Dennis Godelia v. Zoll Services, LLC , 881 F.3d 1309 ( 2018 )


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  •               Case: 17-10736      Date Filed: 02/08/2018   Page: 1 of 25
    [PUBLISH]
    IN THE UNITED STATES COURT OF APPEALS
    FOR THE ELEVENTH CIRCUIT
    ________________________
    No. 17-10736
    ________________________
    D.C. Docket No. 0:16-cv-60471-DPG
    DENNIS GODELIA,
    individually and as personal representative of the Estate of Debra Godelia,
    S.Y.,
    surviving minor child of Debra Godelia,
    Plaintiffs - Appellants,
    versus
    John Doe 1, et al.,
    Defendants,
    ZOLL SERVICES, LLC,
    as successor in interest to ZOLL Lifecor Corporation,
    SAMANTHA ORSINI,
    ANA CECELIA-MASTERS,
    Defendants - Appellees.
    ________________________
    Appeal from the United States District Court
    for the Southern District of Florida
    ________________________
    (February 8, 2018)
    Case: 17-10736      Date Filed: 02/08/2018      Page: 2 of 25
    Before MARTIN, JORDAN, and GINSBURG, * Circuit Judges.
    MARTIN, Circuit Judge:
    Dennis Godelia and Sterling Youmas appeal the District Court’s dismissal of
    their case against ZOLL Services, LLC (“ZOLL”), which brought seven claims
    under Florida law. Mr. Godelia is suing individually and as the personal
    representative of the estate of Debra Godelia, who was his wife. Mr. Youmas was
    Ms. Godelia’s son. Ms. Godelia went into cardiac arrest while wearing an external
    defibrillator device manufactured by ZOLL, and known as the LifeVest. Ms.
    Godelia died as a result of this heart attack. The claims against ZOLL for strict
    products liability, negligence, fraudulent misrepresentation, fraudulent marketing
    and promotion, breach of express warranty, negligent misrepresentation, and
    negligent infliction of emotional distress all relate to the operation (or failure to
    operate) of Ms. Godelia’s LifeVest. After careful consideration, and with the
    benefit of oral argument, we affirm the District Court’s dismissal of the plaintiffs’
    negligent infliction of emotional distress claim. However, in light of developing
    and binding precedent in our circuit, we reverse the District Court’s dismissal of
    the remaining claims.
    *
    Honorable Douglas H. Ginsburg, United States Circuit Judge for the District of
    Columbia Circuit, sitting by designation.
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    I. BACKGROUND
    A. THE FACTS
    Because we are reviewing the District Court’s ruling based on the pleadings,
    we accept the factual allegations in the complaint as true, and indeed we construe
    them in the light most favorable to the plaintiffs. Hill v. White, 
    321 F.3d 1334
    ,
    1335 (11th Cir. 2003) (per curiam). Our account of the facts therefore comes from
    the plaintiffs’ complaint.
    ZOLL designs, manufactures, and markets the LifeVest, which is a
    wearable, external defibrillator designed for patients at risk of sudden cardiac
    arrest. The LifeVest is designed to detect a threatening heartbeat pattern, then
    administer a treatment shock, for the purpose of restoring the normal heart rhythm.
    The Food and Drug Administration (“FDA”) originally approved the LifeVest for
    sale in 2001 and classified it as a Class III medical device, which is the highest risk
    category. A LifeVest must be prescribed by a doctor. But once the LifeVest has
    been prescribed, ZOLL enters into a contract directly with the patient and the
    patient’s insurance provider.
    ZOLL advertised the LifeVest as providing “constant monitoring, immediate
    protection, and [] peace of mind for patients” and family members. According to
    ZOLL, “if [a] patient experiences a life-threatening heart rhythm, the LifeVest will
    detect the rhythm and will deliver a treatment shock to restore the normal heart
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    rhythm.” ZOLL also advertised the LifeVest as having “a 98 percent first
    treatment shock success rate for resuscitating patients.”
