United States Court of Appeals

For the First Circuit

No. 20-2093

JEANNETTE RODRÍGUEZ-VALENTIN, in representation of her minor 

son, D.A.L.R.,

Plaintiff, Appellee,

v.

DOCTORS' CENTER HOSPITAL (MANATI), INC.,

Defendant, Appellant.

APPEAL FROM THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF PUERTO RICO

[Hon. Bruce J. McGiverin, U.S. Magistrate Judge]

Before

Lynch and Selya, Circuit Judges,

and McCafferty,* District Judge.

Roberto E. Ruiz-Comas, with whom RC Legal & Litigation 

Services, PSC was on brief, for appellant.

David Efron, with whom Law Offices of David Efron, P.C. was

on brief, for appellee.

February 24, 2022

 

* Of the District of New Hampshire, sitting by designation.
- 2 -

MCCAFFERTY, District Judge. This medical malpractice 

suit arises from obstetric care provided to the plaintiffappellee, Jeannette Rodríguez-Valentin in connection with the 

birth of her minor son, DALR. A jury found appellant Doctors'

Center Hospital (Manati), Inc. ("Doctors' Center") liable for 8 

percent of a $14,296,000 total award. Doctors' Center appeals the 

denial of its post-verdict motions for judgment as a matter of 

law, for a new trial, and for remittitur under Federal Rules of 

Civil Procedure 50 and 59. We affirm.

BACKGROUND

I. Complications During DALR's Birth

Rodríguez-Valentin gave birth to DALR by caesarean 

section at Doctors' Center in Puerto Rico in late September 2008. 

A few months after his birth, DALR was diagnosed with cerebral 

palsy. Rodríguez-Valentin alleged that DALR's cerebral palsy

resulted from, or was exacerbated by, medical malpractice by

treating physicians and nurses during the late stages of her 

pregnancy and DALR's delivery. This appeal by Doctors' Center is 

pertinent only to the medical care provided by treating nurses

employed by Doctors' Center.

The nurses' alleged malpractice occurred during DALR's 

birth. Doctors' Center's nurses, per a physician's order, began 

administering the pharmaceutical drug Pitocin to RodríguezValentin at about 9:31 A.M. on September 25 while she was in labor. 
- 3 -

The Pitocin was intended to aid delivery by reducing the time 

between Rodríguez-Valentin's contractions.

Soon after the nurses administered Pitocin, however,

DALR's "heart rate variability," as documented by a monitor placed 

on Rodríguez-Valentin's abdomen, dropped to a "very minimal 

level." At trial, Rodríguez-Valentin's expert witness, Dr. Bruce 

Halbridge, testified that DALR's heart rate variability had been 

within an appropriate range before the nurses administered 

Pitocin. Dr. Halbridge explained that the drop in heart rate 

variability from that appropriate range showed that DALR was not 

receiving enough oxygen, glucose, or blood through the placenta. 

Dr. Halbridge noted that such a loss of heart rate variability is 

the most important signal that a soon-to-be-born baby lacks 

sufficient oxygen.

Dr. Halbridge identified where and when the nurses 

should have seen the changes in heart rate variability. 

Specifically, according to Dr. Halbridge, DALR's heart rate 

variability issues occurred in several, sometimes prolonged, 

"episodes" throughout Rodríguez-Valentin's labor. Dr. Halbridge 

testified that, in his opinion, by the third "episode" of decreased 

heart rate variability, the treating nurses should have stopped 

administering Pitocin, placed Rodríguez-Valentin on her left side, 

increased her IV fluid intake, provided her with an oxygen mask, 
- 4 -

and notified a physician about the drop in DALR's heart rate 

variability. 

Rodríguez-Valentin's labor continued for eight hours 

after the nurses began administering Pitocin. During this time 

the treating nurses failed to recognize or act on the drop in

DALR's heart rate variability, failed to stop administering

Pitocin, and failed to notify any physician about the change in 

DALR's heart rate variability.

Dr. Halbridge testified that oxygen deprivation during 

the delivery increased DALR's brain damage and aggravated his 

cerebral palsy. Dr. Halbridge noted that, had the nurses notified 

a physician, the caesarean section could also have been expedited, 

which likely would have reduced the severity of DALR's injuries

because he would have spent less time without sufficient oxygen.

