982 F.3d 846
1st Cir.2020Background
- On June 29, 2012 Dr. Richard Nadal performed an abdominoplasty on Gretchen Laureano; the signed consent form warned of scarring.
- Laureano alleges the resulting scar resembled a second belly button and that Nadal agreed to a cosmetic revision, but she refused to sign Nadal’s required preoperative consent for the revision.
- Laureano sued Nadal in Puerto Rico (case dismissed without prejudice) and then filed in federal court under diversity in 2015, consenting to magistrate-judge jurisdiction.
- She asserted multiple Puerto Rico-law claims; this appeal focuses on lack of informed consent and patient abandonment (later framed as conditioning corrective surgery on signing an unacceptable consent form).
- Laureano proffered a consultation report from Dr. David Leitner; the magistrate excluded Leitner’s testimony under Daubert and Rule 702 as unreliable.
- The magistrate granted summary judgment for Nadal because Laureano produced no expert testimony showing breach or causation (required under Puerto Rico law) and denied reconsideration; the First Circuit affirmed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether informed-consent claim required expert testimony under Puerto Rico law | Laureano: no expert needed; relied on cases and a patient-centered disclosure standard (raised partly at reconsideration) | Nadal: Puerto Rico law requires expert testimony to establish the prevailing medical practice and causation | Held: Expert testimony required; Laureano failed to present admissible expert proof; summary judgment affirmed |
| Whether patient-abandonment claim required expert testimony | Laureano: abandonment claim did not need expert proof (and relied on PR regulation arguments) | Nadal: same general malpractice rules apply; expert testimony needed to show standard of care and causation | Held: Expert testimony required; summary judgment affirmed |
| Whether magistrate abused discretion in denying reconsideration | Laureano: raised Regulation No. 7617 and other arguments on reconsideration | Nadal: arguments were forfeited because not timely raised below | Held: Denial of reconsideration affirmed (arguments forfeited / no abuse of discretion) |
Key Cases Cited
- Pagés-Ramírez v. Ramírez-González, 605 F.3d 109 (1st Cir.) (generally requires expert testimony to establish standard of care and causation in PR malpractice cases)
- Sepúlveda de Arrieta v. Barreto, 137 D.P.R. 735 (P.R. 1994) (Puerto Rico Supreme Court: physician-centered standard for disclosure; expert proof required what a reasonable physician would divulge)
- Cruz Avilés v. Bella Vista Hosp., Inc., 112 F. Supp. 2d 200 (D.P.R. 2000) (discussed informed-consent claims under Puerto Rico law but did not displace Sepúlveda’s expert requirement)
- Canterbury v. Spence, 464 F.2d 772 (D.C. Cir. 1972) (patient-centered disclosure standard cited by Laureano but rejected for construing Puerto Rico law)
- Rolon–Alvarado v. Municipality of San Juan, 1 F.3d 74 (1st Cir. 1993) (choice-of-law authority used to apply Puerto Rico law)
- Best Auto Repair Shop, Inc. v. Universal Ins. Grp., 875 F.3d 733 (1st Cir. 2017) (standards for motions for reconsideration and when they target substantive issues)
- Crispin-Taveras v. Municipality of Carolina, 647 F.3d 1 (1st Cir. 2011) (forfeiture/plain-error review when arguments were untimely raised)