United States Court of Appeals

For the First Circuit

No. 23-1018

MÓNICA PÉREZ-PÉREZ, personally and in representation of her 

minor son AMCP; JOSÉ MANUEL CARABALLO-NEGRÓN, personally and in 

representation of his minor son AMCP; AMCP,

Plaintiffs, Appellants,

v.

HOSPITAL EPISCOPAL SAN LUCAS, INC., d/b/a Hospital Episcopal San 

Lucas-Ponce; DR. MARYROSE CONCEPCIÓN-GIRÓN; BEAZLEY USA 

SERVICES, INC., d/b/a Beazley Group; RICHARD DOE; CONJUGAL 

PARTNERSHIP CONCEPCIÓN-DOE; A, B AND C CORPORATIONS; 

UNKNOWN INSURANCE COMPANIES A THROUGH C,

Defendants, Appellees,

JOHN DOE 1; JOHN DOE 2; JOHN DOE 3,

Defendants.

APPEAL FROM THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF PUERTO RICO

[Hon. Jay A. García-Gregory, U.S. District Judge] 

[Hon. Marshal D. Morgan, U.S. Magistrate Judge]

Before

Barron, Chief Judge, 

Kayatta and Montecalvo, Circuit Judges.

David Efron for appellants. 

Luis A. Rodríguez Muñoz, with whom Eduardo A. Vera Ramírez
and Landrón Vera, LLC were on brief, for appellees Hospital 

Episcopal San Lucas and Beazley Insurance, Inc. 

Anselmo Irizarry Irizarry for appellee Maryrose 

Concepción-Girón. 

August 13, 2024
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Kayatta, Circuit Judge. This case is about who decides

whether a Puerto Rico statutory cap on certain medical malpractice 

damages applies to defendant Dr. Maryrose Concepción-Girón 

("Dr. Concepción"). Dr. Concepción delivered plaintiffs' baby at 

Hospital Episcopal San Lucas-Ponce ("HESL" or "the hospital"). 

The baby suffered birth injuries and plaintiffs sued, alleging 

malpractice for which they sought some $6,000,000 in damages. 

Under Puerto Rico law, though, plaintiffs' recovery would be capped 

at $150,000 if Dr. Concepción was a faculty member at HESL at the 

time of the birth.

The applicability of this statutory cap was the subject 

of much dispute below. Defendants maintained that Dr. Concepción

was indeed a member of HESL's teaching faculty at the relevant 

time, but could produce no contract to that effect. In the absence 

of a contract, the district court ordered a pretrial "evidentiary 

hearing," after which it concluded that Dr. Concepción was a 

faculty member when she delivered plaintiffs' baby, and thus was

covered by the statutory cap on medical malpractice damages. In 

so doing, the district court adopted a magistrate judge's Report 

& Recommendation ("R&R"), which stated that "[t]he applicability 

of the statutory cap is a matter of law."

Plaintiffs now appeal, arguing that the applicability of 

the statutory cap is not a matter of law but a question of fact 

and that the district court erred by deciding the issue itself 
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instead of leaving it for the jury. We agree with plaintiffs that 

the applicability of the damages cap hinges on a classic question 

of fact: whether Dr. Concepción was a member of the HESL teaching 

faculty when she delivered plaintiffs' baby. That factual question 

is not one-sided, and should have been resolved by the jury before 

the district court drew a legal conclusion about the applicability 

of the damages cap. We therefore vacate the district court's order 

declaring Dr. Concepción covered by the statutory damages cap. 

Our reasoning follows. 

I.

A.

Dr. Concepción is an OB/GYN with a private practice and 

admitting privileges at HESL. Plaintiff Mónica Pérez-Pérez 

("Pérez") began seeing Dr. Concepción in her private practice for 

prenatal care in September 2014. On April 29, 2015, when Pérez 

was nearly 41 weeks pregnant, Dr. Concepción instructed her to go 

to HESL for labor induction. There, Dr. Concepción took part in 

the delivery of Pérez's son, "AMCP." The baby suffered birth 

injuries, which plaintiffs claim stem from "negligent delivery and 

negligent care performed by Dr. Concepción and [HESL]." 

