Full Opinion

DISTRICT COURT OF APPEAL OF THE STATE OF FLORIDA FOURTH DISTRICT GAIL ALLEN, TAMONICA ALLEN, WILLIAM BOUE, GEORGE DAVIS, ROBYN DAVIS, SANFORD IRA GOLDMAN, as personal representative of the ESTATE OF SUSAN GOLDMAN, deceased, CHEVELLE LEGAMI, LORENZO PIERCE, JENNIFER PIERRE, JAMIE SANCHEZ, ERIKA SPENCER, MICHELLE WASHINGTON, JUAN SANTOS, JOHANNA BERAS, CASSANDRA EVANS, TERRELL HARRIS, JANICE ELLIS, WAITE ELLIS, ANGELA HADLEY, T’NINA HUITT, SHARNEL IRVING, JESSICA JOHNSON, TRINA JOHNSON-EDMOND, ENID KHAN, PATRICK McDONALD, SHIRLEY NELSON, JEAN NEMORIN, ESTEBAN OBISPO-REYES, GALA RALLS, FRITZ RIMPEL, ANTHONY RIVERA, ERIKA RIVERA, RAE SALESMAN, DOMINICK SFORZA, SYTRESE SMITH, GERVENS SOUARIN, SEAN YELLIN, LINFORD JOLLY, DONICA OLIVER-YOUNG, BERNADETTE ADAMS, andJAMES JACKSON, Appellants, v. BETH ISRAEL OUTPATIENT SURGICAL CENTER, LLC d/b/a BROWARD OUTPATIENT SURGICAL CENTER, MERRILL W. REUTER, M.D., ADVANCED ORTHOPEDICS, INC., BROWARD OUTPATIENT MEDICAL CENTER, LLC, PALM COAST ANESTHESIA GROUP, LLC, PREMIER ORTHOPEDIC AND NEUROSURGICAL GROUP, LLC, CENTRAL SPINE AND ORTHOPEDICS CENTERS, LLC d/b/a INTEROPERATIVE MONITORING, KENDALL SPINE AND ORTHOPEDICS, LLC, MEDASSIST SURGICAL, LLC, PRESTIGE ORTHOPEDICS, LLC, UNIVERSAL MEDIQUIP, INC., BROWARD OUTPATIENT URGENT CARE, LLC, CENTER FOR NEUROSURGICAL EXCELLENCE, LLC, BRIAN BAUER, CRAIG BAUER, TWO AND TWO, LLC, COMPLETE REHAB AND MEDICAL CENTER OF PLANTATION, INC., ORTHOPEDIC AND SPINE CENTER OF SOUTH FLORIDA, LLC, COMPLETE REHAB AND MEDICAL CENTERS OF POMPANO, INC., COMPLETE REHAB AND MEDICAL CENTERS OF WEST PALM BEACH, INC., and HOLLYWOOD REHAB AND MEDICAL CENTER, LLC, Appellees. No. 4D2025-1488 [October 28, 2026] Appeal from the Circuit Court for the Seventeenth Judicial Circuit, Broward County; Carol-Lisa Phillips, Judge; L.T. Case No. 062021CA019755AXXXCE. Grace Mackey Streicher and Andrew A. Harris of Harris Appeals, P.A., Palm Beach Gardens, for appellant Robyn Davis. Scott A. Mager of Mager Parúas, PLLC, Hollywood, William D. Zoeller and Eric C. Hayden of Zoeller, Hayden & Thron, PLLC, West Palm Beach, and Kevin C. Smith of Lytal, Reiter, Smith, Ivey & Fronrath, West Palm Beach for appellants. Dinah S. Stein and Michael J. Byrne of Hicks, Porter & Stein, P.A., Miami, for appellees Merrill W. Reuter, M.D., Advanced Orthopedics, Inc. d/b/a Spine/Orthopedics, Broward Outpatient Medical Center, LLC, Palm Coast Anesthesia Group, LLC, Premier Orthopedic and Neurosurgical Group, LLC, Central Spine and Orthopedics Centers, LLC d/b/a Interoperative Monitoring, Two and Two, LLC, Complete Rehab and Medical Center of Plantation, Inc., Kendall Spine and Orthopedics, LLC, Medassist Surgical, LLC, Prestige Orthopedics, LLC, Orthopedic and Spine Center of South Florida, LLC, Universal Mediquip, Inc., Broward Outpatient Urgent Care, LLC, Center for Neurosurgical Excellence, LLC, Complete Rehab and Medical Centers of Pompano, Inc., Complete Rehab and Medical Centers of West Palm Beach, Inc., Hollywood Rehab and Medical Center, LLC, Brian Bauer, individually, and Craig Bauer, individually. Jim White of White Russell, P.A., Palm Beach for appellees Merrill W. Reuter, M.D., and Advanced Orthopedics, Inc. Ryan M. Sanders of Lubell & Rosen, LLC, Fort Lauderdale, and Rolando A. Diaz of DLG Lawyers, Miami, for appellee Beth Israel Outpatient Surgical Center, LLC d/b/a Broward Outpatient Surgical Center. MAY, J. The record is 22,060 pages long, not counting the supplemental record, and this case has not gotten beyond a motion to dismiss. Forty-one plaintiffs were given six attempts to plead a cause of action. The forty-one plaintiffs now appeal the dismissal with prejudice of their 1,492-page Fourth Amended Complaint, containing 7,803 paragraphs, and alleging nine causes of action against twenty-two defendants. They argue the trial court erred in dismissing each count of their complaint with prejudice. We disagree and affirm. 