de Perez v. Hospital del Maestro
| Citation | 910 F.2d 1004 |
| Decision Date | 11 May 1990 |
| Docket Number | 89-2086,Nos. 89-2018,s. 89-2018 |
| Parties | Doris Velez VDA. de PEREZ, etc., et al., Plaintiffs, Appellees, v. HOSPITAL del MAESTRO, et al., Defendants, Appellees. Appeal of Dr. Carmen de LEON, Defendant. . Heard |
| Court | United States Courts of Appeals. United States Court of Appeals (1st Circuit) |
David Rive-Rivera, with whom Vargas & Rive was on brief for appellant.
David Efron, with whom Antonio J. Amadeo-Murga was on brief for plaintiffs, appellees.
Before BREYER, Chief Judge, ROSENN, * Senior Circuit Judge, and CAMPBELL, Circuit Judge.
The plaintiffs in this case, the wife and children of Reynaldo Perez, originally sued the Hospital del Maestro and two doctors who worked there, claiming that the Hospital and doctors negligently caused Perez's death. They said (without dispute) that Perez walked into the emergency room of the Hospital del Maestro, two hours after having begun to suffer chest pains. The hospital emergency room doctor found that he had had a heart attack and treated him, but instead of then transferring him to the hospital's cardiac care unit, she put him into an ambulance and sent him to a different hospital, Guadalupe Hospital, ten to fifteen minutes away. In the ambulance Perez developed a complication, called "arrythmia," and he died within a few minutes of reaching Guadalupe.
The plaintiffs' basic claim was that the Hospital, and one of the doctors, Dr. Jose Vazquez Selles, acted negligently in refusing to admit Perez to its coronary care unit. Plaintiffs said they refused simply because Perez carried a kind of insurance, namely Blue Cross insurance, that the Hospital did not accept. The Hospital and Dr. Vazquez, in a sense, have conceded that they acted negligently in this respect, for they settled the case against them, the Hospital paying $700,000 and Dr. Vazquez paying $240,000.
The plaintiffs continued to pursue their related claim that the second doctor, the emergency room physician Dr. Carmen de Leon, was also responsible for Perez's death through her own negligence. They said that her negligence consisted, in essence, of (1) having failed to administer a drug called Lidocaine, and (2) having failed to keep Perez in the emergency room of the Hospital del Maestro, instead of sending him off to Guadalupe Hospital.
After a jury trial, the jury found in favor of Dr. de Leon. The plaintiffs moved for a new trial on the ground (in the district court's words) that the "weight of the evidence overwhelmingly established that de Leon was negligent." And, the district court granted this motion because, in its view, "even granting that the evidence was more than sufficient to sustain a finding by the jury" on the Lidocaine issue and "all secondary controversies," nonetheless, "crucial, uncontroverted evidence leads to the inevitable conclusion that Dr. de Leon was negligent," in that "it was unsafe and unreasonable for her to transfer this patient at this time."
A second jury, at the second trial, found Dr. de Leon negligent, evaluated the harm that the plaintiffs suffered, and awarded damages of $500,000. Dr. de Leon appeals. She argues (1) that the judgment against her should be reduced by the amounts that the plaintiffs received as a result of their settlements with the Hospital del Maestro and Dr. Vazquez, and (2) that the district court should not have granted the plaintiffs' motion for a new trial. Although Dr. de Leon's argument on the first--damage reduction--issue is a powerful one, we shall not decide that question. Even were we to decide in appellant's favor, to reduce damages to zero would leave in effect a judgment against her, which could have collateral consequences. We therefore reviewed the record to see whether the evidence permitted the district court to grant the motion for a new trial. We conclude that it did not.
In considering whether or not the district court could lawfully grant the plaintiffs a new trial, we recognize that the district court has broad legal authority to determine whether or not a jury's verdict is against the "clear weight of the evidence." See, e.g., Freeman v. Package Machinery Co., 865 F.2d 1331, 1333 (1st Cir.1988); Milone v. Moceri Family, Inc., 847 F.2d 35, 37 (1st Cir.1988). We disturb that determination "only when there has been a clear abuse of discretion." Freeman, 865 F.2d at 1334. We also recognize, however, that the district court "should not act merely as a '13th juror,' " Borras v. Sea-Land Service, Inc., 586 F.2d 881, 887 (1st Cir.1978), that it should not interfere with the verdict " 'unless it is quite clear that the jury has reached a seriously erroneous result,' " id. (quoting 6A J. Moore, Moore's Federal Practice p 59.08, at 59-160 to 161), and that its discretion when granting a new trial on the ground that the verdict is contrary to the great weight of the evidence is no longer "virtually unlimited." Id.; see Coffran v. Hitchcock Clinic, Inc., 683 F.2d 5, 6 (1st Cir.1982) (same); cf. Nissho-Iwai Co. v. Occidental Crude Sales, Inc., 848 F.2d 613, 619 (5th Cir.1988); 11 C. Wright & A. Miller, Federal Practice & Procedure: Civil Sec. 2819, at 126 (). Applying these standards to the record before us, we simply do not see how the district court could have concluded that "crucial, uncontroverted evidence" required a finding of negligence.
For purposes of this appeal, we assume (for the record contains strong evidence) that Dr. de Leon operated the emergency room, that she could not have secured Perez's admission to the coronary care unit of the hospital (for Dr. Vazquez told her Perez would not be admitted), and that the choice facing her consisted simply of either (1) sending Perez to Guadalupe ten to fifteen minutes away or (2) keeping him in the emergency room. The record contains conflicting evidence about which was the wiser choice.
Evidence supporting the plaintiffs
The evidence favoring the plaintiffs basically consists of testimony by the defendant herself and by the plaintiffs' expert Dr. Angel Roman Franco. The defendant herself testified that del Maestro's emergency room had facilities that a cardiac patient might need, such as "a heart monitor, an oxygen machine, [and an] infusion pump." She testified that "one of the[ ] cubicles in the emergency room at the Hospital del Maestro was rather specialized to attend or care for patients having heart conditions or heart attacks."
The plaintiffs' expert, Dr. Angel Roman Franco, a professor of pathology at the University of Puerto Rico, testified that it was important to administer Lidocaine soon after a heart attack as a prophylactic measure to prevent the very sort of arrythmia that killed Perez. But, if Lidocaine was not given, then
The first thing you don't do is you don't get rid of the patient. Now you are obligated to be more aggressive and more watchful of your patient. It's not just ship him out. Now you really have a problem because your main weapon for controlling the potentially deadly arrhythmias, malignant arrhythmias, has been negated.... So now you have to fall back on other strategies for dealing with the potential risk. And what is the best strategy? The best strategy is to keep the patient under your control because he has far better chances of being resuscitated if he develops an arrhythmia in the emergency room than he has in the back of an ambulance. This to me is what is surprising in this particular case.
Dr. Roman Franco also argued strongly that Dr. de Leon should have given Perez the "arrythmia preventative" Lidocaine, certainly before placing him in the ambulance; but, he repeated, if this could not be done
you can keep your patient in the emergency room under your control with medication. You can roll in a cardiac monitor. Basically, that is what you do in the intensive care unit [i.e., the coronary care unit].
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