Caraballo v. Hosp. Pavia Hato Rey Inc.
| Decision Date | 31 March 2017 |
| Docket Number | Civil No. 14-1738 (DRD) |
| Parties | Yomayra Delgado Caraballo,et al. Plaintiffs, v. Hospital Pavia Hato Rey Inc., et al. Defendants. |
| Court | U.S. District Court — District of Puerto Rico |
Juan Ramon Delgado-Caraballo and Yomayra Delgado-Caraballo, personally and on behalf of her minor children B.O.G.D and M.G.D. ("Plaintiffs"), are seeking damages against Hospital Pavia, Inc., Dr. Marjorie Acosta-Guillot, Dr. Nilsa Lopez, and APS Healthcare Inc. ("Defendants"). Plaintiffs allege Defendants violated the Emergency Medical Treatment and Labor Act ("EMTALA"), 42 U.S.C. § 1395dd, and Articles 1802 and 1803 of the Puerto Rico Civil Code, 31 L.P.R.A. § 5141 and § 5142. Pending before the Court are Dr. Nilsa Lopez's Motion for Summary Judgment (Docket No. 66), APS Healthcare Inc.'s Motion for Summary Judgment (Docket No. 68), and Hospital Pavia's Motion for Summary Judgment (Docket No. 71). For the reasons provided below, the Court hereby GRANTS Hospital Pavia's Motions for Summary Judgment.
To comply with EMTALA, hospitals must establish internal screening procedures to follow in order to avoid patient dumping. At Hospital Pavia Hato Rey ("Pavia"), all patients that seek treatment at the Psychiatric Stabilization Unit ("PSU") are interviewed by an evaluating physician under strict confidentiality.¶ 26. The physician compiles clinical information both from the patient and any relatives available at the time of the interview. Id. Generally, Pavia follows the Admission Process Guide to determine if a patient meets the criteria for admission at the PSU. ¶ 34. Pavia's Guideline for the Identification and Management of Patients who Present some Level of Suicidal Risk is used to screen patients with risk of suicide. ¶ 35. For admission to the PSU, a patient must present at least one or more of the criteria established in section (A) of Pavia's Admission Process Guide. ¶ 27.
On October 1, 2012, Natividad Caraballo-Caraballo ("Patient") arrived at the PSU at Pavia with her daughter, Plaintiff Yomayra Delgado-Caraballo . ¶ 16-17. The Patient was evaluated by the triage nurse at 6:30 P.M. Id. The nurse noted that Patient was mildly nervous and had not been taking her medications. ¶ 18. Additionally, the nurse recorded that the Patient's visit was voluntary. ¶ 20. Nonetheless, there is an issue regarding whether Patient was evaluated at Pavia under a Law #408 order.
Dr. Marjorie Acosta-Guillot ("Acosta-Guillot"), the evaluating physician, assessed the patient and performed the medical screening examination at around 7:00 P.M. ¶ 21. Dr. Acosta-Guillot recorded that Patient was 53 years old, had a psychiatric history that included a suicide attempt one year before the visit, and presented "poor compliance or commitment to treatment, exacerbation of depressive symptoms which included anxiety, isolation. ¶ 22. Dr. Acosta-Guillot also noted that "[patient was] not suicidal, not homicidal, [and had] no hallucinations". Id.
Dr. Acosta-Guillot further noted, in the Mental Exam section of the screening sheet, that Patient had appropriate hygiene, adequate visual contact, and a logical and coherent thought process. ¶ 23. Patient was also cooperative and oriented, but showed diminished language production, was anxious, and showed psychomotor retardation. Id.
Dr. Acosta-Guillot diagnosed Patient with major depression according to the Stabilization Unit's Evaluation Disposition form. ¶ 24. However, the form contained the conclusion that Patient did not present the criteria to be admitted at the PSU. Id. This form was signed by both Patient and Plaintiff YomayraDelgado-Caraballo ("Yomayra"). ¶ 31. Dr. Acosta-Guillot testified in her deposition that Patient denied having suicidal ideas, did not present risk of suicide at the time, and thus, considering Patient's history and evaluation, she did not present the criteria for admission at the time of the evaluation. ¶ 32-33. Patient was discharged with instructions to continue taking her medications and to attend an appointment at the Defendant APS Healthcare ("APS") outpatient clinic on October 3, 2012. ¶ 25.
After being discharged from Hospital Pavia, Patient was left alone and slept by herself from October 1, 2012, to October 3, 2012. ¶ 36. On October 3, 2012, Patient's mother-in-law, with whom she had a close relationship, passed away. ¶ 38. The same day, Patient attended her appointment at the APS outpatient clinic in Caguas. ¶ 37. Patient was attended by Dr. Nilsa Lopez ("Lopez"). After Dr. Lopez evaluated Patient, Yomayra spoke with the physician and Patient. Patient was released from the APS clinic and committed suicide the next day. ¶ 39.
