Leon v. Hosp. Metropolitano

Case 3:05-cv-01887-RLA Document 111 Filed 02/06/2007 Page 1 of 12(cid:10)

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF PUERTO RICO

WALESKA LEON, et al.,
Plaintiffs,
v.
HOSPITAL METROPOLITANO, et al.,
Defendants.

CIVIL NO. 05-1887 (RLA)

ORDER IN THE MATTER OF OUTSTANDING MOTIONS
This action was instituted by the relatives of Migdalia Heyward
Leon claiming that defendants are liable for her death pursuant to
the provisions of the Emergency Treatment and Active Labor Act
(EMTALA), 42 U.S.C. § 1395dd, as well as for malpractice under art.
1802 of the Puerto Rico Civil Code, P.R. Laws Ann. tit. 31, § 5141
(1990).
Named defendants are: Metrohealth, Inc. d/b/a Hospital
Metropolitano, Dr. Luis Correa Ponce, the P.R. Health Department, Dr.
Jose Rossello, Dr. Julio Rivera d/b/a PESI, and Sindicato de
Aseguradores para la Suscripcion Conjunta de Seguro de
Responsabilidad Medico Hospitalaria (“SIMED”).
Defendants have filed various motions seeking to dismiss the
outstanding claims asserted against them which plaintiffs have
opposed. The court having reviewed the arguments submitted by the
parties as well as the documents in the record hereby disposes of the
motions as follows.

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RULE 12(b)(6)
In disposing of motions to dismiss pursuant to Rule 12(b)(6)
Fed. R. Civ. P. the court will accept all factual allegations as true
and will make all reasonable inferences in plaintiff’s favor.
Frazier v. Fairhaven School Com., 276 F.3d 52, 56 (1 Cir. 2002);
st
Alternative Energy, Inc. v. St. Paul Fire and Marine Ins. Co., 267
F.3d 30, 33 (1 Cir. 2001); Berezin v. Regency Sav. Bank, 234 F.3d
st
68, 70 (1 Cir. 2000); Tompkins v. United Healthcare of New England,
st
Inc., 203 F.3d 90, 92 (1 Cir. 2000).
st
Our scope of review under this provision is a narrow one.
Dismissal will only be granted if after having taken all well-pleaded
allegations in the complaint as true, the Court finds that plaintiff
is not entitled to relief under any theory. Brown v. Hot, Sexy and
Safer Prods., Inc., 68 F.3d 525, 530 (1st Cir. 1995) cert. den. 116
S.Ct. 1044 (1996); Vartanian v. Monsanto Co., 14 F.3d 697, 700 (1st
Cir. 1994). Further, our role is to examine the complaint to
determine whether plaintiff has adduced sufficient facts to state a
cognizable cause of action. Alternative Energy, 267 F.3d at 36. The
complaint will be dismissed if the court finds that under the facts
as pleaded plaintiff may not prevail on any possible theory.
Berezin, 234 F.3d at 70; Tompkins, 203 F.3d at 93.
FACTUAL BACKGROUND
According to the Third Amended Complaint (docket No. 80), on
August 15, 2004, at approximately 8:30 a.m. fourteen-year old

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Migdalia Heyward Leon was taken by her mother to the Hospital
Metropolitano’s Emergency Room complaining of difficulty breathing,
severe pain in the lower abdominal region, nausea and fever.1
At approximately 7:00 p.m. that same day decedent was
transferred to Hospital Ruiz Arnau, owned and operated by the
Commonwealth of Puerto Rico.2
P.R. HEALTH DEPARTMENT
At the Initial Scheduling Conference plaintiff “clarified for
the record that [the] complaint did not assert any claims under
EMTALA against the RUIZ ARNAU HOSPITAL.” Thus, only the tort claim
3
remains outstanding in these proceedings for any liability arising
from decedent’s treatment at that facility.
According to the complaint, the Hospital Ruiz Arnau is owned by
the Commonwealth of Puerto Rico and operated by the Puerto Rico
Health Department.4
The Eleventh Amendment to the United States Constitution bars
the commencement and prosecution in federal court of suits claiming
damages brought against any state, including Puerto Rico, without its
consent. Toledo v. Sanchez, 454 F.3d 24 (1 Cir. 2006); Fresenius
st

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2

Third Amended Complaint (docket No. 80) ¶¶ 11-12.
Id. ¶ 17.
Minutes and Order of Initial Scheduling Conference held on
3
November 13, 2006 (docket No. 100).
Third Amended Complaint (docket No. 80) ¶ 6.
4

