Mesías v. Hosp. Hima San Pablo

DAMIÁN ANNONI MESÍAS, et al., Plaintiffs, v. HOSPITAL HIMA SAN PABLO, et al., Defendants.

CIVIL NO. 184988 (JAG)

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF PUERTO RICO

March 24, 2021

OPINION AND ORDER

GARCÍA-GREGORY, D.J.

Before the Court is Defendants' Dr. Carlos M. Nieves La Cruz ("Dr. Nieves") and Centro Médico del Turabo, Inc. d/b/a Hospital HIMA San Pablo Bayamón's ("HIMA") (collectively, "Defendants") Motion for Judgment as a Matter of Law and/or Alternative Motion for a New Trial and/or Remittitur, Docket No. 100; Plaintiffs Damián Annoni Mesías and Roberto Annoni Mesías's (collectively, "Plaintiffs") Response in Opposition, Docket No. 106; and Defendants' Reply, Docket No. 113. For the reasons below, the Court GRANTS IN PART and DENIES IN PART Defendants' motion.

BACKGROUND

On January 31, 2020, a jury found Defendants jointly liable to Plaintiffs for emotional damages under Articles 1802 and 1803 of the Civil Code of Puerto Rico, P.R. LAWS ANN. tit. 31 §§ 5141-42. Docket No. 81. Specifically, it found that Dr. Nieves, who performed a coronary catherization on Plaintiffs' brother, José Annoni Mesías (the "Patient"), was "negligent" in doing so, and that "this negligence proximately caused [emotional] injury to plaintiffs . . . ." Id. The jury awarded $700,000.00 in compensatory damages—$350,000.00 for each Plaintiff. Id. On February 5, 2020, the Court entered judgment apportioning the award. Docket No. 86.¹

On March 3, 2020, Defendants filed a Post Trial Motion for Judgment as a Matter of Law and/or Alternative Motion for a New Trial Under F.R.C.P. Rule 59[A][1][A] and/or for Remittitur. Docket No. 100. They contend that the Court should: (1) amend the judgment as a matter of law because Plaintiffs failed to satisfy their burden of proof;² or alternatively (2) grant a new trial because the verdict is contrary to the clear weight of the evidence presented; or (3) remit the award of damages because these were "shocking" and "excessive." Id. On March 23, 2020, Plaintiffs opposed, Docket No. 106; and on April 30, 2020, Defendants replied, Docket No. 113.

ANALYSIS

I. Judgment as a Matter of Law Under Rule 50

Fed. R. Civ. P. 50 ("Rule 50") allows a party to move for entry of judgment as a matter of law during a jury trial. Such a motion may be granted "[i]f a party has been fully heard on an issue during a jury trial and the court finds that a reasonable jury would not have a legally sufficient evidentiary basis to find for the party on that issue." Fed. R. Civ. P. 50(a)(1). If the Court denies the motion, then "[n]o later than 28 days after the entry of judgment . . . [t]he movant may file a renewed motion for judgment as a matter of law and may include an alternative or joint request for a new trial under Rule 59." Fed. R. Civ. P. 50(b); see also Taber Partners I v. Ins. Co. of N. Am., Inc., 917 F. Supp. 112, 115 (D.P.R. 1996). "[C]ourts may only grant a judgment contravening a jury'sdetermination when the evidence points so strongly and overwhelmingly in favor of the moving party that no reasonable jury could have returned a verdict adverse to that party." Monteagudo v. Asociacion de Empleados del Estado Libre Asociado, 554 F.3d 164, 170 (1st Cir. 2009) (citations omitted). As part of this analysis, courts "may not consider the credibility of witnesses, resolve conflicts in testimony, or evaluate the weight of the evidence." 11 James Wm. Moore, MOORE'S FEDERAL PRACTICE 3D, 9 § 50.06[6][b], at 50-40 (2003).

In this medical malpractice case, Plaintiffs must establish three elements under Puerto Rico law: (1) the applicable standard of medical care; (2) that the medical personnel failed to follow the standard; and (3) a causal relation between the act or omission of the physician and the injury suffered. Lama v. Borras, 16 F.3d 473, 478-79 (1st Cir. 1994).

Here, Defendants essentially reallege the arguments presented in their first motion for judgment as a matter of law. Docket Nos. 115 at 3; 116 at 3. Specifically, they argue that the evidence presented in Plaintiffs' case-in-chief is insufficient to establish (1) whether the Patient was reasonably stable enough to undergo the "bridging therapy" prior to the catheterization, and (2) whether such therapy indeed constituted the appropriate standard of care for this type of patient. Defendants contend that in his trial testimony, Plaintiffs' expert—Dr. Andrew Selwyn ("Dr. Selwyn")—admitted (1) not finding "any mention of the 'bridging therapy' as the standard of care" in certain professional guidelines jointly admitted in evidence, and (2) "that the patient was at high risk [of] hemorrhagic bleeding" when intervened. Docket Nos. 100 at 11; 113 at 5.