    On November 1, 2013, Ms. Godelia went to the hospital complaining of
    abdominal and back pain. When medical staff recognized she was having a heart
    problem, she was admitted for urgent cardiac catheterization. Before she was
    discharged, a ZOLL employee, Samantha Orsini, spoke with Ms. Godelia about
    using a LifeVest. According to the complaint, Ms. Godelia “had significant
    reservations about and was reluctant to use the LifeVest.” Among other things, she
    was concerned “that the LifeVest would administer a shock when one was not
    needed and that it would detect a treatable heart event, but fail to administer the
    shock.” In response to Ms. Godelia’s concerns, Ms. Orsini told her: (1) the
    LifeVest would never administer a shock when one wasn’t needed; (2) it would
    administer a shock if a heart event was detected; (3) the success rate for detecting
    and administering a shock was higher than 98%; and (4) that LifeVest had a 98%
    first treatment shock success rate for resuscitating patients. Relying on these
    representations, Ms. Godelia agreed to use the LifeVest and did not ask about
    alternative treatment options. But because she still had concerns about the product,
    Ms. Godelia asked for another ZOLL representative to visit her at her home. Ana
    Cecilia Masters, another ZOLL employee, met with Ms. Godelia and made
    substantially similar representations. Ms. Godelia continued wearing a LifeVest.
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    On November 18, 2013, Ms. Godelia went to the doctor, who confirmed that
    she was using the LifeVest as ZOLL had instructed. Later that same day, Ms.
    Godelia experienced a “Defibrillation Event” and lost consciousness. The
    LifeVest detected a problem with Ms. Godelia’s heart, making an audible alarm.
    However, the LifeVest did not shock Ms. Godelia as it was supposed to. Mr.
    Godelia saw this happen but, following the instructions of ZOLL, he did not touch
    his wife. Ms. Godelia’s son, Mr. Youmas, called 911. When Mr. Youmas realized
    the shock wasn’t being administered, he began performing CPR on his mother.
    Ms. Godelia remained unconscious and died two days later, on November 20,
    2013.
    Then came September 23, 2014, when the FDA sent ZOLL a Warning
    Letter. The letter said the FDA had conducted an inspection of ZOLL’s facilities
    between May 22 and June 20, 2014, and as a result of that inspection, determined
    that the medical devices ZOLL produced were “adulterated within the meaning of
    Section 501(h) of the [Federal Food, Drug, and Cosmetic] Act.” The letter listed a
    number of regulatory violations identified by FDA inspectors relating to quality
    control procedures at the ZOLL manufacturing facility. 1 But the letter was also
    1
    Specifically, the Warning Letter identified the following violations: (1) “Failure to
    document results for corrective and preventive actions, as required by 21 CFR 820.100(b)”; (2)
    “Failure to review, evaluate, and investigate complaints by a designated unit, as required by 21
    CFR 820.198(a)”; (3) “Failure to adequately establish procedures for design validation, as
    required by 21 CFR 820.30(g)”; (4) “Failure of management with executive responsibility to
    review the suitability and effectiveness of the quality system at defined intervals, and with
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    clear that the list of regulatory violations was not all-inclusive. The letter also
    referenced problems with LifeVests administering “inappropriate shocks,” some of
    which were caused by noise or vibration, and difficulties in using the device by
    patients with cognitive or physical limitations.
    B. PROCEDURAL HISTORY
    On November 17, 2015, Mr. Godelia 2 filed a complaint in Florida state court
    relating to the malfunction of Ms. Godelia’s LifeVest. The suit was brought
    against ZOLL and two unknown ZOLL representatives, later identified as Ms.
    Orsini and Ms. Masters. 3 On March 9, 2016, ZOLL removed the case to federal
    court.
    sufficient frequency, according to established procedures to ensure that the quality system
    satisfies the requirements of 21 CFR 820 and the manufacturer’s established quality policy and
    objectives, as required by 21 CFR 820.20(c)”; (5) “Failure to report to us no later than 30
    calendar days after the day that your firm received or otherwise became aware of information,
    from any source, that reasonably suggests that a device that your firm markets may have caused
    or contributed to a death or serious injury, as required by 21 CFR 803.50(a)(1)”; (6) “Failure to
    report to us no later than 30 calendar days after the day that your firm received or otherwise
    became aware of information, from any source, that reasonably suggests that a device that your
    firm markets would be likely to cause or contribute to a death or serious injury, if the
    malfunction were to recur, as required by 21 CFR 803.50(a)(2)”; (7) “Failure to develop,
    maintain, and implement written MDR procedures, as required by 21 CFR 803.17.”
    2
    As noted above, the complaint was filed by Mr. Godelia, individually and as personal
    representative of the estate of Ms. Godelia, together with Mr. Youmas. Although the case
    caption refers to S.Y. as a minor, he has now reached majority, so we use his name. For
    simplicity, we will refer to the claims as brought by Mr. Godelia.