On January 11, 2018, Pérez and AMCP's father, José

Manuel Caraballo-Negrón -- by then both living in Florida -- filed 

a medical malpractice suit against HESL and Dr. Concepción in the 
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U.S. District Court for the District of Puerto Rico.1 On behalf 

of themselves and their minor son, they alleged that defendants 

had "fail[ed] to recognize that Mrs. Pérez was not a suitable 

candidate for an induction of labor" and that Dr. Concepción had 

used "persistent traction on the baby's head and neck" during the 

delivery. Plaintiffs contended that these mistakes caused the 

baby two brachial plexus injuries, "which may result in lifelong 

disabilities." Citing pain and suffering, future expenses, and 

loss of potential to generate future income, plaintiffs estimated 

AMCP's damages "at a sum in excess of $3,000,000." Plaintiffs 

also estimated the "emotional and economic damages" suffered by 

AMCP's parents "at a sum . . . in excess of $1,500,000 each."

B.

In an effort to spur the development of medical education 

and services in the Commonwealth, Puerto Rico established a number 

of Regional Academic Medical Centers ("RAMCs"): groups of 

"one . . . or more hospitals, health facilities, medical groups 

and health professionals education and training programs related 

to an accredited School of Medicine whose mission is to educate, 

conduct research and provide health services." P.R. Laws Ann. 

1 Plaintiffs also named as a defendant Beazley USA Services, 

Inc., d/b/a Beazley Group, which insured HESL at the time of the 

delivery. They additionally named "John Does 1, 2, and 3 and A, 

B, C Corporations . . . whose identities are presently unknown, 

which by their negligent acts or omissions caused or contributed 

to the damages claimed." 
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tit. 24, § 10031(b) (2006). Puerto Rico's Law 136 of July 27, 

2006 ("Law 136") caps the damages recoverable against RAMCs and 

their medical students, residents, and faculty members "for the 

medical procedures practiced in said [RAMCs] in the exercise of 

their teaching duties." Id. § 10035 (2011). 

Under Law 136, damages are limited to "$75,000 for 

damages suffered by a person and up to $150,000 when the damages 

were suffered by more than one person or when there are several 

causes for action to which a single injured party is entitled." 

Id. In cases where there are multiple defendants covered by the 

damages cap (say, a hospital and a doctor), plaintiffs may only 

recover the limit from the defendants as a group, rather than from 

each individual defendant. See Ortiz Santiago v. Hosp. Episcopal 

San Lucas, Inc., 205 P.R. Dec. 222, 236 (2020).

C.

The applicability of this statutory cap was the subject 

of much dispute below. In her answer to plaintiffs' complaint, 

Dr. Concepción asserted that she was "a faculty member of Hospital 

San Lucas' teaching staff ergo; covered by Public Law 136." The 

hospital, on the other hand, answered that Dr. Concepción "was a 

physician with privileges at the time of the events in [HESL] not 

an employee of the institution," with no assertion that she was a 

member of the teaching staff. And while the parties were preparing 

for trial, the Supreme Court of Puerto Rico held in a different 
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medical malpractice case that HESL is an RAMC within the meaning 

of Law 136 by virtue of a consortium between the hospital and Ponce 

School of Medicine. See Ortiz Santiago, 205 P.R. Dec. at 230.

Following that decision by Puerto Rico's Supreme Court, 

the parties entered settlement discussions supervised by a 

magistrate judge. While there was no disputing HESL's status as 

an RAMC, Dr. Concepción's exact role at the hospital was both murky 

and consequential for calculating damages. Defendants contended 

that the entire case would be capped at $150,000 in damages, 

claiming that Dr. Concepción had been part of HESL's medical 

faculty since 2006. Plaintiffs maintained that the cap would not 

apply to Dr. Concepción, since she was "a private doctor, working 

on a private patient, who was not acting as a part of the [m]edical 

[f]aculty of [HESL] at the time of the incident." 

Summing up the settlement discussions, the magistrate 

judge concluded that whether or not Dr. Concepción was a member of 

HESL's medical faculty in 2015 "is a question of fact that can be 

resolved by simply looking at her contract with the hospital." 

But there was one problem: "[T]he contract was not exchanged in 

discovery and its whereabouts [were] not immediately 

ascertainable." Though the court granted a continuance for 

defendants to search for the alleged contract, they were unable to 

locate it. The parties proceeded to prepare for trial, which was 

set for March 1, 2022. 
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On December 29, 2021, defendants presented what they 

claimed to be a copy of a 2006 letter from the president of Ponce 

School of Medicine (the medical school affiliated with HESL) to 

Dr. Concepción, granting her "appointment to the position of 

Clinical Instructor in the OB-GYN Department . . . effective as of 

September 1, 2006." Claiming that the appointment letter provided 

irrefutable evidence that Dr. Concepción had been a member of 

HESL's teaching faculty continuously since September 2006, 

defendants requested a hearing on whether she was covered by the 

statutory damages cap. The issue, they argued, was "a matter of 

law and not a matter for a Jury as this is not a matter of fact." 

