From the Bench to the Witness Stand

Copyright © 2023 Enrique Vázquez Quintana, M.D.

All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the author except in the case of brief quotations embodied in critical articles and reviews.

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ISBN: 978-1-6657-3834-7 (sc)

ISBN: 978-1-6657-3833-0 (hc)

ISBN: 978-1-6657-3835-4 (e)

Library of Congress Control Number: 2023902018

Archway Publishing rev. date: 02/20/2023

Contents

Prologue

Special Message

Surgical Patient Summary and Ensuing Post-Op Events

Chapter 1 Legal Education

Chapter 2 The Unhappiness of Lawyers

Chapter 3 Indifference

Chapter 4 The Origins of Judicial Immunity

Chapter 5 First, Let’s Kill All the Lawyers

Chapter 6 A Crass Error

Chapter 7 Hubris Syndrome or the Illness of Power

Chapter 8 Immunity and Impunity of Judges

Chapter 9 Juries

Chapter 10 How Are We to Manage Injustice?

Chapter 11 Judges with Integrity

Chapter 12 Attorney-Client Privilege

Chapter 13 Contradictions in Courts of Law

Chapter 14 The Halo Effect and Demeanor

Chapter 15 Judicial Review

Chapter 16 The Judges’ Guild

Chapter 17 Judicial Malfeasance

Chapter 18 The Oracle of Delphos and the Agora

Chapter 19 Incapacity in the Courts

Chapter 20 Pro Se and the Unbundling of Legal Services

Chapter 21 The Application of Science in Court Trials

Chapter 22 Catharsis

Chapter 23 Galileo and the Inquisition

Chapter 24 The Health of Our Judges

Chapter 25 Characteristics of Judges

Chapter 26 Depoliticizing the Judicial System

Chapter 27 In Defense of Lawyers

Chapter 28 Coup D’état

Chapter 29 Diego Salcedo, Urayoán, and Human Rights

Chapter 30 Moses, the Tables, and the Puerto Rico Supreme Court

Chapter 31 Should Surgeons and Academia Tolerate This Judicial Sentence?

Chapter 32 Ignorance and Lack of Humanity in the Courts

Chapter 33 Courts and the Absence of Humanitarian Principles

Chapter 34 The Baby Chick Who Thought the Sky Was Falling

Chapter 35 Secrecy among Judges

Chapter 36 The Courts against Science

Chapter 37 Among Firemen, Let’s Not Step on One Another’s Hoses

Chapter 38 Who Are the Happiest? Judges or Doctors?

Chapter 39 Who Controls the Judiciary?

Chapter 40 The Civil Grand Jury—A Return to Direct Democracy

Chapter 41 There Is a Cure for Leprosy

Epilogue

Additional Steps in My Quest for Justice

Reflections on the Road Taken

Prologue

No judicial system is perfect. They are all managed by human beings with flaws, prejudices, discriminatory attitudes, and other biases that lead citizens to doubt the justice systems around the world. Even lawyers are willing to admit that there is no earthly justice and that we must wait for divine justice. An escapist description of the reality faced by human beings, the only animal with the intelligence and capacity to think and discern what is fair, ethical, and moral.

The chapters in this book—a set of articles originally written and shared with a solidary few during the course of my judicial battle—began to take the form of a collective on the heels of a succession of adverse court sentences dealt by three Puerto Rico courts, and later two federal courts. The rulings were unfair by any standard, since it was determined that I had caused dementia on a fifty-three-year-old patient after thyroid and parathyroid surgery; a sentence contrary to the science that cannot yet pinpoint the causes of dementias and Alzheimer’s, the most frequent among them.

Scientific breakthroughs are responsible for the totality of humanity’s progress. Two hundred years ago, there was no human being who could master all things related to medicine, the reason for the two hundred medical specialties that have since developed. If the courts and society assume an attitude that is contrary to science, then their decisions are simply backward. All judges should receive a good scientific education.

Legal education is sophist in nature, as opposed to education in the fields of medicine, engineering, nursing, and teaching, among others. Lawyers are not taught to search for the truth but to bend or twist the truth of the facts to benefit their clients. They are not required to take courses in science, psychology, psychiatry, or human behavior. A bachelor’s degree in any discipline is their only academic requirement. Lawyers do not have the last say about their cases; in any case, there is a winner and a loser, and the decision falls exclusively on the judge. As the only thinking animals, we are on earth for a limited time. We are promised, and we hope and expect for, an eternal life in paradise. Perhaps in paradise we will find happiness; paradise is the place where there is no sex and no currency. Therefore, the problems in this life that are prompted by sexual relationships and greed will not exist beyond life on earth. If you, my dear readers, stop to listen or read the news—ripe with homicides and incarcerations—you will notice that the grittiest events can all be traced back to sex and greed. Some say that they are bored by this world, to which a cynic might respond, Then why do you want to be immortal if you are bored on earth?

