Morales v. US

• Decision Date: 06 August 1986
• Docket Number: Civ. No. 84-0930 (JAF).
• Parties: Aida Rivera MORALES, Aida Luz Morales, Angel Morales, Maria Morales, Nestor Morales, Gil Beauchamp, Jr., Angel Beauchamp, Jackeline Beauchamp, Carlo Calocca, Laura Morales, Gil Beauchamp, and decedent's estate represented by Aida Rivera Morales, Plaintiffs, v. UNITED STATES of America, Defendant.
• Court: U.S. District Court — District of Puerto Rico

642 F. Supp. 269

Aida Rivera MORALES, Aida Luz Morales, Angel Morales, Maria Morales, Nestor Morales, Gil Beauchamp, Jr., Angel Beauchamp, Jackeline Beauchamp, Carlo Calocca, Laura Morales, Gil Beauchamp, and decedent's estate represented by Aida Rivera Morales, Plaintiffs, v. UNITED STATES of America, Defendant.

Civ. No. 84-0930 (JAF).

United States District Court, D. Puerto Rico.

August 6, 1986.

Carlos E. Ríos Moreu, Cancio, Nadal & Rivera, San Juan, P.R., for plaintiffs.

Wanda Rubianes Collazo, Asst. U.S. Atty., Hato Rey, P.R., for defendant.

FINDINGS OF FACT, CONCLUSIONS OF LAW, AND JUDGMENT

FUSTE, District Judge.

This is a Federal Tort Claims Act case, 28 U.S.C. Sec. 2674. Jurisdiction exists pursuant to 28 U.S.C. Sec. 1346. The action is one for damages as a result of a claim of medical malpractice resulting in the death of a patient at the Veterans Administration Hospital, San Juan, Puerto Rico. The applicable law to define the standard of fault and recovery is the law of Puerto Rico. Richards v. United States, 369 U.S. 1, 15, 82 S.Ct. 585, 594, 7 L.Ed.2d 492 (1962), In re N-500 L Cases, 691 F.2d 15, 27 (1st Cir.1982). We find for plaintiffs as outlined herein.

Angel Morales-González, a 69-year-old, service-connected, pensioned veteran, died during the early morning hours of February 24, 1983, at his San Juan home. An autopsy was performed. The same revealed that the cause of death was acute myocardial infarction due to severe coronary artheriosclerotic disease with involvement of major branches, including a 95% obstruction of the left coronary artery and a total occlusion of the right coronary artery. His heart showed multiple areas of early degenerative myocardial fibers. Extensive coronary artery disease was present. Furthermore, the objective findings showed that Mr. Morales-González had suffered an earlier myocardial infarction involving the septum, which infarction went unnoticed. Earlier in 1983, Mr. Morales-González was diagnosed as suffering from a moderate-size aortic abdominal aneurism. Since he was also found to be hypertensive, surgery to attempt to correct the aortic aneurism had been postponed until the patient's blood pressure and general clinical picture had stabilized so as to make surgery less risky. The objective evidence shows that the last myocardial infarction of about February 23-24, 1983 had commenced to accrue at least eight hours and up to possibly twenty-four hours before Morales-González' death in the early morning hours of February 24, 1983, which death occurred between 2:00 and 5:00 A.M.

Decedent was not a healthy individual by any means. All his treatment, and, thus, his multiple diseases, were recorded in the Veterans Administration Hospital records. In addition to hypertension, arteriosclerosis, and the aortic aneurism, he suffered from a benign prostatic hypertrophy and from glaucoma. As stated, he was totally disabled and was receiving a service-connected pension because of his neuropsychiatric illness.

On the evening of February 23, 1983, Mr. Morales-González went to the Emergency Room of the Veterans Administration Hospital in San Juan, complaining of neck and shoulder pain which had been present for two or three days. He was taking Motrin, an analgesic. At times he had felt alleviated. As the day of February 23, 1983 progressed, he felt worse. His daughter, Aida Luz Morales, convinced him to go to the hospital. The evidence shows that before Morales-González was seen by a doctor at the Veterans Administration Hospital emergency room, he felt quite ill. The pain radiated to the arms, his fingers became numb, and he also felt a tight jaw or at least pain in the jaw. He wanted to lie down in the seats at the emergency room reception area.

The medical record shows that the patient's emergency record was opened at 5:27 P.M. on February 23, 1983. He was seen by Dr. Efrain Flores at 9:17 P.M.¹ According to the emergency room record, the only history developed was that of a 69-year-old male with hypertension, claiming pain in vertebras-cervical area, both shoulders, aggravated by body movement. Patient claimed relief with Motrin, and claimed body pain.

