Court Opinion

ID: 2963592
Source: CourtListenerOpinion
Date Created: 2015-09-21 21:12:32.415477+00
Date Added: 2024-06-11T11:42:43.601092
License: Public Domain

USCA1 Opinion

	

                            United States Court of Appeals
                            United States Court of Appeals
                                For the First Circuit
                                For the First Circuit
                                 ____________________

        No. 95-1218

                           MARY E. FEDERICO, ETC., ET AL.,

                               Plaintiffs, Appellants,

                                          v.

                       ORDER OF SAINT BENEDICT IN RHODE ISLAND,

                                 Defendant, Appellee.

                                 ____________________

                     APPEAL FROM THE UNITED STATES DISTRICT COURT

                           FOR THE DISTRICT OF RHODE ISLAND

                     [Hon. Ernest C. Torres, U.S. District Judge]
                                             ___________________

                                 ____________________

                                        Before

                                Torruella, Chief Judge,
                                           ___________
                          Boudin and Stahl, Circuit Judges,
                                            ______________

                                 ____________________

            Dennis J. Roberts II for appellants.
            ____________________
            Michael G. Sarli, with whom Gidley,  Sarli & Marusak was  on brief
            ________________            ________________________
        for appellee.

                                 ____________________

                                   August 29, 1995
                                 ____________________

                      STAHL, Circuit  Judge.   After John  Federico, Jr.,
                      STAHL, Circuit  Judge.
                             ______________

            died  at the  defendant  school,  his  parents  brought  this

            wrongful death action.   Following a thirteen-day  trial, the

            jury  returned a  verdict  in  favor of  the  defendant.   On

            appeal, the  principal issue  is whether  the district  court

            misconceived the scope  of the duty  owed under Rhode  Island

            law  by a  boarding school  to one  of  its students.   After

            careful review,  we determine  that there  was  no error  and

            therefore affirm.

                                          I.
                                          I.
                                          __

                          FACTUAL AND PROCEDURAL BACKGROUND
                          FACTUAL AND PROCEDURAL BACKGROUND
                          _________________________________

                      John Federico, Jr. ("John"), was a sixteen-year-old

            boarding student at defendant  Portsmouth Abbey School  ("the

            school").  The school operated a full-time infirmary, staffed

            by the director of medical services, Pamela Gorman, R.N., and

            a licensed practical  nurse.  The school also  retained, on a

            part-time  basis,  Dr.  Robert  Koterbay,  a  board-certified

            pediatrician, as school physician.  

                      As   a  young  child,  doctors  diagnosed  John  as

            asthmatic  with  a severe  allergy  to  nuts.   The  school's

            medical  staff knew about  John's medical condition.   John's

            father   ("John  Sr.")   --   a   pediatrician  --   actively

            participated in John's medical care.  John Sr. arranged for a

            Pulmo-Aid machine to  be kept in John's room.   However, John

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                                          2

            Sr. apparently rejected  the advice of John's  allergist that

            epinephrine1  in  a  self-administered  form  be  immediately

            available to him.  

                      The events underlying  this case all took  place on

            the evening  of  February  26,  1993.   John's  dorm  parent,

            Stephen Carter, held an end-of-term party and ordered Chinese

            food from a  local restaurant.  Carter and  his wife, Deidre,

            lived in  an apartment attached  to John's dormitory.   John,

            who was known  to be very  careful about his  diet, ate  only

            broccoli and  rice.  The food did not  appear to have nuts in

            it.  At  9:30 p.m., the students were  excused and instructed

            to return to the  dorm at 10:00 p.m. for prayers.   John went

            to an  area behind  the student center,  used by  students to

            smoke  cigarettes.  John remarked to  another student that "I

            just don't feel well."   John smoked one-half of a cigarette.

                      At about 9:45 p.m., John  returned to the dorm.  At

            about 9:50 p.m., John knocked on  the Carter's apartment door

            saying in a wheezy, high-pitched  voice, "Hello -- help me --

            I'm having  an asthma attack."   John was blue  and breathing

            with difficulty.  Mrs. Carter assisted him to the sofa of the

            apartment, and then called out "Emergency -- John Federico is

            having   an  asthma  attack  --  someone  get  his  inhaler."

            Students  came in  with one  or more  inhalers.   Mrs. Carter

                                
            ____________________

            1.  Epinephrine (adrenaline) is used as a muscle relaxant.

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                                          3

            attempted to reach the infirmary  on the telephone.  The line

            was  busy.  Mr. Carter then arrived.   He immediately went to

            the infirmary to get help.  