In defense of the nurses' conduct, Doctors' Center 

offered the testimony of two expert witnesses in obstetrics, Dr. 

Alberto de la Vega Pujol and Dr. Edgar Solis. These physicians

disagreed with Dr. Halbridge, opining that DALR's heart rate 

variability was adequate during labor and that there was no 

evidence that DALR suffered any oxygen deficiency during delivery. 

Dr. Solis also testified that neuroradiological testing conducted 

after DALR's birth supported his opinion that DALR did not suffer 

from oxygen deficiency during delivery.
- 5 -

II. Testimony about DALR's Life Care Expenses

Rodríguez-Valentin claimed considerable damages for 

DALR's future life care costs. Specifically, Gerri Pennachio 

testified for Rodríguez-Valentin as a "life care planning expert,"

opining about the yearly cost of DALR's care and treatment. 

According to Pennachio, these costs would include necessary 

equipment, doctor visits, testing, and physical therapy, among 

other items. Pennachio determined that DALR would require 

$278,021.57 per year until age 18. After age 18, Pennachio opined,

DALR would need $379,235.57 per year.

On cross-examination, Doctors' Center dissected

Pennachio's calculations, asking her whether she had offset the 

yearly amounts by contributions made by insurance or the government

and whether she had based her calculations on costs in Florida

(where DALR lived at the time of trial) as opposed to Massachusetts

(where DALR had lived before moving to Florida). Pennachio 

acknowledged that she had not offset her calculations based on 

contributions made by insurance or the government. She did not 

dispute that she derived her calculations from cost information in

Massachusetts even though, at the time of trial, RodríguezValentin and DALR lived in Florida. 

Additionally, Pennachio acknowledged on crossexamination that she did not discount her yearly estimates to 

present value. Rather, she opined, the cost increases for DALR's
- 6 -

medical care and life care over his lifetime would offset any 

applicable discount rate.

Per a pre-trial ruling on Doctors' Center's motion in 

limine, the court prohibited Pennachio (who lacked requisite 

expertise) from opining about DALR's life expectancy given his 

medical condition.1 Ultimately, neither Doctors' Center nor 

Rodríguez-Valentin presented any expert testimony about DALR's 

life expectancy.

III. Jury Instructions and Verdict

Consistent with the parties' proposed instructions, the 

court instructed the jury that it could award compensatory damages 

to Rodríguez-Valentin and DALR for damages they were "reasonably 

likely to suffer in the future." It instructed the jury that it 

should be "guided by common sense" in fashioning any award and 

that it could not engage in "arbitrary guesswork." The court added

that the law does not require proof of the amount of damages "with 

mathematical precision but only with as much definiteness and 

accuracy as the circumstances permit." It asked the jury to use 

"sound discretion" and to draw "reasonable inferences" where 

appropriate from the "facts and circumstances in evidence."

1 In addition, prior to Pennachio's testimony, the court 

denied a motion by Doctors' Center to limit Pennachio's testimony 

to only one year of expenses.
- 7 -

With respect to DALR's life expectancy, Doctors' Center 

did not seek either a ruling from the judge that life expectancy 

must be proved by expert testimony or a suitable modification to 

the court's jury instruction on damages. Nor did Doctors' Center

request a special verdict form on DALR’s life expectancy. In the 

end, Doctors' Center permitted the case to go to the jury without 

making any argument about how the lack of expert testimony on life 

expectancy should impact the jury's calculation of DALR's future 

life care costs.2 

The jury found Doctors' Center liable and awarded 

$12,996,000 in future life care costs to Rodríguez-Valentin and 

DALR. The jury awarded an additional $1,300,000 for physical and 

emotional pain and suffering. The jury apportioned 92 percent of 

that liability to two treating physicians with whom RodríguezValentin settled prior to trial. The jury apportioned to Doctors'

Center the remaining 8 percent, which sums to $1,143,680.

