s testimony is called into question, the district court
must determine whether the testimony has “a reliable basis” in
light of the knowledge and experience of the relevant discipline.
See Kumho Tire Co., 526 U.S. at 148. Thus, “nothing in either
Daubert or the Federal Rules of Evidence requires a district court
to admit opinion evidence that is connected to existing data only
by the ipse dixit of the expert. A court may conclude that there
is simply “too great an analytical gap between the data and the
opinion proffered.” General Elec. Co. v. Joiner, 522 U.S. 136, 146
(1997).
The Court notes, however, the difference between “unreliable”
support
and
“insufficient”
support
for
an
expert
witness'
conclusion. See Martínez v. United States, 33 F.4th 20, 24 (1st
Cir. 2022) (quoting Milward v. Acuity Specialty Prods. Grp., Inc.,
639 F.3d 11, 22 (1st Cir. 2011)). Whether the underpinning of an
Civil No. 22-1361 (GMM)
Page -6-
expert’s opinion is insufficient is “a matter affecting the weight
and credibility of the testimony – a question to be resolved by
the jury.” Id. (quoting Milward, 639 F.3d at 22). Conversely,
“trial judges may evaluate data offered to support an expert’s
bottom-line opinions to determine if that data provides adequate
support to mark the expert’s testimony as reliable.” Milward, 639
F.3d at 15 (quoting Ruiz-Troche v. Pepsi Cola of Puerto Rico
Bottling Co., 161 F.3d 77, 81 (1st Cir. 1998)). “In a motion to
exclude pursuant to Daubert, the burden on the party who proffers
expert testimony is not to prove that an expert’s conclusion is
correct but rather that the expert reached their conclusion in a
scientifically sound and methodologically reliable way.” Id. at
85.
Ultimately, Rule 702 is generally interpreted liberally in
favor of the admission of expert testimony. See Martínez, 33 F4th
at 24 (quoting Levin v. Dalva Bros., Inc., 459 F.3d 68, 78 (1st
Cir. 2006)).
Furthermore, to ensure reliability and intellectual rigor,
experts “must be able to produce a written report or testimony
supported by an accepted methodology that is based on substantial
scientific, technical, or other specialized knowledge.” Figueroa
v. Simplicity Plan de Puerto Rico, 267 F.Supp.2d 161, 164 (D.P.R.
2003). “Failure to provide a testimony or a report detailing the
basis for the expert’s opinion in a comprehensive scientific manner
Civil No. 22-1361 (GMM)
Page -7-
can cause the expert witness and his report to be eliminated from
trial.” Id. (citing Justo Arenas & Carol M. Romey, Professional
Judgment Standard and Losing Games for Psychology, Experts and the
Courts, 68 Rev. Jur. U.P.R. 159, 180 (1999)).
III. DISCUSSION
Through their Motion in Limine, the Defendants seek to exclude
the testimony of Mrs. Jocelyn Holt (“Mrs. Holt”) as an expert
witness in life care planning. (Docket No. 103). According to
Defendants,
Mrs.
Holt’s
limited
experience
with
pediatric
patients, particularly infants and children with complex medical
conditions like autism and brain injury, and her inexperience in
preparing a life care plan for a medical malpractice case is a
significant factor in disqualifying her testimony. (Id. at 13).
They also posit that Mrs. Holt did not collaborate with or consult
any medical experts, including neurologists, pediatricians, or
other relevant specialists, before rendering her life care plan.
(Id. at 14). Specifically, they sustain that she prepared her life
care plan without consulting any of Kamila’s treating physicians.
In addition, Defendants argue that since Mrs. Holt relied on
generalized data from the Center for Disease Control and Prevention
(“CDC”) as to life expectancy— that is not specific to Kamila’s
condition— and did not consult appropriate experts, her testimony
does not meet the Daubert standards because it lacks a reliable
foundation. (Id. at 17). Defendants also question Mrs. Holt’s
Civil No. 22-1361 (GMM)
Page -8-
methodology and conclusions as speculative and unreliable. (Id. at
18-22).
In response, Plaintiff submits that the Motion In Limine
constitutes and untimely dispositive motion disguised as a motion
in limine. (Docket No. 129 at 8). To this extent, Plaintiff argues
that this District has already held that “a motion in limine to
exclude the plaintiff’s expert on grounds that his opinion is
unreliable was not the appropriate tool to move for judgment on a
particular claim.” (Id. at 9). She argues that “an expert witness
may base his opinion on reports, writings or observations not in
evidence which were made or compiled by others, so long as they
are of a type reasonably relied upon by experts in that particular
field.” (Id. at 10-11). Plaintiff adds that “[t]he opposing party
may challenge the suitability or reliability of such materials on
cross-examination, but such challenge goes to the weight to be
given the testimony, not to its admissibility.” (Id. at 11).
Further, Plaintiff argues that Mrs. Holt “is undeniably an expert
in her field, and her knowledge and experience will allow her to
assist the jury in understanding the damages allegedly sustained
by Plaintiff”. (Id. at 12).
A.