2 • The Facts o The Background of the Underlying Litigation. This is a novel piece of litigation spanning over a decade and featuring three primary chapters. This appeal involves chapter three. Chapter One The plaintiffs were involved in a variety of incidents, including car accidents, slip and falls, and others. They were initially represented by the Fenstersheib Law Group (“FLG”). The FLG referred the plaintiffs to one or more of the defendants in connection with their personal injuries, pursuant to letters of protection. The plaintiffs were treated by one or more of the defendants. The plaintiffs pursued their personal injury claims, seeking damages for, among other things, medical expenses incurred because of their alleged injuries. Ultimately, the plaintiffs settled their respective personal injury claims. Chapter Two During the resolution of the personal injury claims, an FLG employee embezzled money from the FLG trust accounts. This resulted in the FLG failing to pay the medical providers (currently the defendants) for the services rendered despite the letters of protection. Seventeen medical entities—all owned by Craig and Brian Bauer—sued the FLG and plaintiffs to recover payment for services rendered (the “Theft Lawsuits”). 1 The Theft Lawsuits ultimately settled and were dismissed in May 2021. 1 According to a counterclaim filed in this case, attorney Fenstersheib reported the employee theft to the Florida Bar, which opened an investigation. The counterclaim alleged that Fenstersheib and the FLG devised a scheme to pressure the medical providers to back off their collection efforts by claiming the medical providers were engaged in fraudulent practices and performed “fake” surgeries. Specifically, the counterclaim alleged the plaintiffs had injuries requiring minimally invasive surgical treatment and they sought compensation for the surgeries in their personal injury litigation. The plaintiffs submitted the bills for those surgeries and medical care and were paid for those expenses when settling their claims. But neither the FLG nor the plaintiffs ever paid the medical providers. 3 Chapter Three This brings us to the current lawsuit and this appeal. In October 2021, the plaintiffs filed a 325-page, forty-five-count complaint against the same medical providers that had previously sued them, including the Bauers individually, Dr. Reuter, the orthopedic surgeon, and Dr. Reuter’s surgical assistant, Dr. Metzger. The original complaint alleged medical malpractice claims against all defendants except the Bauers, and claims for fraud, negligent misrepresentation, breach of fiduciary duty, accounting, battery, intentional infliction of emotional distress, negligent infliction of emotional distress, violation of the Florida RICO statute, civil conspiracy, and deceptive and unfair trade practices. The next month, the plaintiffs filed an amended complaint alleging similar claims. The defendants moved to dismiss. While those motions were pending, the trial court entered an order on a motion for leave to amend the complaint in a similar case that had been filed earlier by a different plaintiff (Harris), alleging similar claims. In that March 2022 order in the Harris case, the trial court found that the complaint read “more like an introductory statement of a John Grisham novel, rather than a legally based short concise statements of facts, with lack of specificity regarding Counts of Civil RICO, Fraud, IIED, ‘crime schemes’, etc.” The plaintiffs, now including Harris, filed a Second Amended Complaint. The defendants moved to dismiss and sever counts in the Second Amended Complaint. After a lengthy hearing, the trial court once again dismissed the complaint without prejudice. The dismissal order identified numerous deficiencies in each count of the Second Amended Complaint. The plaintiffs’ Third Amended Complaint was nearly twice the length of the Second Amended Complaint and attached over 400 pages of medical bills. The defendants again moved to dismiss. The trial court held another lengthy hearing and dismissed the Third Amended Complaint without prejudice. This time the trial court warned the plaintiffs that it was their final opportunity to plead their case. o The Fourth Amended Complaint 4 After five attempts to plead their claims, all of which resulted in dismissals, the plaintiffs filed their Fourth Amended Complaint, alleging medical malpractice, vicarious liability for medical malpractice, fraud, negligent misrepresentation, violation of the civil RICO Act, and civil conspiracy. The complaint now contained 129 paragraphs of general allegations, followed by 1,763 paragraphs of plaintiff-specific allegations. The plaintiffs incorporated all 129 general allegations into each of the nine counts for each of the 41 plaintiffs, regardless of whether the allegations were connected to the claim or the defendant named in the count. The defendants filed motions to dismiss, which the trial court granted. In doing so, the trial court noted this was the sixth complaint and “attempt to adequately and sufficiently state a cause of action.” In essence, the Fourth Amended