Case 3:21-cv-01539-ADC Document 1 Filed 11/12/21 Page 1 of 10
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`IN THE UNITED STATES DISTRICT COURT
`FOR THE DISTRICT OF PUERTO RICO
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`RANDY SANTIAGO CRUZ
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` Plaintiff
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`v.
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`DOCTORS’ CENTER HOSPITAL
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`CIVIL NO.
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`CAROLINA, LLC; W and X CORP,
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`CONTINENTAL INSURANCE COMPANY;
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`Y and Z INSURANCE Companies
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`Plaintiff demands Trial by Jury
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` Defendants
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`COMPLAINT
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`TO THE HONORABLE COURT:
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`COMES NOW, Randy Santiago Cruz, the plaintiff, represented by the
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`undersigned attorneys and respectfully states, requests and prays as follows:
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`I.
`PARTIES
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`1. Plaintiff Randy Santiago Cruz is of legal age and domiciled in Kalama,
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`Washington.
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`2. Defendant Doctors’ Center Hospital Carolina, LLC for diversity of jurisdiction
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`purposes, is a limited liability company that is the owner of and operates a
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`Hospital by the same name located in Carolina, Puerto Rico.
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`IN THE UNITED STATES DISTRICT COURT
`FOR THE DISTRICT OF PUERTO RICO
`
`RANDY SANTIAGO CRUZ
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`
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` Plaintiff
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`v.
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`
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`DOCTORS’ CENTER HOSPITAL
`
`CIVIL NO.
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`CAROLINA, LLC; W and X CORP,
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`CONTINENTAL INSURANCE COMPANY;
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`
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`Y and Z INSURANCE Companies
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`Plaintiff demands Trial by Jury
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` Defendants
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`
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`COMPLAINT
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`TO THE HONORABLE COURT:
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`COMES NOW, Randy Santiago Cruz, the plaintiff, represented by the
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`undersigned attorneys and respectfully states, requests and prays as follows:
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`
`
`I.
`PARTIES
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`1. Plaintiff Randy Santiago Cruz is of legal age and domiciled in Kalama,
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`Washington.
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`2. Defendant Doctors’ Center Hospital Carolina, LLC for diversity of jurisdiction
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`purposes, is a limited liability company that is the owner of and operates a
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`Hospital by the same name located in Carolina, Puerto Rico.
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`Case 3:21-cv-01539-ADC Document 1 Filed 11/12/21 Page 2 of 10
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`3. W and X Corp are unknown defendants that together with Defendant Doctor’s
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`Center Hospital Carolina, LLC may also be jointly responsible to the plaintiff for
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`some or all damages caused as described in this complaint. Once their true
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`identity is made known to the plaintiff, the complaint may be amended to
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`include and properly name said defendants as parties to this complaint.
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`4. By information and belief, Continental Insurance Company (“Continental”) is an
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`insurance carrier authorized to do business in the Commonwealth of Puerto
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`Rico that had issued one or more insurance policies which covers events and
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`damages as described in the present complaint. Said insurance carrier is
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`responsible to the plaintiff by virtue of the insurance policy in effect at the time
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`of the events described in this complaint.
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`5. Y and Z insurance companies are unknown insurance carriers organized and
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`existing under the laws of the Commonwealth of Puerto Rico who had issued
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`one or more insurance policies which covers events and damages as those
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`alleged and described in this complaint. Said insurance carriers are
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`responsible to the plaintiff by virtue of their respective insurance policies issued
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`and that were in effect to cover the time period and the negligent actions
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`described in this complaint.
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`6. The action against Continental and the unknown insurance carriers constitutes
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`a direct action against named and unknown defendants’ insurance carriers as
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`per Article 20.030 of the Puerto Rico Insurance Code, as amended, 26 L.P.R.A.
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`§ 2003.
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`Case 3:21-cv-01539-ADC Document 1 Filed 11/12/21 Page 3 of 10
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`II.
`JURISDICTION AND VENUE
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`7. This Court has jurisdiction of this matter under 28 U.S.C. § 1332 (diversity).
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`This is a civil action between citizens of different states and the amount in
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`controversy exceeds $75,000, exclusive of interest and costs.