Mrs. Holt’s Qualifications
The record reflects that Mrs. Hold is a certified life care
planner since 2017. (Docket No. 103-1). She is also a Licensed
Occupational Therapist in the state of Florida and a Licensed
Civil No. 22-1361 (GMM)
Page -9-
Occupational Therapist in the State of North Carolina. (Id.). Mrs.
Holt
possesses
Therapy
with
a
a
bachelor’s
minor
in
degree
Health
in
Science,
Science
Occupational
Education
from
the
University of Florida. (Id.) In addition, she holds a Life Care
Planning Certification Course from the Institute of Rehabilitation
Education and Training. Her experience since 2002 has been mainly
as an Occupational Therapist, yet since 2018 she is the owner of
and life care planner at
Planning Hope, LLC
in Gainesville,
Florida. (Id.).
B.
Mrs. Holt’s Life Care Plan for Keila Robles on behalf of
Kamila Robles (“Life Care Plan Report”)
Mrs. Holt’s Life Care Plan Report, dated April 18, 2023,
indicates that “the recommendations are gathered from information
provided
by
[Kamila’s]
medical
providers
through
records
and
evaluations, Keila Robles, evidenced [sic] base practices, as well
as knowledge/experience from this Life Care Planner.” (Docket No.
103-3 at 3). Moreover, during her deposition, Mrs. Holt admitted
that she did not consult any physician before she rendered the
Life Care Plan Report. (Docket No. 103-2 at 16). She also stated
that
the
life
care
plan
reflects
her
opinion,
based
on
her
assessment after speaking with Kamila’s mother and reviewing her
medical record. (Id. at 17). To this extent she expressed that she
interviewed Kamila’s mother on two (2) different occasions. (Id.
at 24). Mrs. Holt used the National Vital Statistic Reports and
Civil No. 22-1361 (GMM)
Page -10-
CDC data and indicated she was not an expert in life expectancy.
(Id. at 20). To that extent, in her Life Care Plan Report, Mrs.
Holt clearly states that “[o]pinions on the life expectancy tables
are deferred to an appropriate expert.” (Docket No. 103-3 at 10).
In addition, in page 15 of her Life Care Plan Report, Mrs. Holt
list a series of references used to prepare her report, which
include
various
website
links
including
the
CDC
and
other
publications from the pediatric and medical field.
Foremost, and Plaintiff admits as much, Mrs. Holt will only
testify as a Life Care Planner, and not as to the applicable
medical
standards
of
care;
the
departures
from
the
medical
standards of care by Defendants in the treatment of Kamila; or the
causal relationship between the alleged departure from the medical
standards of care with Kamila’s damages. To that extent, in her
report, Mrs. Holt references medical history and a summary of the
different
medical
interventions
and
evaluations
performed
by
Kamila’s treating physicians. (Docket No. 103-3 at 4-10). Then,
Mrs. Holt lists current providers and treatment and projects the
lifetime
costs
as
to
physicians,
special
education
services,
Applied Behavioral Analysis, Occupational Therapy, Feeding Clinic
Speech and Language Therapy, Physical Therapy, among others. (Id.
at 13-29).
Although Defendants question the reliability of Mrs. Holt’s
Life Care Plan, because she did not consult Kamila’s physicians,
Civil No. 22-1361 (GMM)
Page -11-
Courts “have found that there is no requirement that an expert
life care planner consult with treating physicians or independent
medical doctors before formulating a life care plan.” Durr v. GOL,
LLC, No. CV 18-3742, 2019 WL 6464971, at *4 (E.D. La. Dec. 2,
2019). Defendants also attack Mrs. Holt’s conclusion because of
her methodology and basis. However, the Court notes that in the
first few pages if his report, Mrs. Holt employed the standard
methodology
applied
by
life
care
planners
which
requires
consideration of: (a) available medical records; (b) assessment of
the individual; (c) assessment of the data and the individual’s
needs,
and
(d)
research
of
the
costs
within
the
relevant
geographical area of items needed for the proper care of the
patient. This appears to be a sufficiently reasonable and reliable
method for formulating a life-care plan. See Marcano Rivera v.
Turabo Med. Ctr. P'ship, 415 F.3d 162, 171 (1st Cir. 2005) (holding
that a district court did not abuse its discretion in admitting
testimony from a life-care expert which was “based on a review of
records from the agency providing her with skilled nursing care,
a letter from her physician, and an interview of Fabiola’s family
and caregiver.”).
The Court agrees with the Defendants to the extent that there
may be some deficiencies in the strength of support for some of
the recommendations in Mrs. Holt’s Life Care Plan Report, but,
following the reasoning of other courts, particularly the First
Civil No. 22-1361 (GMM)
Page -12-
Circuit Court of Appeals in Marcano Rivera, the Court concludes
that those issues go to the weight, and not the admissibility, of
Mrs. Holt’s testimony. Mrs. Holt will be able to testify, and be
subject to cross-examination, about her opinions in this case.
Consequently, the Court declines to exclude her testimony as an
expert witness.
III. CONCLUSION
For these reasons, the Motion in Limine is DENIED.
IT IS SO ORDERED.
In San Juan, Puerto Rico, January 27, 2025.
s/Gina R. Méndez-Miró
GINA R. MÉNDEZ-MIRÓ
UNITED STATES DISTRICT JUDGE
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