Anestis v. United States

• Citation: 749 F.3d 520
• Decision Date: 30 June 2014
• Docket Number: No. 13–6062.,13–6062.
• Parties: Tiffany ANESTIS, Individually, and as Administratrix of the Estate of Cameron Anestis, deceased, and as Mother and Next Friend of IA, an infant, Plaintiff–Appellant, v. UNITED STATES of America, Defendant–Appellee.
• Court: United States Courts of Appeals. United States Court of Appeals (6th Circuit)

749 F.3d 520

Tiffany ANESTIS, Individually, and as Administratrix of the Estate of Cameron Anestis, deceased, and as Mother and Next Friend of IA, an infant, Plaintiff–Appellant,

v.UNITED STATES of America, Defendant–Appellee.

No. 13–6062.

United States Court of Appeals, Sixth Circuit.

Argued: March 20, 2014.

Decided and Filed: April 18, 2014.

Rehearing Denied June 30, 2014.

ARGUED:Albert F. Grasch, Jr., Grasch Law, PSC, Lexington, Kentucky, for Appellant. Henry C. Whitaker, United States Department of Justice, Washington, D.C., for Appellee. ON BRIEF:Albert F. Grasch, Jr., Grasch Law, PSC, Lexington, Kentucky, for Appellant. Henry C. Whitaker, Charles W. Scarborough, United States Department of Justice, Washington, D.C., for Appellee.

Before: BATCHELDER, Chief Judge; McKEAGUE, Circuit Judge; OLIVER, District Judge.^*

OPINION

McKEAGUE, Circuit Judge.

Cameron Anestis, a former-Marine and veteran of the war in Iraq, committed suicide after he was turned away from two Veterans Administrative (“VA”) clinics. His widow asserted claims under the Federal Tort Claims Act, claiming that the VA committed medical malpractice in turning her husband away from the VA clinics. The district court granted the Government's motion to dismiss, holding that it did not have jurisdiction over the claims because they involved a review of a VA “benefits determination” and the Veterans Judicial Review Act precluded it from exercising jurisdiction over all claims challenging VA benefits determinations. For the reasons stated below, we REVERSE and REMAND the case to the district court.

I.

In April 2009, Cameron Anestis (“Cameron”), after serving approximately eight months as a Marine in Iraq, returned to Lexington, Kentucky, where he lived with his wife, Tiffany Anestis (“Anestis” ¹), and their infant daughter. On April 17, 2009, he applied for VA Medical Benefits, but did not include with his application any materials to verify his service in the U.S. military, such as his DD–214 (a document provided to a veteran reflecting his dates of deployment, etc.). Because a document verifying his military service was not included in his application, the VA did not enroll him into the VA medical system and classified his enrollment status as “pending.” When a veteran fails to include a document verifying his military service, the VA attempts to independently verify the qualifying service. By August 12, 2009, the VA had verified that Cameron had served in the military. The VA's electronic record, however, did not reflect that he had served in combat or that he was otherwise eligible to be enrolled in the VA health system, and his enrollment status as of August 12 was “Rejected: Below Enrollment Group Threshold.” On August 26, Cameron's records were updated to show that he had served in combat, and he was then accepted and enrolled in the VA system, retroactive to his original date of application.

Upon his returning after the war, Cameron's family noticed a change in his behaviorand a decline in his mental health. His parents contacted the mental health department of the Lexington, Kentucky VA, seeking advice and help for their son. Cameron's father spoke with Barbara Slater, a program manager in the Lexington VA's mental health division, who suggested that Cameron seek professional help from the VA.

Following this conversation, Cameron's parents began urging him to seek help from the VA. Tiffany, Cameron's wife, told him that she would not continue to live with him unless he sought help. On Sunday, August 16, 2009, Cameron broke down and told his parents that he had been involved in a horrific incident in Iraq involving the killing of a civilian family.

On Monday, August 17, Cameron went to the VA Mental Health Center at the Leestown Road Division of the Lexington VA (“Leestown VA”).² Upon arrival at the Leestown VA, Cameron was greeted by Carol McIntosh (“McIntosh”), the intake clerk. She checked for his name in their computer, but the search returned no results.

McIntosh stated that she recognized that Cameron was in urgent need of help and met with him for 35 to 40 minutes. She recalls that he told her about his difficulties, including the story of the incident in Iraq and his marital problems, and that she concluded that Cameron was suicidal at the time of the visit to the Leestown VA clinic.³

McIntosh knew that no mental health professional was available to see Cameron at the Leestown VA. She testified that if a mental health professional had been available, she would have arranged for Cameron to be seen by a professional at the Leestown VA. However, because no professional was available at the Leestown VA, McIntosh told Cameron that there was nothing she could do except to send him to Cooper Drive, a separate VA clinic, (“Cooper Drive VA”) where walk-ins who came to the Leestown VA were seen.

