Kenyon v. Cedeno-Rivera

• Decision Date: 25 August 2022
• Docket Number: s. 17-1686,17-2217
• Citation: 47 F.4th 12
• Parties: John KENYON, individually, on behalf of his conjugal partnership and as parent and natural guardian of C.A.K.; Rhea Kenyon, individually, on behalf of her conjugal partnership and as parent and natural guardian of C.A.K.; C.A.K.; Conjugal Partnership Kenyon-Kenyon, Plaintiffs, Appellants, v. Dr. Ricardo CEDENO-RIVERA; Dr. Juan R. Jimenez-Barbosa; Dr. Maria De Los Angeles Rodriguez-Maldonado; SIMED, Insurers Syndicate for the Joint Underwriting of Medical-Hospital Professional Liability Insurance; SIMED 1, as insurer for Dr. Juan R. Jimenez-Barbosa; SIMED 3, as insurance carrier of Dr. Maria de los Angeles Rodriguez; SIMED 4, as insurance carrier of Dr. Ricardo Cedeno-Rivera; Dr. Evelyn Gonzalez-del Rio; Dr. Maria Comas-Matos; Joe Does 1-10; Insurance Companies A to Z; John Doe 1 ; Conjugal Partnership Doe 1-Comas; John Doe 2; Conjugal Partnership Doe 2-Gonzalez; Conjugal Partnership Cedeno-Doe 2; John Doe 3 ; Conjugal Partnership Doe 3-Rodriguez; SIMED 2, as insurance carrier of Dr. Evelyn Gonzalez-del Rio; SIMED 5, as insurance carrier of Dr. Maria Comas-Matos; Ms. Ricardo Cedeno Rivera, wife of Ricardo Cedeno-Rivera, Defendants, Appellees, Hospital San Antonio, Inc., Defendant, Third-Party Plaintiff, Appellee, SIMED 7, insurer of Dr. Richard Doe; Servicios Medicos De Anasco, Inc.; Municipality of Anasco; Dr. Richard Doe; Mary Roe, wife of Dr. Richard Doe; Conjugal Partnership Doe-Doe, composed by Dr. Richard Doe and Mary Doe; Dr. Mary Roe; Richard Roe, husband of Dr. Mary Roe; Conjugal Parternship Roe-Roe, composed by Richard Roe and Dr. Mary Roe; Thomas Roe; ABC Insurance Co.; DEF Insurance Co.; HIJ Insurance Company: JKL Insurance Co.; RQS Insurance Company; Company MNO ; Company OPQ; SIMED 8, insurer of DR. Mary Roe; Dr. Francisco Morales, Third-Party Defendants, Appellees, Admiral Insurance Company ; Jane Doe 3; Conjugal Partnership Jimenez-Doe 3, Defendants.
• Court: U.S. Court of Appeals — First Circuit

47 F.4th 12

John KENYON, individually, on behalf of his conjugal partnership and as parent and natural guardian of C.A.K.; Rhea Kenyon, individually, on behalf of her conjugal partnership and as parent and natural guardian of C.A.K.; C.A.K.; Conjugal Partnership Kenyon-Kenyon, Plaintiffs, Appellants,

v. Dr. Ricardo CEDENO-RIVERA; Dr. Juan R. Jimenez-Barbosa; Dr. Maria De Los Angeles Rodriguez-Maldonado; SIMED, Insurers Syndicate for the Joint Underwriting of Medical-Hospital Professional Liability Insurance; SIMED 1, as insurer for Dr. Juan R. Jimenez-Barbosa; SIMED 3, as insurance carrier of Dr. Maria de los Angeles Rodriguez; SIMED 4, as insurance carrier of Dr. Ricardo Cedeno-Rivera; Dr. Evelyn Gonzalez-del Rio; Dr. Maria Comas-Matos; Joe Does 1-10; Insurance Companies A to Z; John Doe 1 ; Conjugal Partnership Doe 1-Comas; John Doe 2; Conjugal Partnership Doe 2-Gonzalez; Conjugal Partnership Cedeno-Doe 2; John Doe 3 ; Conjugal Partnership Doe 3-Rodriguez; SIMED 2, as insurance carrier of Dr. Evelyn Gonzalez-del Rio; SIMED 5, as insurance carrier of Dr. Maria Comas-Matos; Ms. Ricardo Cedeno Rivera, wife of Ricardo Cedeno-Rivera, Defendants, Appellees,Hospital San Antonio, Inc., Defendant, Third-Party Plaintiff, Appellee,SIMED 7, insurer of Dr. Richard Doe; Servicios Medicos De Anasco, Inc.; Municipality of Anasco; Dr. Richard Doe; Mary Roe, wife of Dr. Richard Doe; Conjugal Partnership Doe-Doe, composed by Dr. Richard Doe and Mary Doe; Dr. Mary Roe; Richard Roe, husband of Dr. Mary Roe; Conjugal Parternship Roe-Roe, composed by Richard Roe and Dr. Mary Roe; Thomas Roe; ABC Insurance Co.; DEF Insurance Co.; HIJ Insurance Company: JKL Insurance Co.; RQS Insurance Company; Company MNO ; Company OPQ; SIMED 8, insurer of DR. Mary Roe; Dr. Francisco Morales, Third-Party Defendants, Appellees,Admiral Insurance Company ; Jane Doe 3; Conjugal Partnership Jimenez-Doe 3, Defendants.