The attending physician did not conduct a proper physical examination. Blood pressure was determined to be 180/110. However, the physician did not take the patient's pulse, did not use the stethoscope to auscultate the patient, seemed to pay no attention to respiration rate, and, without the benefit of any further examination, determined that Morales-González was not an emergency case. He made no diagnosis and failed to elicit information that could have assisted him in making a differential diagnosis. Mr. Morales-González was discharged to go home with instructions to return to clinic the next day for cervical X-rays.² While at home, Morales-González got worse. He could not lie down in bed. He found comfort in his living room reclining chair. Morales-González was found dead by his wife in the early morning hours of the 24th of February.

The evidence shows that Dr. Efraín Flores was conscious of the high blood pressure exhibited by Mr. Morales-González, and of his aortic abdominal aneurism. However, he failed to even suspect the potential serious problem that the situation obviously showed even to persons not formally trained in medical science. We find from the credible evidence that the patient presented enough red flags (high blood pressure, pain, aortic aneurism, arteriosclerosis, age factor, possibility of aneurism rupture secondary to hypertension) so as to warrant not only a responsible emergency room examination, but also the proper emergency room treatment and possibly hospitalization. The evidence before the court is tantamount to the patient not having been examined. Based on the superficial contact Dr. Flores had with Mr. Morales-González, it was an irresponsible and negligent act on his part to conclude that the case was not an emergency. We find that in the context of this case, as tried, the attending physician committed an impermissible error of judgment, tantamount to negligence in discharging Morales-González and sending him home with a return to clinic next day. Pérez Cruz v. Hosp. La Concepción, 115 P.R. Dec. 721, 735-37 (1984). Stated differently, there was negligence in sending Morales-González home without the benefit of a proper examination. Had he been examined as expected, with a proper history and inquiries having been made, most probably a competent physician would have decided to hospitalize him or at least observe him for a while in the emergency room. Pérez Cruz, 115 P.R. Dec. at 735-37. This patient was entitled to the benefit of all medical doubts and to the corresponding treatment had the proper diagnosis been made.

We find from the evidence, as confirmed by the objective post-mortem evidence of acute myocardial infarction, that the negligent act of the treating physician was a main fault and probable cause of the consequent damage, that is, the early demise of Morales-González. Pérez Cruz, 115 P.R. Dec. at 735-37; Vda. de López v. E.L.A., 104 P.R. Dec. 178, 183 (1975); Del Valle Rivera v. United States, 630 F.Supp. 750, 756 (D.P.R.1986). The emergency ward or, better stated, the Veterans Administration Hospital, owed Morales-González a known duty of care. The level or quality of medical attention should have been one that fulfilled the professional requirements generally accepted by the medical profession. Del Valle Rivera, 630 F.Supp. at 756. This required properly examining Morales-González before making a decision. Medical professional judgment, whether ultimately right or wrong, had to be based on a complete emergency room examination. Had all factors been considered, hospitalization, or at least observation, and medical treatment, were indicated.

Even though nobody can be precise in matters of life and death, specially when dealing with a patient such as Morales-González, we do not need to determine with certainty whether the negligent act was immaterial to survival, that is, whether in any event Morales-González was going to die as he did. The evidence received from Dr. Germán E. Malaret and Dr. Angel Román Franco is to the effect that with adequate medical attention, survival was a possibility. From this evidence, we find that such survival possibility would have been a lot less than the normal life expectancy of a 69-year-old male as of 1983. We find that a life expectancy of three years would have been reasonable had Morales-González been properly treated.³ There being a finding of negligence and causal connection with the resulting death, we enter our findings and conclusions on the issue of damages.

Damages

The complaint contains four claims for relief. The decedent's estate claims in Count I compensation for decedent's conscious pain and suffering prior to his death. Count II claims loss-of-earning potential. Count III claims plaintiffs' damages for mental and moral suffering. Claim IV prays for attorney's fees. We address these items of damage separately.

Compensation for Decedent's Conscious Pain and Suffering

Under Puerto Rico law, conscious pain and suffering of the plaintiffs' decedent is a recoverable item of damages in a wrongful death, negligence case. Vda. de Delgado v. Boston Insurance, 101 P.R. Dec. 598 (1973). There is no question about the fact that Morales-González suffered pain and discomfort prior to his death as a result of the myocardial infarction which he suffered. The pain and suffering does not relate solely to the Veterans Administration Hospital's negligent acts committed through the emergency ward's attending physician. Here, contrary to a case where the onset of damage and pain is directly attributable to the acts of the responsible party, the fact remains that with or without proper medical treatment, a myocardial infarction is a painful experience. On this record, we cannot attribute the claimed conscious pain and suffering...