Plaintiffs opposed the motion, arguing that it was "a matter of 

testimony and credibility," and thus should be decided by a jury. 

Over plaintiffs' objection, the district court granted 

defendants' motion for a pretrial hearing "on the sole issue of 

whether Dr. [Concepción] was a Teaching Fellow at the time of the 

acts alleged in the Complaint." It again referred the matter to 

the magistrate judge and directed defendants to "submit evidence 

at the hearing (other than the 2006 contract), whether through 

sworn statements or witness testimony, to establish 

Dr. [Concepción's] position at the hospital."2 At the hearing, 

the magistrate judge heard testimony on the structure of HESL's 

2 "[T]he 2006 contract" appears to be a reference to the 2006 

appointment letter. 
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residency program from the Director of the Graduate Program of 

Medical Education at HESL. The director testified that 

Dr. Concepción had privileges at HESL as a physician in private 

practice and was also a "voluntary faculty" member there. 

Defendants also presented as witnesses Dr. Concepción herself and 

a former OB/GYN resident at HESL who said he had assisted with 

Pérez's delivery under Dr. Concepción's supervision. Defendants 

additionally submitted as an exhibit a 2018 letter crafted by Ponce 

School of Medicine after this lawsuit was filed "certify[ing]" 

that Dr. Concepción had been a "Volunteer Faculty Instructor" in 

the OB/GYN department since 2006.

In the R&R issued after the hearing, the magistrate judge 

stated that "[p]laintiffs failed to present any evidence to support 

their position that Dr. Concepción is somehow not a member of the 

voluntary faculty at the Hospital and does not have a teaching 

faculty role at the Hospital." Deeming the defense's witnesses 

"credible," the magistrate judge found that "the evidence 

presented during the evidentiary hearing, which was 

uncontroverted, showed that, at all times relevant to the 

Complaint, and at least as far back as September 1, 2006, 

Dr. Concepción was a member of the voluntary faculty at the 

Hospital." While the magistrate judge referred to the question 

before him as "the factual question of whether [Dr. Concepción] 

was a member of the teaching faculty of [HESL] at the time of the 
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acts alleged in the complaint," he also stated that "[t]he 

applicability of the statutory cap is a matter of law." 

Plaintiffs objected to the R&R, again arguing that 

whether Dr. Concepción was a member of the volunteer faculty was 

a factual question "within the province of the Jury" and that the 

R&R had inappropriately shifted the burden away from defendants. 

Over these objections, the district court adopted the magistrate 

judge's R&R in full, finding that Dr. Concepción "was a member of 

the teaching faculty of [HESL] during the relevant time and is, 

therefore, covered by the statutory cap on damages under 

[Law 136]." In addition to "the lack of evidence to the contrary," 

the court was persuaded by the February 2018 certification, which 

"implie[d] she ha[d] been a faculty member in the residency program 

uninterruptedly" from 2006-2018, and testimony that Dr. Concepción

was supervising medical residents during Pérez's delivery. 

Plaintiffs, the district court concluded, "ha[d] not shown the 

existence of a genuine issue of fact that would require that the 

matter be submitted to a jury."

Following the district court's order, the parties 

entered into a "high-low" agreement in which they settled, but 

plaintiffs "reserve[d], preserve[d] and maintain[ed] their rights 

to appeal" the district court's order.3 To that end, the parties

3 Though the parties have reached a settlement agreement, 

the case presents a live issue because "[t]he limited 
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stipulated that the questions presented on appeal would be 

(1) whether the district court erred by holding an evidentiary 

hearing to decide the applicability of the liability cap and 

(2) whether the district court erred in finding factually that the 

liability cap applied. They agreed that defendants would pay 

plaintiffs an additional $250,000 if this court finds in favor of 

plaintiffs and remands the case. This appeal ensued. 

II.

The district court essentially concluded that there was 

no genuine issue of material fact concerning Dr. Concepción's 

status as a member of HESL's teaching faculty. The order thus 

resembles a partial grant of summary judgment in favor of 

defendants. See Fed. R. Civ. P. 56(a). Given this resemblance, 

we review the district court's decision de novo. See Alberty-Vélez

v. Corporación de P.R. para la Difusión Pública, 242 F.3d 418, 422 

(1st Cir. 2001) ("draw[ing] on the law applicable to [partial 

summary judgment] orders" to "guide . . . analysis" of a pretrial 

order narrowing the scope of trial, since the two types of orders 

serve similar functions). 

agreement . . . left both [parties] with a considerable financial 

stake in the resolution of the question presented in this Court." 

Nixon v. Fitzgerald, 457 U.S. 731, 744 (1982).
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III.