    3
    The parties have since asked this Court to dismiss Ms. Orsini and Ms. Masters, which
    we have done in a separate order.
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    Mr. Godelia then amended his complaint, raising eight claims for relief: (1)
    strict products liability based on a manufacturing defect; (2) negligence based on a
    manufacturing defect; (3) fraudulent misrepresentation; (4) fraudulent omission
    and concealment; (5) fraudulent marketing and promotion; (6) breach of express
    warranty; (7) negligent misrepresentation; and (8) negligent infliction of emotional
    distress. Mr. Godelia said the LifeVest had a manufacturing defect that caused it
    to fail, and that the defect “was the direct result of ZOLL’s failure to comply with
    relevant federal regulations in the manufacturing of the LifeVest.” Mr. Godelia
    based these claims on violations of regulations implementing the Medical Device
    Amendments (“MDA”) that were identified in the FDA Warning Letter, although
    he noted that the Warning Letter itself said its list of violations was not all-
    inclusive. Mr. Godelia said the violations described in the Warning Letter “also
    existed at the time the subject LifeVest was manufactured in May 2013.” Mr.
    Godelia also based a number of his claims on statements made by ZOLL and its
    employees, which he said overstated the effectiveness of the LifeVest.
    Ten days after Mr. Godelia filed the amended complaint, ZOLL moved to
    dismiss it. ZOLL argued that the MDA preempted all of Mr. Godelia’s claims. In
    response, Mr. Godelia acknowledged that the District Court would be justified in
    dismissing his fraudulent omission and concealment claim on preemption grounds,
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    and he dropped that claim. But he stood by the remaining claims, saying they
    should survive under both Florida and federal law.
    The District Court then granted ZOLL’s motion to dismiss in full. Indeed,
    the District Court determined that all of Mr. Godelia’s claims were expressly
    preempted by the MDA because they were premised on the LifeVest being
    defective. The District Court reasoned that claims of defects in the LifeVest would
    be at odds with the FDA’s determination that LifeVests were safe. The District
    Court also found that Mr. Godelia failed to allege a parallel claim, as is required in
    order to avoid preemption, because “there is no nexus between the warning letter,
    Ms. Godelia’s LifeVest, and her injuries.” In addition, the District Court held that
    the breach of express warranty claim failed under Florida law because there was no
    privity between Ms. Godelia and ZOLL, and that the negligent infliction of
    emotional distress claim failed under Florida law because Mr. Godelia and Mr.
    Youmas did not “allege a discernible physical injury.” Finally, the court said that
    even if some of the plaintiffs’ claims were not expressly preempted, they were
    likely impliedly preempted.
    This appeal followed. After Mr. Godelia filed his brief on appeal, but before
    ZOLL filed its answer brief, this Court issued its decision in Mink v. Smith &
    Nephew, Inc., 
    860 F.3d 1319
    (11th Cir. 2017). Mink addressed preemption
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    questions very much like those raised here, and brought under similar
    circumstances.
    II.     STANDARD OF REVIEW
    We review de novo the District Court’s dismissal of a complaint for failure
    to state a claim under Federal Rule of Civil Procedure 12(b)(6). 
    Hill, 321 F.3d at 1335
    . In doing so, we accept the plaintiff’s allegations in the complaint as true,
    and we construe them in the light most favorable to the plaintiff. 
    Id. Even so,
    “only a complaint that states a plausible claim for relief survives a motion to
    dismiss.” Ashcroft v. Iqbal, 
    556 U.S. 662
    , 679, 
    129 S. Ct. 1937
    , 1950 (2009). We
    also review de novo the District Court’s interpretation of state law. Tampa Bay
    Water v. HDR Eng’g, Inc., 
    731 F.3d 1171
    , 1177 (11th Cir. 2013).
    III.      FEDERAL PREEMPTION LAW
    We begin with a brief overview of the law governing medical devices. The
    Medical Device Amendments of 1976 (“MDA”), 21 U.S.C. § 360c et seq., give the
    FDA regulatory authority over medical devices. 
    Mink, 860 F.3d at 1325
    . Class III
    devices like the LifeVest, which are deemed the highest risk, are required to go
    through an extensive premarket approval process. See Riegel v. Medtronic, Inc.,
    
    552 U.S. 312
    , 317–18, 
    128 S. Ct. 999
    , 1003–04 (2008). Once a device has been
    approved, a manufacturer may not make any change to the device that could affect
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    its safety or effectiveness unless that change gets additional approval from the
    FDA. 