Complaint alleged the plaintiffs were “all involved in either a motor vehicle accident, slip and fall, or other such event” and sustained injuries. The plaintiffs presented to the chiropractic Bauer defendants (Brian and Craig Bauer) and their entities 2 as well as medical defendants (Reuter and Metzger) for treatment of these injuries. The plaintiffs alleged the defendants “worked together to fake the performance of a medically necessary and beneficial surgical procedure for the purpose of collecting extra monies from [p]laintiffs’ personal injury settlements.” According to the complaint, the defendants were alleged to have “lied to [p]laintiffs, put them under general anesthesia, and then ‘operated’ on them by cutting them open and sewing them back up without performing any medically beneficial surgery at all.” The dismissal order stated, in part, “[t]he convoluted nature of the pleading renders it impossible for [d]efendants to adequately frame an Answer [because] the allegations repeatedly comingle conclusions against separate individuals and entities without discerning how, or why, or who did what on which occasion that would subject each to collective or vicarious liability under any” cause of action alleged. The plaintiffs filed two motions for rehearing and reconsideration. Both were denied. 2 Defendant entities included Beth Israel, Broward Medical, Palm Coast Anesthesia, Central Spine, Premier Orthopedic, Two and Two, Complete Rehab Plantation, Kendall Spine, MedAssist, Prestige, Orthopedic and Spine, Universal Mediquip, Broward Urgent, Neurosurgical Excellence, Complete Rehab Pompano, Complete Rehab West Palm, and Hollywood Rehab. 5 From the dismissal order and the orders denying the motions for rehearing and reconsideration, the plaintiffs now appeal. • The Analysis We begin with Florida Rule of Civil Procedure 1.110, which provides that “[a] pleading which sets forth a claim for relief . . . must state a cause of action and must contain: . . . (2) a short and plain statement of the ultimate facts showing that the pleader is entitled to relief.” Subsection (f) provides “[e]ach claim founded on a separate transaction or occurrence” must “be stated in a separate count . . . when a separation facilitates the clear presentation of the matter set forth.” Fla. R. Civ. P. 1.110(f). “[G]eneral, vague and conclusory statements are insufficient to satisfy the requirement that a pleader allege ‘a short and plain statement of the ultimate facts showing the pleader is entitled to relief. . . .’” Jordan v. Nienhuis, 203 So. 3d 974, 976 (Fla. 5th DCA 2016) (quoting Fla. R. Civ. P. 1.110(b)). “The complaint must [also] set out the elements and the facts that support them so that the court and the defendant can clearly determine what is being alleged.” Barrett v. City of Margate, 743 So. 2d 1160, 1162 (Fla. 4th DCA 1999). “It is not permissible for any litigant to submit a disorganized assortment of allegations and argument in hope that a legal premise will materialize on its own.” Id. at 1163. Despite these pleading requirements, the plaintiffs’ attempts to comply with the trial court’s direction and the rules of civil procedure ran afoul of both. As the trial court’s August 2023 dismissal order correctly observed, the complaint failed to allege who “made the initial referral and who (which defendants) referred plaintiffs to Dr. Reuter. . . . There are many conclusory statements lumping multiple defendants together with no connectivity.” Regarding the fraud and negligent misrepresentation claims, the trial court commented: “the complaint suffers from a lack of specificity (ie: who, what, when and where).” The complaint failed to describe what false statement was made, what reliance had occurred, and what damages patients had sufferred. Concerning the RICO allegations, the trial court found the plaintiffs had “failed to define the timeframe” and which defendants were engaged and at what times. Regarding the civil conspiracy claim, the trial court found the complaint failed to allege an agreement between two or more parties 6 and each defendant’s role in the conspiracy. The trial court refused to “take notice of what may or may not be found in discovery.” Because the trial court determined the plaintiffs had failed to sufficiently plead an actionable underlying tort or wrong, dismissal of the conspiracy claims was required as well. See City of Miami v. Alvarez, 421 So. 3d 802, 806 (Fla. 3d DCA 2025) (citing Raimi v. Furlong, 702 So. 2d 1273, 1284 (Fla. 3d DCA 1997)). The