United States District Court, S.D. Georgia, Waycross Division
ESTHER WILLIAMS, Individually, and as Administrator of the Estate of PHILLIP WILLIAMS, Plaintiff,
UNITED STATES OF AMERICA, Defendant.
LISA GODBEY WOOD, JUDGE UNITED.
the Court are Defendant's Motion for Summary Judgment,
dkt. no. 61, and Plaintiff's Motion to Strike, dkt. no.
78. The Motions have been fully briefed and are ripe for
review. For the reasons provided below, Defendant's
Motion for Summary Judgment is GRANTED in part and
DENIED in part. Plaintiff's Motion to Strike is
DENIED as moot.
action arises from the death of Phillip Williams (the
"Decedent") on July 3, 2014. Plaintiff alleges that
Defendant committed medical malpractice due to many negligent
acts or omissions that allegedly caused Decedent's death.
Prior Medical History
at least 2010, Decedent had been receiving medical treatment
at the Waycross Veterans Affairs ("VA") clinic.
Dkt. No. 64 ¶ 12. Decedent was first treated at the VA
by Dr. Clay Lee, a board-certified, family-practice
physician. Id. Between 2010 and 2014, Dr. Lee
treated Decedent for hypertension, diabetes, migraine
headaches, depression, obstructive sleep apnea, back pain,
neck pain, hyperlipidemia, obesity, GERD, gout, and foot
pain, among other conditions. Id. ¶ 13.
Decedent was also enrolled in CCHT, care coordination/home
telehealth (the "Home Telehalth System"), which
monitored and helped manage his blood sugar/glucose via an
in-home messaging device. Id. ¶ 14.
1 - July 2, 2014, Treatment at the VA
Tuesday, July 1, 2014, Decedent presented to the emergency
room PER") at the Lake City VA Medical Center in Lake
City, Florida. Id. ¶ 15. At the ER, Decedent
complained of a migraine headache, diarrhea, nausea,
vomiting, fever, a cat scratch to his right wrist, along with
discomfort in his right shoulder and mild streaking up his
right arm. Dkt. No. 61-2 at 16, 21. Decedent described his pain
level from his headache as a level 9 out of 10. Id.
at 17. The ER physician, Dr. White, treated Decedent with an
injection of Rocephin (an antibiotic), an injection of Zofran
(an anti-nausea medication), and an injection of Dilaudid,
for pain. Dkt. No. 64 ¶ 17. Decedent was discharged
around 9:00 p.m. that evening. Id. ¶ 18.
approximately 8:00 a.m. the next day, July 2, 2014, Decedent
was flagged in the VA Home Telehealth System for high blood
glucose. Id. ¶ 19. Decedent had an elevated
blood glucose reading of 560 mg/dl. Id. ¶ 20.
This prompted a Waycross VA nurse to call Decedent around
12:00 p.m.; the nurse requested that Decedent come to the
Waycross VA clinic for an assessment and blood glucose check
Id. Dkt. No. 61-2 at 12. The note from the call
states that Decedent reported that he felt terrible, that he
had a fever, a terrible headache, and red streaks running up
his forearm from what Decedent was told was a cat scratch.
Dkt. No. 61-2 at 12. About an hour-and-a-half later, the
nurse again called Decedent because he had not yet arrived at
the clinic. Id. at 13. The nurse noted that Decedent
told her he was coming in to the clinic within the hour.
Id. Upon arrival at the clinic, Decedent's blood
glucose was checked, and it had decreased to 217 mg/dl. Dkt.
No. 64 ¶ 23. Also while at the clinic, Decedent reported
that he had not eaten that day but had drunk one Gatorade and
a water. Dkt. No. 61-2 at 7. He also reported some swelling
and tightness to his right arm where a cat had scratched him;
his pain was still a level 9 and was at the base of his neck;
he also reported that he had been experiencing a migraine
since June 29. Id.
informed Dr. Lee of Decedent's complaints and requested
that Dr. Lee examine Decedent. Dkt. No. 64 ¶ 25. Dr. Lee
also reviewed Decedent's ER note from the previous night
in order to understand the diagnosis and treatment provided
by the ER physician. Id. ¶ 26. Dr. Lee assessed
Decedent as having "Cellulitis of right arm secondary to
cat scratches," a migraine headache, and a
"[h]istory of back pain with recent increase in
symptoms." Dkt. No. 61-2 at 4. Dr. Lee prescribed a
Rocephin/Ceftriaxone injection (an antibiotic for the
treatment of cellulitis) and an injection of Phenergan (for
nausea). Dkt. No. 64 ¶ 29. Decedent was also given a
cold rag and a diet coke and placed in a dim room to rest
while the pharmacy prepared the injections. Id. The
injections were administered between 5:37 and 5:39 p.m.
Id. ¶ 30. Additionally, Decedent was instructed
to continue the Azithromycin as prescribed by the ER,
continue taking pain medication for treatment of headaches,
take Phenergan as needed for nausea, and to notify the VA
clinic if his headache symptoms worsened. Id. ¶
31. Prior to discharge, Decedent noted some relief of his
headache. Id. ¶ 32. In deciding to discharge
Decedent that evening at around 5:45, Dr. Lee concluded that
Decedent did not require hospitalization because (1)
Decedent's blood sugar had decreased from 560 to 217
mg/dl, (2) Decedent was afebrile (not feverish), (3)
meningitis had been ruled out, (4) Decedent had been given
injections of antibiotics to treat cellulitis both at the ER
and at the VA clinic, and (5) it had been less than 24 hours
since Decedent had received the first antibiotic injection.
