Chesnut v. United States
| Decision Date | 28 September 2021 |
| Docket Number | No. 20-6237,20-6237 |
| Parties | Debra CHESNUT; Glenn Chesnut, Plaintiffs-Appellants, v. UNITED STATES of America, Defendant-Appellee. |
| Court | U.S. Court of Appeals — Sixth Circuit |
ON BRIEF: Annette Morgan-White, MORGAN & WHITE LAW OFFICES, Manchester, Kentucky, for Appellants. Charles P. Wisdom, Jr., Callie R. Owen, UNITED STATES ATTORNEY'S OFFICE, Lexington, Kentucky, for Appellee.
Before: BOGGS, CLAY, and KETHLEDGE, Circuit Judges.
Plaintiffs Debra Chesnut and Glenn Chesnut appeal the district court's findings of fact and conclusions of law, as well as the judgment entered in favor of the United States, in this action brought under the Federal Tort Claims Act ("FTCA"), 28 U.S.C. §§ 1346, 2671 – 80, for medical negligence and related claims arising from the amputation of Debra Chesnut's right leg. The district court entered judgment for the United States after finding that the negligence of Dr. Jared Madden, the federal employee whose conduct is relevant to Plaintiffs’ claims under the FTCA, was not a substantial factor in causing Debra's amputation. For the reasons set forth below, we REVERSE the district court's decision and REMAND for proceedings consistent with this opinion.
On the morning of April 4, 2016, Debra Chesnut suddenly felt pain and numbness in her legs while at her home in Manchester, Kentucky.1 On April 19, 2016, Debra's right leg was amputated below the knee
at the University of Kentucky Medical Center ("UKMC") due to serious clots that restricted blood flow. The Chesnuts sued various healthcare providers that Debra saw between April 4, 2016, and April 12, 2016, for failing to consider that Debra's symptoms were caused by vascular issues rather than musculoskeletal abnormalities. The only remaining defendant is the United States, which was substituted under the FTCA for its employee, Dr. Jared Madden, who examined Debra on April 12, 2016, at a federally supported health center. Plaintiffs’ appeal focuses on the even more circumscribed question of whether Dr. Madden's negligence caused the below-the-knee amputation of Debra's right leg. Accordingly, despite the significant record developed below, our discussion is generally limited to the 22.5-hour period from when Debra saw Dr. Madden the afternoon of April 12 until she was diagnosed with an ischemic (i.e., reduced blood flow) leg and related conditions shortly after 12:00 p.m. on April 13.
On April 4, 2016, Debra went to the emergency room at Manchester Memorial Hospital in Manchester, Kentucky, where she presented with numbness from the waist down, pain in both legs, with the right leg being worse and cold. Dr. James Thomas was Debra's attending physician at Manchester Memorial, and he diagnosed her with sciatica, which is pain along the sciatic nerve in the leg. Dr. Thomas prescribed pain medication for Debra's symptoms and told her to follow up with a family physician if necessary.
Debra's condition had not improved by the next day, so she went to Glenndale Medical Care located in Manchester, Kentucky on April 5, 2016, where Teresa Cole, an advanced practice registered nurse ("APRN"), attended to her. Debra made similar complaints as she had made the previous day to Dr. Thomas, including that her right leg was colder than her left. APRN Cole found that Debra's right leg was cool to the touch, that her left leg was warm, and that pulses were present in both legs. APRN Cole also diagnosed Debra with sciatica and prescribed pain medication. A follow-up visit with APRN Cole was scheduled for April 12, 2016.
Over the next week, the Chesnuts stayed in a camper near the medical facility so that Debra could rest and recuperate. Her condition did not improve, and she went to her appointment with APRN Cole on April 12. APRN Cole again diagnosed Debra with sciatica. At Debra's request, a referral was made to Dr. Jared Madden, a doctor of osteopathic medicine, and an appointment was scheduled for that afternoon.
Dr. Madden was an employee of Grace Community Health Center, which is a federally funded community health center located in Wooten, Kentucky. Debra provided Dr. Madden with an account of her symptoms, including that her lower right leg was cold, and her previous medical treatment. Dr. Madden documented Debra's right-leg pain, that she was a heavy cigarette smoker, and that she had been referred to him for osteopathic manipulative and pain treatments.
Dr. Madden then proceeded to his examination. He found that Debra's dorsalis pedis pulse, from an artery in the foot, which is a measure of blood flow to the legs, was normal. Dr. Madden noticed a slight temperature difference between Debra's right and left legs, but he quickly dismissed its potential significance. Like Dr. Thomas and APRN Cole, Dr. Madden diagnosed Debra with sciatica and other musculoskeletal issues. Dr. Madden's treatment of Debra consisted mainly of osteopathic manipulative treatment, which involves physical manipulation
and reflected Dr. Madden's musculoskeletal diagnosis. This treatment improved Debra's mobility, but not her pain and numbness.
