YOMAYRA DELGADO-CARABALLO; JUAN RAMON DELGADO-CARABALLO; B.O.G.D., minor; M.G.D., minor v. HOSPITAL PAVIA HATO REY, INC., d/b/a Hospital Pavia Hato Rey; APS HEALTHCARE PUERTO RICO, INC.; MARJORIE ACOSTA-GUILLOT; NILSA LOPEZ
No. 17-1654
United States Court of Appeals For the First Circuit
May 7, 2018
Before Howard, Chief Judge, Thompson, and Barron, Circuit Judges.
APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF PUERTO RICO
[Hon. Daniel R. Dominguez, U.S. District Judge]
Hatuey Infante Castellanos, with whom Hatuey Infante Law Offices, P.S.C., and Wilbert Mendez Marrero were on brief, for appellants.
Gloria M. De Corral, with whom De Corral & De Mier was on brief, for appellee Hospital Pavia Hato Rey, Inc., d/b/a Hospital Pavia Hato Rey.
Harry Anduze Montano, with whom Jose 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 Lopez.
Stage-Setting1
Parties
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
Back on October 1, 2012, Juan and Yomayra had to rush their mother, Natividad Caraballo-Caraballo, to the psychiatric stabilization unit at Hospital Pavia Hato Rey (“Hospital Pavia“) 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 Pavia 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 Lopez 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.
Lawsuit
Nearly two years later, on September 30, 2014, Juan and Yomayra sued Hospital Pavia, APS, Dr. Acosta-Guillot, and Dr. Lopez 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 Pavia and APS had violated the Emergency Medical Treatment and Active Labor Act (“EMTALA“), see
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. Pavia 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 Rodriguez v. Am. Int‘l Ins. Co. of P.R., 402 F.3d 45, 48 (1st Cir. 2005)).
As for the EMTALA claim against Hospital Pavia, 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
See Caraballo, 2017 WL 1247872, at *5-6 (internal quotation marks omitted). Sort of echoing
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 Pavia 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 Pavia. 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-Vinas 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
Plaintiffs’ Take10
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 Pavia. So naturally we confine our attention to that claim.
Importantly too, plaintiffs do not quarrel with the judge‘s conclusion that Puerto Rico law requires the “joinder of all heirs to a survivorship claim.” See Caraballo, 2017WL 1247872, at *5. And they essentially concede that, given this reading of Puerto Rico law, the absent heirs are (in Rule-19 lingo) “required part[ies]” to the EMTALA-survivorship action and so must be joined “if feasible.” Obviously, given plaintiffs’ briefing strategy, we need not - and thus do not - decide whether the judge‘s reading of Commonwealth law is correct (the ultimate resolution of that question must await another day).
Turning, then, to the EMTALA-survivorship claim, plaintiffs essentially contend that the judge erred in two ways. Quoting Rule 19(a)(2) - which, again, says (emphasis added) that “[i]f a person has not been joined as required,” then the judge “must order that the person be made a party” - plaintiffs first argue that the judge botched matters by not ordering the missing heirs joined to this suit. They next argue that he gaffed things by assuming, with no analysis, that the absent heirs could not feasibly be joined. To hear them tell it, nothing made joinder “unfeasible” - they premised jurisdiction on the presence of a federal question (through the EMTALA claim), not diversity, they remind us; so joinder would not wreck the jurisdictional predicate for their suit. Ultimately, the judge‘s off-base assumption, they add, led him to examine what “equity and good conscience” required (a process that involved his weighing the parties’ and the absent heirs’ interests), which in turn caused him to wrongly dismiss the EMTALA-survivorship claim against Hospital Pavia. See Caraballo, 2017 WL 1247872, at *6 (quoting Rule 19(b)).
Staying with the EMTALA claim, plaintiffs argue that they can sue not only for Natividad‘s pain and suffering but also for their own. To back up their argument, they cite to our Correa opinion. There we noted that the EMTALA says:
Any individual who suffers personal harm as a direct result of a participating hospital‘s violation of a requirement of this section may, in a civil action against the participating hospital, obtain those damages available for personal injury under the law of the State in which the hospital is located . . . .
