United States Court of Appeals

For the First Circuit

No. 18-1701

JULIO CARRASQUILLO-SERRANO, personally and on behalf of his

minor children; GABRIELA JANIRIS DIAZ OCASIO, [common law wife,]

personally and on behalf of her minor children; N.C.D., a minor; 

JAN CARLOS DELGADO, a minor; Y.C.D., a minor,

Plaintiffs, Appellees,

v.

MUNICIPALITY OF CANOVANAS,

Defendant, Appellant,

C.D.T. OF CANOVANAS; S.M. MEDICAL SERVICES, C.S.P.; OSVALDO 

AVILES-RIBOT; PUERTO RICO MEDICAL DEFENSE INSURANCE CO.; JOHN 

DOE CORPORATION, d/b/a C.D.T. of Canovanas; JOHN DOES 1, 2 AND 

3; A, B AND C CORPORATIONS; UNKNOWN INSURANCE COMPANIES A 

THROUGH J; JANE DOE; CONJUGAL PARTNERSHIP AVILES-DOE,

Defendants.

APPEAL FROM THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF PUERTO RICO

[Hon. Silvia Carreno-Coll, U.S. Magistrate Judge]

Before

Howard, Chief Judge,

Thompson and Kayatta, Circuit Judges.

Edgar Hernández Sánchez, with whom Cancio, Nadal, Rivera & 

Díaz, P.S.C. was on brief, for Appellant.

David Efron, with whom Alberto J. Pérez Hernández, Etienne 

Totti del Toro, and Law Offices of David Efron, P.C. were on brief,

for Appellees.
March 12, 2021
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HOWARD, Chief Judge. The Municipality of Canovanas 

("Canovanas") appeals from the district court's denial of its Rule

60(b) motion to overturn the default judgment entered for 

plaintiffs Julio Carrasquillo-Serrano ("Carrasquillo"), his wife 

Gabriela Janiris Diaz Ocasio, and their minor children NCD, Jan 

Carlos Delgado, and YCD. The plaintiffs' claims arose under the 

Emergency Medical Treatment and Labor Act ("EMTALA"), 42 U.S.C. 

§ 1395dd, and Puerto Rico law, and the liability of Canovanas was 

premised on the plaintiffs' allegation that Canovanas "owned, 

operated and/or managed, in whole or in part," CDT of Canovanas

("CDT"), the emergency medical facility that provided medical 

services to Carrasquillo.

On appeal, Canovanas argues that the judgment should be 

set aside for four independent reasons: (1) the plaintiffs' 

failure to comply with the 90-day notice requirement of the Puerto 

Rico Autonomous Municipalities Act (the "PRAMA"), P.R. Laws Ann. 

tit. 21, § 4703, stripped the district court of jurisdiction; 

(2) the district court never had personal jurisdiction over 

Canovanas because the plaintiffs executed service on an attorney 

who worked for Canovanas instead of the municipality's mayor, as 

required by statute; (3) the judgment exceeded Puerto Rico 

statutory limits on the liability of municipalities; and (4) the 

district court lacked subject matter jurisdiction because CDT lies

outside the reach of EMTALA.
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For the reasons set forth below, we reject each of 

Canovanas's arguments and affirm the judgment of the district 

court.

I. Background

On two separate occasions on March 16 and 17, 2014, 

Carrasquillo sought medical attention at CDT for a variety of 

symptoms, including dizziness, nausea, and difficulty speaking. 

He was treated during each visit by Dr. Osvaldo Avíles-Ribot, who 

discharged Carrasquillo with only medication for nausea and an 

intramuscular antibiotic. A week later, Carrasquillo, unable to 

speak, went to a different hospital and was diagnosed with severe 

neurological injuries. Allegedly as a result of the failures in 

diagnosis and treatment by Dr. Avíles and CDT, Carrasquillo is 

"unable to work and to care for his family, his speech and hearing 

have been severely impaired, the right side of his body has limited 

movement, he lacks coordination, suffers from constant headaches, 

cannot swallow or breathe well, his feet hurt, he must use a cane 

to walk, cannot write, and suffers from diabetes and high 

cholesterol."

