Sun v. Secretary, Department of Veterans Affairs

CourtDistrict Court, S.D. Ohio
DecidedDecember 6, 2019
Docket2:17-cv-01039
StatusUnknown

This text of Sun v. Secretary, Department of Veterans Affairs (Sun v. Secretary, Department of Veterans Affairs) is published on Counsel Stack Legal Research, covering District Court, S.D. Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Sun v. Secretary, Department of Veterans Affairs, (S.D. Ohio 2019).

Opinion

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF OHIO EASTERN DIVISION

Qixin Sun,

Plaintiff, : Case No. 2:17-cv-1039

v. Judge Sarah D. Morrison : Magistrate Judge Kimberly A. Jolson Department of Veterans Affairs,

Defendant.

OPINION AND ORDER This matter is before the Court on Defendant’s Motion for Summary Judgment. (ECF No. 18.) Plaintiff filed an Opposition to the Motion (ECF No. 21), and Defendant filed a Reply (ECF No. 24). The matter is now ripe for decision. I. STATEMENT OF THE FACTS Plaintiff Qixin Sun was born in China and received his medical degree in China. (Sun Dep. 28:6–22; 38:1–8, ECF No. 17.) After graduating medical school, Dr. Sun immigrated to the United States where he became board-certified in internal medicine and obtained a license to practice medicine in Ohio. (Id. 28:7–29:22, 43:18–22.) In 2005, Dr. Sun began working for the Defendant, the United States Department of Veterans Affairs (the “VA”), at the VA’s Chalmer’s P. Wylie Ambulatory Care Center (the “Columbus VA”). (Id. 48:8–11.) On December 6, 2009, Dr. Sun filed an Equal Employment Opportunity (“EEO”) complaint against the VA alleging that he was being discriminated against on the basis of his national origin (the “2009 Complaint”). (Id. 210:4–10, 212:18–22.) On February 23, 2011, the EEOC granted summary judgment for the VA, finding no discrimination. (ECF No. 21-3, at 2.) Dr. Sun appealed, and the administrative proceedings related to this complaint concluded with the denial of Dr. Sun’s appeal on May 1, 2013. (Id. at 3, 5.) Beginning in August 2010, and until the time of his resignation, Dr. Sun was supervised by the chief of primary care, Dr. Edward Bope. (Sun Dep. 110:16–23.) Dr. Bope supervised

approximately 10-12 other primary care physicians at the Columbus VA. (Id. 68:6–23; 111:19– 112:9.) Approximately half of these physicians were born outside of the United States, including physicians born in India, Pakistan, and Korea. (Id. 115:6–16.) Dr. Sun was the only Chinese physician. (Id. 115:16–22.) Beginning in March 2012, Dr. Sun’s second level supervisor was the Columbus VA Chief of Staff, Dr. Marc Cooperman. (Marc Cooperman Decl. ¶¶ 1–2, ECF No. 18-1.) A. The Bradycardic Patient On September 4, 2012, Dr. Sun treated an elderly patient (the “Patient”) who had come into the Columbus VA after suffering a fall. (Edward Bope Decl. Ex. A, ECF No. 18-2.) During this visit, the Patient’s pulse was measured to be very low at thirty-seven beats per minute. (ECF

No. 18-5, at 44.) A low pulse is a condition known as bradycardia, which refers, at the very least, to a pulse below forty beats per minute.1 Two days later, the Patient returned and his pulse was still very low. (Id. at 49.) The evidence as to whether Dr. Sun was aware of the Patient’s low pulse is mixed. The medical records for both appointments documented the Patient’s pulse rate. (Id. at 44, 49.) Dr. Sun acknowledges that he signed these medical records and that by signing a patient’s chart he is