                      Arriving at  the infirmary, Mr.  Carter told  Nurse

            Gorman that  John was having  a severe asthma attack.   Nurse

            Gorman took John's chart and an oxygen tank to the dorm.  She

            did  not take an emergency medical kit containing epinephrine

            and  a syringe.   She  instructed  another infirmary  worker,

            Sister  Frances (a  licensed practical  nurse),  to call  the

            rescue  squad.   However, Nurse  Gorman  did not  tell Sister

            Frances to call Dr. Koterbay.

                      Before   Nurse   Gorman  arrived   at   the  Carter

            apartment, another student brought  the Pulmo-Aid machine  to

            John,  but John could  not grab it.   Brian Bordeau, a senior

            student  prefect in John's  dormitory, arrived in  the Carter

            apartment at about  9:55 p.m.  At this point,  John was lying

            on a couch down with vomitus coming from his  mouth.  Bordeau

            -- trained  in CPR  -- noted  a pulse of  twelve per  fifteen

            seconds.  Nurse Gorman then  arrived.  Bordeau advised her of

            the pulse rate and then left.  Nurse Gorman  noted that  John

            was  no longer  breathing.   Because of  the large  amount of

            material  in John's  airways, Nurse  Gorman  could not  clear

            them.    She  also  unsuccessfully  attempted  mouth-to-mouth

            resuscitation.  Nurse  Gorman asked Mrs.  Carter to get  John

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                                          4

            Perreira, a teacher, athletic trainer, and dorm parent from a

            nearby dorm.  

                      When Perreira arrived, Nurse  Gorman was attempting

            to ventilate  John.  Perreira  tried to find  a pulse and  --

            when he was uncertain about  having found one -- removed John

            to the floor to  begin CPR.  At 10:02 p.m.,  the rescue squad

            arrived and took over John's care.   Rescue efforts continued

            briefly in the apartment.  None of the rescuers could get air

            in John's chest or revive him.

                      After  the rescue squad removed John to the Newport

            hospital, Nurse Gorman called Dr. Koterbay.  At the hospital,

            doctors  administered  intravenous  epinephrine.    An  x-ray

            showed that John  was suffering from tension  pneumothorax, a

            condition  where air  has  lodged between  the lungs  and the

            lining of  the chest  cavity.   The emergency room  physician

            vacated the air.  John was pronounced dead at 10:50 p.m.  

                      Subsequently,   John's   parents   commenced   this

            diversity-based wrongful death action.  A thirteen-day  trial

            ensued,  during  which  both  parties  presented  conflicting

            expert  testimony.   The plaintiffs  presented  two pediatric

            allergists  who testified that John suffered from an allergy-

            induced  anaphylactic shock  reaction,  which  -- perhaps  in

            combination with asthma  -- led to his death.   These experts

            testified that epinephrine  reverses the shock and  opens the

            airways, and that had it  been administered in the  apartment

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                                          5

            or  when Nurse  Gorman arrived,  it  would have  reversed the

            shock and permitted John to survive.  

                      The plaintiffs also  presented another expert,  the

            chief  of  pediatric  pulmonology  at  Massachusetts  General

            Hospital, who  agreed that  John  suffered from  anaphylaxis,

            specifically  testifying that  John  had  not  suffered  from

            pneumothorax.   The court  did not  permit the  plaintiffs to

            present  expert testimony  with  regard  to national  nursing

            standards  and   standards  regarding   the  development   of

            individualized emergency care.

                      The  school's  experts included  a  board-certified

            pulmonologist, who  testified that  John's symptoms  indicate

            that he could  have suffered a tension  pneumothorax and that

            this was the cause of his death.   This expert also testified

            that epinephrine would  not have reversed  the condition.   A

            board-certified  emergency room  doctor  also testified  that

            Nurse Gorman, confronted with  a case of cardiac arrest,  met

            the standards for emergency  care by attempting to  clear the

            airways in  order to perform CPR.   A third expert,  a board-

            certified  pediatrician, testified  that  even  if  John  was

            suffering from  anaphylactic shock,  by the  time that  Nurse

            Gorman   arrived  on   the  scene,   the  administration   of

            epinephrine  would not have  changed the outcome  inasmuch as

            John  was at  that point  suffering  from vascular  collapse.

            Additionally,  Dr.  Koterbay   testified  that  Nurse  Gorman

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                                          6

            followed his  orders and acted appropriately  when confronted

            with a situation constituting cardiac arrest.  

                      Following  the   jury  verdict   for  the   school,

            plaintiff filed a motion for  new trial pursuant Fed. R. Civ.

            P.  59.   The district  court  denied this  motion by  margin

            order.  This appeal ensued.