    Id. at 319,
    128 S. Ct. at 1005.
    The MDA provides for two types of preemption of certain state law claims
    relating to medical devices: express and implied. The express preemption
    provision bars any claim based on a state law requirement “which is different from,
    or in addition to, any requirement” under the MDA that “relates to the safety or
    effectiveness of the device” or any other MDA requirement. 21 U.S.C. § 360k(a).
    The implied preemption provision of the MDA states that “all such proceedings for
    the enforcement, or to restrain violations, of this chapter shall be by and in the
    name of the United States.” 
    Id. § 337(a).
    The Supreme Court has interpreted this
    implied preemption provision to bar claims that merely attempt to enforce duties
    owed to the FDA, so-called “fraud-on-the-FDA claims.” Buckman Co. v.
    Plaintiffs’ Legal Comm., 
    531 U.S. 341
    , 348, 
    121 S. Ct. 1012
    , 1017 (2001).
    Taken together, these two types of preemption leave a “narrow gap” through
    which plaintiffs making medical device claims must proceed. See In re Medtronic,
    Inc., 
    623 F.3d 1200
    , 1204 (8th Cir. 2010). “To make it through, a plaintiff has to
    sue for conduct that violates a federal requirement (avoiding express preemption),
    but cannot sue only because the conduct violated that federal requirement
    (avoiding implied preemption).” 
    Mink, 860 F.3d at 1327
    . Put differently, “a
    plaintiff may proceed on her claim so long as she claims the ‘breach of a well-
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    recognized duty owed to her under state law’ and so ‘long as she can show that she
    was harmed by a violation of applicable federal law.’” 
    Id. (quoting Bausch
    v.
    Stryker Corp., 
    630 F.3d 546
    , 558 (7th Cir. 2010)).
    IV. MR. GODELIA’S CLAIMS
    Mr. Godelia has seven remaining Florida state law claims: (1) strict products
    liability based on a manufacturing defect; (2) negligence based on a manufacturing
    defect; (3) fraudulent misrepresentation; (4) fraudulent marketing and promotion;
    (5) breach of express warranty; (6) negligent misrepresentation; and (7) negligent
    infliction of emotional distress.
    “Because preemption is a principle derived from the Supremacy Clause,
    U.S. Const. Art. VI, cl. 2, we must first analyze whether each claim can stand
    under state law, and only then decide the preemption questions where necessary.”
    
    Id. at 1328.
    As a result, we will first examine each claim under Florida law and
    only if it is viable under state law, will we then consider whether it is expressly or
    impliedly preempted.
    A. CLAIMS BASED ON MANUFACTURING DEFECT
    Mr. Godelia’s complaint raises two claims based on a manufacturing defect:
    strict products liability and negligence. Mr. Godelia says his wife’s LifeVest “was
    defective and unreasonably dangerous as a result of a manufacturing defect.” He
    also says that the “manufacturing defect was the direct result of ZOLL’s failure to
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    comply with applicable federal regulations noted above for manufacturing
    LifeVest devices, including the subject LifeVest, and for detecting and fixing
    manufacturing defects with LifeVest devices before placing them into the stream
    of commerce.”
    Mr. Godelia bases his claims on violations of federal law identified in the
    FDA Warning Letter, “including by way of example, sections 21 CFR 820.100(b),
    21 CFR 820.198(a), 21 CFR 820.30(g), 21 CFR 820.20(c).” However, Mr.
    Godelia stresses the Warning Letter “is not an all-inclusive list of every possible
    violation of deviation from law and regulation observed during the FDA
    Inspection.” He says ZOLL’s “failure to comply with the above regulations
    resulted in Zoll failing to determine that the subject LifeVest was manufactured
    and delivered to Debra Godelia with non-conformities.”
    The District Court found Mr. Godelia’s strict products liability and
    negligence claims based on a manufacturing defect to be expressly preempted by
    the MDA. The court also found Mr. Godelia had not established a causal
    connection between the alleged violations and Ms. Godelia’s injury. The court
    then also made the alternative ruling that Mr. Godelia’s claims were impliedly
    preempted because there is no private right of action for a violation of the FDCA.
    To reach this result, the District Court in Mr. Godelia’s case relied on the
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    preemption analysis from a District Court ruling in Mink, which this Court later
    reversed on 
    appeal. 860 F.3d at 1330
    –31.