2 During closing arguments, Doctors' Center objected to 

Rodríguez-Valentin's observation that there was no evidence 

presented by either side about life expectancy on the ground that 

Rodríguez-Valentin's counsel was improperly "talking about life 

expectancy." The court overruled Doctors' Center's objection.
- 8 -

IV. Post-Verdict Motions

After the jury's verdict, Doctors' Center renewed3 a 

motion for judgment as a matter of law under Rule 50 and moved for 

a new trial and/or remittitur of the damages award under Rule 59.4 

Doctors' Center argued, as it does on appeal, that RodríguezValentin's evidence was insufficient to support the jury's verdict 

as to liability or, alternatively, that the weight of the evidence 

required the jury's verdict to be overturned and a new trial to be 

held. As to remittitur of the damages award or a new trial on 

damages, Doctors' Center argued that the jury's award for future 

life care costs was speculative because Rodríguez-Valentin failed 

to submit expert testimony about DALR's life expectancy. Doctors' 

Center also argued that Pennachio's calculations were deficient.

The district court denied Doctors' Center's motions. As 

to Doctors' Center's motions for judgment as a matter of law and 

for a new trial on liability, the district court found that Dr. 

Halbridge's testimony supported the jury's verdict. As to the 

motion for a new trial on damages and/or remittitur, the district 

3 As it was required to do to preserve its arguments, Doctors' 

Center moved for judgment as a matter of law for the first time

before the matter was submitted to the jury. See Fed. R. Civ. P. 

50(a); Santos-Arrieta v. Hospital del Maestro, 14 F.4th 1, 8 (1st 

Cir. 2021). The district court deferred ruling on the motion, and 

Doctors' Center renewed its motion after the jury's verdict. 

4 Doctors' Center filed its three motions together as part of 

one omnibus legal document.
- 9 -

court stated that the jury could have determined that DALR's life 

expectancy was 46 years5 by dividing the award for future care

costs by the amount that Pennachio testified DALR would require 

for care each year. The district court, however, acknowledged 

that the life expectancy of a child with cerebral palsy "likely 

would be a proper subject for expert testimony." Nonetheless, the 

district court concluded that the jury in this case could issue an 

award for future costs without expert testimony on life expectancy 

because damages in a negligence action need not be shown with 

mathematical certainty.

The court also stated that other jurisdictions permit a 

jury to infer life expectancy from testimony about the injured 

person's medical condition and pain and suffering. While 

acknowledging that "the far better practice would have been for 

both parties to present competent expert testimony of plaintiff's 

life expectancy," the district court found that the jurors could 

make a reasonable estimate of DALR's life expectancy based on their 

common sense, personal knowledge, and experience. The district 

court also reasoned that the jury heard and rejected Doctors' 

Center's arguments about errors in Pennachio's calculations for 

DALR's future life care costs.

5 DALR was 10 years old at the time of trial, so, under these 

calculations, he would be expected to live another 36 years.
- 10 -

DISCUSSION

Doctors' Center appeals the district court's denial of 

its motions for judgment as a matter of law, for a new trial, and 

for remittitur of the jury's damages award. We address each matter 

in turn, and, in the end, affirm the district court's rulings.

I. Judgment as a Matter of Law

Doctors' Center challenges the district court's denial 

of its renewed motion for judgment as a matter of law under Federal 

Rule of Civil Procedure 50(b). Doctors' Center contends that the 

district court erred by denying the motion because Doctors' Center

presented the expert testimony of Drs. de la Vega and Solis, both 

of whom opined, in contention with Dr. Halbridge, that the nurses 

acted appropriately under the circumstances.

The court reviews de novo the denial of a renewed, postverdict motion for judgment as a matter of law under Rule 50(b). 

See Fresenius Med. Care Holdings, Inc. v. United States, 763 F.3d 

64, 67 (1st Cir. 2014). "If a party has been fully heard on an 

issue during a jury trial and the court finds that a reasonable 

jury would not have a legally sufficient evidentiary basis to find 

for the party on that issue," the court can order a new trial or 

direct the entry of judgment in the moving party's favor as a 

matter of law. See Fed. R. Civ. P. 50(a)-(b). A trial court 

evaluating a motion for judgment as a matter of law under Rule 

50(b) must "view the evidence in the light most flattering to the 
- 11 -

verdict and must draw all reasonable inferences therefrom in favor 

of the verdict." Fresenius, 763 F.3d at 67-68.