In March of 2015, Carrasquillo, his spouse, and their 

three minor children filed a complaint, including a claim under 

EMTALA and medical malpractice claims under the Civil Code of 

Puerto Rico. That complaint named several defendants, including 

Dr. Avíles, CDT, its owner Canovanas, and S.M. Medical Services, 
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C.S.P. ("S.M. Medical"), which operated the CDT on behalf of 

Canovanas. The plaintiffs alleged that: (1) Canovanas "owned, 

operated and/or managed" CDT; (2) CDT has an emergency room and 

renders 24-hour emergency medical services; (3) CDT is governed by 

EMTALA; (4) NCD, Jan Carlos Delgado, and YCD were all minors; and 

(5) Carrasquillo was permanently disabled as a result of the 

defendants' negligence.

The complaint was filed on March 11, 2015. Canovanas 

has maintained before us, and the plaintiffs do not dispute, that 

the plaintiffs did not provide advance notice of the suit to 

Canovanas. The plaintiffs served the complaint and summons on 

March 17, 2015, not on the mayor of Canovanas personally, but on 

an attorney employed by Canovanas, Josué González. Neither 

Canovanas nor CDT responded to the complaint or filed any 

dispositive motions in the district court until after judgment was 

entered against them. Other defendants, including Dr. Avíles and 

S.M. Medical, appeared and filed answers to the complaint. 

Throughout much of the period when this litigation was ongoing, 

S.M. Medical continued to operate CDT on behalf of Canovanas and 

was a party to the litigation until S.M. Medical entered bankruptcy 

proceedings.

On April 27, 2015, the plaintiffs moved for an entry of 

default against Canovanas and CDT. On May 4, 2015, the clerk of 

court entered default against Canovanas and CDT. On May 18, 2015, 
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the plaintiffs asked the court to enter default judgment against 

Canovanas and CDT. The district court declined, citing concerns 

about split judgment because other defendants remained in the case. 

The plaintiffs again sought a default judgment two years later in 

June 2017, and the district court again declined, this time because 

a trial on damages had already been scheduled. Neither of the 

plaintiffs' motions for default judgment included the required 

statement "that a copy of the motion has been mailed to the last 

known address of the [defaulting party]," D.P.R. Local R. Civ. P. 

55(a), and the plaintiffs have not submitted any other evidence 

that Canovanas had been notified of its default.

In April 2017, after settlement discussions, the 

district court had entered judgment against codefendants Dr.

Avilés and Puerto Rico Medical Defense Insurance Company. A jury 

trial on damages with respect to Canovanas and CDT was held on 

July 18, 2017, and the jury reached a verdict that day. Judgment 

was entered against Canovanas and CDT on August 30, 2017, in the 

amounts of $900,000 to Carrasquillo ($500,000 for lost wages and 

$400,000 for present and future suffering), $300,000 for Gabriela 

Janiris Díaz Ocasio, and $100,000 to each of the minor plaintiffs, 

for a total of $1.5 million.

In March 2018, almost three years after González was 

served with the initial complaint, Canovanas appeared and moved to 

set aside the verdict and judgment. In its Rule 60(b) motion, 
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Canovanas attributed the delay in its response to Hurricane Maria, 

which made landfall on Puerto Rico in September 2017, roughly 

thirty months after the initial complaint was filed and nearly 

three weeks after judgment was entered against Canovanas. After 

the district court denied this motion, Canovanas appealed from 

that ruling.

II. Standard of Review

We devote attention to the applicable standards of 

review for Canovanas's arguments because those standards are 

central to the outcome of this case. Had they been raised at the 

proper procedural juncture, one or more of the arguments that 

Canovanas now advances might have prevented it from being held 

liable for the $1.5 million judgment. We ordinarily prefer to 

resolve disputes on their merits. See Keane v. HSBC Bank USA for 

Ellington Tr., Series 2007-2, 874 F.3d 763, 765 (1st Cir. 2017) 

("[T]he law . . . manifests a strong preference that cases be 

resolved on their merits."). But there are nevertheless 

consequences for failing to assert rights in a timely manner.

