Blake v. Southcoast Health System, Inc.
| Decision Date | 12 June 2001 |
| Docket Number | No. Civ.A. 00-10591-WGY.,Civ.A. 00-10591-WGY. |
| Citation | 145 F.Supp.2d 126 |
| Parties | William J. BLAKE and Theresa R. Blake individually and as administrators of the Estate of Betty Ann Blake, Plaintiffs, v. SOUTHCOAST HEALTH SYSTEM, INC., d/b/a Charlton Hospital; First Physicians Corporation, Inc.; Miguel Brillantes; Michael A. Pellegrino; and Thomas F. Cahill, Defendants. |
| Court | U.S. District Court — District of Massachusetts |
Philip N. Beauregard, John A. Markey, Beauregard & Burke, New Bedford, MA, for plaintiffs.
Colleen Cronin, William J. Davenport, Bloom & Buell, Curtis R. Diedrich, Sloane & Walsh, Nadine Nasser Donovan, Rindler & Morgan, P.C., Joanne Gulliford Hoban, Alan B. Rindler, Rindler & Morgan, Boston, MA, Joan Eldridge, Martin C. Foster, Foster & Eldridge, Cambridge, MA, Stephen P. Harten, Ratcliffe & Burke, LLP, Providence, RI, for defendants.
The Hippocratic philosophy of medicine1 declares that nothing should be more important to a physician than the best interests of the patient who comes to him for care.... Few people faced with a diagnosis of potentially remediable ... disease should be willing to give up the struggle if there is any reasonable chance that some promising form of treatment is available to lessen the ravages of the disease or cure it. To do anything less is not stoicism, but folly.2
Behind the arid record of every legal case are genuine human beings with hopes, fears, aspirations, and an almost prayerful desire that sound laws will be wisely administered. Occasionally, though, there comes before the Court a situation evidencing such profound and shocking institutional incompetence leading to such unspeakable agony that the very stones of the courthouse would seem to cry out for relief.3
This is such a case.
Betty Ann Blake ("Betty Ann"), born in 1951, suffered from severe mental retardation, microcephaly,5 scoliosis, blindness, deafness, and muteness. She weighed a mere fifty-five pounds. Despite her disabilities, Betty Ann, with the help of her parents, lived a fulfilling life. Her parents, William J. Blake ("Mr.Blake") and Theresa R. Blake ("Mrs.Blake"), despite repeated advice to institutionalize Betty Ann from birth because of her disabilities, chose to keep her at home with their family and to care for her as long as they could. While the Blakes cared for Betty Ann in their home, they provided her with not only loving and nurturing surroundings, but also special care specific to her disability, including special education, occupational therapy, and physical therapy. When the Blakes could no longer care for Betty Ann because of their own advancing age, however, they made the difficult decision to place her in another's care. In 1996, after forty-four years, Betty Ann moved out of her parents' home and into a group home in Fall River, Massachusetts. After this split, the Blakes made sure to visit Betty Ann on a regular basis.
On Friday, October 30, 1998, while at her day care program, Betty Ann began to choke on a large piece of meat — she repeatedly grabbed at her throat; she had substantial secretion and drooling; and she had difficulty breathing. Requiring immediate medical treatment, Betty Ann was rushed to the emergency room at Charlton Hospital,6 the closest emergency medical facility. Betty Ann arrived at 12:00 Noon, still exhibiting pronounced symptoms of choking and respiratory distress.
Were the reader to stop here, she might feel relief that Betty Ann was so quickly placed in the hands of medical care professionals, fully capable of providing life-saving care to Betty Ann. But Betty Ann's story does not end here. Instead of offering appropriate medical assistance, the doctors prolonged Betty Ann's slow suffocation for twenty-six hours and ultimately caused her agonizing death.7
Upon Betty Ann's arrival at Charlton Hospital, Dr. Pellegrino, the emergency room physician on duty, and several nurses observed Betty Ann's symptoms of choking. Although it goes without saying that emergency situations require immediate action, Betty Ann's doctor did not take such action. Instead, he and the nurses tied Betty Ann down on a stretcher and left her alone behind a curtain.
The Blakes, who arrived shortly after Betty Ann, consulted with Dr. Pellegrino. Dr. Pellegrino, who had not looked down Betty Ann's throat, suggested that she had burned her esophagus eating hot food. The Blakes explained to Dr. Pellegrino that this was impossible because Betty Ann never ate hot foods. The Blakes then proceeded to tell Dr. Pellegrino that Betty Ann was choking — she was signaling that she was choking; she was grabbing at her throat; and she was having trouble breathing. With this knowledge in hand, however, Dr. Pellegrino still did not remove the food obstructing Betty Ann's airway. He performed only cursory checks for food, and did not attempt more effective treatments, such as using a scope, because, as he put it, it would be "difficult." His limited efforts proving useless, Dr. Pellegrino left Betty Ann, still slowly choking to death, for two hours without further medical treatment. Her parents' insistence that Betty Ann was choking and their pleas for treatment went unheeded.
