Morales-Ramos v. Hosp. Episcopal San Lucas Guayama, Inc.

• Citation: 261 F.Supp.3d 122
• Decision Date: 13 September 2016
• Docket Number: Civil No. 13–1614 (BJM)
• Parties: Judyann MORALES–RAMOS, et al., Plaintiffs, v. HOSPITAL EPISCOPAL SAN LUCAS GUAYAMA, INC., et al., Defendants.
• Court: U.S. District Court — District of Puerto Rico

261 F.Supp.3d 122

Judyann MORALES–RAMOS, et al., Plaintiffs,

v.HOSPITAL EPISCOPAL SAN LUCAS GUAYAMA, INC., et al., Defendants.

Civil No. 13–1614 (BJM)

United States District Court, D. Puerto Rico.

Signed September 13, 2016

Alicia Margarita Santos–Irizarry, San Juan, PR, for Plaintiffs.

Mayra Vanessa Estrella Perez–Valdivieso, Rovira–Rodriguez Law Offices, Coto Laurel, PR, Jose A. Miranda–Daleccio, Miranda Cardenas & Cordova, Gilda Del C. Cruz–Martino, San Juan, PR, Anselmo Irizarry–Irizarry, Matta & Matta PSC, Ponce, PR, for Defendants.

OPINION AND ORDER

BRUCE J. McGIVERIN, United States Magistrate Judge

This case involves a pregnant woman, Judyann Morales–Ramos ("Morales"), who was transferred to the University District Hospital at the Puerto Rico Medical Center ("University Hospital") sometime after she arrived to the Hospital Episcopal San Lucas Guayama, Inc. ("Hospital") and was examined by Dr. Alberto Matos–Guadalupe ("Dr. Matos"). Docket No. 38 ("Am. Compl."). Morales and Angel Adorno–Morales, individually and on behalf of their minor son, A.M.A.M., brought this action against the Hospital, Dr. Matos, and their insurance carriers, alleging violations of the Emergency Medical Treatment and Labor Act ("EMTALA" or the "Act"), 42 U.S.C. §§ 1395dd(a), (b), and medical malpractice under Article 1802 of the Puerto Rico Civil Code. P.R. Laws Ann. tit. 31, § 5141. The Hospital and Dr. Matos moved for summary judgment, Docket Nos. 65, 78, 112, 119, and Morales opposed. Docket Nos. 95, 116.

For the reasons set forth below, the motion for summary judgment is GRANTED IN PART AND DENIED IN PART .

SUMMARY JUDGMENT STANDARD

Summary judgment is appropriate when the movant shows "there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(a). A dispute is "genuine" only if it "is one that could be resolved in favor of either party." Calero–Cerezo v. U.S. Dep't of Justice , 355 F.3d 6, 19 (1st Cir. 2004). A fact is "material" only if it "might affect the outcome of the suit under the governing law." Anderson v. Liberty Lobby, Inc. , 477 U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). The moving party bears the initial burden of "informing the district court of the basis for its motion, and identifying those portions" of the record materials "which it believes demonstrate the absence" of a genuine dispute of material fact. Celotex Corp. v. Catrett , 477 U.S. 317, 323, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986).

The court does not act as trier of fact when reviewing the parties' submissions and so cannot "superimpose [its] own ideas of probability and likelihood (no matter how reasonable those ideas may be) upon" conflicting evidence. Greenburg v. P.R. Mar. Shipping Auth. , 835 F.2d 932, 936 (1st Cir. 1987). Rather, it must "view the entire record in the light most hospitable to the party opposing summary judgment, indulging all reasonable inferences in that party's favor." Griggs–Ryan v. Smith , 904 F.2d 112, 115 (1st Cir. 1990). The court may not grant summary judgment "if the evidence is such that a reasonable jury could return a verdict for the nonmoving party." Anderson , 477 U.S. at 248, 106 S.Ct. 2505. But the nonmoving party "must do more than simply show that there is some metaphysical doubt as to the material facts," Matsushita Elec. Indus. Co. v. Zenith Radio Corp. , 475 U.S. 574, 586, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986), and may not rest upon "conclusory allegations, improbable inferences, and unsupported speculation." Medina–Muñoz v. R.J. Reynolds Tobacco Co. , 896 F.2d 5, 8 (1st Cir. 1990).

BACKGROUND

Except where otherwise noted, the following facts are drawn from the parties' Local Rule 56¹ submissions.²

Morales's Medical Background

In March 2012, Morales was admitted to the Hospital when her gynecologist, Dr. Gustavo Sanchez ("Dr. Sanchez"), found that she developed "shortness of cervix incompetence

." SUF ¶ 3; OSF ¶ 3. Around that time, Morales reported that she suffered from Hermansky–Pudlak Syndrome, albinism, easy bleeding with minor trauma, and asthma. SUF ¶ 4; OSF ¶ 4. Dr. Gonzalez,³ a hematologist at the Hospital, recommended treatment to correct Morales's coagulopathy. Docket No. 106–2; ASF ¶ 24. Her bleeding time did not improve, and so Dr. Sanchez decided to transfer Morales to the University Hospital after noting the Hospital's "limitation" to assist her. SUF ¶ 7; OSF ¶ 7.

Dr. Sanchez explained "very carefully" to Morales and her husband, who understood the "case and the degree of complexity," that it would be "best" to transfer her to the University Hospital, which has a 24–hour blood bank, 24–hour hematologic service, and maternal-fetal medicine department.

