Torres Vargas v. Santiago Cummings

• Citation: 149 F.3d 29
• Decision Date: 05 May 1998
• Docket Number: No. 97-2389,97-2389
• Parties: Ines TORRES VARGAS, et al., Plaintiffs, Appellants, v. Dr. Manuel SANTIAGO CUMMINGS, et al., Defendants, Appellees. . Heard
• Court: United States Courts of Appeals. United States Court of Appeals (1st Circuit)

Page 29

149 F.3d 29

Ines TORRES VARGAS, et al., Plaintiffs, Appellants, v. Dr. Manuel SANTIAGO CUMMINGS, et al., Defendants, Appellees.

No. 97-2389.

United States Court of Appeals, First Circuit.

Heard May 5, 1998.

Decided July 10, 1998.

Raul S. Mariani Franco, with whom Harry Anduze Montano was on brief, for appellants.

Jose Hector Vivas, with whom Rita M. Velez Gonzalez and Vivas & Vivas were on brief, for appellees.

Before SELYA, Circuit Judge, COFFIN and BOWNES, Senior Circuit Judges.

SELYA, Circuit Judge.

Plaintiffs-appellants Ines Torres Vargas, Evelyn Torres Vargas, and Raul Torres Vargas are the adult children of Raul Torres Arroyo. After their father died, they brought suit for medical malpractice against Dr. Manuel Santiago Cummings (Santiago). The district court granted summary judgment for Santiago on the ground that he was an employee of the Commonwealth of Puerto Rico and, as such, was entitled to immunity under Puerto Rico law. The plaintiffs now seek to set aside that decision, claiming that Santiago was an independent contractor (not covered by the immunity provision), or, at least, that discovery should have been allowed before the court ruled. We vacate the summary judgment order.

I. BACKGROUND

We rehearse the material facts, stating them in the light most favorable to the parties opposing summary judgment, see Garside v. Osco Drug, Inc., 895 F.2d, 46, 48 (1st Cir.1990), and then recount the travel of the case.

A. The Facts.

In 1990, the Puerto Rico Department of Health (the Department) hired Santiago, an anesthesiologist, to render services at Ponce Regional Hospital (the Hospital), a government-owned facility primarily serving indigent patients. The parties' written agreement (the Contract) covered a one-year term commencing on July 1, 1990. It obligated Santiago to work in the Hospital's operating rooms from 7:00 a.m. until 3:00 p.m., Monday through Friday, and to remain "on call" every third weekend. It also required him to complete medical records for assigned patients, submit reports to the Department when requested, and obtain malpractice insurance at his own expense. In return, the Department agreed to pay Santiago a stipend of $10,000 per month, without any withholdings, and also agreed that he could keep any additional fees that he might collect for services rendered to solvent patients (e.g., those who were covered by Medicare or private insurance). The Contract stated explicitly that Santiago would not be entitled to vacation, sick leave, or other fringe benefits.

On February 26, 1991, the Hospital admitted the plaintiffs' decedent, Raul Torres Arroyo (an uninsured person), with complaints of severe throat pain. Dr. Pedro Vendrell, a surgeon, scheduled a laryngoscopy and throat biopsy for the next day. The procedure went badly: Santiago experienced difficulty in intubating Torres Arroyo and a tracheotomy was required. Post-operatively, the tracheotomy tube became dislodged and left the patient without a sufficient airway. As a result, he suffered respiratory arrest, heart failure, and brain damage. Within a week, he died. Torres Arroyo's children blamed a number of care providers, including Santiago, for his demise.

B. Travel of the Case.

After unsuccessfully endeavoring to serve Santiago in the Puerto Rico courts, the plaintiffs voluntarily dismissed all earlier actions against him and brought suit in federal district court. See 28 U.S.C. § 1332(a) (1994) (diversity jurisdiction). Santiago answered the federal complaint on September 4, 1996, and two weeks later moved for summary judgment, citing the immunity for government-employed physicians conferred by the Puerto Rico Medico-Hospital Professional Liability Insurance Act (the MHPLIA), P.R. Laws Ann. tit. 26, § 4105 (1997). In their opposition, the plaintiffs countered that the Contract established an independent contractor relationship between Santiago and the Commonwealth, or, alternatively, that his employment status was a question of fact for trial. In addition, they bemoaned the lack of "meaningful discovery," advocated an adjudicative delay, and proclaimed their intention to "supplement the instant request with a [Fed.R.Civ.P.] 56(f) affidavit ... within the next five (5) days." Almost a year elapsed, but the plaintiffs never filed either a Rule 56(f) motion or an affidavit explaining the need for discovery.