A.

The Supreme Court has long noted "the vexing nature of 

the distinction between questions of fact and questions of law." 

Pullman–Standard v. Swint, 456 U.S. 273, 288 (1982). It has not 

articulated any "rule or principle that will unerringly 

distinguish a factual finding from a legal conclusion." Id. 

Adding to the confusion is that many questions do not fall neatly 

to one side of the law/fact binary. The applicability of the 

statutory cap in this case touches on both legal and factual 

elements. Nonetheless, for the reasons that follow, we hold that 

the threshold determination of Dr. Concepción's relationship with 

HESL in 2015 is a question of fact requiring a jury finding. 

B.

Courts frequently confront questions that contain both 

factual and legal elements. For example, in Torres Vargas v. 

Santiago Cummings, our circuit parsed the legal and factual aspects 

of an immunity dispute closely related to the one now before us. 

149 F.3d 29 (1st Cir. 1998). The issue was whether an 

anesthesiologist accused of malpractice was an employee of the 

Puerto Rico Department of Health and thus immune from suit as a 

Commonwealth employee. Id. at 31. 

At the time, Puerto Rico law provided that: 
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No health service professional may be included 

as a defendant in a civil suit for damages due 

to malpractice caused in the performance of 

his profession while said health service 

professional acts in compliance with his/her 

duties and functions as an employee of the 

Commonwealth of Puerto Rico, its dependencies, 

instrumentalities and municipalities.

P.R. Laws Ann. tit. 26, § 4105 (1996) (emphasis added)). The 

Puerto Rico Supreme Court had also made clear that physicians who 

were merely independent contractors of the Commonwealth were not 

entitled to immunity under section 4105. See Nieves v. Univ. of 

P.R., 7 F.3d 270, 279 (1st Cir. 1993) (construing Flores Román v. 

Ramos Gonzalez, 127 P.R. Dec. 601, 611 (1990)). 

In response to the malpractice allegations against him, 

the anesthesiologist in Torres Vargas moved for summary judgment 

claiming that section 4105 immunized him from suit. 149 F.3d at 

31. Attempting to prove his employment, the doctor provided his 

contract with the Health Department. The contract obligated him 

to render services each weekday at a government hospital for one 

year, but did not contain the types of compensation and benefits 

agreements "characteristic of a modern employer-employee 

relationship." Id. at 34. Plaintiffs argued that the contract 

established either that the anesthesiologist was an independent 

contractor for the Health Department (and thus outside the 

protections of the statute) or that his employment status was a 

question of fact for trial. Id. at 31. 
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Though the district court granted summary judgment to 

the anesthesiologist, this court vacated the judgment. Id. at 36. 

The contract "by itself," we concluded, did "not support the 

district court's finding that as a matter of law the defendant was 

an employee of the Commonwealth entitled to immunity under 

section 4105." Id. at 35. Rather, while the threshold question 

of whether the contract was ambiguous "present[ed] a question of 

law for the judge," the evaluation of "extrinsic evidence relevant 

to the interpretation" of the contract presented questions of fact 

that precluded summary judgment. Id. at 33 (internal quotations 

omitted). To that end, we explained that the contract was a "mixed 

bag": Some of its features suggested that the doctor was an 

employee of the Commonwealth, but others -- including the extent 

to which he was under the control of the Health Department --

"remain[ed] very much open to debate." Id. at 35. Because "the 

call [was] not free from doubt," and required "probative evidence 

of the facts," summary judgment was inappropriate. Id. at 34, 35. 

A similar conclusion fits here, even more snuggly. In 

theory, whether one is a faculty member performing a teaching duty 

within the meaning of Law 136 is a mixed question of fact and law. 

Factually, what is the agreed-upon relationship with the hospital, 

and what was the person doing on the relevant occasion? Legally, 

is that relationship that of a "faculty member" within the meaning 

of the statute, and is certain conduct "teaching"? Here, though, 
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we have a simpler case. No one disputes the legal test for 

determining whether a given person is a faculty member covered by 

the statute's limitation on damages, or that all members of the 

hospital's faculty meet that test. The dispute, instead, trained 

on whether Dr. Concepción was in fact a member of the hospital's 

faculty in April of 2015. As so presented, the issue is one to be 

decided as a matter of fact. 

Of course, if the evidence on a factual issue is so 

one-sided that there is no room for reasonable dispute, a court 

can decide the issue, for example by granting summary judgment. 

But "summary judgment will not lie if the dispute about a material 

fact is 'genuine,' that is, if the evidence is such that a 

reasonable jury could return a verdict for the nonmoving party." 

Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). We 

find that the factual dispute about Dr. Concepción's status at the 

hospital is genuine under this standard. 

On the one hand, Dr. Concepción has presented testimony 

that her employment as a volunteer faculty member at HESL began in 

2006 and continued uninterrupted through the evidentiary hearing 

in May 2022. She pointed to the two letters from Ponce School of 

Medicine as documentation of her status as a faculty member. She

also presented testimony from several witnesses associated with 

the hospital stating that she was a faculty member. 
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On the other hand, the hospital's initial description of 

Dr. Concepción made no mention of her status as a faculty member, 

the 2006 letter was belatedly produced under circumstances that 

could be seen as raising a question about its authenticity and 

applicability to 2015, and the 2018 "certification" letter was 

crafted and produced only after this litigation began. 

Furthermore, the two letters are inconsistent regarding 

Dr. Concepción's title. While the 2006 letter appoints her "to 

the position of Clinical Instructor," the 2018 letter certifies 

that she has been a "Volunteer Faculty Instructor" since 2006.

And finally, no actual contract was ever produced, even though 

Dr. Concepción testified that she signed one every year to 

"continue[]" her "voluntary status" with the residency program.

The magistrate judge and the district court found that 

this evidence as a whole cut in the defendants' favor. In so 

finding, the magistrate judge and the district court found 

Dr. Concepción and her witnesses "credible" and the absence of 

opposing witnesses telling. Our task is not to decide whether 

these findings were correct. Rather, the pivotal question is 

whether a reasonable jury could conclude otherwise. 

The answer is yes. The absence of evidence affirmatively 

showing that Dr. Concepción is not a faculty member is not 

dispositive. The burden to prove the applicability of the cap was 
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on the defendants.4 And in any event, one charged with proving a 

negative often relies on simply disproving the affirmative. We 

agree, too, that a reasonable factfinder could share the magistrate 

judge's view that the absence of any contract when contracts were 

claimed to have been used annually was "curious" -- enough so to 

provide a basis for a contrary finding if the factfinder did not 

find the witnesses credible. All in all, we are convinced that 

the evidence was not one-sided enough to compel the district

court's conclusion that Dr. Concepción held a teaching position at 

the hospital. 

C.

Having found that whether Dr. Concepción was a member of 

HESL's volunteer faculty at the time of AMCP's birth was a question 

of fact that could be resolved either way, we must conclude that 

it was improperly taken from the jury. Though Puerto Rico does 

not use juries for civil questions, it is well established that 

the Seventh Amendment "most decidedly affords litigants in federal 

court in Puerto Rico the right to trial by jury." Marshall v. 

Perez Arzuaga, 828 F.2d 845, 849 (1st Cir. 1987) (citing LaForest

v. Autoridad de las Fuentes Fluviales de P.R., 536 F.2d 443, 446–

4 The damages cap, like the section 4105 immunity discussed 

in Torres Vargas, is an affirmative defense. As in Torres Vargas, 

then, "the defendant bears the burden of establishing its 

applicability." 149 F.3d at 35. As such, it is Dr. Concepción's 

burden to show that she is covered by the cap.
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47 (1st Cir. 1976)). Even in diversity cases applying Commonwealth 

law, then, "it is federal law that must control the division of 

responsibility between judge and jury." Id.

Heeding the "command" of the Seventh Amendment, federal 

law "assigns the decisions of disputed questions of fact to the 

jury." Byrd v. Blue Ridge Rural Elec. Co-op., Inc., 356 U.S. 525, 

537 (1958). To that end, district courts are "not free to weigh 

the parties' evidence or the reasonable inferences that might be 

drawn from that evidence by the jury." 9B Charles Alan Wright & 

Arthur R. Miller, Federal Practice and Procedure § 2524 (3d ed. 

2024). Rather, "[c]redibility determinations, the weighing of the 

evidence, and the drawing of legitimate inferences from the facts 

are jury functions, not those of a judge." Anderson, 477 U.S. at 

255.5 

Given these parameters, we find that in weighing the 

evidence and making credibility findings, the district court

veered into territory reserved for juries. 

IV.

For the foregoing reasons we vacate the order declaring 

defendants covered by the statutory damages cap and remand the 

5 Courts may, however, decide without a jury "any preliminary 

question about whether a witness is qualified, a privilege exists, 

or evidence is admissible." Fed. R. Evid. 104(a). The dispute 

over Dr. Concepción's status at the hospital does not fall under 

this carveout because its resolution goes directly to the merits 

of the case. 
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matter for proceedings consistent with this opinion. The parties 

shall bear their own costs.