Court Opinion

ID: 2964705
Source: CourtListenerOpinion
Date Created: 2015-09-21 21:29:55.078217+00
Date Added: 2024-06-11T11:42:59.958373
License: Public Domain

USCA1 Opinion

	

                                [Not For Publication]
                            United States Court of Appeals
                                For the First Circuit
                                 ____________________

        No. 96-1702

                             MARIA M. LOPEZ-DE ROBINSON,

                                Plaintiff, Appellant,
                                          v.

                              UNITED STATES OF AMERICA,
                                 Defendant, Appellee.

                                 ____________________
                     APPEAL FROM THE UNITED STATES DISTRICT COURT

                           FOR THE DISTRICT OF PUERTO RICO

                    [Hon. Jaime Pieras, Jr., U.S. District Judge]
                                             ___________________
                                 ____________________

                                        Before
                                Selya, Circuit Judge,
                                       _____________

                            Coffin, Senior Circuit Judge,
                                    ____________________

                              and Lynch, Circuit Judge.
                                         _____________
                                 ____________________

            Raul  Barrera  Morales  with  whom  Jesus  Hernandez  Sanchez  and
            ______________________              _________________________
        Hernandez Sanchez Law Firm were on brief, for appellant.
        __________________________

            Fidel  A.  Sevillano  Del Rio,  Assistant United  States Attorney,
            _____________________________
        with  whom Guillermo  Gil, United  States Attorney,  was on  brief for
                   ______________
        appellee.

                                 ____________________

                                     MAY 13, 1997
                                 ____________________

                      Per Curiam.   Plaintiff, a widow,  appeals from the
                      Per Curiam.   
                      __________

            district court's award of $50 thousand under the Federal Tort

            Claims Act (FTCA),  28 U.S.C.    2671  et seq., to compensate

            her for pain and suffering due to the failure of the Veterans

            Administration Hospital in San Juan  to admit her ill husband

            a few days prior to his death.  She seeks additional damages,

            arguing that several of the district court's factual findings

            are clearly erroneous.  She  takes particular issue with  the

            court's  finding that prompt  hospitalization would  not have

            saved her husband's  life.   She also argues  that the  court

            erred  in concluding that  her late husband's  estate was not

            entitled  to any recovery because it was not properly a party

            to the suit.

                                          I

                      We recite the facts as found by the  district court

            after the three-day bench trial. In May 1989, Vance Robinson,

            a 64-year-old veteran, visited  Dr. Luis Marrero, who ordered

            laboratory  tests.   The  tests suggested  that Robinson  had

            liver cancer.

                      On  Friday, July 7,  1989, Robinson went  to the VA

            Hospital  in San  Juan  complaining of  a  host of  symptoms,

            including  a  grossly enlarged  abdomen  (ascites)  and acute

            stomach  pains.   The intake  physician, Dr.  Sylvia Fuertes,

            diagnosed Robinson as having  ascites and an occult neoplasm,

            but did not note the ascites on his medical record.   She did

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            not believe that  Robinson's case was  an emergency, but  she

            recommended that  he be  admitted immediately as  an elective

            admission.  There were no available beds, however, and so she

            told Robinson to return on Monday.

                      Robinson  went to  the  admissions  office  of  the

            hospital on Monday at 9:00 a.m.   He was not re-examined.  He

            waited  there  all  day, but  was  told  there  were no  beds

            available.  The same thing happened on Tuesday. That evening,

            Robinson  was taken  to  the  emergency  room  at  San  Pablo

            Hospital,  where he was admitted as a patient.  The diagnosis

            was  ascites, suspected liver cancer, anemia and hepato-renal

            syndrome.   A  CT  scan revealed  an  enlarged liver  due  to

            lesions suggestive of metastatic cancer.

                      On July  18, Robinson  discharged himself  from the

            hospital.   He  died  the  next  day.   No  biopsy  was  ever

            performed to confirm the diagnosis of suspected liver cancer,

            and no autopsy  was performed at  the time  of death.   Liver

            cancer  was listed  as  the  cause  of  death  on  the  death

            certificate.

                      Robinson's  widow,  the  plaintiff  here,  filed an

            administrative claim  in her  name against the  United States

            with  the  Department of  Veterans  Affairs.   The  claim was

            denied, and she filed a complaint in federal court within six

            months.

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                      Over  two years  after Robinson's  death, plaintiff

            had the body exhumed so that Dr. Yocasta Brugel could prepare

            a  forensic report.  Dr.  Brugel indicated that  she found no

            evidence  of liver  cancer  and  that  Robinson had  died  of

            myocarditis,  a  rare heart  ailment  which  seldom leads  to

            death.    The  autopsy  was admitted  into  evidence  without

            objection.   However, Dr. Brugel  did not appear  at trial to

            testify.   The district  court found that  either the autopsy

            report was  totally unreliable, or, in  the alternative, that

            the  autopsy  had  been   performed  on  someone  other  than

            Robinson.  The court also found  that the slides of the liver

            on  which the report was  based were not  those of Robinson's

            liver.

                      The  district court  concluded that  the hospital's

            failure  to admit Robinson on Friday  evening did not violate

            acceptable  medical  standards.    However,  it   found  that

            Robinson should have been re-examined when he returned to the

            hospital on  Monday, to  ensure that  his  condition had  not

            deteriorated  to emergency  status, and  concluded  that this

            omission did violate acceptable  medical standards and caused

            pain  and suffering to Robinson and his wife.  The court also

            found  that admitting  Robinson  to the  hospital on  Friday,

            Monday or Tuesday  would not  have saved his  life but  would

            have  permitted palliative  treatment  to ease  his pain  and

            suffering.

