Fifth Circuit Rejects Per-Se Emergency Rule for Shoulder Dystocia and Affirms FTCA Jurisdiction over Gross-Negligence Obstetrical Claims

Introduction

In Robledo v. United States, No. 24-50810 (5th Cir. Aug. 5 2025) the United States Court of Appeals for the Fifth Circuit reversed a Rule 12(b)(1) dismissal entered by the Western District of Texas in a Federal Tort Claims Act (FTCA) childbirth-injury suit. The appellant, Destiny Robledo, alleged that a resident physician’s excessive traction on her infant’s head during a shoulder dystocia event caused permanent nerve damage. The district court held it lacked subject-matter jurisdiction because: (1) shoulder dystocia is, as a matter of Texas law, an “obstetrical emergency,” triggering the heightened “willful and wanton negligence” standard of Tex. Civ. Prac. & Rem. Code § 74.153, and (2) any claim requiring proof of willful and wanton conduct necessarily seeks punitive damages, which the FTCA expressly bars. The Fifth Circuit rejected both premises, reinstating the suit and clarifying two significant points of law:

1. Shoulder dystocia does not automatically transform obstetrical care into “emergency medical care” at the pleadings stage; plaintiffs may contest that fact.
2. Seeking compensatory damages for gross or willful-and-wanton negligence remains permissible under the FTCA, notwithstanding its bar on punitive damages.

Summary of the Judgment

• Holding: The district court erred in dismissing for lack of jurisdiction; the suit may proceed.
• Reasoning:
  1. Whether “emergency medical care” was provided is fact intensive and unresolved at the 12(b)(1) stage. Categorical treatment of shoulder dystocia as an emergency conflicts with Texas Supreme Court guidance (Glenn v. Leal, Texas Health Presbyterian Hosp. v. D.A.).
  2. Heightened liability standards (willful/wanton or gross negligence) do not convert all damages into punitive damages. Plaintiffs may still recover economic and non-punitive damages under Texas law, and such relief is within the FTCA’s waiver of sovereign immunity (Molzof v. United States).
• Disposition: Reversed and remanded for further proceedings.

Analysis

Precedents Cited and Their Influence

1. Franka v. Velasquez, 332 S.W.3d 367 (Tex. 2011) & Related Texas Court of Appeals decisions
   • Labeled shoulder dystocia an “obstetrical emergency.” The district court leaned heavily on these characterizations to deem every dystocia an emergency.
   • Fifth Circuit response: Labels alone do not satisfy the statutory definition of “emergency medical care” (Tex. Civ. Prac. & Rem. Code § 74.001(7)).
2. Texas Health Presbyterian Hosp. of Denton v. D.A., 569 S.W.3d 126 (Tex. 2018)
   • The Texas Supreme Court assumed without deciding that the shoulder-dystocia maneuvers were emergency care; it expressly “expressed no opinion.”
   • Fifth Circuit used this caveat to demonstrate that the issue is unsettled and fact dependent.
3. Glenn v. Leal, 596 S.W.3d 769 (Tex. 2020) (per curiam)
   • Held the emergency-care issue was “critical and contested” in a shoulder-dystocia trial, requiring jury resolution.
   • Directly contradicts any per-se rule; pivotal to Fifth Circuit’s reversal.
4. Molzof v. United States, 502 U.S. 301 (1992)
   • Defined § 2674’s punitive-damages bar narrowly: only damages that are punitive in “traditional common-law” sense are barred.
   • Enabled the Fifth Circuit to separate recoverable compensatory damages from forbidden punitive damages even when liability standard is gross negligence.
5. Nowzaradan v. Ryans, 347 S.W.3d 734 (Tex. App.—Houston [14th Dist.] 2011, no pet.)
   • Government cited for the idea that gross-negligence findings relate to punitive damages. Fifth Circuit distinguished by noting Texas first requires proof of ordinary negligence for gross negligence, and economic damages remain available.