It was now 5:30 p.m. Five-and-a-half hours had passed while Betty Ann suffered slow and painful strangulation, increasingly deprived of air. Still having received no treatment, Betty Ann was admitted to the hospital. Dr. Miguel Brillantes ("Dr. Brillantes") was assigned to care for Betty Ann once admitted. The Blakes repeated to Dr. Brillantes that Betty Ann was choking. His response was twofold. First, he prescribed Benadryl — a decongestant utterly ineffective for relieving Betty Ann's choking. Second, he asked the Blakes if they wanted a "do not resuscitate order." Dr. Brillantes thus appeared to recognize that Betty Ann was struggling for her life — yet he turned away, doing nothing further.
Betty Ann was left to gasp for air throughout the night. Blind and deaf, separated from her loving parents, she slowly strangled while in the care of those whose first duty it was to save her life. One cannot begin even to speculate as to the thoughts that crowded through the mind of this lonely, isolated individual.
That same evening, both Dr. Pellegrino and Dr. Brillantes consulted a third physician, Dr. Thomas F. Cahill ("Dr. Cahill"), about Betty Ann's condition. Dr. Cahill "declined" to come to the hospital to observe Betty Ann first hand. He did, however, look in on her on the following afternoon — Saturday, October 31, 1998 — by which time Betty Ann had been struggling to breathe for more than twenty-four hours.
Had there been any doubt that Betty Ann was choking, it was removed when, after merely observing Betty Ann and talking briefly with the Blakes, Dr. Cahill recognized — finally — that he faced an extreme emergency situation requiring immediate action. At approximately 2:30 p.m., Dr. Cahill x-rayed Betty Ann and performed a scope of her throat. With the help of another specialist, Dr. Cahill was at last able to remove the large piece of meat that had been blocking Betty Ann's esophagus and depriving her of air for two days.
Dr. Cahill was too late. The delay in removing the blockage from Betty Ann's throat caused her to develop severe heart and lung complications. The late removal of the blockage could not reverse her worsening condition. On Saturday afternoon, Betty Ann suffered a heart attack. Her lungs filled with liquid, and she suffered convulsions.
Betty Ann died Sunday morning, November 1, 1998, as a direct result of the fact8 that Charlton Hospital, First Physicians, and the named doctors discriminated against her as a disabled person.
Charlton Hospital, First Physicians, and the named doctors now come before this Court seeking dismissal of the plaintiffs'9 claim against them under the Americans with Disabilities Act ("ADA" or "Act") (Count I) on the ground that the Estate lacks standing to sue under Title III of that Act.
Dismissal is appropriate "only if `it appears beyond doubt that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief.'" Roeder v. Alpha Indus., Inc., 814 F.2d 22, 25 (1st Cir.1987) (quoting Conley v. Gibson, 355 U.S. 41, 45-46, 78 S.Ct. 99, 2 L.Ed.2d 80 [1957]). In making this determination, the Court should "take the allegations in the complaint as true and grant all reasonable inferences in favor of the plaintiff." Monahan v. Dorchester Counseling Ctr., Inc., 961 F.2d 987, 988 (1st Cir.1992) (citing Dartmouth Review v. Dartmouth Coll., 889 F.2d 13 [1st Cir.1989]).
Nonetheless, the standard for dismissal is not without any bite. In taking plaintiffs' allegations as true, the Court may "eschew any reliance on bald assertions, unsupportable conclusions, and opprobrious epithets." Dartmouth Review, 889 F.2d at 16 (quoting Chongris v. Bd. of Appeals, 811 F.2d 36, 37 [1st Cir.1987]) (internal quotation marks omitted). Moreover, plaintiffs must set forth in their complaints "`factual allegations, either direct or inferential, regarding each material element necessary to sustain recovery under some actionable legal theory.'" Id. (quoting Gooley v. Mobil Oil Corp., 851 F.2d 513, 514 [1st Cir.1988]).
Signed into law on July 26, 1990 with great fanfare,10 the ADA was expected to "eradicat[e] the bigotry and barriers faced by individuals with disabilities." Walker v. Carnival Cruise Lines, 107 F.Supp.2d 1135, 1143 (N.D.Cal.2000). The four purposes of the Act, as set forth by Congress, are:
(1) to provide a clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities;
(2) to provide clear, strong, consistent, enforceable standards addressing discrimination against individuals with disabilities;
(3) to ensure that the Federal Government plays a central role in...
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