                                         II.
                                         II.
                                         ___

                                      DISCUSSION
                                      DISCUSSION
                                      __________

                      Although not  altogether clear  from their  briefs,

            the  plaintiffs appear  to  argue  that  the  district  court

            committed error  by instructing the  jury to apply  an overly

            narrow  -- and  thus, erroneous  --  interpretation of  Rhode

            Island tort law.  The plaintiffs also argue that the district

            court abused  its discretion when  it refused to grant  a new

            trial.  We discuss each issue separately.2  

                                
            ____________________

            2.  The  plaintiffs also objected,  and now assign  error, to
            the district court's instruction that:

                      Under Rhode Island  law, epinephrine is a
                      drug  that   may  be   administered  only
                      pursuant  through  the   prescription  or
                      order    of    a    licensed   physician.
                      Consequently,  a  nurse cannot  be  found
                      negligent  for   failing  to   administer
                      epinephrine  in  the  absence of  such  a
                      prescription or order  unless she somehow
                      was responsible  for the  absence of  the
                      prescription or order.

                      The plaintiffs argue that the language of the Rhode
            Island   statute   governing  nursing   standards   impliedly
            authorized  Gorman  to  administer epinephrine.    We  do not
            agree.  Rhode  Island law is clear  as to who  may administer
            controlled substances and  Gorman, as a registered  nurse and

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                                          7

            A.  Jury Instructions
            _____________________

                      We first set out the  legal framework.  An error in

            jury instructions warrants  reversal of a judgment  "`only if

            the error is determined to  have been prejudicial, based on a

            review of  the  record  [in  its entirety].'"    Kelliher  v.
                                                             ________

            General  Transp. Servs.,  Inc., 29  F.3d 750,  752  (1st Cir.
            ______________________________

            1994) (quoting Davet v. Maccarone,  973 F.2d 22, 26 (1st Cir.
                           _____    _________

            1992)).    Thus,  the plaintiffs  must  demonstrate  that the

            charge  was erroneous  and that  the  error was  prejudicial.

            Connors  v. McNulty,  697 F.2d  18, 21  (1st Cir. 1983).   We
            _______     _______

            examine   jury  instructions   to   determine  whether   they

            adequately  explained the  law  or  whether  they  tended  to

            confuse  or mislead  the  jury  on  the  controlling  issues.

            Kelliher, 29 F.3d at 752.
            ________

                      An additional consideration  frames our discussion.

            Because   plaintiffs  invoke   diversity  jurisdiction,   our

            analysis  of applicable law is circumscribed.  Plaintiffs who

            select "federal  forum in  preference to  an available  state

            forum may  not expect  the federal court  to steer  state law

            into unprecedented  configurations."  Martel v. Stafford, 992
                                                  ______    ________

            F.2d 1244, 1247  (1st Cir. 1993); see also Ryan v. Royal Ins.
                                              ________ ____    __________

            Co., 916 F.2d 731, 744 (1st Cir. 1990) (rejecting a diversity
            ___

            plaintiff's attempt to stretch New York law to  new frontiers

                                
            ____________________

            lacking a  physician's order,  was not  so authorized.   R.I.
            Gen. L.    21-28-3.20 & 21-23-1.02(29).

                                         -8-
                                          8

            without providing  a "well-plotted roadmap showing  an avenue

            of  relief  that  the  state's  highest  court  would  likely

            follow").  

                      The plaintiffs  have failed to  establish that  the

            district  court's instructions  were erroneous.    As to  the

            school's liability, the district  court instructed the  jury,

            in relevant part, as follows:

                      A  school is  required to  do whatever  a
                      reasonably  prudent  school would  do  in
                      safeguarding the health  of its students,
                      providing  emergency  assistance  to them
                      when   required    and   arranging    for
                      appropriate  medical  care  if necessary.
                      That  does  not  mean  that  a  school is
                      responsible for  guaranteeing the  health
                      of  its students.   Obviously no  one can
                      guarantee anyone's  health.  Nor  does it
                      mean that  a school  is expected to  have
                      the knowledge of a physician or to assume
                      the role of a  physician in diagnosing or
                      treating its students.  What it means  is
                      that a  school must  act as  a reasonable
                      school in responding to medical needs  of
                      the students.  

                      The plaintiffs objected to this instruction  on the

            grounds  that  it understated  the  nature and  scope  of the

            defendant's liability with respect to the provision of health

            care  for its  students  at  the school.    On appeal,  while

            conceding  that there  are no  Rhode  Island cases  precisely

            establishing  the scope  of the  duty owed  by a  school, the

            plaintiffs advance two  arguments supporting  a duty  broader

            than  that reflected in  the court's instructions.   Notably,

            the effect of  both the plaintiffs' proffered  theories would

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                                          9

            be to hold the school liable for the acts or omissions of Dr.