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`8. Venue is proper under 28 U.S.C. § 1391 because a substantial part of the
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`events or omissions giving rise to the claim occurred in this District.
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`III.
`FACTS
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`9. Mr. Santiago Cruz was born on August 12, 1953.
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`10. Mr. Santiago Cruz was admitted to Defendant Hospital on November 15, 2020.
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`11. Mr. Santiago Cruz was 67 years old at the time of admission to the hospital.
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`12. On November 15, 2020, Mr. Santiago Cruz went to the Emergency Room of the
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`Defendant Hospital.
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`13. Mr. Santiago Cruz was seen by Dr. Yadira Moran Betancourt.
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`14. Mr. Santiago Cruz’s chief complaint was that he was having difficulty with
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`breathing.
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`15. Upon physical examination, Mr. Santiago Cruz’s skin was within normal limits.
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`16. Mr. Santiago Cruz did not have any skin ulcers.
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`17. Dr. Moran Betancourt’s impression was that Mr. Santiago Cruz had heart failure
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`with acute decompensation.
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`18. Mr. Santiago Cruz was admitted from the ER to the defendant Hospital that
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`afternoon.
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`19. The admitting diagnosis was that Mr. Santiago Cruz had respiratory failure due
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`to congestive heart failure.
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`Case 3:21-cv-01539-ADC Document 1 Filed 11/12/21 Page 4 of 10
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`20. Mr. Santiago Cruz was intubated on November 16 and put on mechanical
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`ventilation.
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`21. On November 16, 2020, Mr. Santiago Cruz had a renal ultrasound taken. The
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`radiologist, Dr. Lidia Reyes Nieves, noted that the images failed to show a Foley
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`catheter present. The urinary bladder was not visualized, it was collapsed. Dr.
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`Reyes Nieves recommended that the possibility that the Foley catheter was
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`mal-positioned should be considered. She discussed her findings with Dr.
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`Rodriguez.
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`22. On November 17, 2020, Mr. Santiago Cruz’ Foley catheter was removed and
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`placed in again.
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`23. On November 17, 2020, Mr. Santiago Cruz continued to be sedated. The plan
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`of care for Mr. Santiago Cruz included having the nursing staff reposition him
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`every two hours to prevent pressure ulcers from developing.
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`24. On November 18, 2020, a skin assessment was conducted of Mr. Santiago
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`Cruz and his skin was within normal limits.
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`25. On November 18, 2020, Dr. Joel Matos, an infectious disease physician,
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`performed a consultation. His assessment was that Mr. Santiago Cruz had
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`sepsis due to tachycardia, leukocytosis, and fever. He suspected pneumonia.
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`Dr. Matos noted: “possible aspiration during intubation.”
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`26. On November 25, 2020, a chest film was taken with a finding that Mr. Santiago
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`Cruz’ heart was enlarged. Mr. Santiago Cruz’ skin was reported as normal. The
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`care plan included that Mr. Santiago should be repositioned every three hours.
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`27. On November 26, 2020, an x-ray was taken of Mr. Santiago Cruz’ heart. The
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`report noted: “the heart and mediastinum are not enlarged.”
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`Case 3:21-cv-01539-ADC Document 1 Filed 11/12/21 Page 5 of 10
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`28. On November 26, 2020, a right femoral hemodialysis catheter was implanted.
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`29. On November 26, 2020, Mr. Santiago Cruz’ skin was reported as normal.
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`30. November 28, 2020, a skin assessment was performed. The chart noted that
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`Mr. Santiago Cruz’ skin turgor was edematous and skin texture poor. The chart
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`did not note where on Mr. Cruz’ body his skin was edematous. The care plan
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`included repositioning Mr. Cruz every two hours.
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`31. On November 29, 2020, a skin assessment was performed. The chart note
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`reported that Mr. Santiago Cruz’ skin was normal. The care plan included
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`repositioning Mr. Santiago Cruz every two hours.
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`32. A November 30, 2020, radiology report concluded that Mr. Santiago Cruz’ heart
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`was enlarged.
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`33. On November 30, 2020, a skin assessment was performed. The chart entry
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`reported that Mr. Santiago Cruz’ skin was normal.