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Med. Care Cardiovascular Res., Inc. v. Puerto Rico and Caribbean
Cardiovascular Ctr. Corp., 322 F.3d 56, 61 (1 Cir. 2003); Futura
st
Dev. v. Estado Libre Asociado, 144 F.3d 7, 12-13 (1 Cir. 1998); In
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re San Juan Dupont Plaza Hotel Fire Lit., 888 F.2d 940, 942 (1 Cir.
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1989); Ramírez v. P.R. Fire Serv., 715 F.2d 694, 697 (1 Cir. 1983).
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Eleventh Amendment immunity applies even though the state has
not been named in the suit. Its protection is extended to
governmental entities which are deemed an arm or alter ego of the
state. Royal Caribbean Corp. v. Puerto Rico Ports Auth., 973 F.2d 8,
9-10 (1 Cir. 1992); In re San Juan Dupont Plaza Hotel Fire Lit., 888
st
F.2d at 943-44. In this regard, the Puerto Rico Health Department has
been found to be entitled to Eleventh Amendment immunity. See,
Arecibo Cmty. Health Care, Inc. v. Commonwealth of P.R., 270 F.3d 17
(1 Cir. 2001).
st
Based on the foregoing, we find that the negligence claims
asserted against the Puerto Rico Health Department based on the acts
or omissions of the Hospital Ruiz Arnau personnel are entitled to
Eleventh Amendment immunity and cannot be tried in this forum.5
EMTALA – INDIVIDUAL PHYSICIANS AND PESI
According to the complaint, decedent was treated by codefendant
Dr. Luis Correa Ponce during her stay at the Emergency Room of the

Given our ruling, plaintiffs’ Motion to Amend Complaint
5
(docket No. 106) is DENIED AS MOOT inasmuch as the new allegations
pertain to “an epidemic that developed while deceased minor… was
hospitalized at the Ruiz Arnau Hospital.”

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Hospital Metropolitano. Plaintiffs further allege that at all
relevant times Drs. Rossello and Rivera, d/b/a PESI, had a contract
with Hospital Metropolitano to provide Emergency Room services. 6
EMTALA was enacted in 1986 in response to an increasing practice
of hospital emergency rooms of rejecting patients with emergency
conditions because they had no medical insurance. “[I]t is clear that
Congress manifested an intent that all patients be treated fairly
when they arrive in the emergency department of a participating
hospital and that all patients who need some treatment will get a
first response at minimum and will not simply be turned away.”
Reynolds, 218 F.3d 78, 83 (1 Cir. 2000). See also, Roubert-Colon
st
v. Hosp. Dr. Pila, 330 F.Supp.2d 38, 42 (D.P.R. 2004). It is
axiomatic that EMTALA was enacted specifically to avoid “dumping” of
patients lacking medical insurance and that it should not be regarded
as a federal medical malpractice statute. Reynolds, 218 F.3d at 83.
See also, Guadalupe v. Negron Agosto, 299 F.3d 15, 21 (1 Cir. 2002)
st
(statute does not create a medical malpractice claim).
EMTALA imposes upon a hospital’s emergency services the duty to
initially screen patients to ascertain whether an emergency medical

Codefendants Drs. Rossello and Rivera disclaim that they
6
provided services to the Hospital as a d/b/a but rather that “PESI is
a medical corporation dedicated to the administration and management
of pediatric emergency rooms”. Motion to Dismiss (docket No. 66)
¶ 20. However, inasmuch as no extrinsic evidence has been submitted
in support thereof we are constrained to the allegations of the
complaint pursuant to the provisions of Rule 12(b)(6).

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condition exists and if so, to provide the necessary medical
7
examination and treatment as well as to stabilize the patient prior
to his discharge or transfer. Lopez-Soto v. Hawayek, 175 F.3d 170,
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175 (1 Cir. 1999); Correa v. Hosp. San Francisco, 69 F.3d 1184, 1190
st
(1 Cir. 1995). No improper motive is required to be proved by
st
plaintiff in order to prevail. Roberts v. Galen of Va., Inc., 525
U.S. 249, 119 S.Ct. 685, 142 L.Ed.2d 648 (1999).
It has been consistently held that EMTALA does not provide a
viable claim against individual physicians. Millan v. Hosp. San
Pablo, 389 F.Supp.2d 224, 235 (D.P.R. 2005); Alvarez Torres v. Ryder
Mem’l Hosp., Inc., 308 F.Supp.2d 38, 40 (D.P.R. 2003). See also,
Lebron v. Ashford Presbyterian Cmty. Hosp., 995 F.Supp. 241 (D.P.R.
1998) (summarizing cases). Hence, the EMTALA claim against Dr.
Correa is DISMISSED.
We further find that, even taking plaintiffs’ allegations as
correct, no EMTALA cause of action lies against Drs. Rossello and
Rivera d/b/a as PESI.
EMTALA imposes the duty to screen, stabilize and transfer
requirements upon hospitals. Additionally, its enforcement provision
9
applies to “participating hospital[s]” which the statute defines as
10

