Rodríguez-Valentin v. Doctors' Ctr. Hosp. (Manati), Inc.

• Decision Date: 24 February 2022
• Docket Number: No. 20-2093,20-2093
• Citation: 27 F.4th 14
• Parties: Jeannette RODRÍGUEZ-VALENTIN, in representation of her minor son, D.A.L.R., Plaintiff, Appellee, v. DOCTORS' CENTER HOSPITAL (MANATI), INC., Defendant, Appellant.
• Court: U.S. Court of Appeals — First Circuit

27 F.4th 14

Jeannette RODRÍGUEZ-VALENTIN, in representation of her minor son, D.A.L.R., Plaintiff, Appellee,

v.DOCTORS' CENTER HOSPITAL (MANATI), INC., Defendant, Appellant.

No. 20-2093

United States Court of Appeals, First Circuit.

February 24, 2022

Roberto E. Ruiz-Comas, with whom RC Legal & Litigation Services, PSC was on brief, for appellant.

David Efron, with whom Law Offices of David Efron, P.C. was on brief, for appellee.

Before Lynch and Selya, Circuit Judges, and McCafferty,^* District Judge.

MCCAFFERTY, District Judge.

This medical malpractice suit arises from obstetric care provided to the plaintiff-appellee, Jeannette Rodríguez-Valentin in connection with the birth of her minor son, DALR. A jury found appellant Doctors' Center Hospital (Manati), Inc. ("Doctors' Center") liable for 8 percent of a $14,296,000 total award. Doctors' Center appeals the denial of its post-verdict motions for judgment as a matter of law, for a new trial, and for remittitur under Federal Rules of Civil Procedure 50 and 59. We affirm.

BACKGROUND

I. Complications During DALR's Birth

Rodríguez-Valentin gave birth to DALR by caesarean section at Doctors' Center in Puerto Rico in late September 2008. A few months after his birth, DALR was diagnosed with cerebral palsy. Rodríguez-Valentin alleged that DALR's cerebral palsy resulted from, or was exacerbated by, medical malpractice by treating physicians and nurses during the late stages of her pregnancy and DALR's delivery. This appeal by Doctors' Center is pertinent only to the medical care provided by treating nurses employed by Doctors' Center.

The nurses' alleged malpractice occurred during DALR's birth. Doctors' Center's nurses, per a physician's order, began administering the pharmaceutical drug Pitocin to Rodríguez-Valentin at about 9:31 A.M. on September 25 while she was in labor. The Pitocin was intended to aid delivery by reducing the time between Rodríguez-Valentin's contractions.

Soon after the nurses administered Pitocin, however, DALR's "heart rate variability," as documented by a monitor placed on Rodríguez-Valentin's abdomen, dropped to a "very minimal level." At trial, Rodríguez-Valentin's expert witness, Dr. Bruce Halbridge, testified that DALR's heart rate variability had been within an appropriate range before the nurses administered Pitocin. Dr. Halbridge explained that the drop in heart rate variability from that appropriate range showed that DALR was not receiving enough oxygen, glucose, or blood through the placenta. Dr. Halbridge noted that such a loss of heart rate variability is the most important signal that a soon-to-be-born baby lacks sufficient oxygen.

Dr. Halbridge identified where and when the nurses should have seen the changes in heart rate variability. Specifically, according to Dr. Halbridge, DALR's heart rate variability issues occurred in several, sometimes prolonged, "episodes" throughout Rodríguez-Valentin's labor. Dr. Halbridge testified that, in his opinion, by the third "episode" of decreased heart rate variability, the treating nurses should have stopped administering Pitocin, placed Rodríguez-Valentin on her left side, increased her IV fluid intake, provided her with an oxygen mask, and notified a physician about the drop in DALR's heart rate variability.

Rodríguez-Valentin's labor continued for eight hours after the nurses began administering Pitocin. During this time the treating nurses failed to recognize or act on the drop in DALR's heart rate variability, failed to stop administering Pitocin, and failed to notify any physician about the change in DALR's heart rate variability.

Dr. Halbridge testified that oxygen deprivation during the delivery increased DALR's brain damage and aggravated his cerebral palsy. Dr. Halbridge noted that, had the nurses notified a physician, the caesarean section could also have been expedited, which likely would have reduced the severity of DALR's injuries because he would have spent less time without sufficient oxygen.

In defense of the nurses' conduct, Doctors' Center offered the testimony of two expert witnesses in obstetrics, Dr. Alberto de la Vega Pujol and Dr. Edgar Solis. These physicians disagreed with Dr. Halbridge, opining that DALR's heart rate variability was adequate during labor and that there was no evidence that DALR suffered any oxygen deficiency during delivery. Dr. Solis also testified that neuroradiological testing conducted after DALR's birth supported his opinion that DALR did not suffer from oxygen deficiency during delivery.

