Clanton v. United States
| Decision Date | 17 December 2021 |
| Docket Number | No. 20-2059,20-2059 |
| Citation | 20 F.4th 1137 |
| Parties | Kevin CLANTON, Plaintiff-Appellee, v. UNITED STATES of America, Defendant-Appellant. |
| Court | U.S. Court of Appeals — Seventh Circuit |
Stephen J. Telken, Michael Barry Marker, Troy E. Walton, Attorneys, WALTON TELKEN, Edwardsville, IL, for Plaintiff - Appellee.
Edward Himmelfarb, Dana J. Martin, Attorneys, DEPARTMENT OF JUSTICE, Civil Division, Appellate Staff, Washington, DC, Laura J. Jones, Attorney, OFFICE OF THE UNITED STATES ATTORNEY, Civil Division, Fairview Heights, IL, for Defendant - Appellant.
Before Ripple, Kanne, and Rovner, Circuit Judges.
This case is on appeal for the second time, from an action brought in the district court by Kevin Clanton under the Federal Tort Claims Act. Clanton alleged that nurse practitioner Denise Jordan, an employee of the U.S. Public Health Service, failed to educate him about his severe hypertension
or to monitor its advancement, and as a result of that negligent care his hypertension developed into Stage V kidney disease
. As a result, Clanton required dialysis and, at the age of 35, a kidney transplant, and is expected to endure further cycles of dialysis and another transplant in the future. Following a five-day bench trial, the district court found the United States liable, rejected the government's comparative-negligence argument as to Clanton, and awarded Clanton nearly $30 million in damages.
The United States appealed to this court, arguing that the district court erred in its comparative-negligence analysis and in its assessment of damages. We upheld the damages calculation, but remanded for the court to assess Clanton's comparative negligence under Illinois's reasonable-person standard. Clanton v. United States , 943 F.3d 319 (7th Cir. 2020) (" Clanton I "). On remand, the court again concluded that comparative negligence was inapplicable in this case, and the government has again appealed.
For context, we briefly recount the facts underlying the Federal Torts Act claim, which are set forth in greater detail in the district court's initial order. After a pre-employment physical exam in June 2008, Clanton was informed that his blood pressure was too high, and that he needed medication to lower it before he could be cleared for work. Clanton sought medical care for it at the Quick Care Clinic, where he was treated by nurse practitioner Denise Jordan. Jordan noted a diagnosis of obesity
and hypertension, ordered routine lab work, and directed Clanton to follow up with her at Windsor Health Center the next week.
On June 12, 2008, Clanton had his first office visit with Jordan at the Windsor office. At that appointment, Jordan gave him Clonidine
in the office to lower his blood pressure, which immediately lowered it from 210/170 to 200/130. She also gave him some sample blood pressure medications to take home and told him to come back in a week. From her notes, she appears to have talked to him about healthy eating habits but did not document any other patient education efforts. She signed the form clearing him to return to work.
Clanton did not return for nearly two years, during which time he generally felt fine, with no symptoms of high blood pressure
such as blurred vision, headaches or shortness of breath. He returned to Jordan in July 2010, when a routine physical from his employer indicated that his blood pressure was too high and that he needed to seek medical care. He saw Jordan on July 21, 2010, and although the medical records documented that he had not had blood pressure medication during that time, the record does not reflect that Jordan discussed the two-year absence or the risks. Jordan again gave Clonidine to Clanton in the office to lower his blood pressure, which brought it down to some extent. She gave Clanton a prescription for blood pressure medication and told him to return in a week but did not order any lab work.
Clanton returned three weeks later, on August 11, 2010, and he had 10 appointments with her over the ensuing 2 years, at which she checked his blood pressure, administered medication for his high blood pressure
readings, and pre-scribed medications for him to take at home. She noted on some occasions that he was noncompliant, such as an appointment in which she documented that he refused to take a medication she had previously prescribed. He had stopped taking one of the medications that he believed did not work as well as the others, because, as he explained at trial, he still felt bad when taking it. Jordan never discussed with Clanton whether the medication could be causing the adverse symptoms that he was associating it with, nor did she explain to him that his hypertension
could cause such symptoms. She never educated or instructed Clanton about the nature of his hypertension disease, the risks of uncontrolled high blood pressure (including kidney damage), the fact that he was at increased risk for complications because he is African-American, why it was important for him to stay on his medication and return for appointments even when he felt fine, or the potential consequences of sporadic treatment. Throughout that time, Jordan failed to consult with a supervising physician regarding Clanton's care—even on the occasion in which she sent him to the emergency room when he experienced blurred vision and the medication in the office did not sufficiently lower his blood pressure.
