Ramirez v. Hosp. EspaÑol Auxilio Mutuo Inc.
| Decision Date | 03 May 2011 |
| Docket Number | Civil No. 11–1286 (FAB). |
| Citation | 781 F.Supp.2d 49 |
| Parties | Dr. Samuel D. SILVA RAMIREZ, Plaintiff,v.HOSPITAL ESPAÑOL AUXILIO MUTUO, INC., et al., Defendants. |
| Court | U.S. District Court — District of Puerto Rico |
OPINION TEXT STARTS HERE
Enrique J. Mendoza–Mendez, Mendoza Law Office, San Juan, PR, for Plaintiff.
Israel Fernandez–Rodriguez, Pedro J. Manzano–Yates, Fiddler Gonzalez & Rodriguez, P.S.C., San Juan, PR, for Defendant.
Plaintiff has filed a motion for remand. (Docket No. 7.) Defendants have opposed the motion. (Docket No. 11.) Having considered the arguments contained in plaintiff's motion and defendants' opposition, the Court GRANTS plaintiff's motion for remand. (Docket No. 7.)
Dr. Samuel D. Silva Ramirez (“Dr. Silva”) is a medical doctor with a specialty in Gynecology and Obstetrics. At times relevant to this Complaint, he enjoyed medical privileges at the Hospital Español Auxilio Mutuo (“Auxilio Mutuo”). Auxilio Mutuo alleges that it is a lay medical hospital institution, not affiliated to the Roman Catholic Church. Auxilio Mutuo's Bylaws do not state that it has any affiliation with the Catholic Church. The hospital's Bylaws do not require that its medical faculty have either the duty or the obligation to follow the teachings of the Catholic Church while they practice their profession at the hospital. Auxilio Mutuo has not adopted the “Ethical and Religious Directives for Catholic Health Care Facilities” in its Bylaws. Neither do Auxilio Mutuo's Bylaws limit the carrying out of sterilization procedures by its medical faculty.
Dr. Silva alleges, nevertheless, that Auxilio Mutuo does follow the teachings of the Catholic Church when it comes to sterilization procedures. Dr. Silva further alleges that he did not agree to follow those teachings to be able to practice his profession at Auxilio Mutuo, and admits that the hospital did not require that he commit to these teachings as a condition of obtaining his medical privileges. (Docket No. ¶¶ 12–13, 6, 9–10, 12, 15.)
On October 14, 2009, Dr. Silva was in one of Auxilio Mutuo's Operating Rooms performing a Cesarean section 2 on one of his patients. Dr. Silva then performed a sterilization procedure on the patient. His patient was not Catholic and did not follow the postulates of the Catholic Church on the issue of sterilization. Dr. Silva alleges that the personnel assisting him during the sterilization procedure reported to hospital authorities that after the Cesarean section procedure was carried out he sterilized his patient without her consent. Id. ¶¶ 12, 14.
As a result of Dr. Silva's performing a sterilization that was allegedly done without obtaining the patient's proper consent, Auxilio Mutuo temporarily suspended Dr. Silva's medical privileges. Because of the temporary suspension, Dr. Silva was barred from performing any kind of gynecological, obstetric or surgical procedure, whether elective or emergency, at the hospital. Dr. Silva's temporary suspension also precluded him from assisting his private patients in births that had already been scheduled to be delivered at Auxilio Mutuo. The hospital notified Dr. Silva of his temporary privilege suspension on November 18, 2009 through a letter signed by Auxilio Mutuo's Medical Director, Dr. Jose A. Isado–Zardon (“Dr. Isado”). At the time of his temporary suspension, Auxilio Mutuo was the only hospital where Dr. Silva enjoyed active medical privileges. Id. ¶ 15.
Auxilio Mutuo stated reasons for Dr. Silva's temporary suspension were: (1) that the sterilization consent form was incomplete; (2) that Dr. Silva did not follow the protocol for sterilization; and (3) that Dr. Silva had violated Auxilio Mutuo's Bylaws. Dr. Silva states, however, that his patient had consented to the procedure, that it was done in accordance with his patient's request, that it was medically indicated and that the consent form shows his patient gave her consent because it bears her signature and initials on every page.
Auxilio Mutuo's protocol for sterilization procedure is not part of its Bylaws. Id. ¶¶ 9–10, 14, 20, 25. On November 19, 2009, Dr. Alvaro Aranda (“Dr. Aranda”), President of Auxilio Mutuo's Medical Faculty Executive Committee (“Committee”), informed Dr. Silva of his rights to request an evidentiary hearing prior to the determination of whether the temporary suspension would be maintained pending a final adjudication of his case. Id. ¶ 18.