We live in a society plagued by fear; we fear criminals, the corrupt, assailants, pain, and sickness. The sum of those fears clears the way for anxiety, depression, and other mental illnesses. And they trigger a high incidence of suicides, lack of sensibility, and intolerance that leads to other problems related to human conduct. Even lawyers are fearful of judges. No one should be afraid of another human being.

It is imperative to improve our country’s education system. We must educate about morals and ethics like they do in other countries. Although this is the role of parents, many families are managed by a single member; either a parent has died, or the marriage has been dissolved, or the father is in prison. At the other extreme, we need to plan for satisfying the basic needs of an aging society.

It is my sincere hope that this book will serve its purpose and may help to propel the country toward a better judicial system. The system must be improved. The method for selecting judges in Puerto Rico, in particular Supreme Court justices, must be transformed. Also, the evaluation of lawyers should be entrusted to a new, independent entity. It seems a bit odd that Puerto Rico, among the ten top states or territories with the largest number of lawyers per ten thousand residents, is the jurisdiction where most of its lawyers—69 percent—do not practice their profession.

As human beings, we must all struggle to make the world we have inherited better, so that when we exit from this existence, we will be able to say that we contributed toward leaving our heirs a safer, better, and fairer world. A parent or a teacher should strive for a child or a student to become a better person than they.

Always stand up for what you believe in … even if it means standing alone (Kim Hanks).

Special Message

Our country is living under the illusion of a political and economic system called democracy. This system should be nothing other than the organization of a country within a structure that defends the country’s sovereignty and its right to select and control its rulers. It is a social contract that attributes the ownership of power to the citizenry as a whole. The tenets originally adopted for the governed to live better than their rulers for long has been consigned to a self-serving system that allows capitalism, corrupt politicians, and individuals with no ethics to take advantage of the best there is to offer. We the governed have become the motor for a machine that churns out comfort, privilege, and luxury to a handful of individuals. And we have promoted chaos by repeatedly electing the type of person who hungers for control and is inclined to serve themselves abundantly.

The country has totally lost control; we are not consulted, not heard, and not taken into consideration when legislating the rights and benefits due to those who allowed them to take control of public affairs. Inch by inch, we have become accustomed to this anomaly. And also, to receive abuse and take beatings from those who by our own design manage the system, has become the norm. And thus, life goes by; every four years, we recover the hope for a transformation. However, electing the same individuals will never bring about change, because the system is corrupted to such an extreme that for change to happen, we will be forced to destroy it, discard it, and rebuild it from the ground up.

The goal of an upright and responsible professional is to exercise their chosen profession, to flourish with experience, to serve their society and eventually retire with the satisfaction of a job well done. During their professional stage, they must overcome difficulties that may or may not be under their control. The goal will always be to perform impeccably, retire when the time comes, enjoy a leisurely life, be satisfied with themselves, and savor the respect and the gratitude of the country they have served spotlessly. Nevertheless, the upright and responsible professional may at times fall into the spiderweb of other professionals devoid of scruples and accustomed to their privileges who will not hesitate to wound the dignity and stain the reputation of the upright and responsible professional.

Some stories do not have a happy ending, and sometimes circumstances collude to bend the road. The story I tell is a living example of what the lack of scruples, ethics, and morality of some professionals can do to stain the dignity and advance a chaotic end to the spotless performance of a professional who has fully complied with society’s established rules in order to reach the happy ending that every human being has a right to and that he has struggled to deserve.

If the COVID-19 pandemic has taught us anything, it is to aim a spotlight on the members of society who are indispensable. In the end, health professionals and scientists are the ones who have held the life of the planet in their hands. When we become aware of this unquestionable truth, many in the ruling classes who have proven to be simple postscripts are liable to be cast aside when the time comes to set forth new priorities.

Dr. Enrique Vázquez Quintana has no need to prove his verticality, his courage, and the nobility of his spirit to the people of Puerto Rico. His impeccable service record, like an open book, has been submitted to the scrutiny of the country he swore to serve when he became a surgeon. He reached this goal handily, and the country knows that. Can the legal class show their service records in the same way? Numerous instances come to mind when the country has been deceived by the performance of the judicial system. Their privileges, their impunity, immunity, and infallibility are the aura that crowns this brand of public servants, like crowns on the decadent gods of the Olympus. And by the dim light that shines on some of their decisions, it is easy to recognize to whose side the scale is leaning.

A doctor may serve as an arbiter in a court trial if he reads the Constitution and has the capacity to arrive at fair decisions. But a judge could precariously perform a successful surgery by just having read a book about surgical procedures. This is a telling clue as to how privileges are mistakenly granted, about who are the indispensable, and where we must begin to tighten the screws if we want this pathetic machine we call democracy to work the way it was designed to—for the governed to live better than the rulers.