Cameron then called his father and told him that he had been directed to go to the Cooper Drive VA. Cameron called his father again, about 20 to 30 minutes later, stating that he had been turned away from the Cooper Drive VA because he did not have his DD–214. Cameron then drove to his Georgetown home, where he and his wife resided. He told his wife that he had gone to the Cooper Drive VA, but had been turned away because he did not have his DD–214, and they began searching for the form. After an unsuccessful search, Cameron became frustrated, got into an argument with his wife, and quickly lost control. Cameron choked and threatened to kill her, but after a struggle, Tiffany Anestis was able to escape and called 911. While she was on the phone with 911, she heard a gunshot, and discovered that her husband had committed suicide.

The administrators of the VA testified that it was the VA's policy that when a veteran appeared at the Leestown VA seeking immediate treatment to determine whether the veteran needed emergency care. If the intake clerk determined that the veteran needed emergency care, the veteran was to be transported by ambulance to the Cooper Drive VA. Curiously, it is also the VA's position that an intake clerk, such as McIntosh, was not qualified to make an assessment as to whether the veteran was in an emergency situation. However, despite the fact that the VA admits that intake clerks are not healthcare professionals trained to perform such evaluations of a veteran's mental and emotional state, the VA admits that it was its policy and practice to have the clerks make such determinations. Anestis claims that the Lexington VA had a policy to provide care to a veteran in an emergency situation without regard to whether the veteran is deemed eligible for VA benefits.

Furthermore, at the time Cameron attempted to receive treatment at the Cooper Drive VA, it was the VA's policy that under no circumstances was any veteran to be turned away from receiving care for not having a copy of his or her DD–214. James Murray, Assistant Chief of Health Administration Service, and Judith Rittenhouse, Chief of Health Administration Service, testified that no veteran should ever be turned away and denied care for this reason.

After exhausting her administrative remedies, Anestis brought this Federal Tort Claims Act (“FTCA”) suit against the United States in the U.S. District Court in Kentucky. Anestis asserted that the United States had a “duty to provide proper and appropriate medical care” to Cameron, and the failure to provide mental health treatment caused his death.

Following discovery, the United States moved to dismiss, or in the alternative, for summary judgment. The United States claimed that the Veterans' Judicial Review Act (“VJRA”) precluded the district court from exercising jurisdiction over Anestis's claim because all of the claims challenged a VA determination regarding VA medical benefits. The United States claimed that the VJRA established exclusive channels for the review of VA decisions, and because Anestis's claims challenged a VA benefits determination, the VJRA precluded district court review of those claims.

The district court agreed with the Government, resting its decision on its belief that the VJRA precluded the court from having jurisdiction over Anestis's claims. The district court reasoned that district courts “do not acquire jurisdiction [to] hear challenges to benefits decisions merely because those challenges are cloaked as medical malpractice actions brought under the Federal Tort Claims Act.” R. 134, Memo. Op. and Order at 5, PageID # 4197.

II.

In considering a Rule 12(b)(1) motion to dismiss for lack of jurisdiction, a district court may consider factual matters outside the pleadings and resolve factual disputes. See Ohio Nat'l Life Ins. Co. v. United States, 922 F.2d 320, 325 (6th Cir.1990). The district court in the instant case did not resolve factual disputes and instead granted the motion based on the undisputed facts alleged in the pleadings and developed by the parties during discovery. Accordingly, the district court did not make factual determinations because it was dismissing the case even if Anestis's factual assertions were accepted as true. The district court's decision to dismiss for lack of jurisdiction is a question of law that this Court reviews de novo. Gentek Bldg. Prods., Inc. v. Sherwin–Williams Co., 491 F.3d 320, 324, 330 (6th Cir.2007).

The VJRA provides that “[t]he Secretary shall decide all questions of law and fact necessary to a decision by the Secretaryunder a law that affects the provision of benefits by the Secretary to veterans” and that the Secretary's decision “shall be final and conclusive and may not be reviewed by any other official or by any court.” 38 U.S.C. § 511 (emphasis added). ⁴ The Code of Federal Regulations defines “benefit” as “any payment, service, commodity, function, or status, entitlement to which is determined under laws administered by the Department of Veterans Affairs pertaining to veterans and their dependents and survivors.” 38 C.F.R. § 20.3. The VA...