Lawson v. U.S.

• Decision Date: 02 October 2006
• Docket Number: Civil No. RWT 03-884.
• Citation: Lawson v. U.S., 454 F.Supp.2d 373 (D. Md. 2006)
• Parties: Ruth LAWSON, Plaintiff, v. UNWED STATES of America, Defendant.
• Court: U.S. District Court — District of Maryland

454 F.Supp.2d 373

Ruth LAWSON, Plaintiff, v.UNWED STATES of America, Defendant.

Civil No. RWT 03-884.

United States District Court, D. Maryland.

October 2, 2006.

COPYRIGHT MATERIAL OMITTED

COPYRIGHT MATERIAL OMITTED

COPYRIGHT MATERIAL OMITTED

COPYRIGHT MATERIAL OMITTED

Denis Charles Mitchell, Gerard E. Mitchell, Laurie Ann Amell, Stein Mitchell and Mezines, Washington, DC, for Plaintiff.

James A. Frederick, Thomas F. Corcoran, Office of the United States Attorney, Baltimore, MD, for Defendant.

OPINION

TITUS, District Judge.

On March 27, 2003, plaintiffRuth M. Lawson("Mrs.Lawson") brought this action against the United States under the Federal Tort Claims Act, 28 U.S.C. §§ 1346(b),2671-2680.In her Complaint, she asserted claims of medical malpractice relating to care during her second pregnancy that she received from health care providers at the Malcolm Grow Medical Center ("MGMC") at Andrews Air Force Base.

The two basic questions raised by this case are: (1) whether the applicable standard of care required Mrs. Lawson's health care providers at MGMC to recognize that she had an underlying neurological disease or disorder known as Chiari Type I malformation that was being exacerbated by her second pregnancy, and (2) whether the failure to recognize Mrs. Lawson's disease in providing her treatment during and after her second pregnancy caused her to suffer serious personal injury.The trial took place without a jury from February 7 through February 17, 2006.On June 7, 2006, the parties submitted proposed findings of fact and conclusions of law.

Having considered the evidence and arguments of counsel, the Court concludes that both questions must be answered in the affirmative and now makes its findings of fact and conclusions of law.

FINDINGS OF FACT

I. Chiari Type a Malformation

Mrs. Lawson has Arnold Chiari Malformation Type I ("ACM Type I" or "Chiari malformation").This congenital abnormality is characterized by the underdevelopment of the bone at the base of the skull (posterior cranial fossa) and overcrowding of the normally developed hindbrain.As a result of the underdevelopment of the posterior cranial fossa and overcrowding of the hindbrain, individuals with this abnormality have a larger than normal opening at the base of the skull (foramen magnum), which permits the hindbrain/cerebellar tonsils to protrude, or herniate, into the spinal canal.The herniation of the hindbrain happens at birth or shortly thereafter.In its pure form, a Chiari I malformation shows the cerebellar tonsils down to the C1-C2 region, with normal brain stem location.¹

Chiari I malformation exists in approximately one percent of the population, and most cases are diagnosed by MRI.²Even though individuals are born with ACM Type I, those afflicted are generally unaware that they have the condition unless and until symptoms appear.Chiari I malformation can remain a symptomatic, or it can result. in a gradual progression of symptoms over an individual's life.While most Chiari Type I malformations do not result in any symptomatology and are never detected, some individuals develop headaches in conjunction with the condition.These headaches are typically occipital (at the back of the head) in nature and may be associated with nausea and vomiting.

In some instances, age combined with triggering events such as trauma or pregnancy will cause a Chiari Type I malformation to decompensate.Decompensation produces significant cerebrospinal fluid ("CSF") problems below the cerebellum in the posterior cranial fossa and the spinal cord.Decompensation with an associated syrinx³ leads to the progressive development of neurological symptomatology related to anatomical functions of posterior fossa brain structures, manifesting as vertigo, ataxia, focal neurological findings and severe headaches.These symptoms are similar and overlapping with symptoms of other intracranial problems, such as brain tumors.

The treatment for decompensated Chiari I malformation with syrinx is neurosurgical and involves decompression flow by performance of a craniectomy at the level of the foramen magnum, producing space to allow normal CSF flow and reabsorption of syrinx and hydromyelia fluids.A duraplasty is performed to create space around the brain tissues, thereby allowing longterm decompression and promoting CSF flow.Surgical decompression is recommended for patients with a decompensated Chiari Type I malformation and syrinx, because the presence of the syrinx portends a higher risk for problems.