Nos. 17-1686

17-2217

17-2217

United States Court of Appeals, First Circuit.

August 25, 2022

James Healy, with whom Julie Soderlund and Sullivan & Brill, LLP were on brief, for appellants.

Jose H. Vivas, with whom Vivas & Vivas was on brief, for appellee Dr. Ricardo Cedeño-Rivera.

Benjamin Morales Del Valle, with whom Morales Morales Law Offices was on brief, for appellee Dr. María de Los Ángeles Rodríguez-Maldonado.

Jeannette Lopez de Victoria, with whom Oliveras & Ortiz, P.S.C. was on brief, for appellee Dr. Juan R. Jiménez-Barbosa.

Carlos G. Martínez-Vivas, with whom Martinez-Texidor & Martínez-Vivas was on brief, for appellee Hospital San Antonio, Inc.

Nidia I. Teissonniere for appellee SIMED 1, 3 & 4.

Before Kayatta and Howard, Circuit Judges.^*

HOWARD, Circuit Judge.

These appeals require us to interpret and apply a Puerto Rico statute that has been amended several times during the pendency of this litigation. The appeals arise out of a medical malpractice suit filed by the plaintiffs-appellants, John and Rhea Kenyon, on behalf of themselves, their conjugal partnership, and their minor daughter, C.A.K. (collectively, "Kenyon"), against the Hospital San Antonio, Inc. ("HSA") and several doctors who worked in San Antonio Hospital's emergency room. Kenyon alleged that the named defendants, Drs. Ricardo Cedeño-Rivera, Juan R. Jiménez-Barbosa, and María de Los Ángeles Rodríguez-Maldonado (collectively, "the physicians"),¹ breached their duty of care and departed from accepted medical standards when treating C.A.K. in the emergency room of San Antonio Hospital in 2010.

Following discovery, the physicians moved for summary judgment, arguing that they were absolutely immune from liability for negligence under the 2013 amendments to Article 41.050 of the Puerto Rico Insurance Code. Law No. 150-2013 (amending P.R. Laws Ann. tit. 26, § 4105 ) ("Law 150"). The motion was joined by both HSA and the Insurers Syndicate for the Joint Underwriting of Medical-Hospital Professional Liability Insurance ("SIMED"), the physicians' professional liability insurance provider. The district court agreed and granted partial summary judgment to the physicians.

After the district court's ruling, another district court in the District of Puerto Rico analyzed the application of Law 150 to HSA and medical professionals working at San Antonio Hospital. Oquendo-Lorenzo v. Hospital San Antonio, Inc., 256 F. Supp. 3d 103 (D.P.R. 2017). Unlike the district court in Kenyon's case, however, the district court in Oquendo-Lorenzo concluded that HSA was not entitled to a cap on damages, and that the doctor in Oquendo-Lorenzo was not entitled to absolute immunity. Kenyon subsequently moved for reconsideration in light of the Oquendo-Lorenzo decision. The district court denied that motion.

Kenyon appealed both decisions and the appeals have been consolidated. We affirm.

I. Factual Background

The facts underlying the present suit are largely undisputed. In early 2010, C.A.K. began experiencing symptoms of vasculitis, and her parents sought treatment for her condition from her primary care physician. In the early hours of August 14, 2010, C.A.K.'s symptoms became severe, so her mother took her to the emergency room at San Antonio Hospital, where she was evaluated by Dr. Cedeño-Rivera, a licensed physician who worked in the ER. Dr. Cedeño ordered several tests and made a provisional diagnosis of gastroenteritis and dehydration. However, his shift ended before the test results were available, and care of C.A.K. transferred to Dr. Rodríguez-Maldonado, another ER doctor.

