In the case of Florentino Rivera v. Centro Médico del Turabo, Inc. ____F.3d ____, 2009 WL 2343132 (1st Cir. 2009), the U.S. Court of Appeals for the First Circuit recently affirmed Chief Judge Fusté’s dismissal of a patient’s medical malpractice claims on the basis that the patient signed a mandatory forum selection clause by virtue of which he agreed to submit any claims as a result of the medical proceeding to the Puerto Rico Court of First Instance. In what is surely a ground-breaking decision, PMA Attorneys Heidi Rodriguez and Giselle López Soler, representing the defendant hospital, argued that the case law applicable to forum selection clauses is equally applicable in the health care industry and that the forum selection clause was valid and enforceable. The First Circuit upheld the District Court’s decision, holding that, in the absence of exceptional circumstances, when a patient and a health care provider agree on a forum selection clause the same is binding and enforceable. The appellate court also affirmed the dismissal of the claims by the patient’s wife (a non-signatory party) since her claims were contingent on the patient\'s and grounded on the same nucleus of facts. In an interesting twist of events, while the case was pending, the Patients’ Advocate adopted a regulation prohibiting forum selection clauses in this context contrary to a similar regulation adopted by the Puerto Rico Health Department. PMA Attorneys are also handling the regulatory challenge.