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42 U.S.C. § 1395dd(a).
42 U.S.C. § 1395dd(b).
42 U.S.C. § 1395dd(a) and (b).
42 U.S.C. § 1395dd(d).
10

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CIVIL NO. 05-1887 (RLA)

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“a hospital that has entered into a [Medicare] provider agreement.”11
As pointed out by the Court of Appeals in Rodriguez v. Am. Int’l Ins.
Co. of P.R., 402 F.3d 45 (1 Cir. 2005), “[i]t is clear that EMTALA
st
does not apply to all health care facilities; it applies only to
participating hospitals with emergency departments.” 402 F.3d at 48
(emphasis ours). See also, Feliciano Rivera v. Med. & Geriatric
Admin. Serv., Inc., 254 F.Supp. 237 (“Not being a hospital, the CDT
cannot have ‘a hospital emergency department’ as required and
described in § 1395dd(a).”)
Accordingly, the EMTALA claims asserted against Drs. Rossello
and Rivera d/b/a as PESI are DISMISSED. 12
HOSPITAL METROPOLITANO
Hospital Metropolitano joined the request for dismissal of Drs.
Rossello and Rivera essentially arguing that the treatment afforded
decedent did not violate the EMTALA provisions.
Even though defendant labeled its petition as a motion to
dismiss, the inclusion of documents outside the pleadings by both
parties converted it into a summary judgment vehicle pursuant to the
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42 U.S.C. § 1395dd(e).
Even though the EMTALA claims have been dismissed against
12
these parties, the damages claims asserted against them under art.
1802 subsist under our supplemental jurisdiction. See, Millan, 389
F.Supp.2d at 237; Alvarez Torres, 308 F.Supp.2d at 42.
Defendants attached a Certificate of the working relationship
13
between the Hospital Metropolitano and PESI as well as copy of
decedent’s medical record with said institution. Plaintiffs filed a
copy of the report of Dr. Norma Villanueva, their expert witness, as

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provisions of Rule 12(b) Fed. R. Civ. P. Santiago v. Canon U.S.A.,
Inc., 138 F.3d 1, 4-5 (1 Cir. 1998); Rodriguez v. Fullerton Tires
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Corp., 115 F.3d 81, 83 (1 Cir. 1997); Vega-Rodriguez v. Puerto Rico
st
Telephone Co., 110 F.3d 174, 177-78 (1 Cir. 1997).
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Rule 56(c) Fed. R. Civ. P., which sets forth the standard for
ruling on summary judgment motions, in pertinent part provides that
they shall be granted “if the pleadings, depositions, answers to
interrogatories, and admissions on file, together with the
affidavits, if any, show that there is no genuine issue as to any
material fact and that the moving party is entitled to a judgment as
a matter of law.” Sands v. Ridefilm Corp., 212 F.3d 657, 660-61 (1st
Cir. 2000); Barreto-Rivera v. Medina-Vargas, 168 F.3d 42, 45 (1 Cir.
st
1999). The party seeking summary judgment must first demonstrate the
absence of a genuine issue of material fact in the record.
DeNovellis v. Shalala, 124 F.3d 298, 306 (1 Cir. 1997). A genuine
st
issue exists if there is sufficient evidence supporting the claimed
factual disputes to require a trial. Morris v. Gov’t Dev. Bank of
Puerto Rico, 27 F.3d 746, 748 (1 Cir. 1994); LeBlanc v. Great Am.
st
Ins. Co., 6 F.3d 836, 841 (1 Cir. 1993), cert. denied, 511 U.S.
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1018, 114 S.Ct. 1398, 128 L.Ed.2d 72 (1994). A fact is material if
it might affect the outcome of a lawsuit under the governing law.

well as the autopsy report. See, Motion to File Medical Reports
(docket No. 93).