    1. Florida State Law
    Florida law recognizes strict liability claims based on a manufacturing
    defect. See West v. Caterpillar Tractor Co., 
    336 So. 2d 80
    , 87 (Fla. 1976). To
    make a strict liability claim under Florida law, a plaintiff “must establish the
    manufacturer’s relationship to the product in question, the defect and unreasonably
    dangerous condition of the product, and the existence of the proximate causal
    connection between such condition and the user’s injuries or damages.” 
    Id. Florida also
    recognizes negligence claims in relation to manufacturing
    defects. See Ford Motor Co. v. Evancho, 
    327 So. 2d 201
    , 204 (Fla. 1976) (“[T]he
    manufacturer must use reasonable care in design and manufacture of its product to
    eliminate unreasonable risk of foreseeable injury.”). In Florida, “a manufacturer’s
    duty to inspect and test . . . . is a subpart of a manufacturer’s duty to design a
    product with reasonable care.” Adams v. G.D. Searle & Co., 
    576 So. 2d 728
    , 730–
    31 (Fla. 2d DCA 1991). And in Florida, “the violation of a statute may be utilized
    as evidence of negligence.” Fla. Dep’t of Corr. v. Abril, 
    969 So. 2d 201
    , 205 (Fla.
    2007).
    Here, Mr. Godelia says ZOLL manufactured the LifeVest and placed it into
    commerce, the LifeVest was defective and nonconforming, and that those defects
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    caused Ms. Godelia’s injuries. Mr. Godelia also says the “violation of the federal
    regulations noted above” caused the defect in Ms. Godelia’s LifeVest. On its face,
    this is sufficient to state a claim under Florida law for strict liability and negligence
    related to a manufacturing defect. Contrary to ZOLL’s argument, Mr. Godelia
    need not state in his complaint the precise defect that caused Ms. Godelia’s
    LifeVest to malfunction. See Small v. Amgen, Inc., 
    2 F. Supp. 3d 1292
    , 1297
    (M.D. Fla. 2014).
    The District Court’s finding that Mr. Godelia did not show an adequate
    nexus between the regulatory violations and Ms. Godelia’s injury—apparently, a
    determination that Mr. Godelia did not adequately plead causation—is also
    misplaced. While it may come to pass that Mr. Godelia has a difficult time
    proving that it was the violations of the MDA regulations that caused a defect in
    Ms. Godelia’s LifeVest, the allegations in his complaint are sufficient to state a
    claim that is plausible on its face. See 
    Iqbal, 556 U.S. at 678
    , 129 S. Ct. at 1949.
    For example, it is plausible that ZOLL’s failure to document and respond to
    complaints about its products in violation of 21 CFR 820.198(a) could have
    resulted in a defect persisting in LifeVests long after ZOLL should have been
    aware of it, and that this defect caused Ms. Godelia’s death. We decline ZOLL’s
    invitation to apply a heightened pleading standard to allegations of causation in
    medical device claims. Cf. Leatherman v. Tarrant Cty. Narcotics Intelligence &
    14
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    Coordination Unit, 
    507 U.S. 163
    , 168, 
    113 S. Ct. 1160
    , 1163 (1993). Mr.
    Godelia’s claims under Florida law for negligence and strict liability based on a
    manufacturing defect are sufficiently pled.
    2. Express Preemption
    ZOLL argues that Mr. Godelia’s manufacturing defect claims are all
    expressly preempted because he “did not allege that the common law claims were
    based solely on the violation of” the MDA regulations. ZOLL says “[a]s alleged,
    all of the counts could proceed even if ZOLL had complied with federal law
    because the complaint allowed liability to be premised on findings that ZOLL had
    been negligent or had produced an unreasonably dangerous product, apart from
    any federal regulatory violation.”
    We conclude to the contrary that Mr. Godelia has sufficiently pled his strict
    liability and negligence claims so as to avoid express preemption. Mr. Godelia
    alleged that “[t]he manufacturing defect was the direct result of Zoll’s failure to
    comply with applicable federal regulations noted above.” In his Reply Brief (now
    with the benefit of this Court’s decision in Mink), Mr. Godelia reiterates that his
    claims “are premised only on Zoll’s violations of federal regulations, which also
    caused a violation of Florida’s common law duty to use due care in manufacturing
    the LifeVest.” This Court recognized in Mink that both Florida negligence and
    strict liability claims based on manufacturing defects can survive express
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    preemption. 860 F.3d at 1330
    –31. We see no basis for distinguishing Mr.
