Florán v. Doctors' Ctr. Hosp., Inc.
| Decision Date | 12 February 2020 |
| Docket Number | Civil No. 16-1930 (BJM) |
| Parties | NOEMÍ NIEVES FLORÁN, Plaintiff, v. DOCTORS' CENTER HOSPITAL, INC., et al., Defendants. |
| Court | U.S. District Court — District of Puerto Rico |
Plaintiff Noemí Nieves Florán ("Nieves") brought this action against Doctors' Center Hospital ("Doctors"), Dr. Maritza Loinaz-Rivera ("Dr. Loinaz"), and their insurers, alleging violations of the Emergency Medical Treatment and Labor Act ("EMTALA" or "the Act"), 42 U.S.C. §§ 1395dd, and medical malpractice under Article 1802 of the Puerto Rico Civil Code, P.R. Laws Ann. tit. 31, § 5141. Dkt. 126 ("Am. Compl."). Doctors moved to dismiss Nieves's EMTALA claims. Dkt. 191. Nieves has not opposed. This matter is before me by consent of the parties. Dkt. 165.
For the reasons set forth below, the motion to dismiss is GRANTED.
Under Federal Rule of Civil Procedure 12(b)(1), a defendant may move to dismiss for lack of subject matter jurisdiction. Courts are generally obligated to address questions of subject matter jurisdiction before the merits of a case. Sinapi v. Rhode Island Bd. of Bar Examiners, 910 F.3d 544, 549 (1st Cir. 2018) (citing Acosta-Ramírez v. Banco Popular de P.R., 712 F.3d 14, 18 (1st Cir. 2013)). "[T]he party invoking the jurisdiction of a federal court carries the burden of proving its existence." Johansen v. United States, 506 F.3d 65, 68 (1st Cir. 2007) (citing Murphy v. United States, 45 F.3d 520, 522 (1st Cir. 1995)).
When faced with a motion to dismiss for failure to state a claim under Rule 12(b)(6), the court "accept[s] as true all well-pleaded facts alleged in the complaint and draws all reasonable inferences therefrom in the pleader's favor" to determine whether the complaint states a claim for which relief can be granted. Santiago v. Puerto Rico, 655 F.3d 61, 72 (1st Cir. 2011). These facts and inferences may be augmented "with data points gleaned from documents incorporated by reference into the complaint, matters of public record, and facts susceptible to judicial notice." Haley v. City of Boston, 657 F.3d 39, 46 (1st Cir. 2011).
Dismissal under Rule 12(b)(6) is inappropriate if the complaint provides "a short and plain statement of the claim showing that the pleader is entitled to relief." Ocasio-Hernandez v. Fornuno-Burset, 640 F.3d 1, 11 (1st Cir. 2011) (quoting Fed. R. Civ. P. 8(a)(2)). "A short and plain statement needs only enough detail to provide a defendant with 'fair notice of what the . . . claim is and the grounds upon which it rests.'" Id. at 12 (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007)). This requires that the complaint contain sufficient facts "to raise a right to relief above the speculative level on the assumption that all the allegations in the complaint are true." Id.
In making this determination, courts employ a two-pronged approach, first by identifying and disregarding statements in the complaint that offer "legal conclusion[s] couched as . . . fact" or "[t]hreadbare recitals of the elements of action." Twombly, 550 U.S. at 555. All non-conclusory factual allegations are treated as true, "even if seemingly incredible." Ocasio-Hernandez, 640 F.3d at 12 (citing Ashcroft v. Iqbal, 556 U.S. 662, 680-681 (2009)). If the complaint's properly pleaded factual content, read as a whole, "allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged, the claim has facial plausibility." Iqbal, 556 U.S. at 677. Applying the plausibility standard is "a context-specific task that requires the reviewing court to draw on its judicial experience and common sense." Id. at 662.
On May 11, 2015, Nieves fell while she was visiting her sister, sustaining a severe fracture and dislocation to her right ankle. Am. Compl. ¶¶ 1, 3. An ambulance arrived, and first responders used wooden splints to stabilize Nieves's ankle. Id. ¶ 2. They brought her to Doctors' emergency room at 10:26 pm. Id. ¶ 3.
At the hospital, blood work and x-rays were performed, demonstrating that Nieves had suffered multiple fractures and ankle dislocation. Id. ¶ 4. An emergency room doctor told Nieves to wait for an orthopedic doctor, and Nieves waited in an emergency room bed in a hallway. Id. ¶ 5.
At 8:30 am the next morning, hospitalist Dr. Harley Arraut-Ramirez (Dr. Arraut) officially admitted Nieves to the hospital and into the care of Dr. Norbert Correa-Sandina (Dr. Correa). Id. ¶¶ 6-7. At the time of her admission, Nieves was still in the emergency room. Id. ¶¶ 6-7, 10. According to a progress note written by Dr. Correa, Nieves was admitted "for evaluation from medical point of view for treatment of bimalleolarfreacture [sic]" and that there was no "contraindication at the moment for surgery." Id. ¶ 9.