"On motion and just terms, the court may relieve a party" 

from judgment for a handful of enumerated reasons, including that 

"the judgment is void," as argued by the appellant here. Fed. R. 

Civ. P. 60(b)(4). Normally, "[a] motion to set aside a default 

judgment is within the sound discretion of the trial court." Maine 

Nat. Bank v. F/V Explorer, 833 F.2d 375, 378 (1st Cir. 1987) 
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(citing Am. Metal Serv. Exp. Co. v. Ahrens Aircraft, Inc., 666 

F.2d 718, 720 (1st Cir. 1981)). When a motion for relief from

judgment comes under Rule 60(b)(4), however, our review is de novo, 

"because a judgment is either void or it is not." Shank/Balfour 

Beatty, a Joint Venture of M.L. Shank, Co., Inc., Balfour Beatty 

Construction, Inc. v. Int'l Broth. Of Elec. Workers Local 99, 497 

F.3d 83, 94 (1st Cir. 2007) (quoting Fafel v. DiPaola, 499 F.3d 

403, 409-10 (1st Cir. 2005)).

Though our review is de novo, the Supreme Court has 

cautioned that "[a] judgment is not void . . . simply because it 

is or may have been erroneous." United Student Aid Funds, Inc. v. 

Espinosa, 559 U.S. 260, 270 (2010) (quoting Hoult v. Hoult, 57 

F.3d 1, 6 (1st Cir. 1995)).

There are only two sets of circumstances in 

which a judgment is void (as opposed to 

voidable). The first is when the rendering 

court lacked either subject matter 

jurisdiction or jurisdiction over a 

defendant's person. The second is when the 

rendering court's actions so far exceeded a 

proper exercise of judicial power that a 

violation of the Due Process Clause results.

Farm Credit Bank v. Ferrera-Goitia, 316 F.3d 62, 67 (1st Cir. 2003)

(citing United States v. Boch Oldsmobile, Inc., 909 F.2d 657, 661 

(1st Cir. 1990)); see also United Student Aid Funds, 559 U.S. at 

271 ("Rule 60(b)(4) applies only in the rare instance where a 

judgment is premised either on a certain type of jurisdictional 
- 9 -

error or on a violation of due process that deprives a party of 

notice or the opportunity to be heard.").

Furthermore, the Supreme Court has observed with 

approval that "[f]ederal courts considering Rule 60(b)(4) motions 

that assert a judgment is void because of a jurisdictional defect 

generally have reserved relief only for the exceptional case in 

which the court that rendered judgment lacked even an 'arguable 

basis' for jurisdiction." United Student Aid Funds, 559 U.S. at 

271 (quoting Nemaizer v. Baker, 793 F.2d 58, 65 (2d Cir. 1986)). 

In so holding, the Court cited to one of our cases holding that 

"total want of jurisdiction must be distinguished from an error in 

the exercise of jurisdiction, and . . . only rare instances of a 

clear usurpation of power will render a judgment void." Id.

(alterations and internal quotation marks omitted) (quoting Boch 

Oldsmobile, 909 F.2d at 661-62).

Our review is thus non-deferential but narrow; we focus 

solely on whether there was "a clear usurpation of power" in the 

district court's exercise of jurisdiction or the alleged violation 

of due process. Id. (quoting Boch Oldsmobile, 909 F.2d at 662).

Finally, we also note that Canovanas did not raise any

argument about the limits of EMTALA in the district court. We

conclude that, even applying de novo review, there was no clear 

usurpation of power in the district court's exercise of 

jurisdiction over the plaintiffs' EMTALA claims. Accordingly,
- 10 -

this Rule 60(b)(4) argument would fail even if it had been 

preserved.