Plaintiffs respond that the verdict is adequately supported, as "the jury sifted through the evidence and the various conflicting medical opinions and agreed with the plaintiffs' theory." Docket No. 106 at 4-5. Plaintiffs recall part of Dr. Selwyn's trial testimony saying that the Patient was stable, as his initial arrythmia "was controlled with medication," and that the standard of care prior to a coronary catheterization would have been to allow the Patient's measure of coagulation to normalize, then give him heparin and aspirin as "bridging therapy," which Dr. Nieves failed to do. Id. at 4.

After a careful and thorough assessment of the trial evidence and the Parties' motions, the Court finds that it should not disturb the jury verdict on liability. Contrary to Defendants' assertions, the record prevents the Court from concluding that Plaintiffs presented no evidence to make their case. Montgomery Ward & Co. v. Duncan, 311 U.S. 243, 251 (1940) (pursuant to Rule 50, "motion for judgment cannot be granted unless, as matter of law, [plaintiff] failed to make a case.").

To prove medical malpractice, Plaintiffs presented the expert testimony of Dr. Selwyn, a cardiovascular physician with over 32 years of experience and a professor of Medicine at Harvard Medical School, Docket No. 23 at 22-23; and the testimony of Dr. Daniel Arzola, the Electrophysiologist who evaluated the Patient on December 29, 2016, Docket No. 91 at 57-70. Both doctors testified at trial on the relevant standard of care and the reasonable stability of the Patient, as well as Defendants' failure to comply with said standard, which they believe contributed to the Patient's death. Docket No. 90 at 52-55.

Furthermore, co-defendant Dr. Nieves and his expert witnesses all agreed in their trial testimony that the standard of care for a stable patient was to use the "bridging therapy." Docket No. 109 at 43, 46. To that effect, Dr. Selwyn and Dr. Arzola both agreed that the Patient was "reasonably stable" at the time of the intervention. Docket Nos. 90 at 7, 44-45, 54; 91 at 63. Even Dr. José Wiley, Dr. Nieves's expert witness, agreed that the Patient was "hemodynamically stable." Docket No. 109 at 7, 48, 50. The hospital record and various professional guidelines were presented to support the above.

Such combined evidence, viewed in the light "most favorable to the nonmovant," Espada v. Lugo, 312 F.3d 1, 2 (1st Cir. 2002), is sufficient to satisfy the elements of a medical malpractice case. Lama, 16 F.3d at 478-79. As such, a reasonable jury could have weighted the evidence in Plaintiffs' favor, concluding that (1) the Patient's coagulation levels were reasonably stable enough, and (2) that Dr. Nieves deviated from the standard of care ("bridging therapy"), thus causing the Patient's death.

Most importantly, the jury assessed the credibility of Dr. Selwyn's trial testimony, in juxtaposition with that of the other expert witnesses. Even if the witnesses proposed adverse theories as to the standard of care or the Patient's stability, the jury ultimately sided with the theory proposed by Plaintiffs. On this note, it is worth repeating that "there may be substantial evidence on both sides, but it is the jury, by weighting the evidence and adjudicating the witnesses' credibility, who ultimately decided the issues here. The Court is not free to substitute its own views for those of the jury even if it were to agree with Defendants' position." Velez v. Thermo King de P.R., Inc., 2011 WL 1261107, at *4 (D.P.R. March 29, 2011).

As such, Defendants' request for judgment as a matter of law under Rule 50 is DENIED.³

II. New Trial Under Rule 59

Fed. R. Civ. P. 59 ("Rule 59") allows the Court to order a new trial "for any of the reasons for which new trials have heretofore been granted in an action at law in federal court . . . ." Fed. R. Civ. P. 59(a); see also Taber Partners I, 917 F. Supp. at 116. The motion may invoke the discretion of the Court "in so far as it is bottomed on the claim that the verdict is against the weight of the evidence, that the damages are excessive, or that, for other reasons, the trial was not fair to the [movant]; and may raise questions of law arising out of the alleged substantial errors in admission or rejection of evidence or instructions to the jury." Montgomery Ward & Co., 311 U.S. at 251.

The Court may grant a new trial even if it has denied the entry of judgment as a matter of law under Rule 50, China Res. Prods. (U.S.A.) Ltd. v. Fayda Intern., Inc., 856 F. Supp. 856, 862 (D. Del. 1994); or even when substantial evidence supports the jury's verdict, Lama, 16 F.3d at 477. However, "a new trial should only be granted where a miscarriage of justice would result if the verdict were to stand, the verdict cries out to be overturned, or where the verdict shocks our conscience." Oriental Fin. Grp., Inc. v. Fed. Ins., Inc., 598 F. Supp. 2d 199, 205 (2008) (quotations and citations omitted).

Here, Defendants argue that the "incompatibility between the verdict and the evidence warrants a new trial" and that the compensation "was more an award of punitive damages than a fair compensation." Docket No. 100 at 15, 30. Furthermore, they posit that because the amount awarded for Plaintiffs' emotional pain "is in no way supported by the...