Butler v. United States
| Docket Number | 20 Civ. 10044 (JPC) |
| Decision Date | 01 September 2023 |
| Parties | WILLIE M. BUTLER, Plaintiff, v. UNITED STATES OF AMERICA, Defendant. |
| Court | U.S. District Court — Southern District of New York |
FINDINGS OF FACT AND CONCLUSIONS OF LAW
Plaintiff Willie M. Butler (“Butler”), a now 71-year-old woman who suffers from diabetes and hypertension, brings this medical malpractice action against Defendant United States of America (the “Government”) under the Federal Tort Claims Act (“FTCA”), 28 U.S.C. §§ 1346(b), 1402(b), 2401(b), 2671-80. She alleges that medical providers at Greenburgh Health Center (“Greenburgh”), a federally supported health center in Westchester County, New York, deviated from the applicable standard of medical care by refilling her medication, but without seeing her at medical visits, during the period of December 3, 2016 to March 28, 2019. She contends that this substandard care exacerbated her diabetes and led to an infection that eventually required a below-the-knee amputation of her right leg.
The Court conducted a five-day bench trial from January 17 through January 23, 2023.[1] Having considered the evidence admitted at trial, assessed the credibility of the witnesses, and applied the relevant law, the Court makes the following findings of fact and conclusions of law pursuant to Rule 52 of the Federal Rules of Civil Procedure. As discussed below the Court concludes that Butler failed to prove any deviation from the standard of care in her treatment on the part of Greenburgh or any of its employees. Furthermore, even if any such deviation had occurred, Butler failed to establish causation, as she did not show a causal link between any act or omission by Greenburg or its employees and her injuries.
On September 17, 2019, Butler filed an administrative claim, SF-95, with the United States Department of Health and Human Services, in which she alleged as the basis of her claim:
Ms. Butler suffers with diabetes and hypertension and had been under the care of the doctors at Greenburgh Health Center. The facility continued to renew her medications but had not examined her since 2016. By the time her family came to see Ms. Butler in her home, they noticed a very bad stench. They soon found parts of her toes had fallen off her foot. The negligent medical treatment caused claimant to lose her leg from the knee down, lose most of her eyesight and suffer with additional damages.
GX-1 at 1; Dkt. 12 ¶ 5. She further alleged that she GX-1 at 1.
Butler commenced this action on December 1, 2020. Dkt. 1. In her Complaint, she alleges medical malpractice pursuant to the FTCA in connection with treatment she received and did not receive from medical providers at Greenburgh and seeks damages for her injuries. Dkt. 5 (“Compl.”).[2] The Government answered on February 22, 2021. Dkt. 12.[3] The Government asserts that medical providers at Greenburgh properly treated Butler and did not deviate from the applicable standard of care. Id. at 5. The Government further contends that any treatment provided to Butler at Greenburgh was not the proximate cause of any damages she suffered. Id. at 6.
Discovery closed on June 24, 2022. Dkt. 34. At a conference on July 7, 2022, the Court scheduled a bench trial to begin on January 17, 2023. Dkt. 37; see 28 U.S.C. § 2402. The bench trial commenced as planned on that date and concluded on January 23, 2023. Butler testified on her own behalf, Tr. at 12:1-89:1, and also called Glenn Davis, MD, a doctor at Greenburgh, id. at 90:11-151:2; Barbara Lynch, a registered nurse practitioner (“RNP”) at Greenburgh, id. at 238:6334:2; Sharon Knight, a registered nurse (“RN”) and a care manager at Greenburgh, id. at 334:18363:1; Vladimir Lokshin, MD, an expert witness, id. at 158:25-236:25; Butler's son, William Butler, id. at 406:16-443:12; her daughter-in-law, Aquira[4] Butler, id. at 390:11-402:14; and her niece, Deborah Williams, id. at 369:8-389:14. The Government called three expert witnesses: Dr. Alan Roth, id. at 449:8-558:11, Dr. Peter Goulden, id. at 558:19-579:6, 677:7-700:16, and Dr. Tzi Bar-David, id. at 586:24-676:20.
“In an action tried on the facts without a jury,” the Court “find[s] the facts specially and state[s] its conclusions of law separately.” Fed.R.Civ.P. 52(a)(1). Accordingly, the Court below sets forth its findings of facts, see infra III, followed by its conclusions of law, see infra IV. Additional facts not specifically found in the findings of fact section may nonetheless be included in the Court's conclusions of law. See Flatiron Acquisition Vehicle, LLC v. CSE Mortgage LLC, 502 F.Supp.3d 760, 769 (S.D.N.Y. 2020) ().