On November 24, 2009, Dr. Silva requested a formal hearing as well as the production of relevant documents in preparation for the hearing. Instead of scheduling a hearing, however, Auxilio Mutuo scheduled a meeting for December 16, 2009. Dr. Silva was notified of this meeting through a letter signed by Dr. Aranda, dated December 7, 2009. Dr. Silva went to the meeting; the presence of attorneys or recording devices was not allowed at the meeting. During the meeting, Dr. Silva denied Auxilio Mutuo's allegations against him and stated that he had performed the sterilization procedure after obtaining his patient's consent. The Committee granted Dr. Silva the opportunity to produce any evidence that would serve to establish his patient's alleged consent. Dr. Silva could not produce the evidence the Committee needed, however, because doing so would have constituted a violation of the Health Insurance Portability and Accountability Act (“HIPPA”). His patient had not authorized the disclosure of her file. Id. ¶¶ 4, 19, 20–21.
On January 26, 2010, the Committee informed Dr. Silva that it had decided to maintain his temporary suspension until the hearing process had been completed and a final adjudication of his case had been made. The hospital then proceeded to notify Dr. Silva's suspension to the National Practitioner Data Bank (“NPDB”). The NPDB notification indicates that Dr. Silva violated Auxilio Mutuo's Bylaws. Dr. Silva contends that this information is false because even if Auxilio Mutuo can establish that he performed the sterilization in violation of the established procedures, which Dr. Silva denies, that procedure is not included in Auxilio Mutuo's Bylaws. Dr. Silva further alleges that Auxilio Mutuo's NPDB notification was ultra vires, because it was done without following the established reporting procedures and because it was directed to cause him intentional damage. Id. ¶¶ 24–26.
On February 16, 2010, Dr. Silva formally requested an evidentiary hearing. He also again requested the production of documents necessary for his defense at that hearing. On March 19, 2010, however, Dr. Armando Nazario (“Dr. Nazario”), President of the Committee, denied Dr. Silva's request. The Committee based its denial on Dr. Silva's failure to establish his position regarding the allegations against him in his request for a hearing. The Committee concluded that Dr. Silva's omission was a waiver of his right to a hearing. The Committee also sustained its adverse decision regarding the suspension of Dr. Silva's privileges. On May 26, 2010, Dr. Silva then requested a hearing before the hospital's Board of Directors (“Board”), the entity which would issue a final decision in his case. On August 5, 2010, however, Dr. Silva was informed that the Board had recommended that his medical privileges be permanently revoked and that the Board's Appeal Review Committee had endorsed that recommendation. Id. ¶¶ 27–30.
Dr. Silva professes the “Mita” religion, of which Auxilio Mutuo is aware. The Mita religion doctrine differs from the doctrine of the Catholic Church on the issue of sterilization. Dr. Silva claims that Auxilio Mutuo discriminated against him because of his religious beliefs and that it was for this reason that Auxilio Mutuo took the adverse decision of suspending his medical privileges. He claims disparate treatment because even though other practitioners with medical privileges at the Auxilio Mutuo carry out sterilization procedures there, they have not been disciplined and no adverse decision has been taken against them. He particularly alleges that Auxilio Mutuo has not taken any adverse decision against Dr. Adrian Colon–Laracuente (“Dr. Colon”), even though he has carried out sterilization procedures without complying with the requirements that Auxilio Mutuo now demands from Dr. Silva. Moreover, Dr. Silva alleges that the reason Auxilio Mutuo permitted Dr. Colon's actions without imposing adverse consequences is that Dr. Colon kneeled before Dr. Isado and asked for his forgiveness, in a manner similar to the Catholic Church's confession process. Dr. Silva avers that he cannot do as Dr. Colon did because his Mita religion prevents him from kneeling before another man to ask for forgiveness, either in a personal confession or to show remorse. Id. ¶ ¶ 11, 13, 22–23.
On March 4, 2011, Dr. Silva filed suit against: (1) Hospital Español Auxilio Mutuo, Inc., the entity that operates the hospital; (2) Dr. Isado; and (3) the conjugal partnership constituted by Dr. Isado and his wife Mrs. Diana Vigil–Vigil (“Ms. Vigil”), in the Puerto Rico Court of First Instance, San Juan Superior Division, under case number KPE 2011–0846(904). (Docket No. 12–1.) Dr. Silva alleged that the suspension of his privileges was based on illegal discrimination because of religious beliefs, contrary to Article II of the Puerto Rico Constitution (“P.R. Constitution”), id. ¶¶ 5, 44–47, and that Auxilio Mutuo's Bylaws are unjust, unreasonable, null, illegal, and contrary to the Health Care Quality Improvement Act of 1986, 42 U.S.C. §§ 11101–11152 (“HCQIA”). Id. ¶¶ 5, 34, 40, 42. Dr. Silva requested the following remedies: (1) a declaratory judgment, stating that his rights had been violated due to discrimination because of his religious beliefs, Id. ¶ 50; (2) a permanent injunction, requiring Auxilio Mutuo to withdraw the adverse notification made to the NPDB, id. ¶ 51; and (3) damages. Id. ¶ 54.
On March 23, 2011, a day before a preliminary...
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