Grundowski v. United States
| Decision Date | 16 May 2012 |
| Docket Number | CIVIL ACTION NO. 3:07-2207 |
| Parties | KATHLEEN GRUNDOWSKI, as ADMINISTRATOR OF THE ESTATE OF BRETT SANTEE, Plaintiff, v. UNITED STATES OF AMERICA, Defendant. |
| Court | U.S. District Court — Middle District of Pennsylvania |
(JUDGE CAPUTO)
Brett Santee underwent a below-the-knee amputation to his right leg on November 30, 2005. At that time, he was serving a prison sentence in the Federal Correctional Institution at Lewisburg, Pennsylvania ("USP Lewisburg"). The issue in this case of ordinary negligence1 is to what extent did the United States' failure to care for Santee's diabetes cause or contribute to the amputation of his right leg. Because Plaintiff has failed to prove all elements of an ordinary negligence claim, judgment will be entered in favor of the United States.
Santee self-surrendered to USP Lewisburg on March 10, 2005. On that day, he was given an intake examination. During the examination conducted by Physician's Assistant Luis Ramirez ("PA Ramirez") on March 10, 2005, he noted on Santee's Patient Problem List that Santee had a significant diagnosis of "obesity." The Patient Problem List also notes "Diabetes Mellitus, Type 2" as a significant diagnosis, but this entry was undated and was not in the handwriting of PA Ramirez. Rather, the "Diabetes Mellitus, Type 2" notationappears to be the writing of Physician's Assistant Ferdinand Allama ("PA Allama"), who examined Plaintiff on April 5, 2005 and April 7, 2005. On April 7, 2005, Santee's blood sugar was found to be 235 mg/dL, which is clear evidence of diabetes. His blood sugar on April 12, 2005 was 237 mg/dL. On April 14, 2005, PA Ramirez noted that Santee had mild pulsations in his feet. Santee also saw PA Allama on April 26, 2005, at which time his blood sugar, or glucose level, was 292 mg/dL. On that day, Santee was prescribed glyburide, a diabetes medication, and he was informed of an application for special shoes to treat his foot ulcers.
Also germane to this history is that Plaintiff had two toes amputated on his right foot before he arrived at USP Lewisburg. According to Gerard Foti, D.O., the amputations performed in 2002 and 2004 were necessitated by osteomyelitis. There is no mention of Type II Diabetes Mellitus in Dr. Foti's records.
At the intake screening on March 10, 2005, PA Ramirez noticed the toe amputations, and in response to his inquiry, Santee told him that they were due to osteomyelitis. PA Ramirez was also told by Santee that he took no medication. On April 1, 2005, PA Ramirez documented that Santee had peripheral neuropathy with possible circulatory problems. Despite this condition being consistent with diabetes, no blood glucose level was taken.
On April 5, 2005, PA Allama examined Santee and documented that Santee had recently developed open blisters on his left big toe. Two days later, Santee's blood glucose was checked for the first time, which was documented to be 235 mg/dL. Later readings were as previously noted. It is clear that, at the very least, Santee's diabetic condition was known, or should have been known, on April 7, 2005. And, it is probable that blood glucose tests, if conducted between the intake screening on March 10, 2005 and April 7, 2005, would have indicated diabetes.
Although Santee was diabetic on April 7, 2005, and confirmed on April 12, 2005 and April 26, 2006, no diabetes medication was prescribed for him until April 26, 2005. Santee continued to develop blisters and ulcers on his feet, and he had four hospitalizations for those conditions on June 21, 2005, August 29, 2005, September 30, 2005, and November29, 2005. Ultimately, on November 30, 2005, Santee underwent a below-the-knee right leg amputation.
Should the United States bear responsibility for the ultimate amputation of Santee's right leg? From Santee's big right toe amputation in 2002 and his second right toe amputation in 2004, to the below-the-knee amputation on November 30, 2005, it can certainly be said that: (1) Santee should have been tested for diabetes well in advance of losing his right second toe in 2004; (2) he should have been tested upon his arrival at USP Lewisburg in March of 2005; and (3) upon discovering his elevated glucose level on April 7, 2005, he should have been immediately provided diabetes medication. Nevertheless, after Santee's diabetic condition was known on April 7, 2005, USP Lewisburg Staff failed to follow the recommendations set forth in the Federal Bureau of Prisons Clinical Practice Guidelines for Diabetes, September 2002 edition ("Practice Guidelines"), which were followed by USP Lewisburg in 2005. As a result, no baseline assessment of Santee's diabetic condition was conducted and Santee was not prescribed glyburide, a diabetes medication, until April 26, 2005, and attempts to fit Santee for special shoes were not made until May 13, 2005. In light of these facts, the ultimate inquiry for the Court is what was Defendant's role in causing Santee's below-the-knee right leg amputation? Stated differently, in this case of ordinary negligence,2 did the United States' breach a legal dutyowed to Santee, and, if so, was the United States the factual cause of Santee's injury?