Under Puerto Rico law,6 to prove medical malpractice the 

plaintiff must demonstrate, by a preponderance of the evidence, an 

applicable standard of care, that the defendant acted or failed to 

act in violation of the applicable standard of care, and a 

sufficient causal connection between the defendant's act or 

failure to act and the plaintiff's injuries. See Pagés-Ramírez v. 

Ramírez-González, 605 F.3d 109, 113 (1st Cir. 2010). Viewing the 

evidence in the light most favorable to Rodríguez-Valentin, the 

jury's verdict finding Doctors' Center liable for medical 

malpractice is supported by the evidence. The district court did 

not err in denying Doctors' Center's motion for judgment as a 

matter of law.

Doctors' Center's primary argument is that the district 

court should have given greater weight to the testimony of its 

experts as opposed to that of Dr. Halbridge. But, as the district 

court found, Dr. Halbridge's opinion (i.e., that the nurses 

breached the applicable standard of care by failing to stop 

administering Pitocin and by failing to inform treating physicians 

that DALR's heart rate variability had decreased) was sufficient 

6 The substantive law of Puerto Rico controls in this 

diversity suit. See Cortés-Irizarry v. Corporación Insular de 

Seguros, 111 F.3d 184, 189 (1st Cir. 1997).
- 12 -

to support the jury's verdict as to those issues. The jury was 

entitled to credit Dr. Halbridge's testimony over that of Drs. de 

la Vega or Solis. See Feliciano-Hill v. Principi, 439 F.3d 18, 26

(1st Cir. 2006); Lama v. Borras, 16 F.3d 473, 478 (1st Cir. 1994).

Doctors' Center also argues that the jury could not find 

liability based on Dr. Halbridge's testimony because he opined 

that the nurses breached a standard of care applicable generally 

in the United States as opposed to a standard of care specific to

Puerto Rico. We find no merit to Doctors' Center's argument. The 

district court instructed the jury that the standard of care in 

this case was "equal to the degree of care exercised by other 

nurses in the same or similar localities."7 Dr. Halbridge, having

described what the applicable standard of care for the nurses would 

be, added that, as to the nurses in this case, the standard of 

care was the same as the standard of care in the United States

generally. For purposes of this case, the jury was entitled to 

credit Dr. Halbridge's opinion that the applicable standards of 

care in Puerto Rico and the rest of the United States are the same. 

See Lama, 16 F.3d at 478.

Doctors' Center's other arguments about the sufficiency 

of the evidence are without merit and do not warrant further 

7 Since it is not a matter challenged on appeal, we make no 

ruling about whether the district court's instruction was the 

correct interpretation of Puerto Rico law.
- 13 -

discussion. The district court correctly denied Doctors' Center's 

motion for judgment as a matter of law.

II. Motion for a New Trial as to Liability

Leveraging the same arguments presented in its motion 

for judgment as a matter of law under Rule 50, Doctors' Center 

contends that the district court erred by denying its motion for 

a new trial under Federal Rule of Civil Procedure 59. Under Rule 

59, "[t]he court may, on motion, grant a new trial on all or some 

of the issues -- and to any party -- . . . after a jury trial, for 

any reason for which a new trial has heretofore been granted in an 

action at law in federal court." Fed. R. Civ. P. 59(a)(1)(A). "A 

district court's power to grant a motion for new trial is much 

broader than its power to grant a [Rule 50 motion.]" Jennings v.

Jones, 587 F.3d 430, 436 (1st Cir. 2009).

A trial judge may grant a new trial if the jury's verdict 

is "against the weight of the evidence" or if "action is required 

in order to prevent injustice." Id. at 436. A district court can 

independently weigh the evidence when evaluating a motion for a 

new trial under Rule 59 and therefore can determine that a witness 

or evidence lacks credibility; in other words, the court need not 

take the evidence in the light most favorable to the nonmoving 

party. Id.

At the same time, trial judges "do not sit as thirteenth 

jurors, empowered to reject any verdict with which they disagree." 
- 14 -

Id. Indeed, when reviewing a denial of a motion for new trial 

that was, at bottom, based on sufficiency of the evidence, the 

standards under Rule 50 and Rule 59 effectively "merge." See

Dimanche v. Mass. Bay Transp. Auth., 893 F.3d 1, 8 n.9 (1st Cir. 

