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Booker v. United States

United States District Court, E.D. Pennsylvania

July 19, 2018

BRANDI BOOKER ADMINISTRATOR, ESTATE OF ELAINE BOOKER
v.
UNITED STATES OF AMERICA

          MEMORANDUM

          JUAN R. SÁNCHEZ, J.

         In November 2008, following a routine employee tuberculosis screening, Greater Philadelphia Health Action (GPHA) employee Elaine Booker (Ms. Booker) was prescribed a drug to treat latent tuberculosis, which ultimately led to her acute liver failure and death. In this Federal Tort Claims Act (FTCA) action, Ms. Booker's daughter, Brandi Booker, in her capacity as administratrix of her mother's estate, [1] asserts negligence claims against the United States predicated upon the conduct of GPHA and two GPHA physicians, Dr. Monica Mallory-Whitmore and Dr. Heather Ruddock.[2]

         Following a bench trial, and for the reasons discussed herein, the Court concludes Plaintiff failed to show by a preponderance of the evidence that Dr. Mallory-Whitmore owed a duty of care to Ms. Booker or that Dr. Ruddock breached her duty of care to Ms. Booker. The Court further finds that GPHA's Employee Health Program was not defectively designed, and GPHA was not negligent in its supervision or monitoring of its health care providers. Pursuant to Federal Rule of Procedure 52(a), the Court issues the following findings of fact and conclusions of law.

         FINDINGS OF FACT

1. The Plaintiff in this FTCA action is Brandi Booker, in her capacity as administratrix of the estate of Ms. Booker.
2. The Defendant is the United States of America.
3. Ms. Booker was employed by GPHA as an administrative assistant and customer service representative, from 2001 until her death on April 25, 2009. At all times relevant to this case, Ms. Booker was employed at GPHA's Woodland Avenue facility in Philadelphia.
4. GPHA is a Pennsylvania non-profit, tax-exempt corporation that provides healthcare services to residents of Philadelphia County and the surrounding areas. As a designated “community health center, ” GPHA receives federal grant funds under Section 330 of the Public Health Service Act, 42 U.S.C. § 254b. GPHA also provides certain limited medical services to its employees through its Employee Health Program (EHP) within the context of its federally-funded scope. The services provided generally relate to the three primary objectives of the EHP: ensuring Hepatitis B vaccination, annual flu vaccination, and biannual tuberculosis screening for GPHA's employees.
5. Dr. Heather Ruddock is a licensed practicing physician who was previously employed by GPHA at its Woodland Avenue facility in Philadelphia. At all times relevant to this case, Dr. Ruddock was the Clinical Director of the Woodland Avenue facility and one of two general pediatricians at that site. Dr. Ruddock was also the facility's Employee Health Officer. As the Employee Health Officer, Dr. Ruddock administered the EHP, including overseeing the biannual employee tuberculosis screenings.
6. Dr. Monica Mallory-Whitmore is another licensed practicing physician who was employed by GPHA at its Woodland Avenue facility during the relevant time period.
7. Dr. Janet Elizabeth Young has been GPHA's Chief Medical Officer/Director since 1987, and was responsible for drafting the EHP. Under GPHA's supervisory structure, the Clinical Director at each location is supervised by the Associate Medical Director, who reports to the Chief Medical Officer/Director. In this case, Dr. Ruddock, the Clinical Director of the Woodland Avenue facility, reported to Brenda Rogers, the Associate Medical Director. Dr. Rogers reported directly to Dr. Young.
8. The EHP required all GPHA employees to participate in a routine tuberculosis screening twice a year. This requirement was designed to prevent the transmission of infectious diseases between staff and patients. Each screening was accomplished through the use of a purified protein derivative skin test (PPD), which is the standard of care for tuberculosis screening. A positive PPD indicates that the employee has been exposed to the bacteria causing tuberculosis. Any employee with a positive PPD must then have a chest x-ray performed to ensure there is no active tuberculosis infection. If the PPD is positive and the chest x-ray is negative for active infection, the employee is diagnosed with latent tuberculosis. The EHP manual does not require a specific course of action when an employee is diagnosed with latent tuberculosis, but rather allows the medical provider to use his or her professional judgment in making treatment decisions.
9. Although the EHP manual does not require a specific treatment, it is undisputed that the standard of care for latent tuberculosis is a nine-month course of the antibiotic Isoniazid (INH). Taking INH can be dangerous for a person with preexisting liver disease, or for a healthy person if the person's liver function is not properly monitored throughout the course of the drug. Prior to taking INH, a person with latent tuberculosis should discuss the drug within the context of the entirety of his or her health history and current medications with either his or her primary care physician or a different consulting physician.
10. As Dr. Young explained, the EHP manual is intentionally broad regarding some aspects of screening and treatment because it is generally administered by trained, licensed physicians and intended to meet only a few discrete goals. As noted, the EHP does not specify what course of action a physician must take after diagnosing an employee with latent tuberculosis, instead leaving it to the discretion of the medical provider in the exercise of his or her professional judgment. According to Dr. Young, an EHP physician is in compliance with EHP policy if he or she refers an employee to an ...

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