1 In his deposition, when he was asked what constitutes bradycardia, Dr. Sun stated: “Below 60” beats per minute. (Sun Dep. 269:15–19.) When later confronted with the Patient’s specific vitals, Dr. Sun pivoted and said that “40 . . . is the line.” (Id. 287:20–22.) For purposes of this Opinion, the difference is not material, and in an effort to construe the facts in the light most favorable to Dr. Sun, the Court assumes that the lower number—forty— is the standard. responsible for that patient’s visit, but he does not recall whether he reviewed the Patient’s vital signs before signing the chart. (Sun Dep. 281:9–11, 282:17–24, 290:2–7; ECF No. 18-5, at 46, 50.) The Patient’s wife recalled that during the first visit, the nurse reported the Patient’s pulse to Dr. Sun and that Dr. Sun remarked that the pulse was very low. (Bope Decl. Ex. A.) During the

second visit, the treating nurse recalls that she verbally notified Dr. Sun of the Patient’s low pulse. (ECF No. 18-5, at 121.) Dr. Sun denies being notified of the low pulse on either occasion, and he contends that if he had been aware of it, he would have ordered an EKG. (ECF No. 18-6, at 24:10–26:9; Sun Dep. 289:18–23.) On September 30, 2012, the Patient’s wife sent an email to the Columbus VA (the “Patient’s Complaint”) complaining that Dr. Sun had ignored her husband’s low pulse on the two aforementioned visits. (Bope Decl. ¶ 4, Ex. A.) The wife reported that her husband had an appointment with his urologist on September 27, 2012, three weeks after he had seen Dr. Sun, when the urologist ordered him transported to the emergency room due to a dangerously low pulse. (Id.) At the emergency room, a cardiologist determined that the Patient was in immediate

need of a pacemaker, and the Patient was taken by ambulance to a hospital. (Id.) On October 1, 2012, Dr. Bope referred the Patient’s Complaint to the Columbus VA Risk Manager, Deborah Garza, for the initiation of a confidential review by the Peer Review Committee (the “PRC”).2 (Id.) The PRC undertakes a confidential medical quality assurance process when there is a question as to whether a physician met the standard of care. (Id. ¶ 4.) Due to a work backlog, Ms. Garza did not begin processing the Patient’s Complaint until March 30, 2013, and the Patient’s Complaint was not reviewed by the PRC until May 2, 2013. (Deborah Garza Decl. ¶¶ 3-4, ECF No. 18-3.)

2 The PRC’s findings are protected by law and were not a part of discovery. See 38 U.S.C. § 5705 (restricting disclosure of records and documents created by VA through its medical quality-assurance program). After the PRC’s preliminary evaluation of the Patient’s Complaint, on May 15, 2013, Ms. Garza drafted a letter on behalf of Dr. Cooperman notifying Dr. Sun of the PRC’s initial evaluation and inviting him to attend one of the upcoming PRC meetings. (Id. ¶ 4.) On June 20, 2013, Dr. Sun attended a PRC meeting during which the PRC further reviewed the Patient’s

Complaint. (Id.) Subsequent to this meeting, Dr. Cooperman, as chair of the PRC, asked Ms. Garza to research the appropriate action for a VA facility to take when the information provided to the PRC “raises a significant concern.” (Cooperman Decl. ¶¶ 1, 5; Garza Decl. ¶ 5.) Ms. Garza consulted with the VA’s National Director of Risk Management, who recommended that the Columbus VA initiate a management review. (Garza Decl. ¶ 5.) A management review is a third- party review by an expert to assess whether a medical provider met the standard of care. (Bope Decl. ¶ 11.) In line with this recommendation, a management review of the Patient’s Complaint was conducted by Dr. Carl Bixel, a Primary Care reviewer at the Cincinnati VA. (Garza Decl. ¶ 6.) On July 12, 2013, Dr. Bixel provided his conclusions to the Columbus VA. (Id. ¶ 7.) Dr.

Bixel found that in hindsight the Patient should have been referred to the emergency room because he was at a very high risk of falling again, but that the available information did not allow him to decide who was necessarily at fault. (Bope Decl. Ex. D, at 6.) Dr. Bixel’s conclusion regarding the Patient’s first visit, on September 4, 2012, was as follows: On a busy day, a provider on a well functioning [sic] team might rely on the nurse for basic information and assume that a patient who appeared well had simply tripped and was there to have his foot injury addressed. In this scenario, it would be very easy for a competant [sic] provider to do exactly what was done. On the other end of the spectrum, if the provider was aware of the vital signs and did not perceive any problem, then the provider did not meet the standard of care.

(Id. at 7.) Regarding the Patient’s second visit, on September 6, 2012, Dr.

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