2018). Moreover, our review of the district court's denial of 

Doctors' Center's motion for a new trial is only for abuse of 

discretion. Jennings, 587 F.3d at 435-37. 

Considering the deferential abuse-of-discretion 

standard alongside the reality that Doctors' Center's arguments 

under Rule 59 and Rule 50 are based on the same sufficiency-ofthe-evidence grounds, we affirm the district court's denial of

Doctors' Center's motion for a new trial as to its liability. In 

other words, consideration of the same facts that lead us to affirm

the district court's denial of the motion as brought under Rule 50 

likewise lead us to affirm as to Rule 59. Dr. Halbridge was a 

qualified expert witness who testified that Doctors' Center's 

nurses breached the applicable standard of care during RodríguezValentin's labor and DALR's birth. He explained why that breach 

of the standard of care caused or aggravated DALR's injuries. The 

jury was entitled to credit Dr. Halbridge's testimony over that of 

Doctors' Center's experts. The district court did not abuse its

discretion in deferring to the jury's credibility findings. 

Doctors' Center points to no facts that convince us the 

jury's verdict as to liability was against the weight of the 
- 15 -

evidence or was otherwise unjust. Indeed, the district court's 

analysis of the evidence presented at trial was accurate, 

thoughtful, and thorough, leaving us with no doubt that the 

decision was within its considerable discretion. See id. at 441.

III. Motions for a New Trial on Damages or Remittitur of 

Future Life Care Costs Award

Lastly, Doctors' Center contends that the district court 

abused its discretion by denying its motion for a new trial or 

remittitur on the ground that the jury's $12,966,000 award for 

DALR's future life care costs was excessive and unsupported by the 

evidence. Specifically, Doctors' Center argues that the award for 

future care costs should be reduced, or a new trial on damages 

granted, because Rodríguez-Valentin presented no expert testimony 

about DALR's life expectancy and because Pennachio based her

calculations on erroneous assumptions.

As with motions for a new trial on liability, appellate 

review for denial of a motion for a new trial on damages or 

remittitur under Rule 59 is for abuse of discretion. See id. at

435-36. The denial of such a motion "will be reversed only if

'the jury's verdict exceeds any rational appraisal or estimate of 

the damages that could be based on the evidence before the jury.'" 

Astro-Med, Inc. v. Nihon Kohden Am., Inc., 591 F.3d 1, 13 (1st 

Cir. 2009) (quoting Smith v. Kmart Corp., 177 F.3d 19, 29 (1st 

Cir. 1999)). When evaluating a motion for a new trial on damages, 
- 16 -

or for remittitur, the court considers the evidence in the light 

most favorable to the prevailing party. Wortley v. Camplin, 333 

F.3d 284, 297 (1st Cir. 2003).

Under Rule 59, an award for future life care costs is 

rational when it is supported by the evidence, reasonable 

inferences from that evidence, and the jury's common sense, as 

opposed to speculation or conjecture. See Astro-Med, Inc., 591 

F.3d at 13; Climent-García v. Autoridad de Transporte Marítimo y 

Las Islas Municipio, 754 F.3d 17, 23-24 (1st Cir. 2014). And a 

district court does not abuse its discretion by declining to reduce 

a jury's verdict or award a new trial where the grounds for doing 

so derive from the movant's speculation about what the jury might 

have found or what evidence not presented might have demonstrated. 

See Loan Modification Grp., Inc. v. Reed, 694 F.3d 145, 154 (1st 

Cir. 2012). Here, the jury's verdict was not beyond "any rational 

appraisal or estimate of the damages that could be based upon the 

evidence before the jury." See id. Doctors' Center's arguments 

fail to convince us otherwise.

First, Doctors' Center contends that the district court 

abused its discretion by denying its motion under Rule 59 because

Rodríguez-Valentin did not present expert testimony about DALR's 

life expectancy. Specifically, Doctors' Center argues that, under 

Puerto Rico law, an award for future care costs is speculative 

unless the plaintiff submits expert testimony about his or her 
- 17 -

life expectancy. Given the procedural posture of this case and 

waivers by Doctors' Center, as explained below, we do not reach 

the legal question of whether Puerto Rico law requires such expert 

testimony.