Butler, a 71-year-old resident of White Plains, New York, has long suffered from diabetes and hypertension. Tr. at 12:19-22, 17:7-23; Stip. ¶¶ 1-2. In 1976, she received a nursing license from BOCES in Valhalla, New York. Tr. at 13:6-24. From 1976 until the early 1990s, Butler worked at White Plains Hospital where, among other things, she treated patients with hypertension and diabetes. Id. at 13:25-14:15, 60:3-62:2. Butler then worked at a nursing home and in private home care until she retired in 2013. Id. at 14:16-16:15.
Butler has a son, William Butler, and a daughter, Lolita Williams. Id. at 16:17-20. William Butler is married to Aquira Butler. Id. at 16:23-17:1. Butler also has a niece named Deborah Williams who lives in the Westchester area. Id. at 17:2-6.
Greenburgh, a medical facility located in Westchester County, is an approved delivery site of Mount Vernon Neighborhood Health Center, a not-for-profit, federally supported health center that provides healthcare services to underserved individuals and families in low-income neighborhoods. Stip. ¶ 4. Butler started receiving medical care at Greenburgh in April 1980. Id. ¶ 3; see Tr. at 17:24-18:5 (Butler testifying that she was unsure when she started going to Greenburgh, but knew that the doctor who initially treated her has since left). She was 66 years old at the time of her last treatment at Greenburgh in March 2019. Tr. at 12:19-22; Stip. ¶ 1.
The first visit relevant to this action occurred on February 3, 2015, when Butler was seen at Greenburgh by RNP Barbara Lynch for a physical examination and a medication refill. JX-1 at 71-75. Butler, who reported that she had been cleaning snow that day and had failed to take her blood pressure medication, registered a blood pressure of 244/105. Tr. at 287:20-288:5, 290:5-10; 459:9-14; JX-1 at 71-72. The examination further revealed her weight to be 121 pounds, with no skin symptoms, lesions, or rash. JX-1 at 71-72. During this February 3, 2015 visit, RNP Lynch also performed a foot examination of Butler, which entailed checking her feet's pulses, coloration, and capillary refill, as well as for any wounds, bruises, or neuropathy. Tr. 291:2-292:6.[5] That foot examination did not reveal any abnormalities. Id. at 294:15-19. RNP Lynch prescribed Butler Hydrochlorothiazide 25 mg per day, Lisinopril 40 mg per day, Metformin 2000 mg per day, and Metoprolol 100 mg per day. JX-1 at 78; Tr. at 295:4-5. Because Butler had mentioned having cataracts, RNP Lynch referred Butler to an ophthalmologist, whom Butler saw about a month later. Tr. at 295:19-296:19.
Butler was seen again by RNP Lynch at Greenburgh on February 6, 2015. Tr. at 298:1621; JX-1 at 67-70. Butler reported that she again had not taken her blood pressure medication that day. JX-1 at 69; Tr. at 300:4-19. Her blood pressure was taken twice during this visit, registering at 215/91 and 248/105. Tr. at 299:2-3. RNP Lynch instructed Butler on the importance of taking her medications regularly and at the same time each day, which Butler appeared to understand. JX-1 at 69; Tr. at 300:4-19.[6] RNP Lynch prescribed Clonidine 0.1 mg per day and ordered followup in two weeks. Tr. at 300:21-301:19, 469; JX-1 at 69. Butler's laboratory results were as follows: A1C 7.3%[7]; total cholesterol 303 mg/dL (normal total cholesterol is 100-199 mg/dL); and LDL 203 mg/dL (normal LDL is 0-99 mg/dL). JX-1 at 3-4. Butler's physical examination, which included a neurological and skin examination of her feet, was normal. Tr. 299:6-300:3; JX-1 at 68.
Butler's next appointment at Greenburgh was scheduled for February 17, 2015, but she failed to show up. JX-1 at 66. In response, Greenburgh sent her a letter emphasizing the need for her to reschedule the appointment. Id.; Tr. at 254:24-255:2. Greenburgh sent another letter to Butler on March 4, 2015, asking her to return to the clinic as soon as possible to review her test results. Tr. at 302:20-303:12; JX-1 at 64.[8]
Butler finally returned to Greenburgh on March 27, 2015, when she was again seen by RNP Lynch. Tr. at 255:23-25; JX-1 at 57-63. And once again, Butler revealed that she had not taken her blood pressure medications. Tr. at 304:5-9; JX-1 at 57. At this visit, she registered a sitting blood pressure of 241/94. Tr. at 304:20-23; JX-1 at 58. An examination of Butler's feet and legs, including neurological and skin, was normal. Tr. at 305:1-306:3; JX-1 at 58.
Butler returned to Greenburgh on April 2, 2015, and once again was seen by RNP Lynch. Tr. at 265:2-9; JX-1...
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