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Delgado-Caraballo v. Hospital Pavia Hato Rey, Inc.

United States Court of Appeals, First Circuit

May 7, 2018



          Hatuey Infante Castellanos, with whom Hatuey Infante Law Offices, P.S.C., and Wilbert Méndez Marrero were on brief, for appellants.

          Gloria M. De Corral, with whom De Corral & De Mier was on brief, for appellee Hospital Pavía Hato Rey, Inc., d/b/a Hospital Pavía Hato Rey.

          Harry Anduze Montaño, with whom José A. Morales Boscio was on brief, for appellee APS Healthcare of Puerto Rico, Inc.

          Juan J. Vilella-Janeiro and Vilella-Janeiro Attorneys & Counselors at law for appellee Nilsa Lopéz.

          Before Howard, Chief Judge, Thompson, and Barron, Circuit Judges.

          THOMPSON, Circuit Judge.

         We write today to undo errors made by the district judge in granting defendants summary judgment in this case.



         Juan and Yomayra Delgado-Caraballo, brother and sister, have been through quite a lot. So have Yomayra's minor children, referred to pseudonymously as "B.O.G.D." and "M.G.D."[2] At least that is what the record before us reveals when visualized in the light most favorable to them, as we must. Just consider the following.

         Back on October 1, 2012, Juan and Yomayra had to rush their mother, Natividad Caraballo-Caraballo, to the psychiatric stabilization unit at Hospital Pavía Hato Rey ("Hospital Pavía") after Juan found her in a nervous state (the hospital's cumbersome official name is listed in the caption).[3] Natividad - who had tried to kill herself sometime the year before - was not taking meds her psychiatrist had prescribed. A triage nurse at Hospital Pavía described Natividad as "alert" but "anxious" and "disoriented." Performing a medical-screening exam, Dr. Marjorie Acosta-Guillot noted that Natividad's psychiatric history included a "suicide attempt 1 year ago" and that she had "poor compliance or commitment to treatment, exacerbations of depressive symptoms which included anxiety, isolation." Natividad's language and psychomotor skills were somewhat diminished, Dr. Acosta-Guillot added. Ultimately, Dr. Acosta-Guillot diagnosed her with "major depression, " though the doctor said she showed good hygiene, demonstrated logical thought processes, and exhibited no suicidal or homicidal inclinations. Convinced that Natividad did not meet the criteria for admission to the stabilization unit, Dr. Acosta-Guillot discharged her with instructions that she take her meds and attend an appointment at an outpatient clinic with APS Healthcare of Puerto Rico ("APS") scheduled for October 3.

         On the day of her appointment, Natividad's mother-in-law - someone she was close to - died of cancer and diabetes. Natividad still went to APS, accompanied by Yomayra. Dr. Nilsa López evaluated her there, asked her to continue taking her meds, and scheduled some follow-up appointments. Sadly, Natividad committed suicide the very next day, October 4. She was 52 years old.


         Nearly two years later, on September 30, 2014, Juan and Yomayra sued Hospital Pavía, APS, Dr. Acosta-Guillot, and Dr. López in federal court. Yomayra sued on her own behalf and on behalf of her minor children, B.O.G.D. and M.G.D. They alleged that Hospital Pavía and APS had violated the Emergency Medical Treatment and Active Labor Act ("EMTALA"), see 42 U.S.C. § 1395dd, by failing to give Natividad an appropriate screening exam, stabilize her, or transfer her if she could not be stabilized.[4] And they claimed that each defendant had committed medical malpractice in violation of Puerto Rico law. See P.R. Laws Ann. tit. 31, §§ 5141-42.[5] They premised the court's jurisdiction on statutes creating federal- question jurisdiction, see 28 U.S.C. § 1331, diversity jurisdiction, see id. § 1332, and supplemental jurisdiction, see id. § 1367(a).

         Challenged Ruling

         After discovery, the district judge granted defendants summary judgment. The key parts of the judge's ruling are easily summarized.

         Kicking things off, the judge called the EMTALA claim a "survivorship EMTALA action."[6] See Caraballo v. Hosp. Pavía Hato Rey, Inc., Civil No. 14-1738 (DRD), 2017 WL 1247872, at *2 (D.P.R. Mar. 31, 2017). And he reasoned that because the EMTALA "'applies only to participating hospitals with emergency departments'" and because "[p]laintiffs concede[] that 'APS . . . is not a hospital and not subject to the EMTALA provisions, '" he had to jettison the EMTALA claim against APS with prejudice. See id. at *4-5 (emphases removed) (quoting Rodríguez v. Am. Int'l Ins. Co. of P.R., 402 F.3d 45, 48 (1st Cir. 2005)).

