YOMAYRA DELGADO-CARABALLO; JUAN RAMÓN DELGADO-CARABALLO; B.O.G.D., minor; M.G.D., minor, Plaintiffs, Appellants,
HOSPITAL PAVIA HATO REY, INC., d/b/a Hospital Pavía Hato Rey; APS HEALTHCARE PUERTO RICO, INC.; MARJORIE ACOSTA-GUILLOT; NILSA LÓPEZ, Defendants, Appellees.
FROM THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF
PUERTO RICO Hon. Daniel R. Domínguez, U.S. District
Infante Castellanos, with whom Hatuey Infante Law Offices,
P.S.C., and Wilbert Méndez Marrero were on brief, for
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.
Anduze Montaño, with whom José A. Morales
Boscio was on brief, for appellee APS Healthcare of Puerto
J. Vilella-Janeiro and Vilella-Janeiro Attorneys &
Counselors at law for appellee Nilsa Lopéz.
Howard, Chief Judge, Thompson, and Barron, Circuit Judges.
THOMPSON, Circuit Judge.
write today to undo errors made by the district judge in
granting defendants summary judgment in this case.
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." 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.
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). 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.
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.
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. 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. 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).
discovery, the district judge granted defendants summary
judgment. The key parts of the judge's ruling are easily
things off, the judge called the EMTALA claim a
"survivorship EMTALA action." 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)).
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. 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." 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.
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.
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
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).
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. ...