At 4:00 pm on May 12, Dr. Loinaz performed an orthopedic consultation. Id. ¶ 8. She diagnosed Nieves with a right ankle bimalleolar fracture and described a treatment plan as "will admit for proper treatment." Id. At 8:00 am on May 13, Dr. Correa filled out a progress note indicating that Nieves had been admitted to his service. Id. ¶ 9. On May 14, Nieves was informed that Doctors had a room available for her. Id. ¶ 10.
On May 15, Nieves's family arrived from New York and demanded to know why an orthopedic surgeon had not yet seen Nieves even though she had been in the hospital for three days. Id. ¶ 11. An orthopedic surgeon came to see Nieves and advised that she needed ankle surgery as soon as possible. Id. ¶ 12. She also explained that Nieves's insurance would not pay for the surgery if it were performed at Doctors. Id. That same day, Dr. Loinaz wrote a note explaining that she had been notified when Nieves arrived to the emergency room, but she had asked that Nieves be transferred to a public hospital because she had no insurance. Id. ¶ 13. The note also explained that Nieves's admission by Dr. Arraut was against the advice of Dr. Loinaz. Id.
Nieves was discharged from the hospital on May 15. Id. ¶ 14. In a discharge summary, Dr. Loinaz indicated that Nieves's ankle had been re-splinted before Nieves would be leaving to New York. Id. That summary does not indicate that Nieves's ankle was reduced or set. Id.
On May 16, Nieves flew to New York, where she was admitted to another hospital and where x-rays revealed "marked posterolateral dislocation" and fractures. Id. ¶ 15. Nieves's fracture dislocation was reduced, and new x-rays demonstrated that the posterior dislocation was resolved. Id. ¶ 16. Nieves underwent surgery on May 29. Id. ¶ 17. Nine months after the surgery, Nieves was using a walker and suffering from pain and limited mobility, which, according to her expert witness, is a poor outcome. Id. ¶ 18.
Nieves brought suit against Doctors and other defendants alleging, inter alia, that Doctors violated EMTALA's screening and stabilization requirements. Id. ¶¶ 40-46.
At the outset, I note that Doctors fashions its motion as both a Rule 12(b)(6) motion to dismiss for failure to state a claim and a Rule 12(b)(1) motion to dismiss for lack of subject matter jurisdiction. Doctors' arguments, however, "appear to confound jurisdictional with merits-based issues." Cruz-Vazquez v. Mennonite Gen. Hosp., Inc., 717 F.3d 63, 67 (1st Cir. 2013). Despite purporting to question the court's subject matter jurisdiction, Doctors does not address whether Nieves's EMTALA claims, brought under a federal statute, arise under the laws of the United States as required for jurisdiction under 28 U.S.C. § 1331. Rather, Doctors focuses its arguments on the sufficiency of Nieves's allegations. But "the absence of a valid (as opposed to arguable) cause of action does not implicate subject-matter jurisdiction, i.e., the courts' statutory or constitutional power to adjudicate the case." Steel Co. v. Citizens for a Better Env't, 523 U.S. 83, 89 (1998) (citations omitted); see also Oneida Indian Nation of N.Y. v. County of Oneida, 414 U.S. 661, 666 (1974) (); Baker v. Carr, 369 U.S. 186, 200 (1962) (citations omitted) ("[T]he failure to state a proper cause of action calls for a judgment on the merits and not for a dismissal for want of jurisdiction."). Finding that this court has federal question jurisdiction over Nieves's EMTALA claims, I will proceed to consider Doctors' motion as a Rule 12(b)(6) motion to dismiss for failure to plead facts sufficient to sustain an EMTALA claim.
In light of Nieves's failure to oppose Doctors' motion to dismiss, Doctors asked that I grant its motion as unopposed and deem all objections waived pursuant to Local Rule 7(b). Dkt. 195; see Local Rules of the U.S. Dist. Court for the Dist. of P.R. Rule 7(b) (). "When deciding a 12(b)(6) motion, 'the mere fact that a motion to dismiss is unopposed does not relieve the district court of the obligation to examine the complaint itself to see whether it is formally sufficient to state a claim.'" Pomerleau v. W. Springfield Pub. Sch., 362 F.3d 143, 145 (1st Cir. 2004) (citing Vega-Encarnacion v. Babilonia, 344 F.3d 37, 41 (1st Cir. 2003). Indeed, "a court may not automatically treat a failure to respond to a 12(b)(6) motion as a procedural default." Id. (citing Pinto v. Universidad De Puerto Rico, 895 F.2d 18, 19 & n. 1 (1st Cir. 1990)). Accordingly, I will decide Doctors' motion to dismiss based on the sufficiency of the complaint itself despite Nieves's failure to oppose.
EMTALA was enacted "in 1996 in response to claims that hospital...
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