Geibel v. US

• Decision Date: 06 August 1987
• Docket Number: Civ. A. No. 85-2594.
• Citation: 667 F. Supp. 215
• Parties: Rita GEIBEL, Plaintiff, v. UNITED STATES of America, Defendant.
• Court: U.S. District Court — Eastern District of Pennsylvania

667 F. Supp. 215

Rita GEIBEL, Plaintiff, v. UNITED STATES of America, Defendant.

Civ. A. No. 85-2594.

United States District Court, W.D. Pennsylvania.

August 6, 1987.

Louis M. Tarasi, Jr., Pittsburgh, Pa., for plaintiff.

Albert W. Schollaert, Asst. U.S. Atty., Pittsburgh, Pa., for defendant.

MEMORANDUM OPINION

TEITELBAUM, District Judge.

Rita Geibel brought this medical malpractice action against the United States under the Federal Tort Claims Act (FTCA), 28 U.S.C. § 2671 et seq. The case was tried before the Court and for the reasons set forth below, judgment will be entered in favor of the United States.

Geibel was born in 1921 and is a high school graduate. She is a married woman who has two living children. A son died at the age of sixteen, ten years ago, when he fell out of a tree house.

During World War II, Geibel served overseas in the Women's Army Auxiliary Corps from 1943-1945. While in the service, Geibel was hit by a softball on her right leg during a game. Upon examination of the injury, varicose veins were discovered. When Geibel attempted to reenlist in 1946, she was rejected because of high blood pressure. In 1973, she was awarded a ten percent service-connected disability pension based upon high blood pressure.

From January to February 1981, Geibel was a patient at the Butler Veteran's Administration Medical Center ("BVAMC") for treatment of high blood pressure, tearfulness and anxiety. Dr. Lon H. Preston, the admitting physician, prescribed several different types of anti-hypertension medication including, but not limited to, Hydrochlorothiazide and Inderal, in conjunction with a low salt diet. Geibel had never taken drugs prior to this hospitalization. She displayed an adverse reaction to much of the medication and an overall sensitivity to drug therapy. Because Geibel experienced nausea, vomiting, cramps, dizziness and sleeplessness, all medication was discontinued. When her blood pressure dropped, Dr. Preston discharged Geibel, but continued to monitor her condition on an outpatient basis. As an outpatient, Geibel's high blood pressure eventually required treatment with a daily dose of 25 milligrams of Hydrochlorothiazide and 10 milligrams of Inderal in the morning followed by 20 milligrams of Inderal at bedtime.

In March, 1981, Geibel was admitted to The Mercy Hospital of Pittsburgh ("Mercy") for continuing pain on her left side which she claimed to have been experiencing since her introduction to drug therapy at the BVAMC. She underwent a gastroscopy which indicated three duodenal ulcers and a hiatal hernia. Geibel was treated for epigastric problems as well as inner ear problems. She continued taking 25 milligrams of Hydrochlorothiazide daily along with 20 milligrams of Inderal in the morning coupled with another 20 milligrams of Inderal at bedtime for high blood pressure.

Geibel was readmitted to the BVAMC on May 27, 1981 for reevaluation of duodenal ulcer disease and hypertension. She was again assigned to Dr. Preston's care. She was discharged June 10, 1981 and continued the same course of drug treatment.

The hospitalization at issue in this lawsuit began June 30, 1981 when Geibel was admitted to the BVAMC for high blood pressure after complaining of severe vertigo for approximately one half of an hour. She was admitted to the hospital after being examined by a Dr. Abbatiello who detected a rash on her arms which, according to plaintiff's testimony at trial, the doctor believed to have been an allergic reaction to Hydrochlorothiazide.

On July 1, 1981, Dr. Raj K. Marwaha, having been randomly assigned to the case, examined Geibel. She complained of the rash on her arms. At this point, the testimony of Geibel contradicts that of Dr. Marwaha. According to Geibel, Dr. Marwaha said, "There's no rash on your arms. Cut your fingernails. You're scratching yourself." The plaintiff further testified that upon examination of her feet, Dr. Marwaha found that she had athlete's foot between her toes and shouted, "Don't you ever wash your feet?" Questioning Dr. Marwaha's drug therapy, Geibel claims that her inquiries were met with a curt, "I am the Doctor."

Dr. Marwaha, on the other hand, denied the abusive language. According to Dr. Marwaha, he informed Geibel that the rash was not "violent" enough to be an allergy, and that, in fact, he saw no rash. After examining her feet, Dr. Marwaha recalls having said, "There's some dirt between your toes." Dr. Marwaha testified that Geibel then snapped back with, "Do you think I'm dirty?" His response was, "Well, that's all right, don't worry about that." Dr. Marwaha went on to say that Geibel seemed to dislike anything he said and appeared to have difficulty understanding his English as it is tainted with an Indian accent.