II.Run Lawson's Personal History

Mrs. Lawson was born on September 17, 1966.Her parents, Gilbert and Amparo Ferro, lived in Panama at the time of her birth.Mr. Ferro, a former aircraft mechanic for the United States Air Force, worked for the Panama Canal Commission as a shipwright, and Mrs. Ferro worked as a secretary.Mrs. Lawson enjoyed good health during her youth and adolescence.She actively participated in sports including aerobics, swimming, running, and weight training, and was an avid reader.Mrs. Lawson completed her elementary and high school education in Panama.While English has always been Mrs. Lawson's primary language, she is also fluent in Spanish.She attended grades K-6 at Margarita Elementary School and grades 7-12 at Cristobal High School, from which she graduated in June 1983.Mrs. Lawson was a very good student, and participated in school activities without any physical or social limitations.She attended college at Old Dominion University in Norfolk, Virginia, receiving a B.S. degree in Business Administration and Marketing in August 1987 with a cumulative GPA of 2.7.Mrs. Lawson also apparently began working on a Master's degree while living in Panama.

From 1988 to 1989 Mrs. Lawson worked for a private travel agency in Panama, where she made regular use of her bilingual skills.She subsequently worked for the U.S. military from 1989-1995, first with the United States Navy as a lifeguard, and then with Naval Intelligence as a secretary.She then switched over to the United States Air Force, where she was employed as a secretary and then as a management assistant, progressing from a pay grade of GS-05 to a GS-08.In her most senior position, Mrs. Lawson was responsible for maintaining all of the records at Howard Air Force Base, Albrecht Air Force Station, which was on the isthmus of Panama and an air base in Honduras.Mrs. Lawson received several commendations for her work, the most significant of which was "Records Manager of the Year for Air Combat Command," which commends the best performing records manager throughout the entire Air Force.

While working for the Air Force, Mrs. Lawson met Erick J. Lawson, who was stationed in Panama for two years as an Air Force Intelligence Officer.They were married by a judge on November 29, 1995, and the couple was married again in a religious ceremony on March 2, 1996.After she married, Mrs. Lawson suspended outside employment to tend to her family.However, Mrs. Lawson planned to resume working when her children reached school age, finish a Master's degree she had started in Panama, and pursue a career as a teacher or translator.Major Lawson has been an intelligence officer in the United States Air Force since 1992, and, at the time of trial, had been recently assigned to a temporary duty station in Qatar.

III.Ruth Lawson's Medical Records

The first symptom that gave notice that Mrs. Lawson could have a neurological disease or disorder developed around her nineteenth birthday, when she began to experience headaches that were more painful and frequent than normal.In July 1995, Mrs. Lawson also began to develop migraine headaches.Mrs. Lawson's medical records document that she reported these headaches to her health care providers at the various Air Force facilities where her husband was stationed.

In October 1998, Mrs. Lawson became pregnant with her first child, Dominick.During this pregnancy she suffered from hyperemesis gravidarum (excessive vomiting) that moderated during the second half of the pregnancy, and had occasional complaints of dizziness, especially when she rose to a standing position.Aside from an abnormal maternal serum alpha-fetoprotein finding and a single emergency room visit for dehydration, Mrs. Lawson had a normal number of prenatal visits and did not require any unscheduled or emergency visits during her first pregnancy.Mrs. Lawson gave birth to Dominick on July 29, 1997 at the Naval Hospital in Pensacola, Florida.

During her first pregnancy and thereafter Mrs. Lawson was able to carry out her household duties and functioned independently, with only minimal assistance from others.She was healthy and had no medical problems requiring any special medical intervention.Mr. and Mrs. Lawson moved to Andrews Air Force Base in July 1998.

Mrs. Lawson became pregnant with her second child, Nicholas, in March 2000.At that time, her husband was serving as an intelligence officer for the 89th Airlift Wing at Andrews Air Force Base.Mrs. Lawson received her prenatal care at MGMC, a facility with a residency program whereby first or second year family practice residents rotate through the obstetrics clinic for a month or two.At the time of Mrs. Lawson's second pregnancy, the obstetrics clinic was staffed with seven attending obstetricians, two to three residents on a rotating basis, and two to three nurse practitioners.Under the system in place at MGMC, family practice residents often saw the patients outside the presence of an attending obstetrician.In theory, a staff obstetrician was designated to review each obstetrical patient's chart on a trimester basis, but there is no evidence of who that designated person was for Mrs. Lawson.While a patient of the MGMC, Mrs. Lawson was seen by a team of health care providers including four attending obstetricians: Dr. Bruce Erhart, Dr. Gretchen Shaar, Dr. Tracey Golden, and Dr. John Buek; three...