II. Testimony about DALR's Life Care Expenses

Rodríguez-Valentin claimed considerable damages for DALR's future life care costs. Specifically, Gerri Pennachio testified for Rodríguez-Valentin as a "life care planning expert," opining about the yearly cost of DALR's care and treatment. According to Pennachio, these costs would include necessary equipment, doctor visits, testing, and physical therapy, among other items. Pennachio determined that DALR would require $278,021.57 per year until age 18. After age 18, Pennachio opined, DALR would need $379,235.57 per year.

On cross-examination, Doctors' Center dissected Pennachio's calculations, asking her whether she had offset the yearly amounts by contributions made by insurance or the government and whether she had based her calculations on costs in Florida (where DALR lived at the time of trial) as opposed to Massachusetts (where DALR had lived before moving to Florida). Pennachio acknowledged that she had not offset her calculations based on contributions made by insurance or the government. She did not dispute that she derived her calculations from cost information in Massachusetts even though, at the time of trial, Rodríguez-Valentin and DALR lived in Florida.

Additionally, Pennachio acknowledged on cross-examination that she did not discount her yearly estimates to present value. Rather, she opined, the cost increases for DALR's medical care and life care over his lifetime would offset any applicable discount rate.

Per a pre-trial ruling on Doctors' Center's motion in limine, the court prohibited Pennachio (who lacked requisite expertise) from opining about DALR's life expectancy given his medical condition.¹ Ultimately, neither Doctors' Center nor Rodríguez-Valentin presented any expert testimony about DALR's life expectancy.

III. Jury Instructions and Verdict

Consistent with the parties' proposed instructions, the court instructed the jury that it could award compensatory damages to Rodríguez-Valentin and DALR for damages they were "reasonably likely to suffer in the future." It instructed the jury that it should be "guided by common sense" in fashioning any award and that it could not engage in "arbitrary guesswork." The court added that the law does not require proof of the amount of damages "with mathematical precision but only with as much definiteness and accuracy as the circumstances permit." It asked the jury to use "sound discretion" and to draw "reasonable inferences" where appropriate from the "facts and circumstances in evidence."

With respect to DALR's life expectancy, Doctors' Center did not seek either a ruling from the judge that life expectancy must be proved by expert testimony or a suitable modification to the court's jury instruction on damages. Nor did Doctors' Center request a special verdict form on DALR's life expectancy. In the end, Doctors' Center permitted the case to go to the jury without making any argument about how the lack of expert testimony on life expectancy should impact the jury's calculation of DALR's future life care costs.²

The jury found Doctors' Center liable and awarded $12,996,000 in future life care costs to Rodríguez-Valentin and DALR. The jury awarded an additional $1,300,000 for physical and emotional pain and suffering. The jury apportioned 92 percent of that liability to two treating physicians with whom Rodríguez-Valentin settled prior to trial. The jury apportioned to Doctors' Center the remaining 8 percent, which sums to $1,143,680.

IV. Post-Verdict Motions

After the jury's verdict, Doctors' Center renewed³ a motion for judgment as a matter of law under Rule 50 and moved for a new trial and/or remittitur of the damages award under Rule 59.⁴ Doctors' Center argued, as it does on appeal, that Rodríguez-Valentin's evidence was insufficient to support the jury's verdict as to liability or, alternatively, that the weight of the evidence required the jury's verdict to be overturned and a new trial to be held. As to remittitur of the damages award or a new trial on damages, Doctors' Center argued that the jury's award for future life care costs was speculative because Rodríguez-Valentin failed to submit expert testimony about DALR's life expectancy. Doctors' Center also argued that Pennachio's calculations were deficient.

The district court denied Doctors' Center's motions. As to Doctors' Center's motions for judgment as a matter of law and for a new trial on liability, the district court found that Dr. Halbridge's testimony supported the jury's verdict. As to the motion for a new trial on damages and/or remittitur, the district court stated that the jury could have determined that DALR's life expectancy was 46 years⁵ by dividing the award for future care costs by the amount that Pennachio testified DALR would require for care each year. The district court, however, acknowledged that the life expectancy of a child with cerebral palsy "likely would be a proper subject for expert testimony." Nonetheless, the district court concluded that the jury in this case could issue an award for future costs without expert testimony on life expectancy because damages in a negligence action need not be shown with mathematical certainty.

The court also stated that other jurisdictions permit a jury to infer life expectancy from testimony about the injured person's medical condition and pain and suffering. While acknowledging that "the far better practice would have been for both parties to...