Dkt. No. 61-4 ¶ 10; Dkt. No. 61-3 at 27-28.
3, 2014, Decedent's Death
following day, July 3, 2014, Decedent went to work at a local
car dealership, where he worked as a salesperson. Dkt. No. 64
¶ 34. The sales manager at the dealership, Jack Anderson
(who is also Decedent's cousin), observed Decedent arrive
at work around 9:00 a.m. Id. ¶ 35. Shortly
after arriving, Decedent told Anderson that he was not
feeling well, that his doctor had given him some medication
for an infection, and that he wanted to stay in his office to
work on his certifications rather than perform his normal
duties. Id. ¶ 36. Anderson told Decedent that
if he could not perform his normal duties, then he needed to
go home. Id. ¶ 37. When Decedent stood up,
Anderson noticed that he was dizzy, appeared wobbly, and in
no condition to drive, so Anderson offered to drive him home.
Id. ¶ 38. Prior to leaving the dealership,
Anderson asked Decedent if he needed to go to the hospital,
but Decedent declined. Id. ¶ 40. Anderson then
drove Decedent and his truck home, with another employee
trailing behind. Id. On the ride home, Anderson
again asked Decedent if he needed to go to the hospital, and
Decedent again declined. Id. ¶ 41. Upon arrival
at Decedent's house, Anderson helped Decedent to the
doorsteps and told Decedent to call him if he needed
anything. Id. ¶ 42. Decedent then proceeded up
the stairs under his own power, while holding onto the
handrail, and entered the house. Id. ¶ 43. That
was the last contact Anderson had with Decedent. Id.
Emry, Decedent's brother, was inside the house when
Decedent returned from work. Id. ¶ 45. Decedent
then went to sleep for about an hour. Id. ¶ 46.
After awaking and while walking around the house, Decedent
slipped, fell, and hit his head on an object in the living
room. Id. Emry sat with Decedent for about 45
minutes after the fall. Id. ¶ 47. After talking
with Emry for 4 5 minutes, Decedent went back to sleep.
Id. ¶ 48. Decedent woke up sometime later and
told Emry that he wanted to go to his pastor's house for
dinner. Id. ¶ 49. Emry convinced Decedent that
this was a bad idea because Decedent "looked like he
needed to be at home and in bed." Id. ¶
prepared dinner for Decedent at the house and brought the
meal to Decedent's room around 6:00 p.m., setting it up
on a little TV table. Id. ¶¶ 51, 52. Emry
observed Decedent start to eat, but Decedent "was, kind
of, shaking." Dkt. No. 61-6 at 31. Emry testified that
it would take Decedent a second to eat, but when
"finally he went to eat," Emry left the room to get
Decedent some water. Id. Emry made a glass of ice
water, and when he returned, Decedent was slumped over and
was not breathing. Id. Emry tried giving him CPR
while also calling 911. Id. at 31-32. It was about
three to four minutes from the time Emry left to get the
glass of ice water to when he called 911. Id. at 32.
indicate that the 911 call was received at approximately 7:12
p.m. and that the ambulance arrived at Decedent's house
at approximately 7:19 p.m. Dkt. No. 64 ¶ 55. Upon
arrival, the Emergency Medical Services ("EMS")
team observed Decedent laying face-up on the floor, with
bluish skin, not breathing, and with no pulse in his carotid
artery. Id. ¶ 56. The EMS team performed CPR
and applied a cardiac monitor, which noted no electrical
heart activity. Id. ¶ 57. The EMS team
attempted to ventilate Decedent without success. Id.
They noted that they observed "copious amounts of chewed
food [ ] in throat, over trachea causing complete
obstruction." Id. At around 7:39 p.m., the EMS
team removed the foods, and Decedent was ventilated and moved
to a stretcher for transport to the hospital. Id.
¶ 58. During transport, Decedent was administered two
doses of epinephrine, sodium bicarbonate, saline, and oxygen.
Id. ¶ 59. The EMS team noted long sounds
bilaterally, but Decedent remained without a heartbeat
(asystole) when he arrived at the Mayo Clinic hospital at
approximately 7:48 p.m. Id. ¶ 60. The medical
team at the Mayo Clinic hospital attempted to revive
Decedent, and Decedent "developed a pulse with good
palpable blood pressure after defibrillation and then
degenerated into PEA (pulseless electrical activity) and then
systole (no heartbeat/no electrical heart activity)."
Id. ¶ 61. Decedent died at approximately 8:19
p.m. Id. ¶ 62.
Bureau of Investigations Autopsy
7, 2014, an autopsy was performed by the Georgia Bureau of
Investigation's ("GBI") Division of Forensic
Sciences. Id. ¶ 64. An amended autopsy was
entered on September 25, 2018. Id. ¶ 65. The
cause of death was determined to be "airway obstruction
by food due to tramadol, bupropion, propranolol, butalbital,
and acetaminophen intoxication'' with the manner of
death determined to be an accident. Id. The medical
examiner who performed the autopsy, Dr. Donoghue, testified
that he believed the mechanism of death to be respiratory
arrest due to an obstruction of his airway. Dkt. No. 61-12 at
64. Dr. Donoghue also testified that (1) he did not see any
sign of infection on Decedent's arms, (2) he did not see
any sign of cat scratch disease/fever in Decedent, (3) he did
not believe that cat scratch disease contributed to
Decedent's death, (4) to a reasonable degree of medical
certainty, Decedent did not have an infection at the time of
his death, and (5) if Decedent had an infection in the days
before his death, the antibiotics ...