On October 15, 1997, the district court granted Santiago's summary judgment motion. This appeal ensued.

II. DISCUSSION

We begin, and end, with the plaintiffs' primary contention: that, contrary to the lower court's viewpoint, the Contract does not compel the conclusion that the defendant was an employee of the Commonwealth within the meaning of the immunity statute. We divide our analysis into three segments, first describing the MHPLIA, then discussing other legal principles of potential relevance to our inquiry, and finally, addressing the nub of the appellants' asseveration. Because the district court terminated the suit at the summary judgment stage, our review is plenary. See Garside, 895 F.2d at 48.

A. The MHPLIA.

The MHPLIA provides:

No health service professional may be included as a defendant in a civil suit for damages due to malpractice caused in the performance of his profession while said health service professional acts in compliance with his/her duties and functions as an employee of the Commonwealth of Puerto Rico, its dependencies, instrumentalities and municipalities.

P.R. Laws Ann. tit. 26, § 4105. The Puerto Rico Supreme Court has construed the MHPLIA as containing three fundamental requirements for immunity:

(1) [the person who furnishes the service] must be a health care professional; (2) the harm caused by his malpractice must have taken place in the practice of his profession; and, (3) he must have acted in compliance with his duties and functions as an employee of the Commonwealth of Puerto Rico, its agencies, instrumentalities, and municipalities.

Flores Roman v. Ramos Gonzalez, 90 J.T.S. 132 (P.R.1990) (official translation, slip op. at 3-4).

The third requirement--that an immunity-seeking health care provider must be an employee of the Commonwealth--often presents the crucial area of inquiry. See id. at 5. So it is here: Santiago is a licensed physician and the plaintiffs' complaint alleges that he committed malpractice whilst practicing his profession. Thus, the critical question relates to his employment status.

One seemingly reasonable way of answering this question would be simply to segregate full-time government physicians from part-timers, designating the former "employees" and the later "independent contractors." This solution cannot be countenanced, however, for the MHPLIA has been interpreted authoritatively to protect not only physicians who hold full-time career positions with agencies of the Commonwealth, but also physicians who, though engaged in private practice, function part-time as government employees and who, while acting in that capacity, commit alleged malpractice. See Lind Rodriguez v. E.L.A., 12 P.R. Offic. Trans. 85, 87, 112 P.R. Dec. 67, 68, 1982 WL 210674 (1982).

In search of a principled approach to determining which physicians are entitled to protection under section 4105, we previously parsed Puerto Rico precedents and gleaned the factors to be weighed in determining whether a physician is to be regarded as an independent contractor (and, thus, beyond the prophylaxis afforded by the statute). See Nieves v. University of Puerto Rico, 7 F.3d 270 (1st Cir.1993). It was indicative of independent contractor status, we wrote, if the physician

(1) earned compensation on a per-patient basis, rather than a flat salary;

(2) received no fringe benefits of a type given to the principal's employees (e.g., vacation or sick leave, pension benefits, tax withholding);

(3) personally owned, invested in, or paid for the medical equipment and supplies used to treat patients, or the facilities which formed the situs of that treatment, or personally hired and supervised her own administrative or subsidiary medical personnel;

(4) held and paid for her own medical malpractice insurance policy; or

(5) exercised final judgment as to the appropriate medical treatment to render to patients.

Id. at 279. By contrast, it would be indicative of employee status if a health care provider (1) received a flat salary regardless of the number of patients seen or procedures performed, (2) received vacation time, sick leave, and other customary fringe benefits, (3) used only the government's facilities, equipment, supplies, and personnel in rendering services, (4) received protection against malpractice suits at the employer's expense, and (5) enjoyed relatively little autonomy in practice management. See, e.g., Rivera v. Hospital Universitario, 762 F.Supp. 15, 17-18 (D.P.R.1991).

Of course, these factors are merely signposts. They are not of equal import: in performing the necessary triage, the principal focus should be on "the level of control contractually reserved to the governmental entity over the physician's provision of patient services." Nieves, 7 F.3d at 279. Moreover, no single factor possesses talismanic significance. In the last analysis, a status determination in a particular case inevitably hinges on the totality of the circumstances. See id. Therefore, an inquiring court must examine each physician's contract and the surrounding circumstances to determine whether, according to the contract terms and other relevant evidence, the particular physician ranks as an employee of the government agency or other governmental instrumentality. See Flores Roman, slip op. at 5-6.

B. The Interpretive Framework.

We pause at this juncture to clarify a point of law. The parties in this case agree that the Contract plays a pivotal part in determining the existence vel non of section 4105 immunity. They disagree, however, about whether their dispute over its interpretation...