Royal Caribbean Cruises Ltd. v. Swedish Health Services, 76275-3-1

CourtCourt of Appeals of Washington
Writing for the CourtSCHINDLER, J.
Docket Number76275-3-1
PartiesROYAL CARIBBEAN CRUISES LTD., a Liberian Corporation, Appellant, v. SWEDISH HEALTH SERVICES, a Washington Corporation d/b/a SWEDISH MEDICAL CENTER; SEATTLE RADIOLOGISTS, a Professional Corporation; THE POLYCLINIC, a Professional Corporation; FREDERICK A. MANN, M.D.; PEGGY D. HEADSTROM, M.D.; and KYUNG HI HAN, M.D., Respondents.
Decision Date22 October 2018

ROYAL CARIBBEAN CRUISES LTD., a Liberian Corporation, Appellant,

SWEDISH HEALTH SERVICES, a Washington Corporation d/b/a SWEDISH MEDICAL CENTER; SEATTLE RADIOLOGISTS, a Professional Corporation; THE POLYCLINIC, a Professional Corporation; FREDERICK A. MANN, M.D.; PEGGY D. HEADSTROM, M.D.; and KYUNG HI HAN, M.D., Respondents.

No. 76275-3-1

Court of Appeals of Washington, Division 1

October 22, 2018



In 2009, Jacqueline Almonte filed a lawsuit against Royal Caribbean Cruises Ltd. (RCCL). Almonte alleged RCCL provided inadequate medical care and asserted claims under federal maritime law for unseaworthiness, negligence under the Jones Act, 46 U.S.C. § 30104, and maintenance and cure. In 2014, RCCL settled the lawsuit for $700, 000. Almonte released all claims against RCCL and medical care providers. In May 2015, RCCL filed an indemnity and contribution action under federal maritime law and state law against Swedish Health Services, the Polyclinic, Dr. Peggy Headstrom and Dr. Kyung Han, and Seattle Radiologists and Dr. Frederick Mann. We affirm summary judgment dismissal of the indemnity and contribution lawsuit.


Medical Care

Jacqueline Almonte is a Dominican Republic citizen. In 2007, Almonte worked as a crewmember aboard the Royal Caribbean Cruises Ltd. (RCCL) cruise ship Serenade of the Seas. In July 2007, Almonte saw the ship doctor for "severe abdominal pain." When the ship docked in Juneau, Alaska, the ship doctor referred Almonte to Valley Medical Care. On August 16, Valley Medical Care diagnosed Almonte with "an acute peptic ulcer" and prescribed medication. After Almonte returned to work aboard the ship, her symptoms got worse. On September 1, a ship doctor examined Almonte and found her "not fit for duty." RCCL case coordinator Tania Arroyo[1] worked in the crew medical department in Miami, Florida. Arroyo made arrangements for Almonte to leave the ship and go to the Sitka Community Hospital Emergency Department. The hospital admitted Almonte on September 3. Dr. Robert Hunter examined Almonte and ordered a CAT[2] scan. According to Dr. Hunter, the CAT scan showed "Crohn's disease with an inflammatory obstruction of the terminal ilium, fistulas and free fluid in the pelvis." Dr. Hunter treated Almonte for Crohn's disease and prescribed steroids. Dr. Hunter discharged Almonte on September 9. In the discharge instructions, Dr. Hunter refers Almonte to gastroenterologist Dr. Peggy Headstrom at the Polyclinic in Seattle and directs Almonte to call the Polyclinic on September 10 to make an appointment RCCL paid for Almonte to fly to Seattle and stay in a hotel.

At the request of RCCL, on September 10, 2007, AXA Assistance USA faxed the Sitka Community Hospital discharge summary and a "letter of Guarantee of Payment" to the "Poly Clinic - Dr. Peggy Headstrom." The September 10 AXA "Letter of Confirmation of Benefits Medical Services" confirmed coverage for Almonte and reimbursement for reasonable charges as "approved by AXA Assistance USA."

Your facility will be reimbursed reasonable and customary charges as determined by geographic location or by prearranged contractual assignments for emergency treatment which is medically necessary and approved by AXA Assistance USA. Coverage is subject to all terms. conditions limitations and exclusions of the patient's policy.[3]
Dr. Headstrom examined Almonte on September 10. Dr. Headstrom notes
The report I have from that [Sitka] hospitalization is not detailed. Apparently she did have a CAT scan that showed some ileal abnormalities, and she was placed on prednisone and Asacol for the last several days. I do not know the results of any other laboratory testing

Almonte was admitted to Swedish Medical Center for diagnostic testing. Dr. Headstrom ordered a "CAT scan with CT[4] enteropathy" and a colonoscopy. Dr. Frederick Mann of Seattle Radiologists reviewed the CT scan and found it was "[n]egative" for gastrointestinal disease. On September 12, Polyclinic physician Dr. Kyung Han performed the colonoscopy. The results were "normal."

Swedish Medical Center physician Dr. Mark Kohmetscher discharged Almonte on September 13. The discharge states the "CAT scan with CT enteropathy [is] essentially negative. No evidence of that described from films done in Sitka, Alaska."

