González-Arroyo v. Doctors' Ctr. Hosp. Bayamon, Inc.

JAMILET GONZÁLEZ-ARROYO, Plaintiff v. DOCTORS' CENTER HOSPITAL BAYAMON, INC., et al. Defendants

CIVIL NO. 17-1136(RAM)

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF PUERTO RICO

July 23, 2021

OPINION AND ORDER¹

RAÚL M. ARIAS-MARXUACH, District Judge

Pending before the Court is defendant Doctors' Center Hospital Bayamón Motion for Summary Judgment & Legal Memorandum in Support of the Same ("Motion for Summary Judgment" or "MSJ") and Statement of Uncontested Material Facts in Support of Motion for Summary Judgment ("SUMF") requesting the dismissal of the present case. (Docket Nos. 62 and 62-1). Having reviewed the parties' submissions in support and in opposition to the motion (Docket Nos. 67 and 71), the Court GRANTS the Motion for Summary Judgment at Docket No. 62. Judgment dismissing the case with prejudice shall be entered accordingly.

I. BACKGROUND

On January 30, 2017, Jamilet González-Arroyo ("Mrs. González" or "Plaintiff"), in representation of her minor son ALG, filed a lawsuit alleging medical malpractice against Doctors' Center Hospital Bayamón, Inc. ("the Hospital"), Dr. Benito Hernández-Díaz ("Dr. Hernández"), his wife, and the conjugal partnership between them, among other defendants (collectively, "Defendants"). (Docket No. 1). On April 26, 2011, Plaintiff arrived at the Hospital and was admitted under the care of Dr. Hernández. Id. ¶ 20. At the time, Plaintiff's baby had a gestational age between 37-38 weeks. Id. That same day, Plaintiff gave birth to a male infant, ALG, by cesarean section. Id. ¶ 29. Due to complications, ALG was admitted to a special case nursery and was released on May 5, 2011. Id. ¶¶ 33-35. ALG was later diagnosed with autism and cerebral palsy. Id. ¶ 36. Plaintiff alleges ALG'S present and future conditions were caused by Defendants' negligence, that is, their departures from the medical standard of care. Id. ¶ 46. Specifically, these departures included "the failure to timely perform a cesarean section to prevent ALG's loss of oxygen at birth and to timely initiate resuscitative maneuvers." Id. ¶ 47. In addition, she asserts Defendants' failure to "manage and stabilize baby ALG's condition after his birth has been devastating. Baby ALG now is catastrophically injured with severe brain damage as well as physical and neurologic abnormalities that are permanent and incapacitating." Id. ¶ 48. The Hospital and Dr. Hernández deny they failed to meet the standard of care. (Docket Nos. 9 ¶¶ 29 and 31; 12 ¶¶ 22 and 24).

Plaintiff retained Dr. Barry Schifrin ("Dr. Schifrin") as her expert witness and notified he would testify as:

An expert in obstetrics and gynecology regarding his qualifications and experience, his review of the pertinent records, the standards of care applicable to this case, the Defendants' departures from such standards, the causal relationship of these departures with the damages of baby ALG, the contents of his expert report, the applicable medical literature and the testimony given at his deposition.

(Docket No. 22 at 44).

On February 18, 2020, the Hospital filed a Motion in Limine requesting the Court strike Dr. Schifrin as an expert. (Docket No. 44). Subsequently, on February 20, 2020, Dr. Hernández and his wife filed a Motion for Joinder requesting to join the Hospital's Motion in Limine and joinder was granted. (Docket Nos. 45 and 46). Plaintiff presented an Opposition to the Motion in Limine, and accordingly the Hospital filed a reply. (Docket Nos. 50 and 55).

On August 5, 2020, the Court granted the Motion in Limine and struck Dr. Schifrin's expert report for failing to comply with the requirements of Fed. R. Civ. P. 26, Fed. R. Evid. 702, and the applicable case law. (Docket No. 56 at 16).

On December 16, 2020, the Hospital filed a Motion for Summary Judgment. (Docket Nos. 62). Dr. Hernández, Jane Doe and the conjugal partnership between them again moved for joinder and it was granted. (Docket Nos. 63 and 73). On January 29, 2021, Plaintiff opposed the MSJ and propounded additional facts ("Opposition to MSJ") (Docket Nos. 67 and 67-1). Lastly, on February 24, 2021, the Hospital replied to the opposition ("Reply"). (Docket No. 71).

II. LEGAL STANDARD

A. Summary Judgment Standard under Fed. R. Civ. P. 56

Summary judgment is proper under Fed. R. Civ. P. 56(a) "'if 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 a judgment as a matter of law.'" White v. Hewlett Packard Enterprise Company, 985 F.3d 61, 68 (1st Cir. 2021) (quoting Celotex Corp. v. Catrett, 477 U.S. 317, 322).

A genuine dispute exists "if the evidence about the fact is such that a reasonable jury could resolve the point in favor of the non-moving party." Alicea v. Wilkie, 2020 WL 1547064, at *2 (D.P.R. 2020) (quotation omitted). A fact is material if "it is relevant to the resolution of a controlling legal issue raised by the motion for summary judgment." Bautista Cayman Asset Co. v. Terra II MC & P, Inc., 2020 WL 118592, at *6 (D.P.R. 2020) (quotation omitted).

