Garcia v. Municipio De San Juan & San Juan Mun. Hosp.

Decision Date15 February 2023
Docket NumberCiv. 22-cv-01307 (MAJ)
PartiesGARCIA, et al., Plaintiffs, v. MUNICIPIO DE SAN JUAN AND SAN JUAN MUNICIPAL HOSPITAL, et al., Defendants.
CourtU.S. District Court — District of Puerto Rico


I. Introduction

This case arises from an alleged medical malpractice stemming from treatment given to, Mr. Jesus Garcia (Mr Garcia), at San Juan Municipal Hospital (“Municipal Hospital”) from June 23, 2021, until July 4, 2021. Most relevant for purposes of the present motion are codefendants, Dr. Ricardo Alan Hernandez-Castillo (“Dr. Hernandez”) and Dr. Akbar Khan (“Dr Khan”). Plaintiffs allege the co-defendants failed to provide adequate treatment to Mr. Garcia and that their negligent acts and omissions caused Mr. Garcia's death. Id. (ECF No. 27).

In turn, Dr. Hernandez and Dr. Khan filed the present motion to dismiss, claiming they are immune from medical malpractice claims as government-employed physicians under the Puerto Rico Medico-Hospital Professional Liability Insurance Act (MHPLIA), P.R. Laws Ann. tit. 26, § 4105 (2017); (ECF No. 52). Accordingly, the co-defendants request the Court dismiss all claims against them pursuant to Fed.R.Civ.P. 12(b)(6).

Before the Court is also plaintiffs' Opposition to defendants' Motion to Dismiss. (ECF No. 56). In their opposition, plaintiffs put forward two reasons why Dr. Khan and Dr. Hernandez are unable to shield themselves from liability based on statutory immunity. Plaintiffs assert that, for Dr. Khan, his employment contract with Municipal Hospital had expired when he treated Mr. Garcia. (ECF No. 56). Therefore, plaintiffs claim that the expired employment contract prevents Dr. Khan from asserting immunity. Id.

For Dr. Hernandez, plaintiffs allege that his employment contract with Municipal Hospital was not that of an employee but instead an independent contractor. As such, plaintiffs cite case law that supports the notion that only employees of a qualifying hospital are eligible for statutory immunity under the MHPLIA. According to plaintiffs, independent contractors receive no such benefit under the MHPLIA. For the reasons setforth below, the Court finds only Dr. Hernandez can claim immunity from the medical malpractice allegations because he has made a sufficient showing that he satisfies the requirements of MHPLIA. See P.R. Laws Ann. tit. 26, § 4105 (2017).

II. Standard of Review
A. Motion to Dismiss Standard under Fed.R.Civ.P. 12(b)(6)

When addressing a motion to dismiss under Fed.R.Civ.P. 12(b)(6), Courts should “accept as true all well-pleaded facts in the complaint and draw all reasonable inferences in favor of the plaintiff [].” Gargano v. Liberty Int'l Underwriters, Inc., 572 F.3d 45, 48-49 (1st Cir. 2009). Under Bell Atlantic v. Twombly, 550 U.S. 544, 555 (2007), a plaintiff must “provide the grounds of his entitlement [with] more than labels and conclusions.” See Ocasio-Hernandez v. Fortuno-Burset, 640 F.3d 1, 12 (1st Cir. 2011) (“in order to ‘show' an entitlement to relief a complaint must contain enough factual material ‘to raise a right to relief above the speculative level on the assumption that all the allegations in the complaint are true (even if doubtful in fact)') (quoting Twombly, 550 U.S. at 555) (citation omitted). Thus, a plaintiff is required to, present allegations that “nudge [his] claims across the line from conceivable to plausible” to comply with the requirements of Rule 8(a). Id. at 570; see e.g., Ashcroft v. Iqbal, 556 U.S. 662 (2009).

When considering a motion to dismiss, the Court's analysis occurs in a two-step process under the current context-based “plausibility” standard established by Twombly, 550 U.S. 544, and Iqbal, 556 U.S. 662 (2009). “Context based” means that a plaintiff must allege sufficient facts that comply with the basic elements of the cause of action. See Iqbal, at 671-672 (concluding that plaintiff s complaint was factually insufficient to substantiate the required elements of a Bivens claim, leaving the complaint with only conclusory statements). First, the Court must “accept as true all of the allegations contained in a complaint [,] discarding legal conclusions, conclusory statements, and factually threadbare recitals of the elements of a cause of action. Iqbal, at 678; Mead v. Independence Ass'n, 684 F.3d 226, 231 (1st Cir. 2012) (“Any statements in the complaint that are either legal conclusions couched as facts or bare bones recitals of the elements of a cause of action are disregarded.”).

In the second step of the analysis, the Court must determine whether, based on all assertions not discarded in the first step, the complaint “states a plausible claim for relief.” Iqbal, at 679. This second step is “context-specific” and requires that the Court draw from its own “judicial experience and common sense” to decide whether a plaintiff has stated a claim upon which relief may be granted or, instead, whether dismissal under Fed.R.Civ.P. 12(b)(6) is warranted. Id.