There is a cure for leprosy; laws are not written in stone, and ethics and morals cannot be bought in a drugstore. This book is an open condemnation; it is the finger in the canker of mediocrity and the open showcase from where we can see the gross injustice of justice. I dream of seeing a Puerto Rico without Puerto Ricans was the nefarious phrase coined by one of these leaders for whom the government and its branches are but mere steps they are willing to climb, while trampling on the country, to attain their personal benefits. I, in turn, dream of a Puerto Rico free of corrupt individuals, a Puerto Rico where justice is imparted by people who are just, and a Puerto Rico where those with integrity and honesty who have served the country well will not have to live out their final years wiping the stain off their eyeglasses, resulting from the bad decisions of judges who are unscrupulous and lacking in ethics and morals. This is what I dream of.

—Tina Casanova, August 16, 2021

Surgical Patient Summary and Ensuing Post-Op Events

1. A fifty-three-year-old patient with hyperparathyroidism (elevated calcium levels) for twelve to thirteen years, a nodule on the left lobule of the thyroid, and a 4-cm nodule in the right adrenal. She also suffered depression (an early sign of Alzheimer’s disease) and was undergoing psychiatric treatment and had been diagnosed with hypothyroidism and hypertension. Aldosterone and renin were normal. Calcium 10.8 mg/dL, phosphorous 1.7 mg/dL, PTH 118 pg/mL.

2. The patient underwent thyroid and parathyroid surgery on June 26, 2000, and later registered low calcium levels (hypocalcemia). Hypocalcemia is an inherent risk of thyroid and parathyroid surgery. It occurs in 3 to 5 percent of cases.

3. Following are the numbers for the immediate post-op period: August 30, 2000, calcium 7.6 mg/dL, phosphorous 4.5 mg/dL and PTH 109 pg/mL. October 4, 2000, calcium 8.0 mg/dL and phosphorous 4.4 mg/dL. On her final visit, October 27, 2000, calcium 7.7 mg/dl and phosphorous 4.6 mg/dL.

4. In 2001, she and her spouse sued for reason of hypocalcemia. She was on record as taking calcium and vitamin D. As per the US surgeon general, women over fifty must take calcium and vitamin D to avoid osteoporosis.

5. On March 3, 2005, calcium 8.7 mg/dL, phosphorous 4.9 mg/dL and PTH 0.3 pg/mL. (N -.07–5.6).

6. Patient was referred on October 28, 2000, to endocrinologist Julio César López (now deceased) for a follow-up on the hypocalcemia and hypothyroidism she suffered prior to the surgery.

7. In 2005, the patient developed Alzheimer’s disease and was placed on a treatment of Aricept and Namenda (prescription meds used exclusively on Alzheimer patients) at the Levittown Medical Services Center.

8. It is widely recognized that by the time the first symptoms of Alzheimer’s appear, the disease has been present anywhere from five, ten, fifteen, twenty, twenty-five, or up to thirty years.

9. It follows from the above that when I performed surgery on the patient in 2000, she was already ill with Alzheimer’s. Therefore, there is no way the operation could have caused the disease.

10. Ten years and seven judges/justices later, the case was finally heard by a court of first instance (Superior Court of San Juan) in 2011. An eloquent measure of the inefficiency of our judicial system.

11. San Juan Superior Court Judge Gloria María Soto Burgos ruled that hypocalcemia had caused the patient’s dementia.

12. Her decision was based on the testimony of Dr. Stephan A. Falk, an otolaryngologist from Connecticut, USA, who certified that the low calcium resulting from the surgery caused dementia in the patient. This expert was brought in to testify about the reason for the surgery and the surgical technique applied.

13. The medical expert’s opinion was based on an interview with the patient at the lobby of the Marriot Hotel in Isla Verde, with the plaintiff’s attorney, Antonio L. Iguina González, as interpreter. The next day, he testified in court that the low calcium level had caused the patient’s dementia, although he had no knowledge of the patient’s calcium levels and did not examine her medical records from the Puerto Rico Medical Center, a hospital in the US, or the Levittown Center.

14. During the trial, Judge Gloria María Soto Burgos certified that the patient was oriented in time and space. (This is known as practicing medicine without a license, since only a licensed medical professional is qualified to make such an assessment.)

15. Additionally, attorney Mary Cele Rivera certified that she had dealt with the patient professionally for the last ten years and that her mental state had remained unchanged. (Again, practicing medicine without a license.)

16. Nonetheless, Judge Soto Burgos ruled that the surgery was the cause of the patient’s dementia. This is a serious contradiction that suggests confusion on behalf of the judge.

17. The appellate court, in a document rife with errors, ratified the court of first instance and imposed a $6,000 fine on me for appealing the case.