SUF ¶¶ 7, 8; OSF ¶¶ 7, 8. Dr. Sanchez called the University Hospital's obstetrics and gynecology ("OB/GYN") department, and the transfer was accepted. Morales was considered a "complex obstetric patient," and began receiving prenatal care at the University Hospital after April 2012. SUF ¶¶ 10, 11; OSF ¶¶ 10, 11.

Alleged Deviations from Hospital Protocol

On August 10, 2012, Morales had completed 37 weeks of her pregnancy and arrived to the Hospital's emergency room at 1:50 a.m. suffering from vaginal bleeding and pelvic pain. Docket No. 106–6 at 1, 19. She voiced both of these two symptoms upon arrival, and they were documented in her medical record. RSF ¶ 4; Docket No. 106–6 at 1, 19. At 3:30 a.m., Morales was transferred to the University Hospital after being seen by Dr. Matos and the Hospital's medical staff. ASF ¶ 15; RSF ¶15. Morales asserts that the Hospital deviated from its standard screening and transfer procedures during her visit on August 10, and marshals various examples in support of this assertion.

At the outset, Morales highlights that on August 10—according to Dr. Matos—the Hospital had an OB/GYN department, delivery rooms, pediatrician services, operation rooms, and a blood bank. SAF ¶ 25. In contrast, the operational executive director for the Hospital, Elyonel Ponton–Cruz ("Ponton"), certified in May 2016 that the Hospital "does not have" a blood bank, and that this service is subcontracted when it is needed.⁴ Docket No. 121–9 at 1.

According to Dr. Matos, a patient's vital signs are checked and documented when the patient arrives to the Hospital, at each "intervention" by either a nurse or doctor, and before the patient is transferred to another hospital. Docket No. 106–19 at 1. Morales's vital signs were checked and documented upon her arrival to the Hospital's emergency room. ASF ¶ 10; Docket No. 106–6 at 20. They were also documented when she was transferred at 3:30 a.m. ASF ¶ 35. On the other hand, the nurses' notes that were entered at 2:15, 2:30, and 2:57 a.m. do not document Morales's vital signs. ASF ¶ 13. Dr. Matos also did not document Morales's vital signs at 2:30 a.m. Docket No. 106–6 at 5.

It is also "protocol," according to Dr. Matos, to connect a fetal monitor to "every pregnant woman with over twenty weeks of gestation." Docket No. 106–21 at 1. The fetal monitor, which "traces" the times when it is connected to the patient, must be connected from the moment a pregnant woman enters the emergency room until she is transferred. Docket No. 106–21 at 1–2. Dr. Matos claimed that Morales was connected the "entire time" she was at the Hospital. Docket No. 106–21 at 1. However, Dr. Matos also acknowledged that there is no way to identify when the fetal monitor was connected to, or disconnected from, Morales. Docket No. 106–23 at 1–2. And while Morales was in the Hospital for approximately 100 minutes, the fetal monitor traced only 50 minutes. Docket No. 106–22 at 1. Of these 50 minutes, Dr. Matos "discarded" part of the tracing because there was "a lot of interference" and "nobody" would be able to use the part he discarded or "issue judgment on it." Docket No. 106–22 at 3–4.

Dr. Matos also testified about the screening procedures that are conducted prior to making the decision to transfer a patient. When determining whether a patient should be transferred, the following are considered: the patient's chief complaint or problem, the "clinical picture," any findings, and the laboratory tests. ASF ¶ 7. Dr. Matos made clear that the laboratory tests must be evaluated before a decision to transfer the patient is made, as well as before any arrangements to transfer the patient are made. Docket No. 160–25 at 1. Once the decision to transfer a patient is made, Dr. Matos adheres to the following procedure. Docket No. 106–8 at 2–3. He first determines the facility that will accept the patient. Id. Once that location is determined, Dr. Matos calls the doctor at that facility who will accept the transfer. Id. After the doctor at the transferring facility accepts the transfer, arrangements are made to transport the patient.⁵ Id.

At 2:00 a.m., Dr. Matos evaluated Morales and ordered various laboratory tests (NST, CBC, BMP, U/A, and the patient's blood type

and group) and drugs (R/1, Brethine, Demerol, and oxygen).⁶ RSF ¶ 21; Docket No. 106–6 at 4. Morales testified that her pain worsened while she was in the Hospital, and that she was provided a hospital pad to collect the profuse bleeding. Docket No. 106–32 at 1–3. At 2:15 a.m., the Hospital began making arrangements to transfer Morales to the University Hospital. Docket No. 106–6 at 18. And at 2:30 a.m., Dr. Matos called Dr. Rodriguez to coordinate Morales's transfer to the University Hospital.⁷ Docket No. 106–6 at 5 & 6.

At 2:45 a.m., Dr. Matos completed the Hospital's Form for Transfer of Patients ("Transfer Form"). Docket No. 106–6 at 6–8. He wrote the following in a section titled "medical reason for transfer": "hemophilic" patient, "albinism," and "vaginal bleeding." Id. at 6. Dr. Matos left blank the sections asking for the benefits of the transfer, the risks of the transfer, and the alternatives to the transfer. Id. at 7. Dr. Matos also checked a box that said Morales "was stabilized within a reasonable medical...