    Godelia’s and Mr. Mink’s claims in this regard.
    ZOLL would have us dismiss Mr. Godelia’s claims because his complaint
    didn’t expressly limit them to violations of federal regulations. But that would
    verge on requiring plaintiffs to invoke magic words in their complaints. Cf.
    Urquilla-Diaz v. Kaplan Univ., 
    780 F.3d 1039
    , 1054 (11th Cir. 2015) (holding that
    plaintiff’s “failure to include the adverb solely—a word with no talismanic
    power—is not enough to preclude the inference that he pleaded a plausible
    violation of the False Claims Act”). Here at the pleadings stage, Mr. Godelia has
    satisfactorily limited his claims to violations of federal regulations. If they should
    later be shown to extend beyond the purview of the applicable federal regulations,
    his claims may be defeated at that point.
    Mr. Godelia has also met his burden to plead specific violations of federal
    regulations. In Wolicki-Gables v. Arrow International, Inc., 
    634 F.3d 1296
    (11th
    Cir. 2011), this Court held that a plaintiff’s Florida manufacturing defect claims
    were expressly preempted in part because the plaintiffs did “not set forth any
    specific problem, or failure to comply with any FDA regulation that can be linked
    to the injury alleged.” 
    Id. at 1301–02
    (quotation omitted). This case is different.
    Mr. Godelia alleged the violation of the specific federal regulations identified in
    the FDA Warning Letter. The fact that the regulations identified are not device-
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    specific is of no moment. See 
    Mink, 860 F.3d at 1331
    n.3 (“To the extent [the
    defendant] argues that some of the federal regulations cited by [the plaintiff] are
    not sufficiently device-specific, we reject its argument. We agree with our sister
    circuits that there is no sound legal basis to distinguish these federal requirements
    because the plain text of 360k refers to ‘any requirement.’” (quotation omitted)).
    We are mindful that Mr. Godelia would not likely have an opportunity to
    access documents describing all of the LifeVest-specific regulatory requirements
    without discovery. As the Seventh Circuit recognized, “[t]he specifications of the
    FDA’s premarket approval documents, for example, are confidential, and there is
    no public access to complete versions of these documents. An injured patient
    cannot gain access to that information without discovery.” 
    Bausch, 630 F.3d at 560
    . In any event, Mr. Godelia has alleged a violation of federal regulations
    sufficient to avoid express preemption under the MDA.
    3. Implied Preemption
    ZOLL also argues that Mr. Godelia’s claims are impliedly preempted
    because the specific federal regulations Mr. Godelia alleges were violated sound
    more like “fraud-on-the-FDA” claims than traditional state law tort claims. This
    argument misses the mark. While Mr. Godelia’s claims would have been
    impliedly preempted if he were asking the court to find ZOLL liable based solely
    on a failure to report to the FDA, Mr. Godelia is not pursuing this type of claim.
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    Instead, Mr. Godelia is claiming negligence and strict liability based on a
    manufacturing defect, and in order to succeed, he will have to prove all the
    elements of those claims under Florida law. Again, we find Mink controlling on
    this point. There, we concluded that Mr. Mink’s strict liability and negligence
    claims based on a manufacturing defect were not impliedly preempted because
    “the duty enforced here is the traditional state tort duty of a manufacturer to use
    due care in manufacturing.” 
    Mink, 860 F.3d at 1331
    . And as already noted, in
    Florida, a manufacturer’s duty includes the duty to inspect and test. See 
    Adams, 576 So. 2d at 730
    –31. Mr. Godelia’s strict liability and negligence claims are
    sufficient on the pleadings to avoid implied preemption. Because these claims are
    sufficient under state law, and are not expressly or impliedly preempted, we
    reverse the District Court’s dismissal.
    B. CLAIMS BASED ON REPRESENTATIONS
    Mr. Godelia also makes a number of claims based on representations made
    by ZOLL about the efficacy of the LifeVest. His claims include fraudulent
    misrepresentation, negligent misrepresentation, fraudulent marketing and
    promotion, and breach of express warranty.
    Mr. Godelia says ZOLL and its employees made affirmative
    misrepresentations to the Godelias that contained material facts they knew or
    should have known were false. Specifically, he says ZOLL advertised that the
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    LifeVest would provide “constant monitoring, immediate protection, and [] peace
    of mind for patients,” and that the LifeVest had a “98 percent first treatment shock
    success rate for resuscitating patients.” Mr. Godelia also says Ms. Orsini and Ms.