Dr. Marwaha increased the dosage of Hydrochlorothiazide and Inderal to 40 grams of Inderal twice a day and 50 milligrams of Hydrochlorothiazide daily. Geibel perceived the double dosage as negligent and "upsetting" conduct on the part of Dr. Marwaha. Dr. Marwaha testified that the increase of her prescribed medication was an effort to control her already high blood pressure.

Geibel then complained to the hospital administration that Dr. Marwaha's care did not meet with her approval. Geibel voiced her displeasure at a meeting with the Chief of Medicine. In an effort to accommodate the patient, Geibel was thereupon returned to the care of Dr. Preston. The staff also suggested that Geibel undergo psychiatric and neurologic evaluation, which she declined.

Geibel filed an administrative claim with the Veteran's Administration alleging that she was severely over-drugged on July 1, 1981 at the BVAMC. In her administrative claim, she described the nature and extent of her injury as "negligently over-drugged by the agents and/or employees of the Veteran's Administration which resulted in severe varicose veins, high blood pressure and total disability." The Veteran's Administration denied Geibel's claim and she subsequently brought suit under the FTCA.

Geibel's basic contentions stem from two related theories. First, Geibel contends that the administration of a double dosage of Hydrochlorothiazide and Inderal was negligent, and caused physical problems. Specifically, plaintiff contends that the BVAMC was negligent in failing to consider Geibel's age at the time (60 years) and history of allergic reaction to medication. The physical ailments allegedly suffered as a result include, but are not limited to, "gastroesophageal reflux with hiatal hernia; esophageal stricture; deep vein thrombophlebitis, severe varicosity in both legs; and veneous insufficiency." As a consequence of receiving the alleged overdose of medication, Geibel seeks to recover past and future medical expenses.

Second, her position as the Court understands it, is that the abrasive interaction between Geibel and Dr. Marwaha caused emotional trauma and possibly psychosomatic ailments. Specifically, Geibel contends that Dr. Marwaha breached the medical standard of care by allegedly refusing to treat Geibel with dignity and human kindness. Dr. William L. Bair testified as an expert witness on Geibel's behalf. Dr. Marwaha's behavior, in failing to recognize a patient's sense of helplessness and fear, was deemed by Dr. Bair to be "inappropriate." Dr. Bair testified that Dr. Marwaha's conduct fell below any appropriate standard of care. The alleged deviant behavior culminated in what Dr. Bair described as an iatrogenic disorder, which refers to the adverse effects induced by a physician in caring for his patients. This includes not only direct injuries which may result from therapeutic or diagnostic measures, but also the hurt that can be inflicted by words or actions. Dr. Bair connected some, not all, of Geibel's subsequent ailments to an iatrogenic disorder. Geibel testified that, following her interaction with Dr. Marwaha, she was upset, increasingly agitated, easily argumentative and irritable. Her testimony was corroborated by her husband. She seeks to recover damages for medical expenses related to psychiatric treatment, emotional distress and pain and suffering.

Defendant, United States of America, contends that the dosage was a proper response to Geibel's high blood pressure and that Dr. Marwaha's "bed side manner" was in no way improper. Defendant further contends that if Dr. Marwaha's increase in Geibel's medication and/or his behavior fell below a reasonable standard of care, these actions cannot be causally linked to Geibel's subsequent ailments.

Defendant contends that Geibel was never administered an "overdose" of Hydrochlorothiazide and Inderal during her hospitalization at the BVAMC from June 30, 1981 through July 15, 1981, rather that the medication administered to Geibel during this hospitalization met the appropriate standard of care.

Further, defendant contends that the medical conditions suffered by Geibel, i.e. a hiatal hernia and varicose veins, were clearly documented prior to the hospitalization in question. In addition, defendant contends that Geibel's other contentions as to her medical condition have never been medically documented.

Defendant also contends that Dr. Marwaha's bedside manner was in no way inappropriate. Any emotional condition allegedly suffered by Geibel cannot be causally connected to Dr. Marwaha's behavior. Finally, defendant contends that the Court lacks jurisdiction to consider plaintiff's claim of emotional trauma on the basis that Geibel failed to comply with the provisions of the FTCA regarding this claim.

Administrative Claim

The filing of an administrative claim is a jurisdictional prerequisite that cannot be waived. United States v. Kubrick, 444 U.S. 111, 117-118, 100 S.Ct. 352, 356-57, 62 L.Ed.2d 259 (1979); Apollo v. United States, 451 F.Supp. 137 (M.D.Pa.1978). There is no clear consensus on the requirements of an administrative filing. Where the defendant has been put on notice of the incident out of...