Lugo v. Hosp. Matilde Brenes Inc.

RUBMARIE VALENTIN LUGO; HERNAN OTERO AND THEIR LEGAL CONJUGAL PARTNERSHIP, Plaintiffs v. HOSPITAL MATILDE BRENES INC., D/B/A DOCTORS' CENTER HOSPITAL BAYAMON;CONTINENTAL INSURANCE COMPANY; DR. HECTOR RIVERA RIVERA;MARY DOE AND THEIR LEGAL CONJUGAL PARTNERSHIP; EFG INSURANCE COMPANY;EMERGENCIOLOGOS PARA PUERTO RICO PSC; XYZ INSURANCE CO.;DR. ANGEL TORRES SANCHEZ; JANE DOE AND THEIR LEGAL CONJUGAL PARTNERSHIP;MNO INSURANCE COMPANY, Defendants

CIVIL 12-1757 (PAD)

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF PUERTO RICO

November 7, 2014

MAGISTRATE JUDGE'S REPORT AND RECOMMENDATION

On December 18, 2013, plaintiffs Rubmarie Valentín Lugo, Hernán Otero and their Legal Conjugal Partnership filed a third amended complaint alleging violations under the Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. §§ 1395dd et seq. and articles 1802 and 1803 of the Puerto Rico Civil Code, P.R. Laws Ann. tit. 31 §§ 5141 and 5142, against defendants Hospital Matilde Brenes, Inc. D/B/A Doctors' Center Hospital Bayamón, Dr. HectorRivera Rivera, Dr. Ángel Torres Sánchez, Emergenciólogos para Puerto Rico PSC, their respective insurance companies and any other party that might potentially be responsible for the injuries suffered. (See Docket Nos. 1, 16, 20, 49). Defendants answered the complaint and amended complaints, including the third amended complaint, denying the existence of an EMTALA violation since the transfer to another hospital at issue was conducted per patient's request (Docket Nos. 10, p. 1, ¶2¹, 51 at 4, 61-1, p. 2², ¶2, Docket No. 80, p. 8³) after it was determined by an examining doctor that she was stable. (Docket No. 10, p. 1, ¶2). They also claimed that the treatment provided was the appropriate one based on the physician's diagnostic impressions. (Docket No. 12, pp. 3-4, ¶13 and 26).

Defendants moved for Summary Judgment (Docket No. 61) based on a lack of genuine issues of material fact as shown by the evidence presented and on the absence of a genuine dispute under the substantive law relevant to the case. (Docket No. 61, p. 4).

Plaintiffs responded in opposition to the Motion for Summary Judgment (Docket No. 66) by claiming that there are sufficient genuine issues of materialfact that preclude summary disposition (Docket No. 66, p. 2, ¶2) regarding the appropriate screening exam available within the hospital's capabilities (Docket No. 66, p. 2, ¶4), the patient's stabilization prior to her transfer (Docket No. 66, p. 3, ¶7) and the validity of the certifying document. (Docket No. 66, p. 3, ¶9).

In the reply to the plaintiffs' response in opposition to the Motion for Summary Judgment (Docket No. 80) defendants claimed that the test required by EMTALA is for appropriate treatment based on what the physicians perceived the condition to be and not what the adequate treatment should have been, which would turn the claim under EMTALA into a malpractice federal claim. (Docket No. 80, p. 6).

Having considered the opposing statements of the parties and their arguments, I recommend that the court enter the following

II. FINDINGS OF FACT

1. On December 27, 2011, plaintiff Rubmarie Valentín developed sudden onset abdominal and pelvic pain during her lunch break at Doctors' Center Hospital Bayamón where she worked, and was transferred to the Doctors' Center Hospital Bayamón's Emergency Room. (Docket No. 49, p.5, ¶12-13).

2. Defendants claim that plaintiff Rubmarie Valentín was first taken to the Labor Room where she refused to be examined by the resident obstetrician Dr. Hernández, preferring to be treated by her personal obstetrician in Manatí.(Docket No. 51, p. 2, ¶1; p. 6, ¶27). In the Emergency Room, a Non-Stress Test⁴ was performed that indicated a normal fetal heart rate⁵ and showed no evidence of contractions⁶. (Docket no. 51, p. 3, ¶13).

3. Plaintiffs claim that the Non-Stress Test did show a wave that could have been a uterine contraction, (Docket No. 67, p. 2, ¶ 3) but that the test performed was not complete enough to provide for an appropriate screening. (Docket No. 67, p. 3, ¶11).

4. A pelvic examination⁷ further revealed that plaintiff Rubmarie Valentín had not dilated⁸. (Docket no. 51, p. 4, ¶15). Both examinations were performed by Dr. Ángel Torres Sánchez (Docket no. 51, p. 4, ¶16) in an attempt to identifya critical medical condition, according to the symptoms plaintiff Rubmarie Valentín presented and the level of screening applied to all patients with similar complaints. (Docket no. 80, p. 5).

5. Plaintiff Rubmarie Valentín's vital signs⁹ and Dr. Hector Rivera Rivera's diagnostic impression of back pain¹⁰, pelvic pain and renal colic¹¹ were obtained and recorded after which a CBC¹², a U/A¹³, a PT¹⁴, a PTT¹⁵, a CMP¹⁶, and a renalsonogram¹⁷ were ordered. (Docket no. 49, p. 5, ¶ 13; Docket no. 51, p. 1-2, ¶1; Docket no. 52, p. 3, ¶13).