    Masters told Ms. Godelia that the LifeVest would never administer a shock when
    one wasn’t needed, and that it would administer a shock whenever one was needed.
    Because ZOLL did not have procedures to evaluate how effective LifeVests
    actually were, Mr. Godelia says “Zoll could not know and did not know the
    success rate of the LifeVest.” Mr. Godelia says that these misrepresentations
    induced his wife to wear a LifeVest.
    1. Florida State Law
    To make a claim for fraudulent misrepresentation under Florida law, a
    plaintiff must allege: “(1) a false statement concerning a material fact; (2) the
    representor’s knowledge that the representation is false; (3) an intention that the
    representation induce another to act on it; and (4) consequent injury by the party
    acting in reliance on the representation.” Butler v. Yusem, 
    44 So. 3d 102
    , 105
    (Fla. 2010) (emphasis removed). A party alleging negligent misrepresentation
    makes a valid claim “only if the recipient of the information justifiably relied on
    the erroneous information.” Gilchrist Timber Co. v. ITT Rayonier, Inc., 
    696 So. 2d
    334, 337 (Fla. 1997).
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    The District Court treated Mr. Godelia’s fraudulent and negligent
    misrepresentation claims identically, and neither party has given us reason to
    distinguish them now. Mr. Godelia said ZOLL and its employees made the false
    statements described in the complaint to Ms. Godelia with the intent to sell their
    product, that ZOLL and its employees knew or should have known that those
    statements were false, and that Ms. Godelia reasonably relied on those statements
    when she purchased the LifeVest that caused her injury. This is sufficient to state
    a claim under Florida law for both fraudulent misrepresentation and negligent
    misrepresentation.
    Next, Mr. Godelia’s fraudulent marketing and promotion claim is based on
    Florida Statutes Sections 817.40(5) and 817.41(1). Among other things, these laws
    make it “unlawful for any person to make or disseminate or cause to be made or
    disseminated . . . any misleading advertisement.” Fla. Stat. § 817.41(1). A
    “misleading advertisement” is defined as statements made with the purpose of
    selling property or services “which are known, or through the exercise of
    reasonable care or investigation could or might have been ascertained, to be untrue
    or misleading.” Fla. Stat. § 817.40(5). Mr. Godelia points to specific marketing
    statements he says were false and misleading, noting that ZOLL could not and did
    not have a factual basis for making those statements. This is sufficient to state a
    claim under Florida law for fraudulent marketing and promotion.
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    Finally, Mr. Godelia brings a claim for breach of express warranty. The
    District Court stated that under Florida law, a breach of express warranty claim
    requires privity of contract between the parties. The court found no privity of
    contract here, stating: “Plaintiffs allege that Mrs. Godelia required a prescription to
    obtain the LifeVest. As such, Mrs. Godelia could not purchase the device directly
    from Defendants.” Our review of Florida law reveals no clear rule about whether
    privity is required in every Florida express warranty claim. Compare T.W.M. v.
    Am. Med. Sys., 
    886 F. Supp. 842
    , 844 (N.D. Fla. 1995) (stating that privity is
    required for all express warranty claims), with Smith v. Wm. Wrigley Jr. Co., 
    663 F. Supp. 2d 1336
    , 1342–43 (S.D. Fla. 2009) (recognizing that privity may not be
    required for all express warranty claims). But even if we assume privity is
    required, Mr. Godelia has sufficiently alleged it. We see no basis for the broad
    rule articulated by the District Court that there can be no privity when a
    prescription is required for purchase. Here, Mr. Godelia alleged that his wife
    contracted directly with ZOLL to purchase her LifeVest, and ZOLL has made no
    showing to the contrary. At this stage in the proceedings, and accepting Mr.
    Godelia’s allegations as true, he has sufficiently stated a claim for breach of
    express warranty under Florida law.
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    2. Express and Implied Preemption
    In Mink, this Court concluded that the plaintiff’s fraudulent
    misrepresentation claim was not expressly or impliedly 
    preempted. 860 F.3d at 1333
    . In so holding, we said that if any representations by the manufacturer
    imposed new requirements on its products, those requirements “were undertaken
    by [the manufacturer], not imposed by the state of Florida.” 