18. The appellate court’s three-judge panel was presided by Hon. Judge José Alberto Morales Rodríguez and included Judges Félix R. Figueroa Cabán and Felipe Rivera Colón.

19. The Supreme Court ratified the appellate court’s sentence in a 5–4 vote on June 11, 2015.

20. The five Supreme Court justices who concluded that the surgery caused a non-Alzheimer dementia on the patient were Chief Justice Liana Fiol Matta, Anabelle Rodríguez, Maite Oronoz Rodríguez, Erick V. Kolthoff Caraballo, and Roberto Feliberty Cintrón.

21. Dissenting without a written opinion were Supreme Court Justices Luis Estrella Martínez, Edgardo Rivera García, Mildred Pabón Charneco, and Rafael Martínez Torres.

22. Hon. Justice Anabelle Rodríguez Rodríguez’s mother passed on June 1, 2012, at the age of eighty-four. According to her death certificate, the cause of death was Alzheimer’s disease. However, the honorable judge voted against me, sentencing that I had caused dementia on one of my patients.

23. Hon. Justice Anabelle Rodríguez Rodríguez had the legal, moral, and ethical obligation to advise her colleagues on the topic of Alzheimer. I cannot vouch for whether she did or not. Judges and justices are intelligent professionals and are aware that the causes of dementia are still unknown.

24. A majority of Supreme Court justices voted against me as punishment for having prevailed against a female lawyer who filed a frivolous lawsuit against me.

25. At the end of the book, I discuss the circumstantial evidence that documents a collusion among judges of the three courts to impose a punishment on me. This action violates Article 291 of the Puerto Rico Penal Code.

26. We submitted two appeals for reconsideration by the Supreme Court and were both answered with a there are no grounds. An oral hearing was denied.

27. It is apparent that all three courts decided contrary to scientific knowledge and that they have opened the door to a rift between the judiciary and academia. The Supreme Court in this case has chosen to disregard what is true and fair.

28. There is no causal relationship between hypocalcemia (low calcium) and dementias.

29. The American Alzheimer Research Foundation affirms that there is no causal relationship between hypocalcemia and Alzheimer’s.

30. The Supreme Court is fallible; it is evident by their crass error of judgment in this case. With their ruling, the court has chosen to demonstrate that its knowledge of medicine and neurology is superior to that of recognized academicians in the field.

31. The Supreme Court decision concludes that hypocalcemia was the cause of a dementia different from Alzheimer’s. Such a detailed conclusion requires a degree of diagnostic finesse that no neurologist in Puerto Rico or anywhere else in the world possesses. Besides, during the trial, there was no mention of dementias other than Alzheimer’s.

32. The Supreme Court justices transformed a scientific lie into a judicial truth!

33. Based on this case, we must conclude that throughout the world, there are but nine judges, all in Puerto Rico—one in superior court, three in the appellate court, and five in the Supreme Court—who know the cause of dementias.

34. This defendant filed three separate appeals on his own right. The third requested that the trial be annulled and the case be sent to the Supreme Court for a new trial.

35. In my second appeal to the court, I expressed that my intention had always been to show deference and respect for the honorable Supreme Court, the highest in the country. In times when our country is plagued with severe problems on all fronts—economy, safety, health, education, government corruption—it has never been my desire to stain the credibility and prestige that the court has merited throughout its existence. The judgment in this case is easy fodder for anyone who would doubt the quality of our Supreme Court. Even in the difficult personal and professional juncture I find myself, fruit of an unfair sentence, it has never been my desire to stain the dignity of the court; I have always demonstrated my deference and respect toward this honorable court, the highest in the country.

36. Additionally, I referenced a quote by Supreme Court retired judge Raúl Serrano Geyls in his description of a prudent and reasonable judge: Judges are not expected to innocently believe what a regular bystander citizen would not believe. It is as simple as that.

37. In this case, it would be wise to change the saying that Bad law makes hard cases, hard cases make good law (Oliver Wendell Holmes Jr.) to bad law makes bad cases.

38. In my final communication to the honorable court on December 7, 2015, eleven days prior to their decision of there are no grounds to the second special action appeal, I wrote, My intention is to avert a decision that is not based on science and that may trigger a confrontation with academia … I am a man who respects the three branches of government and who has always lived according to the rule of law.

39. I will calmly await the Honorable Court’s decision—the end of the fifth act of a trial reminiscent of the theater of the absurd. And I will conduct myself as the Prudent and Reasonable Man that I am.

40. As I have expressed earlier, the Supreme Court ruled that I had caused dementia on one of my patients.

41. I entered a lawsuit in the San Juan District Court of the US on my own behalf (pro se) against seven judges of the country’s judicial system and medical expert Dr. Stephen A. Falk.

42. The case was assigned to Hon. District Court Judge Gustavo Gelpí prior to his designation as president of the