Janyce Brown v. United States ( 2009 )


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  •                       RECOMMENDED FOR FULL-TEXT PUBLICATION
    Pursuant to Sixth Circuit Rule 206
    File Name: 09a0364p.06
    UNITED STATES COURT OF APPEALS
    FOR THE SIXTH CIRCUIT
    _________________
    X
    -
    JANYCE ELAINE BROWN, Deceased; ASA
    -
    ROBERT GRAYDON BROWN, a minor child;
    HELEN ELIZABETH BROWN, a minor child,             -
    Plaintiffs-Appellants, -
    No. 08-2506
    ,
    >
    -
    -
    v.
    -
    -
    UNITED STATES OF AMERICA, the U.S.
    Department of Veterans Affairs,                   -
    Defendant-Appellee. -
    -
    N
    Appeal from the United States District Court
    for the Eastern District of Michigan at Detroit.
    No. 04-73411—John Corbett O’Meara, District Judge.
    Argued: July 30, 2009
    Decided and Filed: October 15, 2009
    Before: BATCHELDER, Chief Judge; KENNEDY and McKEAGUE, Circuit Judges.
    _________________
    COUNSEL
    ARGUED: Robert Paul Walsh, LAW OFFICE OF ROBERT P. WALSH, Battle Creek,
    Michigan, for Appellants. Steven P. Croley, ASSISTANT UNITED STATES ATTORNEY,
    Detroit, Michigan, for Appellee. ON BRIEF: Robert Paul Walsh, LAW OFFICE OF
    ROBERT P. WALSH, Battle Creek, Michigan, for Appellants. Steven P. Croley,
    ASSISTANT UNITED STATES ATTORNEY, Detroit, Michigan, for Appellee.
    _________________
    OPINION
    _________________
    McKEAGUE, Circuit Judge. In this suit brought under the Federal Tort Claims Act
    (“FTCA”), Janyce Brown and her two minor children (collectively, “appellants”) appeal the
    district court’s order granting summary judgment to the government. As the wife and
    children of a veteran of the first Persian Gulf War, appellants claim that the United States
    1
    No. 08-2506           Brown, et al. v. United States                                           Page 2
    Department of Veterans Affairs (the “VA”) is liable for failing to diagnose the veteran, Arvid
    Brown, with a parasitic disease called Leishmaniasis and for failing to warn him that he
    could transmit the disease to his family. Because there is insufficient evidence that the VA
    owed a duty to appellants, we affirm.
    I. BACKGROUND
    Arvid Walter Brown, Jr. served in the United States Army during the first Persian
    Gulf War. He was on active duty in Saudi Arabia from January 3, 1991 until June 4, 1991.
    During that time, appellants contend he contracted Leishmaniasis, a parasitic disease
    common in certain parts of the Middle East that is spread by the bite of infected sand flies.
    Three years after he returned from active duty, on September 3, 1994, Mr. Brown
    married Janyce Brown. They had two children together: Asa Brown, born August 30, 1995,
    and Helen Brown, born June 18, 1997. Appellants allege that Mr. Brown transmitted
    Leishmaniasis to his wife via their daily personal and sexual contact, and that Mrs. Brown
    transmitted the disease to their two children in utero.
    From 1991 until 1998, Mr. Brown received medical care from the VA for various
    physical and psychological problems. In 1998, the VA conducted four blood tests to
    1
    determine whether Mr. Brown had Leishmaniasis. All of these tests were negative.
    Unaware of the tests conducted by the VA, Mr. Brown’s private health care
    provider, Dr. Gregory Forstall, also ordered blood tests in September 1998 to determine
    whether Mr. Brown had Leishmaniasis. Both of these tests indicated that he was
    positive for the disease. A bone marrow biopsy conducted in August 1998 had indicated
    no parasitic infection, but it had also indicated “atypical lymphoid aggregates.” Faced
    with what Dr. Forstall believed to be “equivocal” bone marrow results and the positive
    blood tests, Dr. Forstall treated Mr. Brown with a twenty-one day course of
    Amphotericin B. According to Dr. Forstall, he was not “clear either way” as to whether
    Mr. Brown in fact had Leishmaniasis. Rather, he testified that “at that point it was let’s
    1
    Leishmaniasis is diagnosed through blood testing and biopsy. Blood tests measure the presence
    of antibodies or antigens produced to combat the parasite. Biopsy of the spleen, liver, or bone marrow
    confirms the presence of the parasite.
    No. 08-2506            Brown, et al. v. United States                                              Page 3
    treat him and see what happens.” Another bone marrow biopsy conducted in February
    1999 indicated no evidence of parasitic infection. Finally, blood tests performed in 2000
    by an unnamed lab located in Rio de Janeiro, Brazil, indicated that “Arvid is for sure
    negative.”
