Opinion ID: 198066
Heading Depth: 2
Heading Rank: 1

Heading: The MHPLIA. The MHPLIA provides:

Text: 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. The Puerto Rico Supreme Court has construed the MHPLIA as containing three fundamental requirements for immunity: (1) [the person who furnishes the service] must be a health care professional; (2) the harm caused by his malpractice must have taken place in the practice of his profession; and, (3) he must have acted in compliance with his duties and functions as an employee of the Commonwealth of Puerto Rico, its agencies, instrumentalities, and municipalities. Flores Romn v. Ramos Gonzlez, 90 J.T.S. 132 (P.R. 1990) (official translation, slip op. at 3-4). The third requirement that an immunity-seeking health care provider must be an employee of the Commonwealth often presents the crucial area of inquiry. See id. at 5. So it is here: Santiago is a licensed physician and the plaintiffs' complaint alleges that he committed malpractice whilst practicing his profession. Thus, the critical question relates to his employment status. One seemingly reasonable way of answering this question would be simply to segregate full-time government physicians from part-timers, designating the former employees and the later independent contractors. This solution cannot be countenanced, however, for the MHPLIA has been interpreted authoritatively to protect not only physicians who hold full-time career positions with agencies of the Commonwealth, but also physicians who, though engaged in private practice, function part-time as government employees and who, while acting in that capacity, commit alleged malpractice. See Lind Rodriguez v. E.L.A., 12 P.R. Offic. Trans. 85, 87, 112 P.R. Dec. 67, 68 (1982). In search of a principled approach to determining which physicians are entitled to protection under section 4105, we previously parsed Puerto Rico precedents and gleaned the factors to be weighed in determining whether a physician is to be regarded as an independent contractor (and, thus, beyond the prophylaxis afforded by the statute). See Nieves v. University of Puerto Rico, 7 F.3d 270 (1st Cir. 1993). It was indicative of independent contractor status, we wrote, if the physician (1) earned compensation on a per-patient basis, rather than a flat salary; (2) received no fringe benefits of a type given to the principal's employees (e.g., vacation or sick leave, pension benefits, tax withholding); (3) personally owned, invested in, or paid for the medical equipment and supplies used to treat patients, or the facilities which formed the situs of that treatment, or personally hired and supervised her own administrative or subsidiary medical personnel; (4) held and paid for her own medical malpractice insurance policy; or (5) exercised final judgment as to the appropriate medical treatment to render to patients. Id. at 279. By contrast, it would be indicative of employee status if a health care provider (1) received a flat salary regardless of the number of patients seen or procedures performed, (2) received vacation time, sick leave, and other customary fringe benefits, (3) used only the government's facilities, equipment, supplies, and personnel in rendering services, (4) received protection against malpractice suits at the employer's expense, and (5) enjoyed relatively little autonomy in practice management. See, e.g., Rivera v. Hospital Universitario, 762 F. Supp. 15, 17-18 (D.P.R. 1991). Of course, these factors are merely signposts. They are not of equal import: in performing the necessary triage, the principal focus should be on the level of control contractually reserved to the governmental entity over the physician's provision of patient services. Nieves, 7 F.3d at 279. Moreover, no single factor possesses talismanic significance. In the last analysis, a status determination in a particular case inevitably hinges on the totality of the circumstances. See id. Therefore, an inquiring court must examine each physician's contract and the surrounding circumstances to determine whether, according to the contract terms and other relevant evidence, the particular physician ranks as an employee of the government agency or other governmental instrumentality. See Flores Romn, slip op. at 5-6.