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`34. On November 30, 2020, Mr. Santiago Cruz was scheduled to undergo dialysis.
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`However, the chart note documented: “Dialysis treatment time could not be
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`completed because the system coagulated.”
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`35. On December 7, 2020, the healthcare providers at defendant Hospital failed to
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`complete the diagram documenting Mr. Santiago Cruz’ skin condition. In the
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`written notes of the chart it was documented that Mr. Santiago Cruz’ skin turgor
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`was edematous. Once again, there was no documentation of where on Mr.
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`Santiago Cruz’ body his skin was edematous.
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`36. On December 9, 2020, once again, healthcare providers at defendant Hospital
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`failed to complete the diagram documenting Mr. Santiago Cruz’ skin condition.
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`Case 3:21-cv-01539-ADC Document 1 Filed 11/12/21 Page 6 of 10
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`However, in the written notes it was reported that Mr. Santiago Cruz’ skin turgor
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`was elastic, the skin texture was smooth, and skin color was normal.
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`37. On December 14, 2020, the imaging report reported that Mr. Santiago Cruz’
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`heart was not enlarged.
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`38. The December 16, 2020 nephrology chart note reported: “Only completed one
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`hour of dialysis because the system coagulated.”
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`39. On December 18, 2020, for the first time, there is charting in the medical record
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`documenting that Mr. Santiago Cruz had a pressure ulcer. The chart noted
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`“undetermined stage sacral ulcer.” The charting did not make any notation of
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`the size of the ulcer, whether there was any drainage, whether there was any
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`odor, or the color of the ulcer. There were no directions as to how the ulcer was
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`to be treated.
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`40. The December 19, 2020 chart note documented an operative procedure
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`involving the exchange of the right femoral vein double lumen hemodialysis
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`catheter.
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`41. On December 19, 2020, the chart noted Mr. Santiago Cruz’ decubitus ulcer on
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`the sacrum on the skin assessment diagram. Once again, there was no
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`description as to the size, smell, or color of the ulcer. There was no notation as
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`to whether the ulcer had any drainage. The only direction for treating the ulcer
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`in the chart was to reposition Mr. Cruz every two hours.
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`42. On the day following the notation of the presence of a decubitus ulcer, the chart
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`failed to report any ulcer. Instead, on December 20, 2020, the chart reported
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`that the skin assessment was once again normal. The charting documented
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`Case 3:21-cv-01539-ADC Document 1 Filed 11/12/21 Page 7 of 10
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`that Mr. Santiago Cruz’ skin turgor was elastic the skin texture was smooth and
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`good, and the skin color was normal.
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`43. On December 22, 2020, a procedure note documented the placement of a
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`temporary catheter.
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`44. On December 27, 2020, Mr. Santiago Cruz was extubated.
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`45. The December 28, 2020 imaging report noted: “The NG tube is not placed
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`correctly. It is coiling in the upper oropharynx. … Consider repositioning the
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`NG tube.”
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`46. On December 29, 2020, a left femoral hemodialysis catheter was placed. The
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`prior catheter had been obstructed.
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`47. On December 30, 2020, healthcare providers at defendant Hospital failed to
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`complete the diagram documenting Mr. Santiago Cruz’ skin condition. In the
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`written notation the skin was reported to be normal.
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`48. However, on the next day, December 31, 2020, the skin assessment diagram
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`showed “unstageable sacral ulcer.” Once again, no other description given.
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`49. For the first time, without any additional description, the chart reported that
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`“wound care” was part of the care plan.
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`50. The January 1, 2021 skin assessment note reported an unstageable sacral
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`ulcer. Once again, no other description for the ulcer was documented.
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`51. The January 2, 2021 skin assessment note reported an unstageable sacral
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`ulcer. Once again, no other description was given.
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`52. The January 4, 2021 the skin assessment showed the sacral ulcer was
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`unstageable. Once again, there was no further description. There was no
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`directed course of treating the pressure ulcer.
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`Case 3:21-cv-01539-ADC Document 1 Filed 11/12/21 Page 8 of 10
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`53. Just two days later, on January 6, 2021, once again the skin assessment
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`diagram showed normal skin.