Core Legal Reasoning

The appellate court applied a two-step analysis:

1. Statutory Trigger for Heightened Standard
   The Texas emergency-care statute (§ 74.153) elevates the plaintiff’s burden only when “emergency medical care” is actually provided. The term is statutorily defined as “bona fide emergency services” delivered after a sudden onset condition with risk of jeopardy if not immediately treated (§ 74.001(7)). Merely labeling a condition an “obstetrical emergency” does not conclusively establish that the provider met these criteria. Because Robledo pled facts suggesting time and opportunity for routine maneuvers, she plausibly alleged the absence of “bona fide emergency services,” precluding dismissal.
2. Damages vs. Liability Standard
   The district court conflated the standard of fault (willful and wanton) with the type of damages. Under Texas law, a gross-negligence finding opens the door to exemplary damages in addition to compensatory damages, not instead of them. The FTCA only forbids punitive or exemplary damages; it leaves compensatory economic—and in some circuits noneconomic—damages intact. Therefore, even if § 74.153 applies, Robledo’s prayer for medical expenses and other economic losses is jurisdictionally sound.

Impact of the Judgment

• Practical Litigation Effect: Federal malpractice suits involving shoulder dystocia (and perhaps other obstetric complications) can rarely be dismissed at the pleadings stage on the theory that emergency care is conclusively established.
• Strategic Consequence for the Government: The United States can no longer shortcut FTCA liability by equating gross negligence with punitive relief; it must prepare to litigate the factual emergency-care question and defend on the merits.
• Doctrinal Clarification:
  • Separates the emergency-care trigger from the underlying medical condition.
  • Clarifies that the FTCA’s punitive-damages bar does not preclude compensatory recovery for gross negligence, aligning Fifth Circuit precedent with Molzof.
• Jury Instructions: Trial courts must let juries decide whether obstetrical maneuvers constituted emergency medical care when facts are disputed, echoing Glenn.
• Broader Tort-Reform Landscape: The decision limits the reach of state tort-reform statutes that heighten negligence standards, at least in federal FTCA contexts, by demanding strict adherence to statutory predicates.

Complex Concepts Simplified

Federal Tort Claims Act (FTCA)

A 1946 statute waiving the United States’ sovereign immunity for most negligence claims “under circumstances where a private person would be liable” under state law, with specific exceptions (e.g., punitive damages, discretionary-function acts).

Sovereign Immunity

The doctrine that the government cannot be sued without its consent. The FTCA is a limited consent.

Rule 12(b)(1) Dismissal

A procedural motion challenging the court’s subject-matter jurisdiction; the court must take well-pleaded facts as true and may look beyond the pleadings.

Gross Negligence / Willful & Wanton Negligence

Under Texas law, conduct involving an extreme risk of harm and conscious indifference. It is a higher fault level than ordinary negligence but lower than intent.

Punitive (Exemplary) vs. Compensatory Damages

Compensatory damages reimburse losses (medical bills, lost wages, pain). Punitive damages punish egregious conduct and deter others; the FTCA bans only the latter.

Shoulder Dystocia

An obstetric complication where the baby’s shoulder becomes lodged behind the mother’s pelvic bone during delivery, posing risk of nerve injury if mismanaged. Its occurrence does not automatically mandate emergency maneuvers.

Conclusion

Robledo v. United States sets an important precedent in both FTCA jurisprudence and Texas obstetrical-malpractice law. The Fifth Circuit’s decision:

• Restores fact-finding primacy to the “emergency medical care” inquiry, denying categorical treatment of shoulder dystocia.
• Affirms that plaintiffs may pursue compensatory relief for gross negligence against the federal government despite the FTCA’s punitive-damages prohibition.

Going forward, litigants and courts must disentangle (1) whether emergency care was actually provided, (2) the applicable negligence standard, and (3) the nature of recoverable damages. By rejecting over-broad jurisdictional dismissals, the Fifth Circuit ensures that substantive obstetrical negligence claims receive their day in court, thereby reinforcing accountability standards within federal medical facilities and clarifying the contours of sovereign immunity.