Damages – Homemaker – Loss of consortium

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Where a U.S. District Court judge awarded damages to a plaintiff who alleged that her doctors and nurse practitioner at a federally funded health center breached their duty of care, the damages for loss of consortium must be vacated for failure to exhaust administrative remedies, while a remand is necessary because the judge’s per-diem calculation of homemaker damages was unsupported by the evidence and grossly excessive in light of the plain meaning of R.I. Gen. Laws §9-1-47.

“This appeal involves a negligence claim brought under the Federal Tort Claims Act (‘FTCA’), 28 U.S.C. §§ 1346(b), 2671–80, by Plaintiff-Appellee Lucia Urizar-Mota (‘Urizar-Mota’), a homemaker and mother of four. Urizar-Mota alleged that her doctors and nurse practitioner at Providence Community Health Center (‘PCHC’), a federally funded health center, breached their duty of care by failing to refer her to a neurologist or for neuroimaging that could have detected a slow-growing tumor in the fourth ventricle of her brain. Instead, the tumor — left undetected — grew and caused an abnormal buildup of cerebral fluid. During the eventual surgery to resect the tumor, Urizar-Mota suffered cerebellar strokes, resulting in permanent neurological damage that continues to impact her mobility and daily life functions — including her provision of homemaker services to her husband and children. After motions practice and then a bench trial, the district court awarded Urizar-Mota damages for post-diagnosis medical expenses; pre- and post-diagnosis pain and suffering; and homemaker loss. Further, the court awarded Urizar-Mota’s children damages for loss of consortium. This appeal followed. We affirm in part and reverse in part, remanding for further proceedings regarding determination of homemaker damages. …

“With the assistance of counsel, Urizar-Mota filed an administrative claim with the Department of Health and Human Services (‘HHS’) on October 5, 2020, asserting personal injury. … Her submission included a Standard Form 95 (‘SF-95′), which referred to a singular claimant (Urizar-Mota) and which only Urizar-Mota signed; her husband, Sergio Reyes, did not sign the form on his behalf, and neither he nor Urizar-Mota signed on their children’s behalf. The SF-95 indicated that Urizar-Mota sought $20 million in damages, which she did not allot to any claims other than her own, such as any loss-of-consortium claims for her children. Conspicuous instructions on the SF-95 provided that a claim ‘must show the title or legal capacity of the person signing and be accompanied by evidence of his/her authority to present a claim on behalf of the claimant as … parent,’ but Urizar-Mota’s form did not indicate that she had authority to make a claim for her children, let alone that she was doing so. The form also instructed that each claimant seeking damages ‘should submit a separate claim form,’ but Urizar-Mota’s husband and children never submitted SF-95s. …

“The government moved to dismiss in part for lack of subject matter jurisdiction, arguing that the Reyes Plaintiffs failed to exhaust their administrative remedies because, unlike Urizar-Mota, they had not presented HHS with an SF-95 or other written notification of the incident accompanied by a claim for money damages in a sum certain specific to each of them. The district court denied the motion, holding that the government had sufficient notice of the Reyes Plaintiffs’ loss-of-consortium claims under the First Circuit’s lenient approach to FTCA presentment because those claims were ‘purely derivative’ of Urizar-Mota’s claim, which had been presented to HHS. …

“Refined to its bare essence, the government’s appeal presents five main questions for us. First, did the Reyes Plaintiffs sufficiently satisfy the FTCA’s administrative exhaustion requirements as to their loss-of-consortium claims, such that the court can exercise subject matter jurisdiction? Second, was the district court’s award of damages for Urizar-Mota’s loss as a homemaker an abuse of discretion? Third, did the district court clearly err by crediting the testimony of Urizar-Mota’s primary-care expert regarding the standard of care, under which a reasonable primary-care provider would refer a patient with headaches for neuroimaging? Fourth, given the opposing testimony of the medical experts, did Urizar-Mota meet her burden to show that the government’s negligence caused her injuries? Finally, was the medical expense damages award excessive? …

“The first issue presented is whether the loss-of-consortium award is fatally flawed because the Reyes Plaintiffs failed to satisfy the FTCA’s presentment requirement. …

“As the government argues, the Reyes Plaintiffs failed to exhaust their claims. Urizar-Mota’s submission of an administrative claim for personal injury in her name cannot suffice. … The submission, which included both the SF-95 and the accompanying letter, did not name her husband or children, request a sum certain in damages for their claims, or mention a loss-of-consortium claim. ‘Allowing one claimant’s exhaustion of her administrative remedies to satisfy the exhaustion requirement for other possible claimants’ — here, for her husband and children — ‘would make it extremely difficult for the agency to know the value of the suit, thus making settlement less likely.’ … Because the Reyes Plaintiffs did not avail themselves of the FTCA’s limited waiver of sovereign immunity — which we must construe strictly in the government’s favor, … — by filing a claim form, their claims are barred. …

“Our conclusion is not altered because the Reyes Plaintiffs’ loss-of-consortium claims are derivative of Urizar-Mota’s claims under Rhode Island law. …

“The second issue presented is whether Urizar-Mota is entitled to an award of damages for her loss as a homemaker. Although Urizar-Mota, as the government notes, never specifically requested damages in any filing for her loss as a homemaker under Rhode Island law, the district court awarded her $2.92 million in damages to make up for the ‘economic loss to her’ due to her inability to perform homemaking duties. …