To survive a motion to dismiss, a plaintiff must allege facts sufficient to state a plausible claim for relief. Doe v. Stonehill College, Inc., 55 F.4th 302, 316 (1st Cir. 2022). [W]here the well-pleaded facts do not permit the court to infer more than the mere possibility of misconduct, the complaint has alleged - but it has not ‘show[n]' ‘that the pleader is entitled to relief.' Iqbal, at 679 (quoting Fed.R.Civ.P. 8(a)(2)). Furthermore, such inferences must be at least as plausible as any “obvious alternative explanation.” Id. at 682 (citing Twombly, 550 U.S. at 567).

The First Circuit has warned against equating plausibility with an analysis of the likely success on the merits, affirming that the plausibility standard assumes “pleaded facts to be true and read in a plaintiff s favor” “even if seemingly incredible.” Sepulveda-Villarini v. Dep't of Educ. of P.R., 628 F.3d 25, 30 (1st Cir. 2010) (citing Twombly, 550 U.S. at 556); Ocasio-Hernandez, at 12 (citing Iqbal, at 680); see Twombly, at 556 ([A] well- pleaded complaint may proceed even if it appears that a recovery is very remote and unlikely.”) (internal quotation marks omitted); see Ocasio-Hernandez, at 12 (citing Twombly, at 556) ([T]he court may not disregard properly pled factual allegations, ‘even if it strikes a savvy judge that actual proof of those facts is improbable.'). Instead, the First Circuit has emphasized that [t]he make-or-break standard . . . is that the combined allegations, taken as true, must state a plausible, [but] not a merely conceivable, case for relief.” Sepulveda-Villarini, 628 F.3d at 29.

But a complaint that rests on “bald assertions” and “unsupportable conclusions” will likely not survive a motion to dismiss. See Alston v. Spiegel, 988 F.3d 564, 573 (1st Cir. 2021) (internal quotations and citation omitted). Similarly, bare factual assertions as to the elements of the cause of action are inadequate as well. Penalbert-Rosa v. Fortuno-Burset, 631 F.3d 592 (1st Cir. 2011). “Specific information, even if not in the form of admissible evidence, would likely be enough at [the motion to dismiss] stage; pure speculation is not.” Id. at 596.

B. Matters Outside of the Pleadings under Fed.R.Civ.P. 12(b)(6)

When a defendant raises an affirmative defense that is obvious on the face of plaintiff's pleadings, and the court makes its ruling based only on those pleadings, the motion is treated as a Rule 12(b)(6) motion to dismiss. Fudge v. Penthouse Intern., 840 F.2d 1012, 1015 (1st Cir. 1988). If the court considers matters “outside” the pleadings, this converts the motion to one for summary judgment under Fed.R.Civ.P. 56; Puerto Rican-American Ins. Co. v. Benjamin Shipping Co., 829 F.2d 281, 285 (1st Cir. 1987).

But “when a complaint's factual allegations are expressly linked to and admittedly dependent upon a document (the authenticity of which is not challenged) then the court can review it upon a motion to dismiss.” Arroyo-Audifred v. Verizon Wireless, Inc., 431 F.Supp.2d 215, 218 (D.P.R. 2006) (citing Diva's Inc. v. City of Bangor, 411 F.3d 30, 38 (1st Cir. 2005)) accord Perry v. N. England Bus. Serv., Inc., 347 F.3d 343, 345 n. 2 (1st Cir. 2003).

Put another way, at the motion to dismiss stage, a court may consider additional documents outside the pleadings, if a document is central to the plaintiff's claim, is sufficiently referred to in the complaint, or its authenticity is not disputed by the parties. See Alvarez-Mauras v. Banco Popular, 919 F.3d 617, 622-23 (1st Cir. 2019). Additionally, a court may consider: (1) ‘implications from documents' attached to or fairly ‘incorporated into the complaint,' (2) ‘facts' susceptible to ‘judicial notice,' and (3) ‘concessions' in plaintiff's ‘response to the motion to dismiss.' Rivera v. Marriott Intl., Inc., 456 F.Supp.3d 330, 335 (D.P.R. 2020) (quoting Nieto-Vicenty v. Valledor, 984 F.Supp.2d 17, 20 (D.P.R. 2013)).

If a court decides to consider matters outside the pleadings, the materials effectively, ‘merge[] into the pleadings.' Delaney v. P.R. Children's Hosp., 261 F.Supp.3d 235, 237 (D.P.R. 2016) (quoting Beddall v. State St. Bank & Trust Co., 137 F.3d 12, 17 (1st Cir. 1998)).

In the case at hand, the co-defendants attached copies of their respective employment contracts with Municipal Hospital to their Motion to Dismiss. (ECF No. 52-1,2). While these documents are not expressly referred to in the pleadings, plaintiffs' Second Amended Complaint makes numerous factual allegations regarding the co-defendants' employment with Municipal Hospital for the purposes of substantiating a vicarious liability claim. See (ECF No. 27 ⁋ 171174, 187, 196-7).

Plaintiffs contend in their Opposition to co-defendants' Motion to Dismiss, the ...

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