Champagne v. US, Civ. No. A2-90-51.
| Decision Date | 04 August 1992 |
| Docket Number | Civ. No. A2-90-51. |
| Citation | 836 F. Supp. 684 |
| Parties | Debra CHAMPAGNE & Richard Champagne, as personal representatives of the Estate of Ricky Champagne, Plaintiffs, v. UNITED STATES of America, Defendant. |
| Court | U.S. District Court — District of South Dakota |
Alice R. Senechal, R. Raymond Sundling, Robert Vogel Law Office, P.C., Grand Forks, ND, for plaintiffs.
Lynn E. Crooks, U.S. Atty's Office, Fargo, ND, for defendant.
The parents of Ricky Champagne, as the personal representatives of his estate, bring this medical malpractice/wrongful death action against the United States of America pursuant to the Federal Tort Claims Act, 28 U.S.C. §§ 2671 et seq., and 1346(b). The plaintiffs allege that employees of the Indian Health Services (IHS) in Belcourt, North Dakota, were negligent in their care of Ricky Champagne following his suicide attempt on January 25, 1989, and that this negligence was a proximate cause of his later suicide on February 20, 1989. A bench trial was held on October 16-17, 1991. After considering the evidence presented at trial and the briefs submitted by the parties, the court concludes that IHS was negligent, that this negligence was a proximate cause of Ricky's death, but that the contributory fault of Ricky was greater than the fault of IHS, barring recovery under North Dakota law. See N.D.Cent. Code § 32-03.2-02.
On February 20, 1989, Ricky Champagne, an eighteen year-old Native American male, died as a result of a self-inflicted gunshot wound to the chest. Ricky was the son of Richard and Debra Champagne, the plaintiffs in this case. Ricky had a fraternal twin, Nicky, a younger sister, Vicki, and a younger brother, Joe. Ricky was not close to his twin brother. While Nicky enjoyed outdoor activities like working on cars, Ricky enjoyed cooking and cleaning indoors. This created tension between Ricky and his father, and to some extent, the rest of the family as well. Richard sometimes accused Ricky of not being masculine and called him a "queer" or a "faggot." Evidently Ricky's mother shared her husband's sentiments, but may not have expressed her views as pointedly.
The months prior to Ricky's death reflect the life of a troubled young man. Ricky turned eighteen two months prior to his death. An eighteenth birthday marks a watershed in any person's life, signifying the beginning of adulthood and independence. It possibly has even more significance to a young Native American because they receive a lump sum payment of treaty money from the government at that time.
About a month before his eighteenth birthday, Ricky had a fight with his father. Testimony elicited at trial leads the court to believe that the fight represented a classic conflict between father and son as the latter struggles for his independence, and the father struggles to let go. Sometimes these conflicts are handled in a healthy manner, sometimes not. In this case, it appears that Richard resorted to brute force and intimidation. Whatever the reasons for the fight or its severity, Ricky filed a complaint with the police against his father for assault, and left home. He stayed with relatives, moving from one house to another, not wanting to be a burden to anyone.
After turning eighteen just before Christmas, Ricky received his treaty money and spent it on presents for his family and relatives, including his father; however, the rift between Ricky and his father remained unresolved. Ricky still did not return home after celebrating Christmas. At some time during this period, Ricky began to miss his classes at school. Testimony from his friend, Chad Trottier, indicates that Ricky became depressed and withdrawn.
On January 12, 1989, Ricky was seen at the hospital for a "cold, coughing up junk." Plaintiff's Exhibit 11, Outpatient Records at p. 1. An HIV test was done at Ricky's request. No one knows why Ricky requested the HIV test or whether Ricky thereafter knew the test was negative.
On January 25, 1989, at approximately 1:00 p.m., Ricky attempted suicide with an overdose of medication, and was admitted to the IHS Hospital in Belcourt, North Dakota. Treatment to stabilize Ricky's medical condition was provided by Dr. James Blain. Dr. Blain referred Ricky to the IHS mental health unit for treatment of his mental condition, and wrote an order for someone to see Ricky immediately. Ricky was not seen by someone from the mental health unit until the following day.
