Gable v. United States

District Court, District of Columbia·Decided November 2, 2020·No. Civil Action No. 2012-1634·Published

Opinion

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

)

RICHARD MAURICE GABLE, )

)

Plaintiff, )

)

v. ) Civil Action No. 12-1634 (ABJ)

)

UNITED STATES OF AMERICA, )

)

Defendant. )

____________________________________)

MEMORANDUM OPINION

Plaintiff Richard M. Gable, proceeding pro se, filed this action under the Federal Tort Claims Act (“FTCA”), 28 U.S.C. §§ 1346, 2674 et seq., in 2012. 1 Plaintiff alleged that in 2006, the U.S. Department of Veterans Affairs Hospital (“VA Hospital”) negligently amputated his left leg at the knee and subsequently provided substandard medical and hygienic care. The case was first assigned to this Court on October 2, 2012, Notice of Transfer [Dkt. # 1], and there are several pending dispositive motions that are ripe for adjudication. For the following reasons, it is ORDERED that:

• Defendant’s motion for summary judgment [Dkt. # 151] is granted in part and denied in part;

• Plaintiff’s “motion for an appeal based on the court’s recommendation[] and motion for a venue change for the location of the appeal” [Dkt. # 166] is denied;

• Plaintiff’s cross motion for summary judgment [Dkt. # 175] is denied;

• Defendant’s motion for summary judgment on the claims related to bathing [Dkt. # 179] is granted; and

• Plaintiff’s motion for miscellaneous relief [Dkt. # 181] is denied.

1 See Gable v. United States, 106 Fed. Cl. 294, 296 (2012).

These rulings cover all of the remaining claims and bring the case to its conclusion. The Court acknowledges that there were many troubling aspects to the care that plaintiff received many years ago, and it does not doubt that he has suffered greatly. It also understands why he would continue to be deeply frustrated by a ruling dismissing claims on the grounds that they were late. But given the posture of the case at this time and the law that governs the few issues that have yet to be decided, there is nothing left to litigate, and the case in this court has come to an end. This a final order which may be appealed.

BACKGROUND

The facts of this case are laid out in detail in the many prior opinions in the case. 2 Plaintiff’s claims arise out of complications following a total knee arthroplasty (replacement) recommended by his primary care physician, Dr. Jean Estime, in January 2006. Ex. 1 to Def.’s Am. Statement of Undisputed Material Facts [Dkt. # 98-2] (“Medical Records”) at 1. Plaintiff was referred to VA Hospital, admitted on January 18, 2006, and underwent the procedure on January 19, 2006. Id. at 1–4. Soon after, the site of the surgery became infected with methicillin-resistant Staphylococcus aureus (“MRSA”), id. at 12, which required the insertion of an antibiotic- impregnated spacer in plaintiff’s left leg on February 21, 2006. Id. at 17–20. In March, another MRSA infection was detected, id. at 39, but by May, the infection was no longer detectable, and a new prothesis was implanted on May 19. Id. at 26–30. In June, a vancomycin-resistant enterococci (“VRE”) infection was detected in plaintiff’s knee, id. at 39, and the wound remained open. Suppl. Medical Rs. [Dkt. # 101-1 at 4–45] (“Suppl. Medical Records”) at 29.

2 See Gable v. United States (Gable I), 319 F. Supp. 3d 37 (D.D.C. 2018), adopting in full Report and Recommendation of December 29, 2017 [Dkt. # 108] (“December 2017 R&R”); Report and Recommendation of July 17, 2019 [Dkt. # 165] (“July 2019 R&R”); Gable v. United States (Gable II), No. 1:12-cv-01634, 2019 WL 4261046 (D.D.C. Sept. 9, 2019); and Report and Recommendation of February 28, 2020 [Dkt. # 188] (“February 2020 R&R”).