Doctors' Center did not timely argue to the district 

court that the jury could consider DALR's future care costs only 

by reference to expert testimony. Similarly, Doctors' Center did 

not timely argue that the jury had to make an estimate of DALR's 

life expectancy, or even that it needed to calculate DALR's future 

care costs in any particular way. Indeed, Doctors' Center's life 

expectancy argument was not part of its motion for judgment as a 

matter of law. It was neither reflected in any of Doctors' 

Center's proposed jury instructions nor posed as an objection. 

Likewise, Doctors' Center did not ask for a special verdict form 

that would have required the jury to decide or agree upon DALR's 

life expectancy. 

Instead, Doctors' Center first argued that expert 

testimony on life expectancy was required after the jury delivered 

an adverse verdict, in the context of a motion for a new trial or 

remittitur reviewable only for abuse of discretion.8 Because the 

district court had, without objection, already instructed the jury 

8 In its earlier motion in limine, Doctors' Center argued that 

Pennachio should be precluded from testifying about DALR's life 

expectancy. Doctors' Center did not argue that the jury could not 

award future costs without expert testimony about life expectancy.
- 18 -

on how to calculate damages for future life care costs, Doctors' 

Center's argument that the jury could not, as a matter of law,

return a damages award for future life care costs without expert 

testimony on life expectancy came much too late.

In other words, Doctors' Center knew before the jury was

instructed that no expert testimony had been presented on life 

expectancy and that none would be. Nonetheless, Doctors' Center 

neither moved for judgment as a matter of law on that ground nor 

offered a jury instruction asking the jury to estimate and agree 

on DALR's life expectancy or to calculate that figure in any 

particular way. See Cheshire Med. Ctr. v. W.R. Grace & Co., 49 

F.3d 26, 35-36 (1st Cir. 1995) (affirming denial of motion for a 

new trial where moving party failed to "object precisely on" the 

pertinent ground and failed to "propose[] to the trial judge an 

acceptable instruction to the jury"). And, Doctors' Center voiced 

no objection to the district court's instruction on calculating 

damages, which was, in short, to award Rodríguez-Valentin "fair 

compensation" of a "reasonable" amount to compensate her and DALR 

for physical, emotional, and economic injuries to whatever extent 

Doctors' Center was legally liable.

With no pertinent argument made by Doctors' Center

before the case was submitted to the jury, the district court's 

jury instructions are the law of the case. United States v. 

Oliver, 19 F.4th 512, 517 (1st Cir. 2021) ("Because the defendant 
- 19 -

neither objected to the district court's instructions below nor 

assigns error to them on appeal, we treat the instructions as the 

law of the case."); United States v. Kilmartin, 944 F.3d 315, 328-

29 (1st Cir. 2019) (holding that an unobjected-to jury instruction 

that is neither patently incorrect nor internally inconsistent 

becomes the law of the case); Moore v. Murphy, 47 F.3d 8, 11 (1st 

Cir. 1995) ("The failure to object to the instructions at the time, 

and in the manner, designated by Rule 51 is treated as a procedural 

default, with the result that the jury instructions, even if 

erroneous, become the law of that particular case.").

At best, we can review the district court's instructions 

on this issue for plain error. See Fed. R. Civ. P. 51(c)-(d) 

(stating when objections to jury instructions must be made and 

that the consequence for failing to timely object to a jury 

instruction is review for "plain error" that "affects substantial 

rights"); Sindi v. El-Moslimany, 896 F.3d 1, 19-20 (1st Cir. 2018) 

("It is black-letter law that claims of instructional error not 

seasonably advanced in the district court can be broached on appeal 

only for plain error."); see also P.R. Hosp. Supply, Inc. v. Boston 

Sci. Corp., 426 F.3d 503, 505 (1st Cir. 2005) ("In general, 'a 

party may not appeal from an error to which he contributed, either 

by failing to object or by affirmatively presenting to the court 

the wrong law.'"). For Doctors' Center to prevail under plain

error review, we must at least conclude that the claimed error was 
- 20 -

clear or obvious. See Sindi, 896 F.3d at 19-20; Babcock v. Gen.