            Koterbay.3  

                      First,  the   plaintiffs  argue   that  we   should

            interpret  Rhode  Island   law  to  hold  the   school  to  a

            nondelegable  duty  to provide  reasonable  health care,  the

            scope of which includes having individualized standing orders

            in  place in the  event of an  emergency.  Had  such an order

            been in place for  John, presumably it would have  authorized

            Nurse Gorman to administer epinephrine  subcutaneously in the

            event of an  allergic reaction.  Importantly,  the plaintiffs

            essentially concede that the school discharged duties created

            by Rhode Island's applicable laws and regulations.  Thus, the

            thrust  of  their  argument  is that  the  school  should  be

            required to  do more  than the "bare  minimum required  of it

            under state law."   Although the plaintiffs offer an extended

            policy-based discussion as to why a boarding school should be

            held  to a higher duty, they  do not cite any legal authority

            supporting  their  argument.   Our  own  search  has revealed

            nothing  suggesting that such  a broadly defined  duty exists

            under Rhode Island law.  On that basis, we detect no error in

            the court's description of the duty owed by the school.  

                                
            ____________________

            3.  The   sole  defendant  in   this  suit  is   the  school.
            Importantly,  the district court  found that Dr.  Koterbay --
            who  was not  named as a  defendant --  was not  the school's
            agent.  Accordingly,  the court instructed the jury that "the
            school is not legally responsible for the manner in which Dr.
            Koterbay performed his services as a physician."  

                                         -10-
                                          10

                      Second,   the  plaintiffs   argue  that   the  jury

            instructions should have  reflected the holding of  Rodrigues
                                                                _________

            v. Miriam Hosp., 623 A.2d 456 (R.I. 1993), in which the Rhode
               ____________

            Island  Supreme Court  held  that a  hospital  could be  held

            vicariously   liable  for  a  doctor  acting  under  apparent

            authority.   Beyond  noting that  the  language of  Rodrigues
                                                                _________

            itself appears to be limited to the hospital context, see id.
                                                                  ___ ___

            at 462, we  do not speculate as to what  other situations the

            Rhode   Island   Supreme  Court   might  apply   that  case's

            principles.    Even  assuming  that,  like  the  hospital  in

            Rodrigues, a boarding school could be held vicariously liable
            _________

            for the acts  or omissions of  a non-employee physician,  the

            plaintiffs have failed to establish that Dr. Koterbay had the

            requisite apparent  authority.  Cf. id.  (quoting Restatement
                                            ___ ___

            (2d) Agency   267).4 

                      We  have reviewed  carefully the  plaintiffs' other

            arguments,  and we  detect no  error in the  district court's

            jury instructions.

                                
            ____________________

            4.  We also disagree  with the plaintiffs' argument  that the
            school  should  be  held directly  liable  under  a corporate
            negligence theory.   The plaintiffs did not  present evidence
            on  this theory,  and  we  detect nothing  in  the record  to
            suggest that the school "fail[ed] to exercise reasonable care
            in selecting [Dr.  Koterbay] who the [school] knew  or should
            have  known  was  unfit or  incompetent  for  the employment,
            thereby exposing  third parties  to an  unreasonable risk  of
            harm."  Rodrigues, 623 A.2d at 463 (quotation omitted).
                    _________

                                         -11-
                                          11

            B.  Motion for New Trial
            ________________________

                      A district court may set aside a jury's verdict and

            order a new trial only  if the verdict is so clearly  against

            the  weight  of the  evidence  as  to  amount to  a  manifest

            miscarriage of justice.   See, e.g., Lama v.  Borras, 16 F.3d
                                      ___  ____  ____     ______

            473, 477 (1st Cir. 1994).  A trial judge's refusal to disturb

            a jury verdict is reversed only for abuse of discretion.  Id.
                                                                      ___

                      We conclude that  the district court did  not abuse

            its discretion.  Although the  facts in this case are tragic,

            the  legal principles are  relatively straightforward and, as

            our discussion  above suggests, the  district court  properly

            presented  them to  the jury.   We  have reviewed  the record

            carefully, and it  would serve no purpose  to recapitulate it

            in  detail  here.    Directly  stated,  we  conclude  that  a

            reasonable  factfinder   could  have   determined  that   the

            defendant was not liable, and that such a determination would

            not constitute a miscarriage of justice.  The record supports

            a conclusion that the defendant  did not breach any duty that

            it owed  to John.   Accordingly, the district court  was well

            within its discretion in denying the plaintiffs' motion.

                                         III.
                                         III.
                                         ____

                                      CONCLUSION
                                      CONCLUSION
                                      __________

                      For  the  foregoing reasons,  the  decision  of the

            district court is affirmed.
                              affirmed.
                              ________

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