6. Since plaintiff had a prior history of renal stones¹⁸, she was tested to determine whether they were the source of the pain (Docket no. 61, pp. 17-18), without considering her pregnancy since there were no apparent contractions and she appeared to be stable. (Docket no. 61, p. 19).

7. At plaintiff's own request, the hospital started an arrangement for her transfer to Doctors' Center Hospital in Manatí, where her OB/GYN, Dr. Jorge Otero Quintana, was available to treat her. (Docket no. 49, p. 5, ¶16; Docket no. 51, p. 2, ¶1). Dr. Angel Torres Sánchez drafted a detailed certification of transfer, which was supposedly signed by plaintiff Rubmarie Valentín. (Docket no. 51, p. 4, ¶16)¹⁹.

8. Defendants claim that at the time the ambulance left the hospital plaintiff Rubmarie Valentín's vital signs were normal (Docket No. 51, p. 4, ¶16), while plaintiffs claim that according to the paramedic record she was having prematurecontractions and that her pulse indicated the possibility of hypovolemic shock²⁰ and class II hemorrhage²¹. (Docket no. 66, p. 5, ¶ 14; Docket no. 66-1, p. 5).

9. Upon arriving at Doctors' Center Hospital in Manatí, the receiving nurse recorded there was no fetal heart rate and that the patient was having contractions; as well as being pale, diaphoretic²² and restless. (Docket no. 49, p. 6, ¶18).

10. The physical examination performed in the Emergency Room revealed she had tachycardia²³ without respiratory distress²⁴, her abdomen as being gravid²⁵ with tenderness²⁶ to palpation and an inability to detect the fetal heartrate frequency. (Docket no. 49, p. 6, ¶19).

11. An emergency exploratory laparatomy²⁷ performed by her OB/GYN revealed a ruptured uterus²⁸ caused by a previous cesarean section²⁹ scar³⁰, and intra-uterus death fetus³¹. (Docket no. 49, p. 7, ¶ 20-21, Docket no. 51, p. 5, ¶20).

12. Plaintiff had to be transferred to the intensive care unit and developed further complications while hospitalized. (Docket No. 49, p. 7, ¶22). Upon being released on January 3, 2012 she became aware of further neurologic³² deficits in her senses of taste and smell. (Docket No. 49, p. 7, ¶23 and 25).

Based upon the above proposed findings of fact, I recommend that the court enter the following

III. CONCLUSIONS OF LAW

1. Defendants moved for summary judgment under Rules 7.1(a), 7.1(d), 7.1(e) and 56(a) of the Local Rules of the United States District Court for the District Court of Puerto Rico. "Under Federal Rule of Civil Procedure 56(a), '[t]he court shall grant summary judgment if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.'" Nunes v. Massachusetts Dep't. of Correction, 766 F.3d 136, 142 (1^st Cir. 2014); see Celotex Corp. V. Catrett, 477 U.S. 317, 323, 1056 S. Ct. 2548 (2000); Cruz-Gascot v. HIMA-San Pablo Hosp. Bayamon, 728 F. Supp. 2d 14, 18 (D.P.R. 2010).

2. "A fact is material if it carries with it the potential to affect the outcome of the suit under the applicable law. Newman v. Advanced Tech. Innovation Corp., 749 F.3d 33, 36 (1^st Cir. 2014) (quoting One Nat'l Bank v. Antonellis, 80 F.3d 606, 608 (1^st Cir. 1996))." García-González v. Puig-Morales, 761 F.3d 81, 87 (1^st Cir. 2014). "Summary judgment is inappropriate if the evidence 'is sufficiently openended to permit a rational fact finder to resolve the issue in favor of either side.' Gerald v. Univ. of P.R., 707 F.3d 7, 16 (1^st Cir. 2013)." Ahmed v. Johnson, 752 F.3d 490, 495 (1^st Cir. 2014).

3. The Emergency Medical Treatment and Active Labor Act, also known as EMTALA, was enacted by Congress "to prevent the unsavory practice known as patient 'dumping', whereby hospitals precipitously discharged or transferred toother hospitals patients who were unable to pay for their healthcare, in many cases even before the hospital determined whether the patient had a critical medical condition which was likely to deteriorate after discharge or during the inter-hospital transfer. See Correa v. Hosp. San Francisco, 69 F.3d 1184, 1189-90 (1^st Cir. 1995)." Fraticelli-Torres v. Hospital Hermanos, 300 Fed. Appx. 1, 3 (1^st Cir. 2008); cf. Kenyon v. Hospital San Antonio, Inc., 951 F. Supp. 2d 255, 262 (D.P.R. 2013).

4. "To establish an EMTALA violation, a plaintiff must show (1) the hospital is a participating hospital, covered by EMTALA, that operates an emergency department; (2) the plaintiff arrived at the facility seeking treatment; and (3) the hospital either (a) did not afford the patient an appropriate screening in order to determine if she had an emergency condition, or (b) released the patient without first stabilizing the emergency medical condition. Correa [v. Hosp. San Francisco, 69 F.3d 1184, 1190 (1^st Cir. 1995)]." Cruz-Vázquez v. Mennonite Gen. Hosp., Inc., 717 F.3d 63, 68-69 (1^st Cir. 2013); Maldonado-Rodriguez v. St. Luke's Memorial Hosp., Inc., 940 F. Supp. 2d 30, 35 (D.P.R. 2013); Matta-Rodriguez v. Ashford Presbyterian Community Hosp., 2014 WL 3592087 at *4 (D.P.R. July 18, 2014).

5. The EMTALA statute itself does not define what an appropriate medical screening or examination consists of but our Court of...