Motors Corp., 299 F.3d 60, 65 (1st Cir. 2002).9

We cannot do so here. Doctors' Center offers no 

authority demonstrating that it is clearly the case under Puerto 

Rico law that a plaintiff must present expert testimony about life 

expectancy to receive damages for future care costs in a medical 

malpractice action. Although we agree with the district court 

that presenting expert testimony about life expectancy is the best 

practice in a medical malpractice case involving an uncommon and 

severe medical condition and a request for future costs, we can 

find no authority clearly establishing that such expert testimony 

is necessary to recover damages for future care costs as a matter 

of law in Puerto Rico. Rather, the only arguably relevant 

authorities offered here are the Puerto Rico Supreme Court cases

relied on by the district court in denying Doctors' Center's 

motion, Zambrana v. Hospital Santo Asilo de Damas, 9 P.R. Offic. 

Trans. 687, 692 (1980), and Suro v. E.L.A, 111 P.R. Dec. 456, 461 

(1981), which merely stand for the general principle that damages 

need not be computed with mathematical rigor or precision. 

9 As we conclude that there was no clear or obvious error, we 

need not reach the other aspects of plain error, which include 

whether the claimed error affected the appellant's substantial 

rights and "seriously impaired the fairness, integrity, or public 

reputation of judicial proceedings." Fothergill v. United States, 

566 F.3d 248, 251-52 (1st Cir. 2009).
- 21 -

Thus, if there were any error under Puerto Rico law in 

the district court's instructions on how to calculate damages, it 

was not plain. See Sindi, 896 F.3d at 19-20; Babcock, 299 F.3d at 

65. Considering those instructions, the evidence that was 

presented, and Doctors' Center's failure to timely raise its legal 

argument on the need for expert testimony on life expectancy, the 

district court did not abuse its discretion in denying the motion.

Finally, Doctors' Center takes issue with Pennachio's 

opinion about DALR's future life care costs because Pennachio did 

not discount her calculations to present value, used numbers based 

on costs in Massachusetts instead of Florida, and did not offset 

her calculations for possible contributions by insurers or the 

government. The jury, however, heard extensive evidence about 

DALR's condition and the care that he required. The district court 

allowed Doctors' Center substantial leeway in cross-examining 

Pennachio about the accuracy of her calculations.10 Doctors' 

Center's cross-examination of Pennachio included questions about 

whether she discounted her numbers to present value, whether she 

used accurate regional cost-of-living expenses, and whether she 

considered potential offsetting contributions. And Pennachio 

10 On appeal, Doctors' Center challenges the methodology of 

Pennachio's opinions and does so only in the context of a new trial 

or remittitur, as opposed to admissibility under the Federal Rules 

of Evidence. Doctors' Center does not challenge Pennachio's 

expertise.
- 22 -

explained, as one example, that her methodology did not require 

discounting her numbers to present value because the prospect of 

inflation offset the discount rate. The jury was therefore able 

to assess Pennachio's testimony, including Doctors' Center's 

criticisms of her methodology, in fashioning its damages award. 

See Casco, Inc. v. John Deere Constr. & Forestry Co., 990 F.3d 1, 

13-14 (1st Cir. 2021) (rejecting argument that a new trial or

remittitur was necessary due to claimed methodological errors by 

plaintiff's damages expert).

Doctors' Center's other arguments regarding the jury's 

damages award -- including its contention that the damages are 

excessive in light of comparable cases -- are unpersuasive and do 

not merit discussion.

At bottom, the jury's verdict was not beyond "any 

rational appraisal or estimate of the damages that could be based 

upon the evidence before the jury." Accordingly, the district 

court did not abuse its discretion in denying Doctors' Center's

motion for a new trial and, in the alternative, remittitur.

CONCLUSION

In sum, the district court did not err or abuse its 

discretion in deferring to the jury's evaluation of the evidence. 

Accordingly, the district court's order denying Doctors' Center's 

motions for judgment as a matter of law, for a new trial, or for 

remittitur is affirmed.