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Morales-Melecio v. United States

United States Court of Appeals, First Circuit

May 21, 2018

UNITED STATES (Department of Health and Human Services), Defendant/Third-Party Plaintiff, Appellee,


          José F. Velázquez-Ortiz and Velázquez Law Offices, PSC on brief for appellants.

          John A. Mathews II, Assistant United States Attorney, Rosa Emilia Rodríguez-Vélez, United States Attorney, and Mariana E. Bauzá-Almonte, Assistant United States Attorney, Chief, Appellate Division, on brief for appellee.

          Before Torruella, Lipez, and Kayatta, Circuit Judges.

          TORRUELLA, Circuit Judge.

         This case once again calls for this Court to determine the accrual date of a claim arising under the Federal Tort Claims Act ("FTCA"), 28 U.S.C. §§ 1346(b), 2671-2680, and the potential application of the so-called "discovery rule."


         On March 1, 2010, Emilio Matos-Martínez ("Matos") died at the Puerto Rico Medical Center ("PRMC") after having been diagnosed with septic shock and multiple organ failure, and suffering two cardiorespiratory attacks. Prior to his death at PRMC, Matos was treated at two other medical facilities on February 27 and February 28, 2010. At some point after Matos's death, Matos's parents, sister, and daughter (collectively, "Appellants") became aware that the first medical facility at which Matos was treated was a federally supported entity. Appellants filed an administrative claim with the United States Department of Health and Human Services ("USDHHS" or the "government") on April 16, 2012, followed by a medical malpractice complaint pursuant to the FTCA against USDHHS in the district court on April 22, 2013. The district court granted summary judgment in favor of the government, holding that Appellants' claims were time-barred for failing to file compulsory administrative claims within the FTCA's two-year statute of limitations. See 28 U.S.C. § 2401(b).

         Appellants now appeal the dismissal of their complaint, arguing that their FTCA claims did not begin to accrue until they received Matos's autopsy report on July 28, 2010. After careful review of the record, we agree with the district court that Appellants' claims are time-barred. We therefore affirm.


         The facts are largely undisputed.[1] On February 27, 2010, at 4:55 p.m., Matos, a thirty-six year old man weighing 370 pounds[2]with a history of hypertension, arrived at Salud Integral en la Montaña, Inc. ("SIM"), a health center located in Naranjito, Puerto Rico, complaining of abdominal pain that had persisted for five days, constipation, and fever. SIM is a covered entity under the Federally Supported Health Centers Assistance Act of 1995, Pub. L. 104-73, 109 Stat. 777 (codified at 42 U.S.C. § 233). After triaging Matos, a resident nurse at SIM determined that his condition was such that he needed to be promptly evaluated by a doctor. After the duty physician, Dr. María Román-Bruno ("Dr. Román"), conducted a cursory examination of Matos that did not involve x-rays, laboratory tests, or other imaging, she diagnosed Matos with "abdominal pain" and prescribed him Maalox and Enulose for his constipation, [3] and Bentyl for his abdominal pain.[4] Dr. Román then discharged Matos and instructed him to see his primary doctor in two days.

         The next day, Matos's sister, Mariela Matos, took Matos to the Hospital Universitario Ramón Ruiz-Arnau ("HURRA"), a regional hospital in Bayamón, because his symptoms had worsened overnight. Upon arrival, Matos was diagnosed with abdominal pain, dehydration, and hematuria.[5] Medical tests revealed that Matos had a bowel obstruction, which prompted the emergency room physician to request a surgical evaluation. However, the head of HURRA's surgery department, Dr. Ricardo Rosario ("Dr. Rosario"), refused to evaluate Matos because he believed that the surgical tables at the hospital would not support Matos's weight.[6] Due to HURRA's inability to properly evaluate Matos, the staff at HURRA attempted to transfer Matos to another medical facility but was unable to do so until the next day.

         On March 1, 2010, Matos was transferred to the PRMC where he was diagnosed with septic shock and multiple organ failure. Shortly thereafter, Matos suffered two consecutive cardiac arrests and, at 4:15 p.m., was declared dead. Immediately after Matos's death, a PRMC physician appears to have informed his father, Emilio Matos-Pérez, that Matos died of a heart attack. That same day, Matos's mother, María Martínez-Ortiz ("Martínez"), authorized PRMC to perform an autopsy of Matos's body. The autopsy was performed on March 2, 2010.

         On March 6, 2010, Matos's body was cremated. Two days later, Martínez was given Matos's ashes along with a copy of his death certificate. The death certificate listed Matos's immediate cause of death as "septic shock, secondary to peritonitis, secondary to intestinal perforation." On May 26, 2010, Martínez requested a certified copy of Matos's complete PRMC medical file. She received the file, along with the final autopsy report, on July 28, 2010. The autopsy report matched the death certificate findings as to the septic shock and the peritonitis.[7] However, rather than listing "intestinal perforation, " the autopsy report went into further detail about Matos's torn intestine, listing "diverticulitis, perforated with peritonitis with abscess formation." The narrative section of the autopsy report labeled "Laboratory Findings" reads that "[a]n intestinal perforation in the Colon at 192 cm from the ileo-cecal valve (distal portion) measuring 0.5 cm corresponded to a diverticuli (Sigmoid Colon)." At an unidentified time after obtaining possession of the medical file, Appellants hired an attorney to explore their legal options.

         On March 16, 2011, Appellants filed a medical malpractice suit in the Puerto Rico Court of First Instance against SIM, HURRA, and several physicians, alleging the wrongful death of Matos. On June 30, 2011, Appellants voluntarily dismissed their state court lawsuit. At some point thereafter, Appellants became aware that SIM was a federally covered entity and, on April 16, 2012, they filed an administrative claim with the USDHHS.[8] While that administrative claim was still pending, on April 22, 2013, Appellants filed this FTCA medical malpractice claim against the USDHHS, as the representative of SIM and Dr. Román (as SIM's agent), seeking compensatory damages for their own suffering as a result of Matos's death. In the same complaint, Matos's minor daughter, Z.M.M., as heir of her deceased father, also asserted an inherited action for Matos's pain and suffering before his death as a result of the alleged medical malpractice.[9] The government brought a third-party complaint against HURRA and several physicians that cared for or evaluated Matos in the events leading up to his death, seeking to add them as additional parties to the lawsuit. On May 3, 2013, the USDHHS denied the administrative claims against SIM.

         After discovery was complete in the district court, Appellants filed a motion for partial summary judgment on November 27, 2015, claiming there was no factual dispute as to the negligence of the government's agent. On November 30, 2015, the government filed its own motion for summary judgment, positing that the Appellants' claims were barred by their failure to file an administrative claim within two years after their causes of action accrued, as mandated by 28 U.S.C. § 2401(b). Appellants countered that there was undisputed evidence that Matos's diverticulitis triggered his death, and that they could not have known of that evidence and possibly connected Matos's death to any governmental malfeasance until they received the autopsy report on July 28, 2010. ...

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