III. Canovanas's Claims

Canovanas advances four arguments in support of its 

contention that the district court erred in refusing to grant its

motion to set aside the judgment against it as void under Federal 

Rule of Civil Procedure 60(b)(4): (1) the plaintiffs failed to 

comply with the notice deadline of the PRAMA and thus the district 

court never obtained jurisdiction over Canovanas; (2) the 

plaintiffs served notice on counsel for Canovanas instead of the 

mayor and thus the district court never obtained personal 

jurisdiction over Canovanas; (3) the judgment exceeds Puerto Rico 

law limitations on the liability of municipalities; and (4) the 

district court lacked federal question subject matter jurisdiction 

because CDT is not covered by EMTALA. Because none of the 

arguments identifies a clear usurpation of power, each argument 

fails.

A. The PRAMA Service Requirement Is Not Jurisdictional.

The PRAMA requires that individuals who plan to sue a 

Puerto Rico municipality for damages notify the mayor of the 

municipality within ninety days of learning of the damages giving 

rise to the claim. P.R. Laws Ann. tit. 21, § 4703. Canovanas 

contends that the requirement is jurisdictional and, because the 

plaintiffs did not comply with it, the district court never 
- 11 -

obtained jurisdiction over Canovanas. We conclude, however, that 

the PRAMA's notice requirement is not jurisdictional, and so we 

need not address whether the plaintiffs satisfied the statute.

The PRAMA is part of a chapter of Puerto Rico's code 

titled, "Jurisdiction of the Courts," and the statute itself states 

that it is a "Jurisdictional Requirement. No legal action of any 

kind shall be initiated against a municipality for damages due to 

negligence unless written notification is made in the form, manner 

and terms provided in this subtitle." Id. § 4703(b). The 

requirement "is 'a condition precedent of strict compliance in 

order to be able to sue [a] municipality.'" Rodriguez-Robledo v. 

P.R. Elec. Power Auth., 90 F. Supp. 2d 175, 178 (D.P.R. 2000) 

(quoting Mangual v. Superior Court, 88 P.R.R. 475, 483 (1963)). 

At first glance, this would seem to settle the matter in 

Canovanas's favor.

But, as a federal court construing the requirements of 

Puerto Rico law, "we must apply the state's law on substantive 

issues and 'we are bound by the teachings of the state's highest 

court.'" Phoung Luc v. Wyndham Mgmt. Corp., 496 F.3d 85, 88 (1st 

Cir. 2007) (quoting N. Am. Specialty Ins. Co. v. Lapalme, 258 F.3d 

35, 37-38 (1st Cir. 2001)). Because "[i]n regard to lawdetermination, Puerto Rico is the functional equivalent of a 

state[,] . . . an on-point decision of the Puerto Rico Supreme 
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Court normally will control." Gonzalez Figueroa v. J.C. Penney 

P.R., Inc., 568 F.3d 313, 318 (1st Cir. 2009) (citation omitted).

The Puerto Rico Supreme Court has chipped away at the 

PRAMA notice requirement and its predecessors in three ways that 

cause us to conclude that the requirement is not jurisdictional. 

First, the court has consistently treated the notice requirement 

as an affirmative defense that can be waived. See Mintatos v. 

Municip. of San Juan, 322 F. Supp. 2d 143, 146 (D.P.R. 2004) 

(observing that the Puerto Rico Supreme Court has called the notice 

requirement an "unprivileged defense" and held that the 

requirement can be waived) (citing Ins. Co. of P.R. v. Ruiz

Morales, 96 D.P.R. 164, 176, 1968 WL 17227 (P.R. 1968)). Indeed, 

counsel for Canovanas agreed at oral argument that the notice

requirement is an affirmative defense. Affirmative defenses are 

generally waivable if not asserted at the proper juncture and 

rarely, if ever, limit the court's jurisdiction. Compare Fed. R. 

Civ. P. 12(h)(1) (enumerating ways in which certain affirmative 

defenses can be waived), with Fed. R. Civ. P. 12(h)(3) ("If the 

court determines at any time that it lacks subject-matter 

jurisdiction, the court must dismiss the action.").