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`54. Mr. Santiago Cruz was discharged to another hospital where stage four
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`pressure ulcers were found.
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`FIRST CAUSE OF ACTION:
`NEGLIGENCE
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`55. Defendant and its employees owed a duty of care to Mr. Santiago Cruz.
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`Defendant acts through its officers, employees, and agents were negligent. The
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`defendant and its medical staff to include nurses, departed from its own
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`established protocols for the assessment, diagnosis, monitoring and treatment
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`of Mr. Santiago Cruz. Any act or omission of an officer, employee, or agent is
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`also the action or omission of the Defendant. The Defendant’s officers,
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`employees, and agents owed a duty to exercise the degree of skill, care, and
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`learning expected of reasonably prudent officers, employees, and agents of
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`hospitals in Puerto Rico acting in the same or similar circumstances. The
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`Defendants’ officers, employees, and agents were negligent and breached that
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`duty. As a direct and proximate result of the breach and negligent actions, Mr.
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`Santiago Cruz has been damaged.
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`SECOND CAUSE OF ACTION:
`LACK OF INFORMED CONSENT
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`56. The physicians at the defendant Doctor’s Hospital owed a duty to inform and
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`failed to warn and inform Mr. Cruz of all material facts, including risks and
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`alternative, that a reasonably prudent patient would need in order to make an
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`informed decision whether to consent or reject a proposed course of treatment.
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`Case 3:21-cv-01539-ADC Document 1 Filed 11/12/21 Page 9 of 10
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`The physicians at the Defendant Doctor’s Hospital breached this duty.
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`Defendant Doctor’s Hospital is liable for this breach.
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`THIRD CAUSE OF ACTION:
`PHYSICAL AND MENTAL ANGUISH
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`57. The acts and omissions of the defendant and its employees, in the medical
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`treatment administered to Mr. Santiago Cruz, caused Mr. Santiago Cruz to
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`suffer from various damages, to include pressure ulcers to the point of
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`developing Stage Four pressure ulcers. Mr. Santiago Cruz suffered severe
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`physical pain and mental anguish due to the negligence of the defendant and
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`its employees to the point that he thought he was going to die.
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`58. The defendants and their employees are jointly liable to Mr. Santiago Cruz for
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`all damages caused.
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` TRIAL BY JURY
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`59. Defendant and its employees caused severe damages to Mr. Santiago Cruz.
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`The defendant and its employees’ negligent acts and omissions departed from
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`the standards of evaluations, medical treatment and care due patients like Mr.
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`Santiago Cruz. Their actions and lack of actions directly caused or contributed
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`to the damages suffered by Mr. Santiago Cruz as described in this complaint.
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`60. All damages caused by the negligent acts and omissions of the defendant and
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`its employees are compensable under the provisions of the Civil Code of Puerto
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`Rico and are reasonably estimated in a sum in excess of TWO MILLION
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`DOLLARS ($2,000,000.00).
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`61. Plaintiff requests trial by jury.
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`WHEREFORE THE PLAINTIFF PRAYS FOR THE FOLLOWING RELIEF:
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`Case 3:21-cv-01539-ADC Document 1 Filed 11/12/21 Page 10 of 10
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`1. That after jury trial, judgment be entered in his favor for an amount compensating
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`him for the damages caused by the Defendant and the defendant’s employees acts
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`and omissions;
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`2. That all judgment amounts accrue interest at the applicable legal rate;
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`3. That he be allowed to recover his attorney fees and costs.
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`4. For such further relief as the Court may deem just and proper.
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`RESPECTFULLY SUBMITTED.
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`In San Juan, Puerto Rico this 12 th day of November, 2021.
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`RIVERA-ASPINALL, GARRIGA
`& FERNANDINI LAW FIRM
`Attorneys for Plaintiff
`1647 Adams Street
`Summit Hills
`San Juan PR 00920
`Telephone: (787) 792-8644
`Facsimile: (787) 792-6475
`Email: aspinall@ragflaw.com
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`S/ Julian R. Rivera Aspinall
`Julian R. Rivera Aspinall
`USDC PR 208506
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