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Williams v. United States

United States District Court, S.D. Georgia, Waycross Division

August 13, 2019

ESTHER WILLIAMS, Individually, and as Administrator of the Estate of PHILLIP WILLIAMS, Plaintiff,



         Before 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.


         This 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.

         Decedent's Prior Medical History

         Since 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.

         July 1 - July 2, 2014, Treatment at the VA

         On 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.[1] 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.

         At 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.

         A nurse 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.[2] 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.

         July 3, 2014, Decedent's Death

         The 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. ¶ 44.

         Michael 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. ¶ 50.

         Emry 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.

         Records 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.

         Georgia Bureau of Investigations Autopsy

         On July 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 ...

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