Second, the Puerto Rico Supreme Court has discerned a 

wide variety of exceptions that might not be immediately apparent 

from the text of the statute, holding that:
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[T]he notice requirement is not jurisdictional

in the sense that it admits of certain 

exceptions. For example, the provision is not 

applicable to the municipality's insurance 

company. In addition, it does not apply to 

actions against a municipality arising out of 

a contractual relationship, or to cases where 

the municipality is the plaintiff and the 

defendant files a counterclaim against it, or 

cases where the plaintiff is seeking just 

compensation in a civil expropriation case.

Rodriguez-Robledo, 90 F. Supp. 2d at 178 (collecting cases) 

(citations omitted). The Puerto Rico Supreme Court characterized 

its own approach as "liberal . . . in the application of the notice 

requirement [with a] tendency to strictly construe those 

provisions that limit a person's right to seek redress." 

Passalacqua v. Mun. de San Juan, 116 D.P.R. 618, 16 P.R. Offic. 

Trans. 756, 768 (P.R. 1985) (interpreting a predecessor to the 

current municipality notice requirement).

Third, and critically, in recounting the evolution of 

its interpretations of the PRAMA, the Puerto Rico Supreme Court 

quoted from its prior ruling that a predecessor to the current

notice requirement, "although it is of strict compliance . . . is 

not a strictly jurisdictional requirement." Id. at 767 (emphasis 

added) (quoting Ruiz Morales, 96 D.P.R. at 174). In Passalacqua, 

the Puerto Rico Supreme Court also cited one of its earlier 

decisions, which had concluded that:

where the risk of the objective evidence's 

disappearance is minimal, where there is 

effective proof of the identity of the 
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witnesses, and where the State may easily 

investigate and corroborate the facts alleged 

in the complaint filed -- the prior notice 

requirement is not strictly applicable 

inasmuch as the objective sought by the 

application thereof has no raison d'être.

16 P.R. Offic. Trans. at 769 (alterations omitted) (quoting 

Meléndez Gutiérrez v. E.L.A., 113 D.P.R. 811, 815 (P.R. 1983)). 

The Passalacqua court went on to hold that the filing of the 

complaint and service of the summons within the statutory period 

sufficed to satisfy the notice requirements. Id.

Because the Puerto Rico Supreme Court has treated the 

PRAMA notice requirement as an affirmative defense, has read 

exceptions into it, and has specifically held that a predecessor 

notice statute was not jurisdictional, we conclude that the 

requirement is not jurisdictional. Therefore, regardless of 

whether the plaintiffs satisfied the requirement, the judgment is 

not void for lack of jurisdiction.

B. Service of Process Was Sufficient.

Canovanas argues next that the district court lacked 

personal jurisdiction over it because it was never properly served. 

Under Federal Rule of Civil Procedure 4(j)(2), service of process 

may be made on a municipality by "(A) delivering a copy of the 

summons and of the complaint to its chief executive officer; or 

(B) serving a copy of each in the manner prescribed by that state's 

law for serving a summons or like process on such defendant." The 
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Federal Rules thereby incorporate the Puerto Rico Rules, which

provide for service "[u]pon a municipal corporation or agency 

thereof with standing to sue and be sued, by delivering a copy of 

the summons and of the complaint to the chief executive officer 

thereof or to a person designated by him." P.R. Laws Ann. tit.

32a, § 4.4(h) (emphasis added). We ask, then, whether González 

was "a person designated by" the mayor to accept service. Id.

We have held that "[a] return of service generally serves 

as prima facie evidence that service was validly performed." Blair

v. City of Worcester, 522 F.3d 105, 111 (1st Cir. 2008). That 

presumption of proper service is not insurmountable: in Blair, the 

presumption was overcome by a simple affidavit stating that the 

parties who received service were not authorized to accept service. 

Id. at 111-12.

Here, the plaintiffs filed a return of service with the 

court, executed by process server and declaring under penalty of 

perjury that the complaint and summons were served upon González,

"who is designated by law to accept service on behalf of" 

Canovanas. That return of service thereby creates the rebuttable 

presumption "that service was validly performed." Id. at 111.

Canovanas has failed to overcome that presumption. 