Patient had three children, Yomayra-Delgado Caraballo, Juan Ramon Delgado-Caraballo, and Vanessa Delgado-Caraballo. The members of the estate of Mrs. Caraballo are Yomayra, Juan Ramon, Vanessa, and widower Juan Delgado-Gonzalez. In the present complaint, only Yomayra and Juan Ramon are bringing forth Patient's survivorship EMTALA action. Juan Ramon and Yomayra, personally and on behalf of her minor children B.O.G.D and M.G.D., are only seeking personal damages. ¶ 3-6, 9-11.
On September 30, 2014, Plaintiffs filed a Complaint (Docket No. 1) against Defendants alleging that Pavia failed to give Patient an appropriate medical screening examination and failed to stabilize her pursuant to the requirements of EMTALA. See 42 U.S.C. §§1395 (a)-(c). Furthermore, Plaintiffs claim that Hospital Pavia failed to meet the accepted practices of the medical profession by not complying with a Law 408 order2, not documenting the comprehensive risk assessment, not providing the higher level of carerequired, failing to provide a psychiatric evaluation, not scheduling follow up appointments, and failing to provide adequate medication.
On April 4, 2016, Dr. Lopez filed a Motion for Summary Judgment (Docket No. 66) claiming that EMTALA applies exclusively to hospitals that participate in the Medicare program and that it does not create a cause of action against physicians. Dr. Lopez further avers that Plaintiffs and Defendants lack complete diversity. Thus, Dr. Lopez argues the Court lacks grounds for jurisdiction.
On June, 24, 2017, Plaintiffs filed a Response in Opposition to Motion for Summary Judgment (Docket No. 91). Plaintiffs specify that their claims against the individual physicians, Dr. Lopez and Dr. Acosta, are brought under Article 1802 and 1803 of the Puerto Rico Civil Code. Plaintiffs aver that supplemental jurisdiction over these claims should be invoked as they have a valid EMTALA claim as well as diversity jurisdiction.
On April 4, 2016, APS Healthcare Inc. filed a Motion for Summary Judgment (Docket No. 68). Defendant APS claimed that they were not subject to the EMTALA statute as they are a Managed Behavioral Healthcare Organization and not a hospital. On June 26, 2016, Plaintiffs filed a Response in Opposition to Motion for Summary Judgment (Docket No. 94) where they conceded that Defendant APS is not a hospital and not subject to the EMTALA provisions.
On April 4, 2016, Defendant Pavia filed a Motion for Summary Judgment (Docket No. 71). Dr. Acosta-Guillot, Dr. Lopez, and APS Healthcare Inc. all joined Pavia's motion. Defendant Pavia claimed that they complied with the screening, stabilization, and transfer provisions of EMTALA. Furthermore, Defendant Hospital Pavia avers that EMTALA allows state law to govern inherited causes of action and thus the survivorship claim should be summarily dismissed since Plaintiffs did not join Vanessa Delgado Caraballo and Juan Delgado-Gonzalez, who are indispensable parties under Puerto Rico law. Defendant Pavia further avows that minors B.O.G.D. and M.G.D. were both domiciled in Puerto Rico and thus there isno jurisdiction under 28 U.S.C. §1332. Defendant Pavia concludes that, since the Court lacks original jurisdiction, it should dismiss all claims under supplemental jurisdiction.
On June 20, 2016, Plaintiffs filed a Response in Opposition to Motion for Summary Judgment (Docket No. 87) and stated that, although Defendant Hospital Pavia screened Patient, the screening provided was not consistent with that of other similarly situated patients. Plaintiffs claim that although EMTALA does allow state law to govern inherited causes of action, the law in Puerto Rico permits survivorship actions to be brought by any heir and does not require that all heirs be included in the action.
On August 8, 2016, Defendant Hospital Pavia filed a Reply to response to Motion to Summary Judgment (Docket No. 117) requesting that Plaintiffs' EMTALA claim be dismissed since they admitted that Mrs. Caraballo was indeed screened at Hospital Pavia. Defendant avers that state jurisprudence regarding the issue has stated that all members of an estate are indispensable parties whenever the estate is party to a claim. Defendant also claims that even though diversity jurisdiction is sought in the alternative, not even the minors B.O.G.D. and M.G.D. can claim diversity as they only lived in Massachusetts temporarily.
Rule 56 of the Federal Rules of Civil Procedure provides that summary judgment should be entered where "the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(c); see Celotex Corp. v. Catrett, 477 U.S. 317, 324-325 (1986). Pursuant to the clear language of the rule, the moving party bears a two-fold burden: it must show that there is "no genuine issue as to any material facts," as well as that it is "entitled to judgment as a matter of law." Veda-Rodriguez v. Puerto Rico, 110 F.3d 174, 179 (1st Cir. 1997). A fact is "material" where it has the potential to change the outcome of the suit under governing...
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