    Id. And because
    the
    MDA only preempted regulations imposed by the state, there was no preemption
    problem for claims arising from the statements manufacturers make about their
    products. 
    Id. The Mink
    opinion found support for this proposition in a Supreme
    Court ruling that determined breach of express warranty claims were not
    preempted by another federal statute. See Cipollone v. Liggett Group, Inc., 
    505 U.S. 504
    , 525, 
    112 S. Ct. 2608
    , 2622 (1992) (“A manufacturer’s liability for
    breach of an express warranty derives from, and is measured by, the terms of that
    warranty. Accordingly, the requirements imposed by an express warranty claim
    are not imposed under State law, but rather imposed by the warrantor.” (quotations
    omitted and alteration adopted)).
    The same reasoning controls here. If ZOLL’s various statements held its
    product out as meeting a higher standard than that required by the FDA, this was
    ZOLL’s independent undertaking. ZOLL could have chosen to promise its
    patients less, but that may have resulted in patients not choosing to use a LifeVest.
    22
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    Because Mr. Godelia’s claims for fraudulent misrepresentation, negligent
    misrepresentation, fraudulent marketing and promotion, and breach of express
    warranty are traditional state-law claims and address promises made by ZOLL
    rather than imposed by the state, we conclude that these claims are not impliedly or
    expressly preempted. Because these claims are also sufficient under state law, we
    reverse the District Court’s ruling that dismissed them.
    C. NEGLIGENT INFLICTION OF EMOTIONAL DISTRESS
    The plaintiffs’ last claim is for negligent infliction of emotional distress.
    Mr. Godelia and Mr. Youmas say that “[a]s a result of witnessing the sad and
    devastating death of Debra Godelia, [they] suffered and continue to suffer
    emotional distress and damages, which . . . have manifested into physical
    symptoms.” Specifically, Mr. Godelia says he has experienced “insomnia,
    depression, short-term memory loss, inability to stop reliving [] Debra Godelia’s
    death, muscle and stomach pain.” Mr. Youmas says he suffers from an “inability
    to stop reliving the event, depression, short-term memory loss, muscle and other
    pain.”
    1. Florida State Law
    In Florida, “persons who suffer a physical injury as a result of emotional
    distress arising from their witnessing the death or injury of a loved one may
    maintain a cause of action for negligent infliction of emotional distress.” Zell v.
    23
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    Meek, 
    665 So. 2d 1048
    , 1050 (Fla. 1995). In Zell, the Florida Supreme Court
    concluded that the plaintiff had shown a physical injury sufficient to make a claim
    for negligent infliction of emotional distress. 
    Id. at 1054.
    The plaintiff in Zell saw
    a physician for treatment of severe pain below her rib cage and in her chest, a
    blockage in her esophagus, irritable bowel symptoms, and joint pain, all of which
    resulted from her proximity to a bomb that exploded at the door of her parents’
    apartment. 
    Id. at 1049–50.
    The physician said that the psychological trauma the
    plaintiff suffered contributed to her physical symptoms and increased her need for
    medical care. 
    Id. at 1050.
    In contrast, in R.J. v. Humana of Fla., Inc., 
    652 So. 2d 360
    (Fla. 1995), the Florida Supreme Court held that general allegations of “bodily
    injury including hypertension, pain and suffering” resulting from a wrong report
    about the result of a blood test were not sufficient to state a claim for negligent
    infliction of emotional distress. 
    Id. at 364.
    Our review of Florida law leads us to conclude that Mr. Godelia and Mr.
    Youmas have failed to allege a physical injury sufficient to state a claim for
    negligent infliction of emotional distress. Their generalized allegations of muscle
    and stomach pain appear closer to the symptoms deemed insufficient in R.J. than
    those found sufficient in Zell. Because the plaintiffs’ negligent infliction of
    emotional distress claim is not sufficient under Florida law, we affirm the District
    Court’s dismissal of this claim. If the plaintiffs’ symptoms have manifested into
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    more concrete physical injuries, those facts would properly be the subject of an
    amendment to the complaint.
    V. CONCLUSION
    We affirm the District Court’s dismissal of Mr. Godelia’s negligent
    infliction of emotional distress claim. We reverse the District Court’s dismissal of
    Mr. Godelia’s remaining claims, which we conclude are cognizable Florida
    common law causes of action and are not preempted by federal law.
    AFFIRMED IN PART, REVERSED AND REMANDED IN PART
    25