The tests showed some evidence of acute kidney failure, but Dr. Rodríguez nevertheless discharged C.A.K. at 6:00 P.M. on August 15, 2010. C.A.K.'s condition continued to deteriorate, and she was taken to various other physicians over the next three weeks. Finally, on September 8, 2010, C.A.K. was diagnosed with renal failure and was taken to the ER at San Antonio Hospital to be stabilized. While there, she was diagnosed with acute renal failure and anemia and ordered to be transferred to University Pediatric Hospital in San Juan. However, C.A.K. was not transferred until 2:15 P.M. the next day. During this time, both Dr. Rodríguez and Dr. Jiménez-Barbosa were involved in the treatment of C.A.K.

C.A.K. remained at University Pediatric Hospital until November 2, 2010. By the time she was discharged, she had lost 99% of the function in her kidneys and required daily dialysis. She eventually received a kidney transplant in 2014.

Kenyon initially sued HSA and the physicians in the U.S. District Court for the District of Puerto Rico on September 7, 2011, asserting a claim under the Emergency Medical Treatment and Active Labor Act ("EMTALA"), and also state-law claims. The suit was dismissed on June 28, 2013, after the district court dismissed all federal EMTALA claims with prejudice and declined to exercise supplemental jurisdiction over Kenyon's medical malpractice claims, dismissing them without prejudice.

On June 27, 2014, after the family had moved to New Jersey, Kenyon refiled the suit for medical malpractice under the district court's diversity jurisdiction. Following discovery, the physicians, SIMED, and HSA moved for summary judgment. The physicians argued that they were immune from suit due to Article 41.050. HSA also sought summary judgment with respect to the question of whether it was entitled to a limitation on liability for the claims against it.

On March 30, 2017, the district court granted defendants' motions for partial summary judgment. It held that the physicians were immune from suit under the 2013 version of Article 41.050 and, by extension, that SIMED could not be required to compensate Kenyon for damages resulting from that alleged misconduct. See Colon v. Ramirez, 913 F. Supp. 112, 119 (D.P.R. 1996) ("[T]he immunity afforded state doctors is not a personal defense but rather the ‘inexistence of a cause of action’ and ... where no cause of action lies against the insured, the insurer is not liable." (citing Lind Rodríguez v. Commonwealth of Puerto Rico, 12 P.R. Offic. Trans. 85, 112 D.P.R. 67 (1928) )). The court also held that HSA's liability "for all damages alleged by all parties and by all causes of action[ ] in the complaint" was capped at $150,000. However, it found that there was a genuine issue of material fact with respect to HSA's liability, and allowed that portion of the suit to proceed.²

After this appeal was filed, Kenyon sought reconsideration in the district court, arguing that Oquendo-Lorenzo represented a change in controlling law. The district court disagreed, and Kenyon appealed the denial of reconsideration as well.

The two appeals were consolidated before us.

II. The Statutory Scheme

Because this case rests on the proper interpretation of P.R. Laws Ann. tit. 26, § 4105, we start by tracing the evolution of the statute.³ Article 41.050 of the Puerto Rico Insurance Code originally passed in 1986 and provided certain medical providers with limits on liability for medical malpractice. Over the years, the provision has been amended repeatedly.

As of 2010, when C.A.K. was treated at San Antonio Hospital, Article 41.050 had last been amended in 2006. This version immunized all "health services professional[s]" who worked as "employee[s]" of the Commonwealth of Puerto Rico, "its dependencies and instrumentalities," the Comprehensive Cancer Center of the University of Puerto Rico, "and the municipalities or contractor[s] thereof" from suits for damages "because of culpability or negligence arising from malpractice incurred ... while acting in compliance of his/her duties and functions." Law No. 260-2006 (amending P.R. Laws Ann. tit. 26, § 4105 ).

The statute was amended on June 27, 2011, a few months before Kenyon first filed suit in federal district court, specifically to protect the employees of certain medical providers, namely Mayagüez Medical Center. See Law 103-2011 (amending P.R. Laws Ann. tit. 26, § 4105 ) ("Law 103"). The relevant section of this version of the statute did not explicitly mention...