Stemmle v. Interlake S.S. Co.
| Docket Number | CV 15-4937 (AYS) |
| Decision Date | 08 August 2022 |
| Parties | Thomas Charles STEMMLE, Jr., Plaintiff, v. INTERLAKE STEAMSHIP CO., Defendant. |
| Court | U.S. District Court — Eastern District of New York |
Charles F. Herd, Pro Hac Vice, Herd Law Firm, Houston, TX, Lawrence Paul Wilson, W. Mark Lanier, Pro Hac Vice, The Lanier Law Firm P.C., Houston, TX, for Plaintiff.
Gino Zonghetti, Kaufman Dolowich & Voluck LLP, Hackensack, NJ, Kenneth B. Danielsen, Cipriani & Werner PC, Islen, NJ, for Defendant.
This admiralty case was commenced in December of 2014 by Plaintiff Charles Stemmle ("Plaintiff" or "Stemmle") against Defendant Interlake Steamship Company ("Interlake" or "Defendant") in New York State Court. After the filing of an amended complaint on April 29, 2015, the case was removed to this Court. Docket Entry herein ("DE") [1]. A motion to remand was denied on July 27, 2016. During an initial conference held before this Court on September 27, 2016, the parties advised that they wished to pursue an early settlement. A settlement conference was thereafter held on January 29, 2017. After extensive negotiation, the parties agreed to a settlement. They also agreed to consent to the exercise of full jurisdiction by this Court, and this Court agreed to exercise such jurisdiction after settlement was reached.
Among other terms, the parties' settlement provides for Defendant to make premium payments for a policy of health insurance supplemental to Plaintiff's Medicare coverage. Defendant agreed to continue to make premium payments until Stemmle reached maximum medical cure, as that term is defined under admiralty law. It was agreed that this Court would determine when such cure was achieved.
Presently before this Court is Defendant's motion pursuant to Rule 9(h) of the Federal Rules of Civil Procedure, and 28 U.S.C. § 2201(a) for an order declaring that Plaintiff has reached maximum medical cure. For the reasons set forth below, the Court holds that Stemmle has reached maximum medical cure. Accordingly, Defendant's motion is granted.
Plaintiff's claims arise out of cardiac illness that he suffered while working as a seaman aboard Defendant's commercial ship. Because the illness was experienced by Plaintiff while working on board Defendant's vessel, Stemmle sought maintenance and cure pursuant to the admiralty law of the United States. While Defendant opposed Plaintiff's claims, it shared Plaintiff's desire to place this matter into an early settlement posture. Accordingly, counsel and their clients (including Plaintiff's wife) appeared before this Court on January 9, 2017 to engage in settlement negotiations. It became clear that early settlement was sought because of the dire nature of Plaintiff's heart condition. In particular, Plaintiff represented that the only cardiac treatment option then available to him was a heart transplant. At the time, Plaintiff was seeking to be placed on a heart transplant waiting list for surgery to be performed at Cedars-Sinai Hospital in the State of California ("Cedars-Sinai"). Cedars-Sinai was represented as the place where Plaintiff had the best and earliest chance of receiving a new heart because, as Plaintiff explained, California is an "opt-out" State where individuals opt-out of being organ donors, as opposed to the State of New York, where individuals who agree to be organ donors agree to opt-in to a donation program.
As a result of their discussions and negotiations, the parties worked together and agreed to settlement of this action. Their agreement is memorialized in a final written settlement agreement, which is discussed in further detail below. See Settlement Agreement and General Release annexed as Exhibit J-1 to the Declaration of Gino Zonghetti (the "Zonghetti Decl.") DE [65-13] (the "Agreement"). Pursuant to the Agreement, this Court has exercised continuing jurisdiction over the parties' disputes, and now, as to the final disposition of this matter. This latest matter is sought by way of the motion presently before the Court. See DE [65-13] at ¶ 4. Before turning to the merits of the motion, the Court turns to a discussion of the facts that are relevant to the disposition of the motion.