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                      The court awarded  plaintiff $50  thousand for  her

            pain  and suffering  as she  watched her  husband's condition

            deteriorate  during  the three  days  before  he was  finally

            admitted to a  hospital.  The  district court also  indicated

            that it  would have  awarded an  additional $50  thousand for

            Robinson's pain and suffering if his estate had been named as

            a plaintiff.

                      Plaintiff appeals on  several grounds.  She  argues

            that  the district  court's  finding that  the VA  Hospital's

            failure  to  admit Robinson  was not  the  cause of  death is

            clearly erroneous,  as was the district  court's finding that

            the autopsy report  was totally unreliable.   She also argues

            that  the court erred in refusing to award pain and suffering

            damages  to the  decedent's estate:  she contends  that under

            Puerto  Rico law, when a man dies intestate (as did Robinson)

            his widow and children are his heirs.  She concludes that she

            and  her  sons  should  have received  the  $50  thousand the

            district court indicated it would have awarded for Robinson's

            pain and suffering.

                                          II

            Factual Findings
            ________________

                      We review the district court's findings of fact for

            clear error.  Irving v. United States, 49 F.3d  830, 835 (1st
                          ______    _____________

            Cir. 1995);  see also Fed. R.  Civ. P. 52(a).   In this case,
                         ________

            there  is a significant amount  of support in  the record for

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            the  district court's factual determinations, which therefore

            are not clearly erroneous.

                      The  district court's  finding that  the hospital's

            failure to  admit Robinson was not the  cause of his death is

            supported by  the testimony  of Dr. Figueroa,  the government

            expert  in cardiology.  He testified that, in his opinion, at

            the time Robinson went  to the VA  Hospital on July 7,  there

            was nothing that could have  been done to prevent  Robinson's

            death on the 18th; at that point the hospital could have done

            nothing more than to have made him comfortable.

                      There is  also evidence in support  of the district

            court's conclusion that  the autopsy report was  not based on

            an examination of Robinson's liver.  The liver from which the

            slides were taken was of  normal size, while Robinson's liver

            had  been  enlarged.   The  slides  of  the  liver showed  no

            evidence of  severe liver disease such  as metastatic cancer.

            Instead,  they indicated a  fatty liver, a  much less serious

            condition.   However, all of the clinical data indicated that

            Robinson was suffering from severe liver  disease at the time

            he died.    The  testimony  of  Dr.  Marrero  indicates  that

            Robinson  likely had  severe liver  disease as  early as  May

            1989.    Dr. Ramirez,  the  government  expert in  pathology,

            testified that  there  was ample  clinical, radiological  and

            laboratory evidence that Robinson suffered from severe  liver

            disease,  but that  there was  no indication  of this  in the

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                                          6

            autopsy  slides.   Furthermore,  Dr.  Ramirez  testified that

            descriptions in the  autopsy report of other organs  were not

            what  one  would  have  expected  given  Robinson's   medical

            history.   For example,  Robinson  had dilated  veins in  his

            esophagus butthere wasno mention ofthis in theautopsy report.

            Exhaustion of Administrative Remedies
            _____________________________________

                      The  district court  held that  it could  not award

            damages for Robinson's pain  and suffering because his estate

            did not present a  claim to the proper administrative  agency

            and therefore  did not exhaust  its administrative  remedies.

            Review of this  legal conclusion is de novo.   Roche v. Royal
                                                           _____    _____

            Bank of Canada, 109 F.3d 820, 827 (1st Cir. 1997).
            ______________

                      The  Federal  Tort  Claims Act  provides  that  "no

            action shall  be instituted upon  a claim against  the United

            States . . .  unless the claimant shall  have first presented

            the claim  to the  appropriate Federal  agency and his  claim

            shall have been finally denied . . . ."  28 U.S.C.   2675(a).

            In this case the  appropriate agency is the Veterans  Affairs

            Department.

                      The  determination  of  when   a  claim  is  deemed

            presented  is made  pursuant  to  federal regulations,  which

            require  the  submission  of  written   notification  of  the

            incident and a claim for money damages in a  specific sum. 28

            C.F.R.    14.2(a).  The  purpose is to  encourage settlement:

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            if the agency knows exactly what the claimant seeks, there is

            more likely to be a settlement.

                      Plaintiff  filed an  administrative claim  with the

            Department  of  Veterans  Affairs  in  which  she  identified

            herself  but not her late husband's estate as claimant.1  She

            now  argues that  this satisfied  the exhaustion  requirement

            with  respect to both her claims and  those of the estate.  A

            similar argument was rejected in  Estate of Santos v.  United
                                              ________________     ______

            States, 525 F. Supp. 982, 986 (D.P.R. 1981).  The court there
            ______

            held that each person seeking personal damages under the FTCA

            must file an individual claim, and  that a claim must put the

            agency on notice of  who was actually pursuing the  claim and

            the amount  of the  claim.   Id.; see also  Adames Mendez  v.
                                         ___  ________  _____________

            United States,  652 F. Supp.  356, 358 (D.P.R.  1987), aff'd,
            _____________                                          _____

            873 F.2d 1432  (1st Cir.  1989) (tbl.); Del  Valle Rivera  v.
                                                    _________________

            United States, 626 F. Supp. 347, 348-49 (D.P.R. 1986).
            _____________

                      We agree.   Allowing one claimant's   exhaustion of

            her  administrative   remedies  to  satisfy   the  exhaustion

            requirement  for  other  possible  claimants  would  make  it

            extremely difficult for the  agency to know the value  of the

            suit, thus making settlement less  likely.  Del Valle Rivera,
                                                        ________________

            626 F. Supp. at 348-49.

                      The decision of the district court is affirmed.
                                                            ________

                                
            ____________________

            1.  The  administrative   claim  was  not  included   in  the
            appellate record, but counsel  conceded at oral argument that
            Robinson's estate was not named as a claimant.

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