Due to underlying mental health issues, plaintiff signed control over medical decision-

making to his stepson, James Prather, in the spring of 2006. Pl.’s Mot. to Oppose Def.’s Amend. Mot. for Summ. J. [Dkt. # 101] (“Pl.’s Mot. to Oppose”) at 18–19; Affirmation of James M. Prather [Dkt. # 101-1 at 46–48] (“Prather Affirm”) at 46. 3 Plaintiff grew concerned about the possible need for amputation and sought a second medical opinion in July 2006 from Dr. Christopher Attinger of the Wound Healing Center at Georgetown University Medical Center. Suppl. Medical Records at 29; Prather Affirm at 46. Dr. Attinger examined plaintiff’s knee and informed him that the options were to amputate above the knee or replace the spacer, follow a six-month course of antibiotics, and reassess knee replacement at a later date. Suppl. Medical Records at 26, 29. A new spacer was inserted in plaintiff’s left knee at VA Hospital on August 15. Medical Records at 32–36. On August 18, Dr. Reuben Bueno, chief of plastic surgery at VA Hospital, consulted with plaintiff and discussed the risks of closing the open knee wound with a myofascial graft. Id. at 37–38.

That same day, Mr. Prather met with plaintiff and hospital staff to discuss plaintiff’s treatment plan and indicated he would not consent in advance to any treatment more invasive than an “antibiotic sleeve” around plaintiff’s knee space while he was away for two weeks on his honeymoon. Suppl. Medical Records at 28–29; Prather Affirm at 46–47. On August 21, doctors at VA Hospital noted plaintiff had developed an amount of “wet gangrene” above the spacer site that would be potentially life-threatening absent an amputation. Medical Records at 41. Witnessed by a VA hospital doctor and registered nurse, plaintiff gave consent to the amputation on August 23, and the procedure was performed. Def.’s Am. Statement of Undisputed Material Facts

3 Detailed facts about this agreement are not included in the record, so the Court construes the agreement as a medical power of attorney or designation of health care proxy. See December 2017 R&R at 3 n.5.

[Dkt. # 98-1] (“Material Facts”) ¶¶ 8–9; Medical Records at 46–53. Plaintiff notified his stepson of the amputation sometime after the surgery, and Mr. Prather complained to the head of the orthopedics units, Dr. Willie Banks, on September 5. Prather Affirm at 46–47. Dr. Banks reported that plaintiff “appeared to have understood the decision to amputate.” Medical Records at 59. 4 In September 2006, plaintiff had three post-amputation surgeries at VA Hospital. Due to a fall on September 5, plaintiff underwent surgery to re-close the wound. Material Facts at ¶ 14. Plaintiff required two more surgical repair procedures on September 12 and September 19, id. at ¶ 16, and remained in the intensive care unit until October 6. Pl.’s Mot. for Statute of Limitations [Dkt. # 100] at 5; Pl.’s Resp. to Def.’s Reply in Supp. of Def.’s Mot. for Summ. J. [Dkt. # 106] at 14. Plaintiff was discharged from VA Hospital on October 18, 2006. Material Facts at ¶ 17.

Plaintiff brought this action seeking damages for the alleged injuries he suffered from the ten-month course of medical treatment and associated care. The 2012 complaint included seven claims:

(1) plaintiff’s knee replacement was negligently performed;

(2) improper hygiene led to the MRSA and VRE infections;

(3) the amputation was performed without proper consent;

(4) the amputation was performed unnecessarily;

(5) the amputation was performed negligently;

(6) the post-amputation surgical procedures were negligently performed; and

(7) the non-surgical, post-operative care also fell below the standard of care; in particular, plaintiff alleges that he was not permitted to bathe during the entire ten-month period he was hospitalized for treatment. Notice of Transfer at 12.

4 Plaintiff’s medical records indicate that Dr. Bueno personally discussed the treatment plan with plaintiff, including “the problems leading up to the amputation” and explained the underlying surgical issues. Medical Records at 59.

See Gable I, 319 F. Supp. 3d at 40–41.

Finally, it appears from the record that plaintiff had two subsequent reconstructive surgeries: the first at Georgetown University Hospital in Washington, D.C., in April 2007, Suppl. Medical Records at 4, 37–42, and the second at Cĺínica Santa Maŕía in San Jose, Costa Rica, on August 22, 2007. Id. at 7–9.

PROCEDURAL HISTORY

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