Lance Azure, a social service representative in the mental health unit, met with Ricky on January 26 for one to two hours. Azure is not a physician or psychologist, does not hold a college degree, but is an experienced and capable counselor. The written history of Ricky from that meeting is sketchy. Based on the limited history that was obtained, it is surmised by the experts who testified in the case that Ricky was suffering from an adolescent adjustment disorder with suicidal ideations. However, some of the experts could not rule out major depression. It was clear, however, from the medical records that do exist and from the testimony elicited at trial, that the conflict between Ricky and his father weighed heavily on Ricky's mind.
On January 27, Dr. Blain wrote an order that Ricky could be discharged upon Mental Health's approval. Ricky was discharged on Azure's approval the next day on the condition that he return to see Azure later that afternoon. Ricky and his mother returned to the hospital that afternoon, but did not locate Azure.
IHS did not schedule or provide any further counseling for Ricky after his discharge. IHS did not refer Ricky for evaluation by, or consult with, a psychologist or psychiatrist.
Ricky returned home to live with his parents, but the tension between Ricky and his father remained unresolved. As is often the case, the subject of the suicide attempt was avoided. No counseling was provided the family in order to deal with the suicide attempt of a family member, or to resolve the conflicts in the family that may have led to the attempt.
On February 13, Debra went to see Azure and told him that her son had quit school again, had again moved away from home, and was giving away prized possessions, one of the classic signs of planned suicide. Azure responded to Debra's concerns by intimating that Ricky was eighteen, old enough to take care of himself and do what he wanted, and that Debra should not be concerned. However, Azure did attempt to contact Ricky, was unable to, and left a note at Ricky's grandmother's house. He made no further attempts to contact Ricky.
A consulting psychologist, Dr. Simhai, was at the Belcourt IHS Hospital on February 14, the day after Debra reported to Azure that Ricky was exhibiting suicidal behavior. Dr. Simhai was not asked to review the case.
Ricky called Azure on February 16, 1989, and Azure asked Ricky if he would like to make an appointment for counseling. Ricky made an appointment for the next day, but did not keep it. After the missed appointment, Azure took no subsequent action to contact Ricky or to determine whether Ricky was suicidal. At this point in time, Ricky had essentially received no counseling or other form of treatment since his discharge from the hospital. Ricky shot himself three days later.
The standard of care applicable in this case is that which would be provided in the same or similar localities anywhere in the United States. Winkjer v. Herr, 277 N.W.2d 579, 583 (N.D.1979). IHS recognizes its duty to give care to suicide attempters in its written suicide protocol, which states, "every person giving evidence of suicidal ideation or suicidal behavior should be offered appropriate counseling and/or referral services."
Several experts testified regarding the care given Ricky by IHS. Dr. David Sharbo, a psychiatrist practicing in Fargo, North Dakota, testified for the government. Dr. Byron Crouse, a family practitioner in Duluth, Minnesota; Dr. William Shore, a family practitioner in San Francisco, California; and Nelrene Little Bird, a licensed certified social worker in Grand Forks, North Dakota, testified for the plaintiffs. All the experts agreed that the care given Ricky by IHS fell below accepted standards of care in one or more respects.
Among the specifics identified by Dr. Sharbo as below acceptable standards of care were: 1) the failure to consult with Dr. Simhai on February 14; 2) Azure's failure to follow up when the February 17 appointment was missed; 3) lack of adequate history in determining whether the January 25 attempt was planned or impulsive, whether any significant relationships had ended recently, the extent of psychosocial support systems available, exploration of sexual identity as a possible problem, lack of a differential diagnosis, and exploration of possible substance abuse; 4) failure to establish a specific, structured follow-up plan including a contact person if Ricky had repeated thoughts of suicide, scheduled individualized counseling sessions, and family counseling; and 5) assignation of overall responsibility and discharge decision to Lance Azure.
Among the specifics identified by Dr. Crouse as problems were: 1) inadequate history and differential diagnosis, identifying the same deficiencies as Dr. Sharbo; 2) problems in division of authority between the physician, Dr. Blain, and the mental health unit; 3) unstructured discharge plan...
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Champagne v. U.S.
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