trial court provided an example in the order dismissing the Fourth Amended Complaint. “[I]n reference to the allegations of taking kickbacks or engaging in other acts by the ‘surgeon group’, [d]efendants identify 328 references to possibly ‘other members’ thereof (not Dr. Reuter) without identifying which ‘other’ [d]efendants or possibly non-party persons they are alleging engaged in such conduct.” In each count, the plaintiffs incorporated 129 general allegations, ranging from a description of corporate structures to billing practices, self- referrals and kickback violations, “faked” surgeries, and battery, into each of the nine counts for each of the forty-one plaintiffs. This indiscriminate incorporation of random allegations rendered each count defective under Rule 1.110(b). See Gerstein v. Int’l Asset Value Grp., LLC, 199 So. 3d 979, 981―82 (Fla. 4th DCA 2016) (affirming dismissal with prejudice where trial court took issue with complaint’s incorporation of thirty-three introductory paragraphs into all counts). We also note that plaintiff Tamonica Allen’s specific allegations appear on pages thirty-four to forty-four of the complaint (at pages 14792 to 14802 of the record), but the allegations of Allen’s medical negligence claim do not appear until page 423 of the complaint, 361 pages later. And even then, they shed little light on plaintiff Allen’s theory. In the specific section, plaintiff Allen alleges that she “underwent . . . orthopedic spine ‘surgery,’” and that defendant Reuter concealed the “true nature” of the surgery, which had no medical benefit. A reader cannot discern whether the claim is that defendant Reuter negligently recommended and performed a procedure that was not indicated, recommended the correct procedure but performed a different procedure, or was simply negligent in performing the procedure. Perhaps the most conspicuous void in the plaintiffs’ complaint is the lack of causation to any actual damage. The complaint fails to allege how the plaintiffs suffered any damage from the alleged fraudulent medical bills. No plaintiff was alleged to have paid a fraudulent bill. In fact, the 7 complaint indicates the bills were used to corroborate the plaintiffs’ claims in their personal injury actions, which were then settled. The complaint also failed to identify any claimed injuries from alleged felonious touching as opposed to medical malpractice. The plaintiffs’ allegations that defendant Reuter’s surgeries caused them to have additional medical care are too tenuous to support a claim for civil RICO. See Bortell v. White Mountains Ins. Grp., Ltd., 2 So. 3d 1041, 1047 (Fla. 4th DCA 2009) (plaintiff who suffered financial harm through lost commissions due to defendants’ unauthorized sale of insurance was precluded from asserting RICO claims because illegal activity was directed toward the state, and plaintiff’s lost commission was only indirectly related to the improper conduct). As the trial court appropriately noted, “damages are not fungible when there are approximately forty individual [p]laintiffs alleging approximately forty separate and individual claims resulting from separate and distinct . . . facts.” Because the complaint failed to articulate the causal link between the alleged misrepresentations and any specific injury, dismissal of those claims was warranted. • Conclusion This is a case where it is impossible to find a life raft―“a short and plain statement of the ultimate facts showing that the pleader is entitled to relief”―in a vast ocean. One thing is certain: the trial court here patiently waded multiple times through a sea of allegations in an ocean of pages and provided the plaintiffs with numerous opportunities to state a claim that could be answered by the defendants. The plaintiffs simply failed to do so. We have similarly spent days wading through the treacherous waters of this complaint and reached the same conclusion. The Fourth Amended Complaint neither complies with the Florida Rules of Civil Procedure nor the trial court’s direction. As the trial court’s order stated: “[t]here is simply a point in litigation when defendants are entitled to be relieved from the time, effort, energy, and expense of defending themselves against seemingly vexatious claims.” Kohn v. City of Miami Beach, 611 So. 2d 538, 539 (Fla. 3d DCA 1992) (citing Feigin v. Hosp. Staffing Servs., Inc., 569 So. 2d 941 (Fla. 4th DCA 1990)). Affirmed. GROSS and CIKLIN, JJ., concur. 8 * * * Not final until disposition of timely-filed motion for rehearing. 9