The next morning, April 13, 2016, Debra woke up in greater pain than she had experienced up until that point, and her right foot had turned blue. She called Dr. Madden, and he told her that she had to go to the emergency room immediately, as the discoloration indicated that the right foot was not receiving blood flow. When Debra arrived at the emergency room at Manchester Memorial Hospital shortly after noon, the severity of her condition was recognized immediately, and the attending emergency room physician diagnosed her with ischemia (i.e., lack of blood flow to tissues) in her leg and suspected compartment syndrome
from the ischemia. Based on his diagnosis, the attending physician, Dr. Kobkit Putrakul, contacted the UKMC's vascular team in Lexington, Kentucky, specifically Dr. Eric Endean, and arranged for Debra to be transported to UKMC by helicopter that afternoon.
When Debra arrived at UKMC, doctors were not able to find a pulse in her right foot or lower leg, and a computed tomography
("CT") angiogram revealed serious blood clots
in her right leg. Over the next few days, multiple surgical and non-surgical treatments were attempted to save the leg. On April 15, Dr. Eleftherios Xenos performed transcatheter thrombolytic therapy—which is a non-surgical option that involves inserting a catheter in the groin—to revascularize the leg. Once that attempt failed, Debra underwent two fasciotomies, a surgical procedure that involves cutting open the leg, on April 16 and April 19. After these efforts to restore blood flow were unsuccessful, Dr. Endean performed a below-the-knee amputation of Debra's right leg on April 19.
Plaintiffs originally filed two federal lawsuits related to Debra's amputation. The first, Case No. 17-cv-79 (E.D. Ky.), was filed against Manchester Memorial Hospital, which operated the emergency room where Debra had gone on April 4; Dr. Thomas, the physician who had treated her there; and APRN Cole, who saw Debra on April 5 and April 12 at Glenndale Medical Care, a facility owned and operated by Memorial Hospital. An entity named Delta Locum Tenens, which was alleged to be Dr. Thomas’ employer, was added as a defendant in an amended complaint. Plaintiffs filed a separate lawsuit against the United States and Dr. Madden, Case No. 17-cv-185 (E.D. Ky.), after they had exhausted their administrative remedies, as required by the FTCA. The cases were consolidated in the docket as Case No. 17-cv-79 (E.D. Ky.) in December 2017.2
In January 2018, the district court granted Defendants’ motion to dismiss Dr. Madden as a defendant and to substitute the United States under the FTCA, specifically, 28 U.S.C. § 2679(d)(1). Plaintiffs’ claims against APRN Cole and Manchester Memorial Hospital were voluntarily dismissed with prejudice in October 2018.
Through 2019, the parties prepared for a jury trial, until, in the midst of a number of pretrial filings (e.g., trial briefs, exhibit lists, proposed jury instructions, proposed voir dire, motions in limine, etc.) on December 31, 2019, the parties filed a proposed agreed order of dismissal of Delta Locum Tenens. The claims against Delta Locum Tenens were dismissed without prejudice on January 3, 2020. A jury trial remained scheduled for January 21, 2020.
On January 14, 2020, Plaintiffs filed a notice of settlement as to Dr. Thomas, effectively leaving the United States as the only defendant in the case.3 The claims against Dr. Thomas were dismissed with prejudice on February 7, 2020.
Since a plaintiff does not have a jury trial right in an FTCA action, the jury trial was converted to a bench trial set to begin on January 22, 2020, in light of the settlement with Dr. Thomas. See Carlson v. Green , 446 U.S. 14, 22, 100 S.Ct. 1468, 64 L.Ed.2d 15 (1980). At a telephone conference on January 14, 2020, the government suggested a bench trial "submitted on briefs," where all the testimony would be submitted by either videotape or transcript and "basically just both sides would write trial briefs and then response briefs." (1-14-20 Telephone Conference Tr., R. 435, Page ID #10466.) Plaintiffs’ counsel was initially skeptical of the government's proposal, noting that "I really think the Court needs to hear from the expert in regard to the medicine." (Id. at Page ID #10467.) However, on January 17, 2020, the parties agreed to cancel the bench trial and submit the case on the briefs, which were to include proposed findings of fact and conclusions of law. Plaintiffs’ counsel explained that she had spoken to the Chesnuts, and they had given their permission to submit the case on the briefs.
After the filing of the trial briefs, the district court entered findings of fact and conclusions of law pursuant to Federal Rule of Civil Procedure 52(a)(1). The district court found that Dr. Madden had been negligent when he...
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