Canovanas admits that González "was an in-house counsel employed 

by" Canovanas, claiming only that González was not the mayor, and, 

"[r]esultantly, the Municipality of Canóvanas was not properly 
- 16 -

served." Although Canovanas has apparently been unable to locate 

González after being confronted with the judgment, Canovanas does 

not dispute that González was served, and the burden at this point 

is on Canovanas, not the plaintiffs. Canovanas has not presented 

an affidavit that González was not authorized to accept service, 

any other evidence that might rebut the presumption of proper 

service, any argument that the presumption should not apply under 

these circumstances, or any other reason why the presumption should 

be rebutted.

Without any evidence about González's status or argument 

from Canovanas about the inapplicability of the presumption, we 

conclude that the district court did not undertake "a clear 

usurpation of power" by applying the rebuttable presumption of 

proper service and exercising jurisdiction over Canovanas. United 

Student Aid Funds, 559 U.S. at 271.

C. A Statutory Limitation of Liability Is an Affirmative

Defense.

Canovanas has also argued that the $1.5 million judgment 

against it is void because Canovanas, as a municipality, is 

entitled to a limitation of its liability under Puerto Rico law. 

P.R. Laws Ann. tit. 21, § 4704 provides:

Claims against municipalities for personal or 

property damages caused by the fault or 

negligence of the municipality, shall not 

exceed the amount of seventy-five thousand 

dollars ($75,000). When damages are claimed 

by more than one person in a single cause of 
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action or omission, or when a single claimant, 

is entitled to several causes of action the 

compensation shall not exceed the sum of one 

hundred and fifty thousand dollars ($150,000). 

If the court finds the damages to each of the 

persons exceed one hundred and fifty thousand 

dollars ($150,000), the court shall proceed to 

distribute or prorate said amount among the 

plaintiffs, on the basis of the damages 

suffered by each of them.

While a judgment ten times the statutory limit certainly 

raises eyebrows, to serve as a basis to set aside a judgment under 

Rule 60(b)(4), the excessive judgment must either be "a clear 

usurpation of power" in the court's exercise of jurisdiction or "a 

violation of due process that deprives a party of notice or the 

opportunity to be heard." United Student Aid Funds, 559 U.S. at 

271. It is neither.

We have seen this issue before. We previously reviewed 

a case in which a defendant failed to assert a statutory 

limitation-of-liability defense, but the district court 

nonetheless found that the Massachusetts statute limited the 

plaintiff's potential recovery. See Knapp Shoes, Inc. v. Sylvania 

Shoe Mfg. Corp., 15 F.3d 1222, 1225-26 (1st Cir. 1994). We 

reversed the district court, holding that "a statutory provision 

limiting damages to a fixed sum constituted an affirmative defense 

for purposes of [Federal Rule of Civil Procedure] 8(c)," and that 

affirmative defenses not included in an appropriate responsive 

pleading are waived. Id. at 1226. We went on to explain that 
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"[t]he reason why affirmative defenses under Rule 8(c) must be 

pled in the answer is to give the opposing party notice of the 

defense and a chance to develop evidence and offer arguments to 

controvert the defense." Id.

The defense that Canovanas raises is a statutory 

limitation on liability, and, like the defendant in Knapp Shoes, 

Canovanas has waived the defense by failing to include it in a 

responsive pleading. Id. at 1225-26.

Moreover, any potential due process concerns may be 

undercut by the ability of Canovanas to assert the statutory 

liability limitations in a different venue. As the plaintiffs and 

the district court both point out, Puerto Rico provides for a right 

of contribution action between joint tortfeasors. The Puerto Rico 

Supreme Court has observed that:

In Puerto Rico, the right of contribution 

between joint tortfeasors has been 

acknowledged since [1951]. The well-known 

rule that applies when the damage is caused by 

two or more persons provides that all joint 

tortfeasors are liable to the plaintiff for 

the damage sustained by the latter. However, 

there is among these joint tortfeasors a right 

of contribution derived from [P.R. Laws Ann.

tit. 31, § 3109], which allows one of the 

codebtors who has paid more than his or her 

share to claim from the other codebtors their 

respective shares.