The discharge diagnosis is "possible gastroparesis, still with some pending workup." Dr. Kohmetscher prescribed medication and noted Almonte is "planning to emigrate back to the Dominican Republic." Dr. Kohmetscher suggests Almonte "follow up [with] Dr. Headstrom Monday to look at finalized biopsy results."

Almonte saw Dr. Headstrom on September 17 for a follow-up appointment. Almonte told Dr. Headstrom she was "able to eat" and still had "some lower abdominal discomfort, but nothing severe." Dr. Headstrom wrote Almonte "a note saying she is okay to go back to the ship." Dr. Headstrom also gave Almonte "some of her records from her recent hospitalization to take with her back to the Dominican Republic."

The first time Almonte spoke to RCCL case coordinator Arroyo was after Almonte saw Dr. Headstrom on September 17. Almonte told Arroyo she had the "same symptoms." On September 18, Arroyo decided to send Almonte home.

[C]rew will be sent home she still has pain and no clear diagnosis was given apparently the CT[ ]scan and the colonoscopy came back negative she still suffers from pain and is worried to return to the ship in this condition so I will send her home for a further investigations [sic].

On September 19, Arroyo requested the Polyclinic and Dr. Headstrom provide "all med[ical] report & letter saying [patient] is fit to go back to work." The Polyclinic refused to disclose patient information without Almonte's consent.

Almonte flew home to the Dominican Republic on September 20. On September 21, Almonte was admitted to a clinic. The clinic performed surgery to drain an abscess and remove her perforated appendix. The attending physician diagnosed and treated Almonte for Crohn's disease.

2009 Florida Lawsuit

On November 16, 2009, Almonte filed a lawsuit against RCCL in Miami-Dade County circuit court. Almonte alleged RCCL did not provide adequate medical care. Almonte alleged she did not receive adequate medical care from the ship's doctors or the "shoreside doctors." Almonte alleged RCCL "willfully and callously delayed, failed and refused to provide Plaintiff's entire maintenance and cure" when it sent her home without any type of assistance. Almonte alleged the lack of "reasonably fit medical staff' and facilities onboard made the ship unseaworthy. Almonte asserted federal maritime claims for unseaworthiness, negligence under the Jones Act, 46 U.S.C. § 30104, and maintenance and cure.

Almonte alleged she "kept returning" to the ship doctor "as her pain increased." The ship doctor diagnosed her with "peptic ulcer disease," gave her medication, and she returned to work. The complaint alleged that under the Jones Act, RCCL was liable for the failure of "its chosen doctors and agents" to properly diagnose and treat Almonte. The complaint alleged that under maritime law, RCCL was responsible to ensure prompt and adequate medical treatment. Almonte alleged RCCL breached its duty and she suffered injury as a result of the negligence of RCCL "and/or its agents, servants, and/or employees." RCCL filed an answer. RCCL denied the allegation that it chose the onshore doctors or that they were the agents of RCCL.

Almonte did not file a federal maritime claim against the Seattle health care providers for negligent care or treatment. To invoke admiralty jurisdiction over a tort claim against the health care providers, Almonte had to show the tort occurred on navigable water or an injury suffered on land was caused by a vessel on navigable water. Jerome B. Grubart, Inc. v. Great Lakes Dredge & Dock Co., 513 U.S. 527, 534, 115 S.Ct. 1043, 130 L.Ed.2d 1024(1995). The inquiry under the connection test is whether the allegedly tortious activity "is so closely related to activity traditionally subject to admiralty law that the reasons for applying special admiralty rules would apply in the suit at hand." Grubart, 513 U.S. at 539-40.

November 2013 Letter

On November 25, 2013, RCCL sent a "Notice and Tender of Defense and Demand for Indemnity" to Seattle Radiologists and Dr. Mann. Seattle Radiologists and Dr. Mann denied tender of defense because the three-year statute of limitations barred state law claims for medical malpractice in 2007.

2014 Settlement and Release

In June 2014, RCCL settled the federal maritime lawsuit Almonte filed in Florida for $700, 000. In exchange, Almonte signed a release of all claims against RCCL and all medical care providers.

2015 Indemnity and Contribution Lawsuit

On May 27, 2015, RCCL filed a lawsuit in King County Superior Court against Swedish Health Services, Seattle Radiologists, the Polyclinic, Dr. Frederick Mann, Dr. Peggy Headstrom, and Dr. Kyung Han (collectively, health care providers) for equitable contribution and indemnity under federal maritime law and breach of an implied maritime contractual claim. In the alternative, RCCL asserted claims for contribution and indemnity under state law. The health care providers filed answers and asserted a number of affirmative defenses, including the statute of limitations.

Motion for Partial Summary Judgment on Indemnity and Contribution Claims

The health care providers filed motions for summary judgment dismissal of the federal maritime and state law claims for indemnity and contribution. The health care providers argued RCCL could not meet the test under Grubart to invoke admiralty tort jurisdiction and the undisputed evidence did not establish breach of an implied maritime contract. The health care providers argued the court should dismiss the...

To continue reading

Request your trial

VLEX uses login cookies to provide you with a better browsing experience. If you click on 'Accept' or continue browsing this site we consider that you accept our cookie policy. ACCEPT