Paul C. Edwards v. United States

519 F.2d 1137, 1975 U.S. App. LEXIS 12727
CourtCourt of Appeals for the Fifth Circuit
DecidedSeptember 17, 1975
Docket74-2922
StatusPublished
Cited by19 cases

This text of 519 F.2d 1137 (Paul C. Edwards v. United States) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fifth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Paul C. Edwards v. United States, 519 F.2d 1137, 1975 U.S. App. LEXIS 12727 (5th Cir. 1975).

Opinions

PER CURIAM:

Paul C. Edwards seeks in this action under the Federal Tort Claims Act, 28 U.S.C. §§ 1346(b), 2671-80 (1970), to recover damages from the United States for injuries allegedly received as a result of negligent medical treatment while an inmate of the Federal Correctional Institute at Texarkana, Texas (F.C.I.). Edwards, then fifty-five, entered prison an active man, though afflicted with diabetes mellitus, angina pectoris, exogenous obesity, and labile hypertension. Fourteen months later, he had a stroke that left him partially paralyzed on his left side. After his release from prison, he filed this suit, alleging that the negligent failure of the treating physicians at F.C.I. to control his diabetes had been a proximate cause of his stroke. The district court, after a full trial, found the evidence insufficient to establish either causation or negligence and dismissed the case with prejudice. We affirm.

Edwards has been diabetic since at least 1946. For the seven years before his imprisonment, he had been under the care of his personal physician, Dr. Richard Liebendorfer, a board eligible internist. In treating Edwards, Dr. Lieben-dorfer had relied on insulin and dietary control. Edwards’ wife had cooperated closely with Dr. Liebendorfer. She prepared properly balanced diabetic meals and varied insulin dosages to meet demands created by her husband’s dietary indiscretions, changes in levels of activity, stress, and other factors affecting his urine sugars. Dr. Liebendorfer had maintained Edwards on 50 to 80 units of insulin per day.

When Edwards arrived at F.C.I. he was taking 50 units of insulin daily. The Chief Medical Officer, after interviewing him, taking his medical history, and evaluating test results, reduced this insulin dosage to 35 units a day, though he later increased it to 40 units.1 He and his successor maintained the dosage at that level throughout Edwards’ imprisonment, except for the period immediately following the stroke when dosages were increased to as much as 80 units daily. Otherwise, there were no variations in the daily dosages. When Edwards first arrived, the Chief Medical Officer discussed with him dietary principles with which, as a long-time diabetic, Edwards was familiar. Edwards’ urine sugars were checked four times daily. When high readings resulted, a test for acetone was run. The doctors ordered blood tests at regular intervals during the first eight months of Edwards’ imprisonment. During the six months preceding the stroke, however, they ran no blood tests. In January 1969, Edwards had a stroke which, the experts agreed, bore all the earmarks of [1139]*1139a thrombosis. Edwards was left partially paralyzed on his left side, impotent, and unable to earn a living in his former occupation as a used-car salesman. He was released from prison in April 1969.

State law controls the issue of liability under the Act. United States v. Muniz, 1963, 374 U.S. 150, 162-163, 83 S.Ct. 1850, 10 L.Ed.2d 805; Richards v. United States, 1962, 369 U.S. 1, 82 S.Ct. 585, 7 L.Ed.2d 492. Texas law, therefore, would determine if expert testimony is necessary to establish the negligence of a physician. Rewis v. United States, 5 Cir. 1966, 369 F.2d 595; Watson v. United States, 5 Cir. 1965, 346 F.2d 52, cert. denied, 382 U.S. 976, 86 S.Ct. 544, 15 L.Ed.2d 467. Applied to this case, Texas law imposes on the treating physicians a duty to exercise that degree of care which a general practitioner of ordinary prudence and skill, practicing in the Texarkana community or a similar community would have exercised in the same or similar circumstances. See, e. g., Bowles v. Bourdon, 1949, 148 Tex. 1, 219 S.W.2d 779; Bender v. Dingwerth, 5 Cir. 1970, 425 F.2d 378, 384; 45 Tex.Jur.2d § 131. Texas cases are in agreement that a plaintiff, to recover for injuries suffered from medical negligence, must show, by expert testimony, that the treating physicians breached the standard of care.2 Hart v. Van Zandt, Tex. 1966, 399 S.W.2d 791; Bowles v. Bour-don. The record supports the district court’s finding that Edwards failed to bear that burden.

Edwards complains of a number of specific acts and omissions allegedly amounting to negligence: the reduction of his insulin dosage to 40 units daily; the failure to provide him with a diet adequate to his special needs; the refusal to transfer him to a medical facility equipped to handle his problems; and the failure of the young practitioners3 who treated him to call in a specialist in internal medicine to monitor Edwards’ health.4

We pass the question of the causal connection between these alleged failures and the stroke. The most salient defect in Edwards’ case was the failure to establish by expert testimony that any of these acts amounted to negligence. Dr. Liebendorfer, Edwards’ only expert witness, did not express the opinion that Edwards had received improper medical care, nor did he testify as to a standard of care, a predicate on which the court might have based a finding of negligence.

Dr. Liebendorfer testified that many prominent specialists believed that frequent injections of varying doses, correlated to urine sugar levels, was preferable to the single daily dose administered at F.C.I. He offered this, as the district [1140]*1140court pointed out, not as a standard of medical care but as a working medical hypothesis. He conceded that there were other medically acceptable approaches. He did not criticize the decision to reduce the insulin Edwards received, nor did he indicate how the level of insulin administered should be determined. He did not indicate that the readings turned up by Edwards’ urine tests should have alerted the doctors that his diabetes was not in control.5 6 In fact, he did not indicate why he thought the diabetes had not been in control. He did not testify that a diabetic, exercising judgment and restraint, could not obtain a generally adequate diet in the prison cafeteria, although after an examination of typical ten-day menu, he concluded it “might be spotty”.6 He conceded he had no first hand knowledge of the food served there. He also expressed some doubt about the average diabetic inmate’s ability to avoid some of the items offered that are proscribed for diabetics. He did testify that he believed Edwards should have seen a consulting specialist in internal medicine once a month. He conceded at the same time that general practitioners regularly treated similar patients without the aid of specialists.

Dr. Jack Smith testified for the United States. Dr. Smith is a diplómate of the American Board of Internal Medicine, an internist in a nineteen-doctor clinic in Texarkana, and a member of the faculty of the Louisiana State University School of Medicine, Shreveport, Louisiana. He testified that the food served at F.C.I.

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Paul C. Edwards v. United States
519 F.2d 1137 (Fifth Circuit, 1975)

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Bluebook (online)
519 F.2d 1137, 1975 U.S. App. LEXIS 12727, Counsel Stack Legal Research, https://law.counselstack.com/opinion/paul-c-edwards-v-united-states-ca5-1975.