These issues were presented to the Court in a non-jury trial on April 12, 2012. At the conclusion of the trial, the parties were permitted to submit supplemental proposed findings of fact and conclusions of law. Both parties have done so. (Docs. 120; 121.) The Court, having now considered the testimony of witnesses and evidence admitted at trial, as well as the submissions of the parties, will analyze the evidence and the law and make Findings of Fact and Conclusions of Law as required by Rule 52 of the Federal Rules of Civil Procedure.
Santee commenced this action against Defendant for professional negligence on December 5, 2007. (Doc. 1.) After Defendant moved to dismiss the Complaint because Plaintiff failed to timely file a Certificate of Merit ("COM"), Magistrate Judge Blewitt, on May 8, 2008, issued a Report and Recommendation that the United States' motion be denied. (Doc. 19, 24.) On September 30, 2008, after Defendant objected to Magistrate Judge Blewitt's recommendations, Judge Nealon rejected in part and adopted in part the Magistrate Judge's recommendations. (Doc. 23.) Specifically, Judge Nealon concluded that Plaintiff's Complaint involved a professional malpractice claim which required Plaintiff to file a COM, but the Court held in abeyance Defendant's motion to dismiss pending the Magistrate Judge's recommendation as to whether Plaintiff should be excused for failing to file a timely COM. (Doc. 24, 9-10.)
On January 14, 2009, Magistrate Judge Blewitt issued a supplemental Report and Recommendation recommending Defendant's motion to dismiss be granted for Plaintiff's failure to file a timely COM. (Doc. 40, 17.) The Magistrate Judge also recommended that Plaintiff be denied the opportunity to assert a simple negligence claim. (Doc. 40, 16.) The proposed simple negligence claim rejected by Magistrate Judge Blewitt was described by Plaintiff as follows:
Santee's primary theory of negligence was that the prison personnel denied Santee access to his medication, which was already prescribed for him by his physician. (See e.g. Doc. 1 at ¶¶ 16 & 35) Santee's secondary theory of negligence was that he was denied proper shoes. Absolutely no professional judgment was exercised in denying Santee shoes that fit him. Santee's third theory of negligence was that he was denied reasonable and timely access to outside medical treatment. (See id. at ¶¶ 29 & 39). Santee was denied access, contact, and communication with medical care providers that were outside the confines of a prison.
(Doc. 32, 12 n.2) (emphasis in original).
On March 24, 2009, Judge Nealon adopted Magistrate Judge Blewitt's recommendation to dismiss Plaintiff's Complaint alleging professional negligence. (Doc. 44, 30.) However, because Plaintiff's Complaint provided Defendant adequate notice that Plaintiff was alleging that the prison employees' negligence caused Santee's injuries, Judge Nealon concluded that "Plaintiff's ordinary negligence claim . . . relates back to Plaintiff's original pleading, pursuant to Fed. R. Civ. P. 15(c), and Plaintiff will be granted leave to amend his complaint." (Doc. 44, 30.) Specifically, Judge Nealon reasoned:
Plaintiff, in his original pleading, supplied a basis for this breach by alleging that certain employees of Defendant denied Plaintiff his prescribed medication, that they denied Plaintiff access to outside medical care and treatment, that hey were negligent in hiring and retaining personnel, and that Plaintiff was denied properly fitting boots which may have been a factor in the subsequent amputation. . . . If the amended pleading, alleging ordinary negligence, as opposed to professional negligence, stems from the same incident and a common core of operative facts and Defendant will not be prejudiced as the original pleading gave Defendant ample notice of the claims against it, Plaintiff should be permitted to amend his pleading to allege simple negligence.
(Doc. 44, 27-28) (emphasis added).
Plaintiff subsequently filed an Amended Complaint, asserting a single claim for negligence. (Doc. 45.) After Defendant filed a motion to dismiss and for summaryjudgment, Magistrate Judge Blewitt recommended that the motion to dismiss be granted in part and denied in part. (Doc. 55, 18.) In particular, Magistrate Judge Blewitt recommended dismissal of Plaintiff's allegation that Defendant was negligent in hiring and/or retaining employees. (Doc. 55, 18.) The Magistrate Judge, however, noted that the Court had "already found a basis for the breach of an ordinary duty of care owed by [BOP] employees can be made based on certain employees of Defendant denying Plaintiff's prescribed medications, denying Plaintiff access to outside medical care and treatment, . . . and denying Plaintiff...
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