         As for the EMTALA claim against Hospital Pavía, the judge recognized (at least implicitly) that the EMTALA tells courts to look to state law - defined to include Puerto Rico - regarding the availability of damages. See 42 U.S.C. §§ 410(h), 1395dd(d)(2)(A). Next, the judge read Puerto Rico law as holding that "for an estate to be able to . . . substitute a deceased plaintiff, all members of the estate must be brought to the suit." See Caraballo, 2017 WL 1247872, at *6 (quoting Vilanova v. Vilanova, 184 P.R. Dec. 824, 839-40 (2012)). Natividad's estate, the judge then wrote, includes not only Juan and Yomayra but also "Vanessa Delgado Caraballo[] and widower Juan Delgado Gonzalez." See id. at *5. So the judge considered the latter two "necessary part[ies]" under Fed.R.Civ.P. 19(a), saying, for example, that he thought "the absent heirs['] interest might be affected or prejudiced by the decision" on the EMTALA-survivorship claim against Hospital Pavía.[7] See Caraballo, 2017 WL 1247872, at *5-6 (internal quotation marks omitted). Sort of echoing the words of Fed.R.Civ.P. 19(b), the judge suggested - without any explanation or analysis - that the missing heirs could not "be feasibly joined."[8] See Caraballo, 2017 WL 1247872, at *6 (internal quotation marks omitted). And he then concluded that the action could not in "'equity and good conscience'" proceed without them, principally because "[i]f the survivorship claim is dismissed with prejudice, the absent heirs would not be able to bring their own federal claim representing the estate against the same particular defendant." Id. at *6-7. Which is why he dismissed the EMTALA-survivorship claim against Hospital Pavía without prejudice. Id. at *7.

         Emphasizing that diversity jurisdiction requires complete diversity of citizenship of each plaintiff from each defendant, the judge found that requirement not met here because Juan and Yomayra "are both from Puerto Rico, " just like the four defendants. Id. (relying on Gabriel v. Preble, 396 F.3d 10, 13 (1st Cir. 2005), which in turn relied on Strawbridge v. Curtiss, 7 U.S. (3 Cranch) 267, 267 (1806)). Having dismissed the federal-EMTALA claim and having concluded no diversity jurisdiction exists, the judge then declined to exercise supplemental jurisdiction over the local-law claims and dismissed them without prejudice as well. Id. at *8.

         Plaintiffs later asked the judge to reconsider his decision to dismiss their EMTALA-survivorship claim against Hospital Pavía. But the judge would not budge. And this appeal followed.[9]

         Federal-EMTALA Claim

         Standard of Review

         Our analysis necessarily starts with the standard of review, which is a little tricky because the judge partly relied on Rule 19 in granting defendants summary judgment. We typically review Rule-19 decisions for abuse of discretion, see Maldonado-Viñas v. Nat'l W. Life Ins. Co., 862 F.3d 118, 121 (1st Cir. 2017), knowing that an error of law is always an abuse of discretion, see Koon v. United States, 518 U.S. 81, 100 (1996); see also United States ex rel. D'Agostino v. Ev3, Inc., 802 F.3d 188, 192 (1st Cir. 2015) (stressing that a judge abuses his discretion if he "adopts and applies the wrong legal rule"). And we normally review summary-judgment decisions with fresh eyes ("de novo, " in law-speak), see Rivera-Corraliza, 794 F.3d at 214, asking whether the summary-judgment winners (here, defendants) are "entitled to judgment as a matter of law" because "there is no genuine dispute as to any material fact, " see Fed.R.Civ.P. 56(a) - even after taking all facts and inferences in the light most flattering to the summary-judgment losers (here, plaintiffs), see Rivera-Corraliza, 794 F.3d at 210, 214. In the present case, these standards come together like this: if the judge abused his discretion by making an error of law in his Rule-19 analysis, and if that error sabotaged his summary-judgment ruling, then we must vacate that ruling - if not, then we must affirm. See generally United States v. San Juan Bay Marina, 239 F.3d 400, 403, 405-08 (1st Cir. 2001) (reviewing a summary-judgment ruling driven in part by a Rule-19(b) analysis).

         Plaintiffs' Take[10]

         Plaintiffs do not contest the judge's dismissal of the EMTALA claim against APS. They challenge only his dismissal of the EMTALA claim against Hospital Pavía. ...

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