Szendrey v. Hospicare, Inc., 158 D.P.R. 648, 2003 WL 751582 (P.R. 

2003) (English translation lacks pincites). Canovanas mounts no 

argument that the district court erred in observing that Canovanas 
- 19 -

will be able to assert the statutory limit on liability in a 

subsequent contribution action against its codefendants,1 or that 

forcing it to do so "deprives [it] of notice or the opportunity to 

be heard." United Student Aid Funds, 559 U.S. at 271.

The statutory limit on municipal liability does not 

render the judgment void.2

1 Because Canovanas has thus waived any argument on the 

matter, we therefore have no occasion to decide whether the 

district court was correct on this point.

2 As a last-ditch effort on this point, Canovanas also 

attempts to take advantage of P.R. Laws Ann. tit. 26, § 4105, which 

provides immunity from suit to health professionals. Canovanas 

argues that, since the statute references municipalities, it 

should also be read to grant municipalities immunity from suit. 

The plain language of the statute belies this argument, providing:

No health professional (employee or 

contractor) may be included as a defendant in 

a civil action in a claim for damages for guilt 

or negligence for professional malpractice 

("malpractice") caused in the performance of 

his profession, while said professional acts 

in compliance with his duties and functions, 

including teaching, as employee of the 

Commonwealth of Puerto Rico, its dependencies, 

instrumentalities, the comprehensive Cancer 

Center of the University of Puerto Rico and 

the municipalities.

P.R. Laws Ann. tit. 26, § 4105. The statute unambiguously 

references immunity for the employees of the municipalities, not 

the municipalities themselves. The cases that Canovanas cites 

similarly address immunity for employees, and not for the 

municipalities themselves. See Frances-Colon v. Ramires, 107 F.3d 

62, 64 (1st Cir. 1997) (finding doctor employees immune from suit); 

Oquendo-Lorenzo v. Hospital San Antonio, Inc., 256 F. Supp. 3d 

103, 117 (D.P.R. 2019) (examining immunity for health care 

professionals and doctors, not municipalities). Section 4105 does 

not grant immunity to municipalities.
- 20 -

D. The District Court Had Jurisdiction to Determine the 

Merits of Plaintiffs' EMTALA Claims.

Finally, the district court did not lack federal 

question jurisdiction to hear this suit. District courts have 

"original jurisdiction of all civil actions arising under the 

Constitution, laws, or treaties of the United States." 28 U.S.C. 

§ 1331. To determine whether the exercise of federal question 

jurisdiction is proper, we apply the familiar "well-pleaded 

complaint rule, which 'requires the federal question to be stated 

on the face of the plaintiff's well-pleaded complaint.'" LópezMuñoz v. Triple-S Salud, Inc., 754 F.3d 1, 4 (1st Cir. 2014) 

(quoting R.I. Fishermen's All., Inc. v. R.I. Dep't of Envtl. Mgmt., 

585 F.3d 42, 48 (1st Cir. 2009)). Where the district court has 

federal question jurisdiction over claims "arising under the 

Constitution, laws, or treaties of the United States," 28 U.S.C. 

§ 1331, the district court "shall have supplemental jurisdiction 

over all other claims that are so related to claims in the action 

within [the court's] original jurisdiction that they form part of 

the same case or controversy under Article III of the United States 

Constitution." 28 U.S.C. § 1367(a).

Here, the parties agree that (1) the complaint stated 

certain EMTALA claims, and (2) if the district court properly 

exercised jurisdiction over EMTALA claims, then its exercise of 
- 21 -

jurisdiction over the plaintiffs' remaining claims was proper 

under § 1367(a).

Canovanas argues that EMTALA does not apply to CDT, and 

thus the plaintiffs' ostensible claims under EMTALA are not under 

EMTALA at all. Therefore, Canovanas argues that the district court 

lacks federal question jurisdiction under § 1331. In support of 

this proposition, Canovanas points us to Rodriguez v. Am. Intern. 

