Rodriguez v. Hosp. San Cristobal, Inc., 2024
(Editor’s note: This is the first reported appellate decision to cite the new Rule 702 amendments effective Dec. 1, 2023. While the appellate court noted the changes, it also cited outdated but familiar precedents. For a more thorough analysis of this issue and case, please see an article by the law firm Faegre-Drinker here.)
This suit sought to recover under Puerto Rico law for the allegedly negligent care that Ramona Rodriguez Rivera, mother of the plaintiffs in this case, received at Hospital San Cristobal Inc. during and following an abdominal surgery Dr. Iris Vélez García and Dr. Zacarías A. Mateo Minaya performed. The district court excluded the testimony of the plaintiffs’ medical expert witness, Dr. Jason S. James, which led to granting of a summary judgment in favor of the defendants (Hospital San Cristobal, Dr. Velez, Dr. Mateo, and other related entities).
The Circuit Court of Appeals (1st Circuit Court) held that the “[d]istrict court did not abuse its discretion under Fed. R. Evid. 702 in excluding a medical expert’s broad conclusion that doctors deviated from acceptable standards of care in their treatment of a deceased patient that led to the perforation of the patient’s sigmoid colon during surgery and that the hospitals’ staff deviated from acceptable standards of care in their management of the patient’s diabetes because the expert’s opinion could only have been construed as one based on a res ipsa loquitur inference as the expert’s report identified no national standard of care against which the allegedly negligent acts or omissions could have been measured by the trier of fact and there was no other basis in the record for concluding by a preponderance of the evidence that the expert’s opinion was the product of reliable principles and methods.”
The circuit court provided a lengthy recitation of the details of the facts and treatment of Rodriguez, which is aptly distilled and summarized in the above two paragraphs. The operative complaint asserts that the defendants were practicing below the standard of care in the treatment of Rodriguez and that the negligent management of her condition caused her premature death, making the defendants liable for negligence under Puerto Rican law.
Under Puerto Rican law, healthcare professionals are held to a national standard of care. “[P]hysicians are protected by a presumption to the effect that they have exercised a reasonable degree of care and the treatment provided was adequate.” (López Delgado v. Cañizares) To establish “a breach of a physician’s duty of care,” a plaintiff “ordinarily must adduce expert testimony to limn the minimum acceptable standard and confirm the defendant doctor’s failure to meet it.” (Cortéz-Irizarry)
The plaintiffs indicated they would rely on the testimony of Dr. James to establish the defendants’ negligence. Dr. Velez, Dr. Mateo, and Hospital San Cristobal indicated they would call their own experts. Various of the defendants filed two separate motions in limine. The motions sought to exclude the testimony of Dr. James because his report did not comply with Rules 26(a) and Rule 702. Rule 26(a) deals with proper and timely disclosure of witnesses and rules of disclosure related thereto. Rule 702 relates to the admissibility of expert opinion testimony.
Dr. James’ report provided details of his believed defects in the treatment Rodriguez received from the doctors and HSC. In conclusion, “it is [Dr. James’] opinion—based upon a reasonable degree of medical certainty—that in the case discussed above there were numerous deviations, failures, and departures from acceptable standards of care on the part of Dr. [Vélez], Dr. Mateo, as well as on the part of [Hospital San Cristobal] and its staff.”
The defendants explained deficiencies under Rule 26(a) that they asserted as grounds for exclusion of Dr. James’ testimony. Alternatively, the defendants argued his testimony should be excluded as speculative under Rule 702. “They contended that was so because Dr. James’s expert report did not articulate either a ‘[s]cientifically acceptable methodology’ or ‘the bases and foundations that underlie [his] expert opinion’ and because nothing else in the record enabled the plaintiffs to meet their burden to show that his testimony was admissible under Rule 702.”
The plaintiffs opposed the defendants’ motion but did not ask for a hearing and asserted that “the entirety of Dr. James’s proposed testimony was admissible based on the expert report itself.” Based solely on Rule 702, the district court granted the defendants’ motion to exclude Dr. James’ testimony. The district court observed that, although Dr. James “conclude[d that] Dr. Vélez and Dr. Mateo deviated from acceptable standards of care,” his report did not “state what those standards are, nor where they come from[, nor] how Dr. Vélez and Dr. Mateo deviated from them.” The district court also found that, regarding Hospital San Cristobal, James’ opinions fared no better. The district court excluded Dr. James’ testimony as to the defendants and gave leave for the defendants to file a motion for summary judgment in 10 days.
The plaintiffs objected to both motions and argued that they could rely on the defendants’ witnesses to prove their case even though Dr. James’ testimony had been excluded. The district court denied the plaintiffs’ objections and granted summary judgment to the defendants with prejudice. “The plaintiffs simply contend based on the report itself that the District Court abused its discretion in ruling that the plaintiffs had failed to meet that burden. The plaintiffs then go on to contend, in the alternative, that we must overturn the summary judgment ruling even if the District Court’s Rule 702 determination was not error. And that is so, they contend, because of evidence in the record that is independent of Dr. James’s Testimony.”
The circuit court held that the plaintiffs’ grounds for challenging the summary judgment ruling had no merit and affirmed the district court.
In assessing the plaintiffs’ challenge to the summary judgment, it helps to focus on the district court’s ruling to exclude Dr. James’ testimony under Rule 702. The circuit court recited the full four primary rules of Rule 702 [drawn from Daubert] and based its decision on Rule 702 as restated on Dec. 1, 2023. However, it then referred back to committee notes on the 2000 version of Rule 702 in justifying its exclusion of Dr. James. (See the Faegre article linked above for a more complete explanation.)
The district court, in explaining its exclusion of Dr. James, noted that his opinion was based on his conclusion that Drs. Velez and Mateo perforated Rodriguez’s colon during their surgery on her and that perforation is what caused the sepsis shock and her death. The district court further indicated that there was not sufficient evidence that the doctors had in fact perforated her colon during the surgery. Dr. James’ report opined only that the perforation occurred during the surgery on April 21 but does not specifically indicate the doctors perforated it. However, the district court did seem to understand that Dr. James would testify that the doctors had perforated the colon. Despite this apparent confusion as to the “factual underpinning” (which should be a matter to the weight and not admissibility), Dr. James’ testimony was (per the circuit court) excluded under Rule 702, saying that the district court did not abuse its discretion regarding that “Dr. Vélez and Dr. Mateo deviated from acceptable standards of care” in their treatment of Rodríguez. Further, “Dr. Vélez and Dr. Mateo deviated from acceptable standards of care” in their treatment of Rodríguez could “only be construed as one based on a res ipsa loquitur inference, an inference insufficient to withstand scrutiny in this setting.”
As to summary judgment, the plaintiffs contend that they would have helped a jury to understand the standards of care and the causal nexus between the defendants’ negligence and the plaintiffs’ damages. However, all of the defendants’ experts opined that the “defendants’ actions did not deviate from the standards of care.” “Thus, the record in this case contains no ‘expert testimony to limn the minimum acceptable standard and confirm the defendant doctor[s’] failure to meet it,’ as is required to ‘establish a breach of a physician’s duty of care” under Puerto Rico’s negligence statute. (Cortéz-Irizarry)