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Morrissey v. Boston Five Cents Sav. Bank, 54 F. 3d 27, 31 (1 Cir.
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1995).
In cases where the non-movant party bears the ultimate burden of
proof, he must present definite and competent evidence to rebut a
motion for summary judgment, Anderson v. Liberty Lobby, Inc., 477
U.S. 242, 256-257, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986); Navarro v.
Pfizer Corp., 261 F.3d 90, 94 (1 Cir. 2000); Grant’s Dairy v. Comm’r
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of Maine Dep’t of Agric., 232 F.3d 8, 14 (1 Cir. 2000), and cannot
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rely upon “conclusory allegations, improbable inferences, and
unsupported speculation”. Lopez v. Rubianes, 230 F.3d 409, 412 (1st
Cir. 2000); Maldonado-Denis v. Castillo-Rodríguez, 23 F.3d 576, 581
(1 Cir. 1994); Medina-Muñoz v. R.J. Reynolds Tobacco Co., 896 F.2d
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5, 8 (1 Cir. 1990).
st
The court having reviewed the evidence on file, particularly the
opinion of Dr. Villanueva, finds that issues of material fact
preclude summary judgment at this time regarding the breach of
EMTALA’s duties at the Hospital’s Emergency Room. Plaintiffs’ expert
witness specifically challenged the Hospital’s position on this
matter. Hence, summary judgment is not available on this particular
controversy.

DIVERSITY JURISDICTION
Federal courts are courts of limited jurisdiction and hence,
have the duty to examine their own authority to preside over the
cases assigned. “It is black-letter law that a federal court has an

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obligation to inquire sua sponte into its own subject matter
jurisdiction.” McCulloch v. Velez, 364 F.3d 1, 5 (1 Cir. 2004). See
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also, Bonas v. Town of North Smithfield, 265 F.3d 69, 73 (1 Cir.
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2001) (“Federal courts, being courts of limited jurisdiction, have an
affirmative obligation to examine jurisdictional concerns on their
own initiative.”)
Further, subject matter jurisdiction is not waivable or
forfeited. Rather, because it involves a court’s power to hear a
case, it may be raised at any time. Kontrick v. Ryan, 540 U.S. 443,
124 S.Ct. 906, 157 L.Ed.2d 867 (2004); United States v. Cotton, 535
U.S. 625, 122 S.Ct. 1781, 152 L.Ed.2d 860 (2002). “The objection that
a federal court lacks subject-matter jurisdiction… may be raised by
a party, or by a court on its own initiative, at any stage in the
litigation, even after trial and the entry of judgment.” Arbaugh v.
Y&H Corp., ___ U.S. ___, 126 S.Ct. 1235, 1240, 163 L.Ed.2d 1097
(2006).
Pursuant to 28 U.S.C. § 1332(a)(1), federal courts have
jurisdiction over claims between “citizens of different states” so
long as the amount in dispute exceeds $75,000.00. The statute
requires complete diversity between the plaintiffs and the
defendants. Id. at 139. In other words, the plaintiffs and the
defendants must be citizens of different states. “[D]iversity
jurisdiction does not exist unless each defendant is a citizen of a
different State from each plaintiff… diversity jurisdiction is not

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to be available when any plaintiff is a citizen of the same State as
any defendant.” Owen Equip. & Erection Co. v. Kroger, 437 U.S. 365,
373-74, 98 S.Ct. 2396, 57 L.Ed.2d 274 (1978) (italics in original).
The complaint asserts § 1332 as alternative jurisdictional
grounds. Specifically, it is alleged that Iris Pacheco, decedent’s
grandmother, resides in New York. Plaintiffs having failed to
14
identify the domicile of the remaining plaintiffs, the court must
assume that they are Puerto Rico residents. It appearing that
defendants are also citizens of Puerto Rico for purposes of the
statute, diversity is destroyed.
Accordingly, plaintiff Iris Pacheco may not assert diversity
jurisdiction in this case.

CONCLUSION
The Motion to Dismiss Second and Third Amended Complaints filed
by the P.R. Health Department (docket No. 75) is GRANTED and the
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claims asserted against it in these proceedings are hereby DISMISSED
WITHOUT PREJUDICE.

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Third Amended Complaint (docket No. 80) ¶ 5.
See, Plaintiffs’ Opposition (docket No. 77). See also, Motion
15
to Dismiss (docket No. 29); Plaintiffs’ Opposition (docket No. 30)
and Reply (docket No. 37).

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The Motion to Dismiss filed by Dr. Jose Rossello and Dr. Julio
Rivera (docket No. 66) is GRANTED but limited to the dismissal of
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the EMTALA claims asserted against them and PESI.
The Motion to Join (docket No. 103) filed by Dr. Luis Correa
Ponce is GRANTED and the EMTALA claims asserted against him are
DISMISSED.
Judgment shall be entered accordingly.
The Hospital Metropolitano’s Motion to Dismiss (docket No. 96)17
is DENIED.
IT IS SO ORDERED.
San Juan, Puerto Rico, this 6 day of February, 2007.
th

S/Raymond L. Acosta
RAYMOND L. ACOSTA
United States District JUDGE

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17

See, Plaintiffs’ Opposition (docket No. 69).
See, Plaintiffs’ Opposition (docket No. 98).

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