The party moving for summary judgment "bears the initial burden of showing that no genuine issue of material fact exists." Feliciano-Muñoz v. Rebarber-Ocasio, 2020 WL 4592144, at *6 (1st Cir. 2020) (citation omitted). This burden is met "when the moving party demonstrates that the opposing party has failed 'to make a showing sufficient to establish the existence of an element essential to that party's case, and on which that party will bear the burden of proof at trial.'" E.E.O.C. v. Kohl's Dept. Stores, Inc., 774 F.3d 127, 131 (1st Cir. 2014) (quoting Celotex Corp., 477 U.S. at 322).

The non-movant may "defeat a summary judgment motion by demonstrating, through submissions of evidentiary quality, that a trialworthy issue persists." Robinson v. Town of Marshfield, 950 F.3d 21, 24 (1st Cir. 2020) (quotation omitted). Nevertheless, a non-movant "cannot merely 'rely on an absence of competent evidence but must affirmatively point to specific facts that demonstrate the existence of an authentic dispute.'" Vogel v. Universal Insurance Company, 2021 WL 1125015, at *2 (D.P.R. 2021) (quoting Feliciano-Muñoz, 2020 WL 4592144, at *6). Solely relying on "conclusory allegations, improbable inferences, and unsupported speculation" is insufficient to defeat summary judgment. River Farm Realty Tr. v. Farm Family Cas. Ins. Co., 943 F.3d 27, 41 (1st Cir. 2019) (quotation omitted).

Local Rule 56 also governs summary judgment. See L. CV. R. 56. Per this Rule, a non-movant must "admit, deny or qualify the facts supporting the motion for summary judgment by reference to each numbered paragraph of the moving party's statement of material facts." Id. The First Circuit has stated that adequately supported facts "shall be deemed admitted unless controverted in the manner prescribed by the local rule." Muñiz Negrón v. Worthington Cylinder Corporation, 2021 WL 1199014, at *3 (D.P.R. 2021) (quoting Advanced Flexible Circuits, Inc. v. GE Sensing & Inspection Techs. GmbH, 781 F.3d 510, 520 (1st Cir. 2015)). Hence, "litigants ignore Local Rule 56 at their peril." Calderón Amézquita v. Vices, 2019 WL 3928703, at *1 (D.P.R. 2019) (citation omitted).

B. Expert Testimony in Medical Malpractice Cases in Puerto Rico

The substantive law of Puerto Rico controls in a diversity case. See Baum-Holland v. Hilton El Con Management, LLC, 964 F.3d.77, 87 (1st Cir. 2020) ("Because this is a diversity case, we apply Puerto Rico's substantive law."); Summers v. Fin. Freedom Acquisition LLC, 807 F.3d 351, 354 (1st Cir. 2015) ("Since this is a diversity case, we look to federal law for guidance on procedural matters (such as the summary judgment framework) and to state law (here, [Puerto Rico] law) for the substantive rules of decision."). Thus, pursuant to Puerto Rico law, a plaintiff in a medical malpractice case must prove three key elements: "(1) the duty owed (i.e., the minimum standard of professional knowledge and skill required in the relevant circumstances); (2) an act or omission transgressing that duty; and (3) a sufficient causal nexus between the breach and the harm." Santa Cruz Bacardi v. Metro Pavia Hospital Inc., 2020 WL 249433, at *6 (D.P.R. 2020) (quotation omitted). This duty owed, which is the standard of care owed by physicians to their patients, is based on a national standard. See Noel Martínez et al. v. United States of America, 2020 WL 5039242, at *4 (D.P.R. 2020) (citation omitted). Thus, "in the light of the modern means of communication and education," this duty must "meet[] the requirements generally recognized by the medical profession." Id. (quotation omitted).

Under Puerto Rico law there is a presumption that "physicians have 'provided an appropriate level of care.'" Laboy-Irizarry v. Hospital Comunitario Buen Samaritano, Inc., 2019 WL 3311270, at *9 (D.P.R. 2019) (quoting Borges ex rel. S.M.B.W. v. Serrano-Insern, 605 F.3d 1, 7 (1st Cir. 2010)). "Plaintiffs are obligated to refute this presumption by proffering evidence which shows the minimum required standard of care and the doctor's failure to achieve said standard." López Ramírez v. Grupo HIMA San Pablo, Inc., 2020 WL 5351851, *2 (D.P.R. 2020) (citation omitted). Therefore, absent proof of the duty owed "it is virtually impossible to prove either breach or proximate cause." Vargas-Alicea v. Cont'l Cas. Co., 2020 WL 3470325, at *3 (D.P.R. 2020) (quotation and internal quotation marks omitted) (emphasis added).

To prove the "causal nexus" described in the third element of a medical malpractice claim, a plaintiff must establish "adequate causation." This adequate cause "is not every condition without which a result would not have been produced, but that which ordinarily produces it according to general experience." Laboy-Irizarry, 2019 WL 3311270, at *9 (quotation omitted) (emphasis added). Likewise, "[u]nder Puerto Rico law, '[i]n...