Ins. Co. of P.R., 402 F.3d 45 (1st Cir. 2005). There we found 

that EMTALA did not apply to a different CDT, the Corozal CDT.3 

In Rodriguez, we held that EMTALA did not apply to the Corozal CDT 

because (1) the Corozal CDT treats outpatients instead of 

inpatients, and (2) Puerto Rico law has different regulations for 

hospitals than for CDTs. Id. at 48-49. Canovanas points out, 

correctly, that the Canovanas CDT also treats outpatients instead 

of inpatients and is also regulated as a CDT instead of as a 

hospital.4

3 In this Section, we refer to CDT of Canovanas as "the 

Canovanas CDT" and the CDT at issue in Rodriguez as "the Corozal 

CDT."

4 On the merits of the EMTALA issue, the plaintiffs make two 

arguments that the EMTALA claims here are distinguishable from the 

ones at issue in Rodriguez, and that we should therefore read 

EMTALA to apply to the Canovanas CDT. First, while in Rodriguez

we relied on the fact that the Corozal CDT had no relationship 

with an EMTALA participating hospital, here the Canovanas CDT does 

have a working relationship with an EMTALA participating hospital: 

the hospital of the University of Puerto Rico. See 402 F.3d at 47 

("It is undisputed that the Corozal CDT is an independent facility 

and is not attached to a hospital."). Second, the regulations 

issued under EMTALA have been amended since Rodriguez to change 
- 22 -

But Rodriguez, instead of illustrating why the district 

court here did not have jurisdiction over the plaintiffs' claims, 

illustrates why it did: we did not simply dismiss the case for 

lack of subject matter jurisdiction. Instead, we first resolved 

the question, "arising under the . . . laws . . . of the United 

States," 28 U.S.C. § 1331, of whether EMTALA applied to the CDT at 

issue. Rodriguez, 402 F.3d at 46-49. If Canovanas, like the 

defendants in Rodriguez, had asserted in a motion that the 

Canovanas CDT here is effectively the same as the Corozal CDT, and 

that therefore the EMTALA claims should be dismissed, the district 

court would have had subject matter jurisdiction to adjudicate 

that motion. See, e.g., id. That subject matter jurisdiction did 

not disappear because Canovanas neglected to appear and seek to 

dismiss the claim against it. Canovanas did not point to any case 

where any court found that the federal cause of action included in 

a well-pleaded complaint was so insubstantial as to rob the 

district court of jurisdiction to adjudicate that federal claim.

the definition of "dedicated emergency department," and the 

plaintiffs claim that the amended definition encompasses the CDT 

at issue here. See 42 C.F.R. § 489.24. Best read, the plaintiffs' 

argument is not that the Canovanas CDT is itself a hospital 

participating in EMTALA, but that the Canovanas CDT functions as 

a dedicated emergency department of the EMTALA participating 

hospital of the University of Puerto Rico. We take no view of the 

merits of these arguments, but the district court would have had 

subject matter jurisdiction to adjudicate them.
- 23 -

Moreover, even "[t]he termination of the foundational 

federal claim does not divest the district court of power to 

exercise supplemental jurisdiction, but, rather, sets the stage 

for an exercise of the court's informed discretion." Senra v. 

Town of Smithfield, 715 F.3d 34, 41 (1st Cir. 2013) (quoting Roche

v. John Hancock Mut. Life Ins. Co., 81 F.3d 249, 256-57 (1st Cir. 

1996)). In Senra, we upheld the district court's exercise of 

supplemental jurisdiction to determine a plaintiff's Rhode Island 

state law claims relating to the termination of his employment 

even after it had dismissed his federal due process clause claims 

arising out of the same termination. Id. Similarly, here, it is 

not immediately obvious that, if the EMTALA claims were dismissed, 

the district court could not have nonetheless exercised 

jurisdiction over the plaintiffs' state law claims.

The possibility that Canovanas would have succeeded on 

a motion to dismiss the EMTALA claims does not mean the district 

court lacked federal question subject matter jurisdiction.

IV. Conclusion

The judgment of the district court is affirmed.