“… The plain language of Section 9-1-47 requires us to vacate the district court’s homemaker damages award as both unsupported by the evidence and grossly excessive. …

“The district court ignored the plain meaning of the statute when it awarded damages based on an assumption, unsupported by evidence, that — absent her permanent injuries — Urizar-Mota would have continued to provide ‘homemaker services’ under the statute for the entirety of her remaining fifty-year life expectancy at a consistent number of hours each day. To accurately determine the number of years for which Urizar-Mota would have maintained ‘primary responsibility’ for the care of a home and family living therein, and the hours per day she would have spent over those years providing services, the district court needed to consider at least the following factors: (1) when Urizar-Mota’s children were likely to become independent, and/or move out of the house; (2) the amount of homemaker services she would continue to provide thereafter, such as for her husband; and (3) the number of years for which she would likely be physically and mentally able to continue taking primary responsibility for household tasks and family care (which may be shorter than her total life expectancy). …

“Remanding the homemaker damages determination to the district court is appropriate here because the record indicates that, though the court meaningfully erred in calculating homemaker damages, Urizar-Mota may still be entitled to some award. …

“Before doing so, however, the district court should determine whether Urizar-Mota waived her right to recover homemaker damages under Section 9-1-47. …

“The government also challenges the district court’s pain and suffering awards. For the reasons explained below, we uphold the district court’s determination that PCHC breached the standard of care by delaying the imaging, diagnosis, and rescission of Urizar-Mota’s brain tumor and thereby caused her permanent injuries. We also conclude that the amount of the awards — $100 per day for Urizar-Mota’s persistent, debilitating headaches pre-diagnosis, and $350 per day for the remainder of her life expectancy to account for loss of enjoyment of life, lost mobility, and depression — is not grossly excessive nor shocking to the conscience. We detect no abuse of discretion on the part of the district court, … and therefore affirm. …

“The final argument raised by the government on appeal is that the district court abused its discretion by awarding damages for Urizar-Mota’s post-diagnosis medical expenses. The government specifically argues that Plaintiffs needed, but failed, to introduce an expert to testify about the medical bills, that the court was wrong to rely on Plaintiffs’ summary chart compiling Urizar-Mota’s medical bills, and that the court’s award compensated Urizar-Mota for expenses unrelated to the government’s negligence — specifically, a skin tag removal, day-of-surgery expenses, and a spinal MRI. With one minor exception, we affirm the district court’s award of medical expense damages for the reasons explained below. …

“We agree in part with the government’s argument that the medical expense award was excessive. Upon our review of the record, we hold that Plaintiffs established a causal connection between PCHC’s negligence and the medical procedures reflected in Urizar-Mota’s bills, except for (1) the inevitable expenses associated with surgery itself, which were already properly excluded by stipulation, and (2) the cost of a spinal MRI, which on our review of the record — paying particular attention to the testimony of Plaintiffs’ expert Dr. Knarik Arkun — does not seem to be causally connected to the headache-related negligence and Urizar-Mota’s brain tumor.

“No expert testified about the spinal MRI’s connection to Urizar-Mota’s brain tumor or surgery. Indeed, Dr. Arkun’s deposition testimony suggests no such connection existed, and Plaintiffs provide no citations to the record linking the spinal MRI to the government’s negligence even though they offer such citations for the skin tag removal and day-of-surgery expenses. We therefore agree with the government that Urizar-Mota failed to carry her burden of persuasion of showing that the government’s negligence caused her to undergo a spinal MRI, and we will reduce the damages award by the cost of that MRI. …

“The overall medical expenses award, excluding the cost of the spinal MRI, is supported by the evidence and not grossly excessive. We therefore modify the award to $658,594.62, deducting $3,600 for the spinal MRI. …

“For all these reasons, the district court’s judgment is affirmed in part and reversed in part. We hold that the district court lacked jurisdiction over the Reyes Plaintiffs’ loss-of-consortium claims and reverse the awards of loss-of-consortium damages. We hold that the district court’s per-diem calculation of homemaker damages was unsupported by the evidence and grossly excessive in light of the plain meaning of R.I. Gen. Laws §9-1-47 and therefore vacate the homemaker damages award and remand with instructions to the district court for further proceedings regarding homemaker damages. We further hold that the district court did not err, or committed only harmless error, as to the breach and causation determinations and accordingly affirm the pre- and post-diagnosis pain and suffering damages awards. Finally, we modify the district court’s award of medical expenses, reducing that award by the cost of Urizar-Mota’s spinal MRI ($3,600).”

Urizar-Mota, et al. v. United States (Lawyers Weekly No. 01-061-26) (51 pages) (Dunlap, J.) Appealed from a decision by McConnell, J., in the U.S. District Court for the District of Rhode Island. Kevin M. Bolan, with whom Sara Miron Bloom and Lauren S. Zurier were on brief, for the defendant-appellant; Katelyn M. Revens, with whom Amato A. DeLuca and DeLuca, Weizenbaum, Barry & Revens were on brief, for the plaintiffs-appellees (Docket No. 25-1131) (March 27, 2026).

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