69 F.3d at 1196 (quoting
Hospital Pavia‘s Take
Tackling the EMTALA-survivorship-claim issue first, Hospital Pavia counters that plaintiffs’ summary-judgment papers never argued that the judge defied Rule 19(a)(2)‘s mandatory directive by not ordering the absent heirs’ joinder.11 Thus, Hospital Pavia protests, plaintiffs cannot make that argument here. Cf. generally DiMarco-Zappa v. Cabanillas, 238 F.3d 25, 34-35 (1st Cir. 2001) (discussing the “‘raise-or-waive’ rule” and some of its exceptions). Shifting to the merits, Hospital Pavia seconds the judge‘s view that, under Puerto Rico law, all heirs must be joined in a survivorship claim (plaintiffs have no beef with that view, don‘t forget, at least at this point - so, again, the correctness of that theory is not before us). Leaning on Rule
19(b), Hospital Pavia argues from there that because plaintiffs failed to join the missing heirs and because the judge rightly held the action could not proceed without them, the judge had to dismiss the EMTALA-survivorship claim. Not until later in its brief does Hospital Pavia argue that joinder is “unfeasible.” And its sole theory is that because (as it sees things) the statute-of-limitations period for the EMTALA-survivorship claim has already expired, the absent heirs cannot be made parties anyway.
As for plaintiffs’ suggestion that they can recover damages under the EMTALA for their own pain and suffering, Hospital Pavia says that they “waived” this issue by not raising it at the summary-judgment stage. Waiver aside, Hospital Pavia argues that the EMTALA‘s “clear language” allows only the patient (and those suing on her behalf) to recover damages under the statute. In other words, Hospital Pavia believes that plaintiffs cannot bring a private cause of action under the EMTALA because “such actions are not contemplated in the statute.” And Hospital Pavia pooh-poohs Correa, calling its plain-error holding “dictum.”
Our Take
Following the parties’ lead, we start with the EMTALA-survivorship issue. To understand who is right and who is wrong here, one needs to know how Rule 19 works.
Rule 19 distinguishes between two types of absentees: “those whose joinder is feasible and those whose joinder is not feasible, because it would defeat subject-matter jurisdiction, or the [absentee] is beyond the personal jurisdiction of the court, or the [absentee] has and makes a valid objection to venue.” Askew v. Sheriff of Cook Cty, Ill., 568 F.3d 632, 634-35 (7th Cir. 2009). We know this in part because Rule 19(a)
Rule 19 lays out a two-step process. Starting with Rule 19(a), the judge first decides whether, if the absentees can be joined, they must be joined (absentees cannot be joined if, for example, service-of-process or subject-matter-jurisdiction problems exist). See
identifies such parties, he then looks to Rule 19(a)(2) - a rule that says that if they have “not been joined as required, the [judge] must order that [they] be made . . . part[ies].” See Askew, 568 F.3d at 635 (quoting
If (and only if) the absentees are required parties but cannot feasibly be joined does the judge, at the second step, pull up Rule 19(b) and see if the suit can proceed without them. See Askew, 568 F.3d at 635; see also Provident Tradesmens Bank & Tr. Co. v. Patterson, 390 U.S. 102, 108-09 (1968). To aid in this effort, the judge looks at various factors - like “the extent to which a judgment rendered in [their] absence might prejudice [them] or the existing parties” - through the lens of “equity and good conscience,”13 ever mindful that the caselaw generally prefers that judges not dismiss suits. See 4 Richard D. Freer, Moore‘s Federal Practice - Civil § 19.02[3][c] & n.54 (3d ed. 2017)
(quoting a case saying that “the phrase ‘good conscience,’ in 19(b), contemplates that very few cases should be terminated due to the absence of non-diverse parties unless there has been a reasoned determination that their nonjoinder makes just resolution of the action impossible“).
Measured against these benchmarks, the judge‘s analysis cannot be sustained. Buckle in as we explain.
As we previously noted, the judge - after examining the factors in Rule 19(a)(1)(A) and (B) - essentially held that the missing heirs are required parties. See Caraballo, 2017 WL 1247872, at *5. Then he basically concluded that their joinder was not feasible. We know this to be true, given his laser-like focus on Rule 19(b), see id. at *5-6 - a prescript (we‘ve been at pains to stress, hopefully without becoming tedious) that instructs judges on how to handle situations where (emphasis ours) “joinder is not feasible,” because of, say, nondiversity. Regrettably, though, the judge never explained why the absent heirs cannot be joined. See id. at *5-7.
Again, by our reading, plaintiffs push two big arguments on the joinder issue.
that because plaintiffs did not develop their “must order” theory in their summary-judgment submissions, they cannot peddle it on appeal. We need not referee this dispute, because plaintiffs’ other argument is a winner for them.
The second argument (remember too) is that the judge gave no reason to back up his joinder-is-not-feasible intimation. So true - the judge said nothing (as in zero, zip, zilch) to explain why joinder cannot occur, and Hospital Pavia makes no effort to convince us we are wrong about that point. Critically too, Hospital Pavia offers no raise-or-waive objection in response to plaintiffs’ second contention - which undoubtedly waives any waiver argument in that direction that it might have had. See, e.g., In re San Juan Dupont Plaza Hotel Fire Litig., 45 F.3d 569, 574 (1st Cir. 1995).