At Clanton's appointment with Jordan in July 2011, she ordered lab tests for the first time since his initial visit to her in 2008. Those lab tests revealed signs of kidney disease
, but she never saw the results. She admitted that had she seen the results, she would have referred Clanton to a nephrologist. During Clanton's final visit in October 2012, Jordan again ordered lab work, which revealed extensive kidney damage. At this point, Clanton was suffering from Stage IV chronic kidney disease. Neither Jordan nor any one at the clinic communicated those results to Clanton, nor was he referred to a specialist. Two months later, Clanton was taken to the hospital suffering from shortness of breath. His blood pressure was high, and he was finally advised at that time of his severe kidney disease. He was subsequently diagnosed with Stage V kidney disease in February 2013.
Clanton began undergoing hemodialysis
in March 2013 and received a kidney transplant in November 2015. Since that time, he has been compliant with his medication regime and his doctor's advice. He would later testify that while he was under Jordan's care, he did not understand the nature of his underlying disease or the risks he faced if he did not take appropriate steps to control his high blood pressure.
As the useful life of a transplanted kidney is ten years, Clanton faces the prospect of returning to dialysis and having one or more additional kidney transplants
in the future. The stipulated cost of his past medical care is approximately $2.8 million, and the cost of his future kidney-related medical care is, according to Clanton, estimated to be $14.5 million.
Clanton sued the government for malpractice under the Federal Tort Claims Act, which was the exclusive remedy for his injuries under 42 U.S.C. § 233(a). After a five-day bench trial, the district court found that Jordan was negligent in failing to properly educate Clanton about the nature and potential complications of his disease
and the risks of not adhering to a treatment plan, and that as a consequence, Clanton treated his hypertension as a chronic or sporadic condition and only sought treatment when he felt bad or was informed of high blood pressure readings. The court also found that Jordan was negligent in not taking action in response to the 2011 and 2012 lab results showing that Clanton was suffering from kidney disease and in failing to consult with a supervising physician regarding Clanton's care. The district court considered whether Clanton was contributorily negligent for missing follow-up appointments, not taking his medications as prescribed, and failing to check on his lab results, as the government argued, but concluded he was not contributorily negligent. Clanton was awarded $15.9 million in economic damages and $13.75 million in non-economic damages, for total damages of approximately $29.7 million.
We remanded the case because the court, in making its decision regarding comparative negligence, had determined only whether Clanton's conduct was subjectively reasonable given Clanton's own knowledge, but had not compared Clanton's understanding of his condition to that of a reasonable person in his situation in assessing comparative negligence as is required under Illinois law. Clanton I , 943 F.3d at 323. We noted that Clanton was in the position of a person whose care-giver had failed to provide information as to the severity of his condition, but who also had a few external clues that he was seriously unwell, such as two employment-related physicals which showed dangerously high blood pressure. Id. We held that "[t]he district court must determine how a reasonable person in the same position would have acted and compare Clanton's behavior to that objective standard of care." Id. We rejected the government's challenges to the damage award.
Therefore, the only issue for the district court on remand was the application of the objective component of Illinois' comparative negligence standard. As we recognized in Clanton I , to assess comparative negligence under Illinois law, "[c]ourts must apply the familiar reasonable-person standard, an objective test that asks ‘whether plaintiff ... used that degree of care which an ordinarily careful person would have used ... under like circumstances.’ " Clanton I , 943 F.3d at 323, quoting McCarthy v. Kunicki , 355 Ill.App.3d 957, 291 Ill.Dec. 502, 823 N.E.2d 1088, 1101 (2005) ; Long v. City of New Bos. , 91 Ill.2d 456, 64 Ill.Dec. 905, 440 N.E.2d 625, 628 (1982).
The district court held...
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