The Agreement recognizes that because of his then-disabling heart condition Stemmle qualified for Medicare as his primary insurance coverage. DE [65-13] at ¶1. Maintenance of a secondary insurance policy was a condition of Plaintiff's acceptance to the Cedars-Sinai transplant program. See DE [65-13] at ¶ 5(B)(i). The Agreement facilitates this condition of the program by providing for Defendant to pay for a then-existing secondary health insurance policy issued by Humana (the "Secondary Policy"). DE [65-13] at ¶1.1 Defendant began payment of premiums for the Secondary Policy in February of 2017. Under the terms of the Agreement, premium payments for this policy are to continue until Defendant's obligations "under the doctrine of Maintenance and Cure are ruled by [the Court] to have been met in full, as determined pursuant to the terms set forth in paragraph 5" of the Agreement. Maintenance and cure obligations to Plaintiff were being paid for the condition suffered by Plaintiff while working on board Defendant's vessel. This condition is described in the Agreement as "systolic heart failure and any related or resulting cardiac conditions". DE [65-1]3 at ¶1. The Agreement recognized that Plaintiff's medical condition was "not curable, based upon the advices received from Cedars-Sinai." DE [65-13] at ¶1. The Agreement provides for Defendant to continue to make premium payments for the Secondary Policy (or any successor policy in the event that policy is no longer in effect) until this Court's legal determination that Stemmle has reached "Maximum Medical Cure," or, as interchangeably used by the parties (and in the case law) "Maximum Medical Intervention" DE [65-13] at ¶1A. The Court refers herein more simply to this concept as "MMI."
The issue of whether MMI has been met was agreed, like all other questions, to be subject to final decision by this Court. See DE [65-13] at ¶ 5. Relevant to that decision, the Agreement makes reference to Stemmle's formal acceptance into the Cedars-Sinai heart transplant program, and the post-transplant care necessary for all transplant patients. DE [65-13] at ¶ 5(B)(i). In particular, the Agreement states that following surgery, Stemmle will "require the use [of] anti-rejection medication, perhaps for the rest of his life." DE [65-13] at ¶ 5(B)(ii). The Agreement also states that following transplant surgery Stemmle "will be required to undergo periodic examinations by physicians, including cardiologists, to check on his post-transplant progress, overall health, status of anti-rejection medications, and other necessary treatments typically required for heart transplant patients." DE [65-13] at ¶ 5(B)(iii).
As to Stemmle's recovery, the Agreement states the parties' intent that Stemmle's heart condition shall be evaluated under maritime law developed with respect to the obligations of a shipowner to a seaman "afflicted with an incurable disease, permanent condition or chronic illness which manifests itself during the seaman's employment aboard a vessel, but is not caused by it." DE [65-13] at ¶ 5(B)(iv). After referring to the cessation of payments pursuant MMI, the Agreement states that Stemmle's needs for post-transplant evaluation and monitoring, including "necessary treatments typically required for heart transplant patients," and the "ongoing need for anti-rejection medication", standing alone, shall not be determinative of the issue of whether Stemmle has reached Maximum Medical Cure." DE [65-13] at ¶ 5(B)(iv) (emphasis added).
The facts regarding Plaintiff's medical treatment and current condition are drawn from the medical opinions discussed below, as well as Plaintiff's testimony - both at deposition and in the form of an affirmation submitted in reply to the present motion. The Court begins with Plaintiff's point of view. Next, the Court discusses the medical facts as described by the parties' expert opinions.
Stemmle testified as to his current health condition and employment during his recent deposition, which was taken on March 16, 2022. See Transcript of Deposition of Thomas Stemmle annexed as Exhibit M to the Zonghetti Decl. ("Stemmle Tr."), DE [65-16]. Plaintiff has supplemented his testimony by way of an affidavit dated May 9, 2022, which was submitted in reply to the present motion. See Affidavit of Thomas Stemmle dated May 9, 2022, annexed as Exhibit B to the Herd Decl. ("Stemmle Reply Aff."). DE [66-3].
Plaintiff is currently thirty-six years old. His heart transplant surgery took place on December 9 and 10 of 2019 at Cedars-Sinai. A two- and one-half-week period of hospitalization immediately followed the surgery. Plaintiff thereafter resided in a Los Angeles apartment for a period of two months. He then moved to Las Vegas, Nevada where he currently resides. After relocating to Nevada, Plaintiff periodically returned to Cedars-Sinai (in Los Angeles) for follow-up visits. Because of the Covid-19 pandemic, Plaintiff has also followed up with his California-based medical team via virtual visits. Stemmle Tr. at 7-8. He testified that all treating medical professionals treating him characterize the surgery as a success. See id. at 9.
Since surgery, Plaintiff has been on anti-rejection and immunologic suppressive therapies. Stemmle Tr. At 10. He states that he will remain on these therapies for life so that his body does not reject the transplanted heart. Stemmle Tr. at 10; 18-1...
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