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Columbus O. Winters v. United States of America

April 5, 2012


The opinion of the court was delivered by: Baylson, J.


I. Introduction

This case involves alleged medical malpractice at two Veterans Administration ("VA") medical establishments located in Philadelphia, occurring between December 17, 2007 and January 2, 2008, which allegedly harmed Plaintiff Columbus Winters ("Plaintiff"). Plaintiff's wife, Tawana Winters, brought this action against the United States of America ("the Government" or "Defendant") on behalf of her husband, pursuant to the Federal Torts Claims Act ("FTCA"), 28 U.S.C. §§ 1346(b), 2671 et seq.

Specifically, Plaintiff alleges that while he was a patient at a VA medical facility, the VA medical practitioners ordered "an anticoagulant regimen of the drug Warfarin," "established a therapeutic range for safe anticoagulation for Plaintiff's medical condition at an International Normalized Ratio (hereinafter 'INR') between 2 and 3,"*fn1 and then failed to monitor Plaintiff's INR properly. Compl. ¶¶ 9-12. Plaintiff's unmonitored INR rose above the established safe range, causing internal bleeding, aspiration of blood to the lungs, and a loss of oxygen to the brain. Compl. ¶¶ 12-13.

Presently before the Court is the Government's Motion for Summary Judgment (ECF No. 16). The Government argues that Plaintiff's claims are barred by the two-year statute of limitations. As discussed below, the Court will DENY the Government's motion due to the genuine dispute of material fact as to when Plaintiff's claim accrued.

II. Factual Background

The following facts are undisputed unless otherwise noted.*fn2 Plaintiff was treated at the Veterans Administration Community Living Center in Philadelphia ("VACLC") and the Veterans Administration Medical Center in Philadelphia ("VAMC") (collectively, "the Centers") between December 19, 2007 and January 2, 2008.*fn3 Def. SUF ¶ 1; Pl. SUF ¶ 1. On January 2, 2008, Plaintiff was treated in the VAMC emergency room. Def. SUF ¶ 5. Soon thereafter, Dr. Bruce Kinosian, Plaintiff's treating physician, visited Plaintiff and had a conversation with Ms. Winters. Def. SUF ¶¶ 5-7; Pl. SUF ¶ 5.

The subject of that conversation is disputed. Compare Def. SUF ¶¶ 5-7, with Pl. SUF ¶¶ 5-7. The Government submits a Declaration from Dr. Kinosian, in which he states that during that conversation he "told Mrs. Winters that her husband had been over-anticoagulated and that we did not check his INR soon enough after the dose change to catch that he was still receiving a higher dose than he needed."

Ms. Winters denies that Dr. Kinosian spoke with her about the events leading to Plaintiff's admission to the emergency room. Pl. SUF. ¶ 6. She specifically denies that he ever mentioned that Plaintiff was "overanticoagulated" or that Plaintiff's INR was not properly monitored. Pl. SUF ¶ 7. In addition, she denies that Dr. Kinosian spoke with her in 2008 about Plaintiff's eligibility for VA benefits due to negligence or that Dr. Kinosian helped her obtain any such benefits for Plaintiff at that time. Pl. SUF ¶¶ 8-9. Ms. Winters also declares that when she asked VA employees why her husband was moved to the emergency room, she was told "he's old, and old people get sick" and "[h]e had another stroke." Pl. Dec. ¶ 9.

Ms. Winters submitted various claims for benefits for her husband but did not mention INR or over-anticoagulation until December 2009. On June 17, 2008, Ms. Winters submitted a "Veteran's Application for Compensation and/or Pension" on behalf of Plaintiff, in which she cites a "R side CVA"-which likely means right-sided cerebrovascular accident or what Plaintiff refers to as a "stroke"-beginning on October 18, 2007, among other disabilities. Pl. SUF ¶ 9; Decl. of Tawana Winters ("Pl. Dec.") ¶ 19; Pl. Ex. A. The Disabled American Veterans, representing Plaintiff, later amended that claim to include "entitlement to service connection for complications, inpatient hospitalization and treatment from October 2007 through April 27, 2009 under the provisions of Title 38 U.S.C. § 1151."*fn4 Pl. Dec. ¶ 20; Pl. Ex. E. The Department of Veterans Affairs denied Plaintiff's claim for "complications of inpatient hospitalization due to stroke." Pl. Dec. ¶ 22; Ex. 9. The Disabled American Veterans filed a Notice of Disagreement on December 7, 2009, which Ms. Winters believes prompted them to ask Dr. Kinosian for help. Pl. Dec. ¶ 23; Ex. G. Dr. Kinosian wrote a progress report on December 8, 2009, in which he provides the explanation for Plaintiff's injuries that forms the basis of Plaintiff's claims in this case. Dr. Kinosian states that giving Plaintiff Coumadin-which the Complaint states is part of an anticoagulant regimen-"was related to his current disabilities and the cost of his care being incurred by his wife." Compl. ¶ 9; Pl. SUF ¶ 23; Pl. Ex. E. Dr. Kinosian then explains:

[Plaintiff's] elevated INR was the cause of his bleeding into his stomach, which resulted in his vomiting blood, subsequent aspiration of the blood, and inflamation in his lungs from the aspirated stomach contents, causing the loss of oxygen to his brain and subsequent anoxic brain injury. His current disabilities are a result of that anoxic brain injury. Prior to his anoxic brain injury, he was recovering from his CVA, and was able to stand and take several steps, and more meaningfully interact with those in his environment. He is now bed-bound and totally dependent. The elevated INR was a consequence of his level of anticoagulation not being able to be successfully monitored during the 3 weeks prior to his bleeding, although several providers ordered that the level be checked. The case was reviewed, and found to be an unexpected outcome of the care Mr. Winters received.

Pl. Ex. C. Another doctor then examined Plaintiff and confirmed Dr. Kinosian's description of Plaintiff's injuries and their cause. Pl. Dec. ¶ 24; Pl. Ex. I. The VA then approved Plaintiff's request for benefits. Pl. Dec. ¶ 24; Pl. Ex. D.

Ms. Winters also made a number of other complaints about the care or treatment her husband received. Def. SUF ¶ 10; Pl. SUF ¶ 10. The ER attending note from January 2, 2008 states that Ms. Winters was "upset about [her husband's] care at the [nursing home] and wishes that he does not return there when he is discharged." Def. SUF ¶ 11; Pl. SUF ¶ 11. Notes in February 2008 indicate that Ms. Winters "does not want [her husband] to go back to the VANH [also known as the VACLC]" and "wants [her husband] at a new nursing home because she was dissatisfied with the treatment he received at the VANH." Def. SUF ¶ 12; Pl. SUF ¶ 12. Other notes document

Ms. Winters's belief that "the VA should pay for 24 hour care as her husband's medical condition was a result of his care at the PVMAC and VANH." Def. SUF ¶ 13; Pl. SUF ¶ 13. Ms. Winters furthermore indicated her desire to place "a claim with the nursing home given her concerns about previous ...

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