Thus freed to weigh in, we easily conclude that the judge‘s inadequate Rule-19 analysis is reversible error. After all, our Rule-19 precedent makes plain that a judge abuses his discretion by not offering a “reasoned analysis” or by pushing an “incomplete and inadequate” analysis. Bacardi Int‘l Ltd. v. V. Suarez & Co., 719 F.3d 1, 9 (1st Cir. 2013). This describes our situation to a T. And because the judge‘s legal misstep skewed and undermined his summary-judgment ruling, we must vacate and remand for further proceedings consistent with our analysis above.
See generally Maldonado-Vinas, 862 F.3d at 122-23 (vacating and remanding where the district court did not reach a Rule-19 issue that it should have); Bacardi Int‘l Ltd., 719 F.3d at 9 (citing a case vacating and remanding where the district court did not give enough reasoning for its Rule-19 decision); Delgado v. Plaza Las Americas, Inc., 139 F.3d 1, 2 (1st Cir. 1998) (per curiam) (vacating and remanding where the district court used an incorrect Rule-19 analysis).
Now on to what Hospital Pavia thinks is its ace up the sleeve - that we (supposedly) can, as an alternative basis for affirmance, fill the hole in the judge‘s analysis by deeming joinder “unfeasible” because the EMTALA‘s limitations period has already lapsed (a “Ctrl-f” search for “feasib” in Hospital Pavia‘s brief reveals this is the only argument it makes for why joinder is not feasible14). But unfortunately for Hospital Pavia, its argument does not do the trick here, for a simple reason. The judge did not address the statute-of-limitations theory. And so we need not either. See Foley v. Wells Fargo Bank, N.A., 772 F.3d
63, 75 (1st Cir. 2014) (collecting cases holding that we can decline to affirm a decision on a ground not relied on by the judge); Lucia v. Prospect St. High Income Portfolio, Inc., 36 F.3d 170, 177 (1st Cir. 1994) (noting, among other things, how the district court did not rule on a statute-of-limitations issue, and so we needed to leave the matter “to be determined in the first instance” by that court). The litigants and the judge can delve into the statute-of-limitations matter on remand. See Tutor Perini Corp. v. Banc of Am. Sec. LLC, 842 F.3d 71, 96 (1st Cir. 2016). We, of course, express no opinion as to the ultimate resolution of this question.
their personal-damages dispute in the district court. As before, we intimate no view about how the judge should rule on this issue.
Recap
To summarize our EMTALA-claim conclusions: We do not disturb the grant of summary judgment for APS, because plaintiffs do not attack that piece of the judge‘s decision. But we vacate the entry of summary judgment for Hospital Pavia so the principals can focus on the outstanding matters discussed above, like helping the judge rework the Rule-19 analysis with the right considerations in mind and determine if plaintiffs can and should recover for their personal damages under the EMTALA.
Local-Law Claims
As we explained above, because the judge found no federal-question or diversity jurisdiction existed, he renounced supplemental jurisdiction over the local-law claims without analyzing them. Our vacating part of the judge‘s summary-judgment ruling on the federal-EMTALA claim undercuts the analysis behind his supplemental-jurisdiction decision. That being so, and in line with past practice, we vacate that aspect of the judge‘s order declining supplemental jurisdiction and instruct the judge to reinstate the local-law claims. If the judge again tosses out the EMTALA claim before trial, he can reconsider the supplemental-jurisdiction question. See, e.g., Rivera-Corraliza, 794 F.3d at
227 (citing Rodriguez v. Municipality of San Juan, 659 F.3d 168, 181-82 (1st Cir. 2011)).
Not so fast, APS and Dr. Lopez insist. The local-law claims face a statute-of-limitations problem. Or so they believe. And, they argue (APS, explicitly; Dr. Lopez, implicitly), that given this problem, we must hold that the judge should have dismissed the local-law claims with prejudice instead of without prejudice. But the judge did not reach this issue. And we see no reason to reach it either. See, e.g., Foley, 772 F.3d at 75; Lucia, 36 F.3d at 177. The parties can litigate this statute-of-limitations issue on remand. Like with the other unexplored issues, we take no position on who should win this fight.15
Our bottom line: We let the summary judgment for APS on the EMTALA claim stand (because plaintiffs don‘t attack it). But
we vacate the summary judgment for Hospital Pavia on the EMTALA claim, leaving it to the parties and the judge to work through the joinder and personal-damages issues. And we also vacate the dismissal of the local-law claims, leaving it to the principals to puzzle out any and all questions related to those claims.
Vacated in part and remanded for further proceedings consistent with this opinion. Costs on appeal to plaintiffs.