    Unlike Mr. Brown, it is undisputed that neither Mrs. Brown nor the children ever
    received treatment or care from the VA or any of its medical personnel. They also were
    never patients of Dr. Forstall. At Dr. Forstall’s direction, however, blood was collected
    from Mrs. Brown and the children and sent to the unidentified lab in Rio de Janeiro in
    2000. The email from the lab indicated that Mrs. Brown and Asa Brown had test results
    that were “above the cutoff,” which indicated “positivity although very discrete.” Helen
    Brown was “just near the cut-off although considered negative.” The results of a second
    test from the same lab apparently indicated that both Mrs. Brown and Asa Brown were
    negative, and that Helen Brown had a “very weak positive reaction.”
    On September 2, 2004, appellants filed suit against the United States under the
    FTCA in the United States District Court for the Eastern District of Michigan.2 They
    sought damages for harm caused by Leishmaniasis, which they alleged they contracted
    from Mr. Brown due to the government’s negligent failure to diagnose him with the
    disease or to warn him of the risks of transmitting it to his family. The government filed
    a motion to dismiss for lack of jurisdiction based upon the Feres doctrine, which
    precludes FTCA claims “for injuries to servicemen where the injuries arise out of or are
    in the course of activity incident to service.” Feres v. United States, 
    340 U.S. 135
    , 146
    (1950). The district court granted the government’s motion and dismissed the case. On
    appeal, however, this court affirmed in part, reversed in part, and remanded the case to
    the district court. Brown v. United States, 
    451 F.3d 411
    , 416 (6th Cir. 2006). Feres, the
    court held, barred appellants’ claims “deriving solely from military decisions incident
    2
    On March 16, 2005, Janyce Brown died of liver cancer. Appellants do not suggest that her
    cancer was caused by Leishmaniasis. Instead, they limit their claim on behalf of Mrs. Brown to the seven
    years of disability they allege was caused by Leishmaniasis. Mr. Brown now serves as the personal
    representative of his wife’s estate. The two minor children are also represented by the conservator of their
    estates. References to “appellants” in this opinion are to Janyce Brown and the two Brown children, rather
    than to the nominal plaintiffs.
    No. 08-2506         Brown, et al. v. United States                                     Page 4
    to Arvid’s service,” 
    id., but it
    did not bar their claims “to the extent that they attribute[d]
    their injuries to medical examinations that took place after Arvid’s discharge, and any
    duty to warn that arose from such examinations,” 
    id. at 414.
    Yet the court “express[ed]
    no opinion with respect to other possible hurdles to recovery by appellants, such as
    whether or not there was a duty or proximate causation.” 
    Id. at 415
    n.3.
    On remand, appellants filed an amended complaint with the district court. The
    government moved for a more definite statement of the factual allegations in the
    complaint and to strike the portions of the complaint that were irrelevant in light of this
    court’s decision. The magistrate judge granted the government’s motion and appellants
    filed a second amended complaint alleging the following claims: 1) failure to warn,
    2) negligence, 3) medical malpractice, and 4) wrongful death of Janyce Brown. At that
    point, the government filed a motion for judgment on the pleadings pursuant to Rule
    12(c) of the Federal Rules of Civil Procedure. It argued that appellants’ second amended
    complaint did not make sufficiently specific allegations to state a claim and, even if it
    did, Michigan law did not recognize a general duty toward third parties such as
    appellants. The district court denied the government’s motion.
    After completion of discovery, the government moved for summary judgment.
    On July 15, 2008, the district court granted the government’s motion. The district court
    first noted that appellants had abandoned their medical malpractice and wrongful death
    claims, a finding appellants do not contest on appeal. It then granted summary judgment
    to the government on appellants’ remaining claims for failure to warn and negligence.
    Appellants filed a motion for reconsideration, which the district court denied. This
    timely appeal followed.
    II. ANALYSIS
    A. Standard of Review
    We review a district court’s grant of summary judgment de novo. White v.
    Baxter Healthcare Corp., 
    533 F.3d 381
    , 389 (6th Cir. 2008). Summary judgment is
    proper “if the pleadings, the discovery and disclosure materials on file, and any
    No. 08-2506         Brown, et al. v. United States                                 Page 5
    affidavits show that there is no genuine issue as to any material fact and that the movant
    is entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(c). To survive a motion
    for summary judgment, the nonmoving party must provide evidence beyond the
    pleadings “set[ting] out specific facts showing a genuine issue for trial.” Fed. R. Civ.
    P. 56(e). The district court must construe the evidence and draw all reasonable
    inferences in favor of the nonmoving party. Jones v. Potter, 
    488 F.3d 397
    , 403 (6th Cir.
    2007).
    B. Liability Under the FTCA
    The United States is liable under the FTCA “in the same manner and to the same
    extent as a private individual under like circumstances.”           28 U.S.C. § 2674.
    Accordingly, “the extent of the United States’ liability under the FTCA is generally
    determined by reference to state law.” Molzof v. United States, 
    502 U.S. 301
    , 304-05
    (1992); see also Harris v. United States, 
    422 F.3d 322
    , 326-27 (6th Cir. 2005). The
    parties do not dispute that Michigan law applies in this case because the alleged
    instances of the VA’s negligence all occurred in Michigan. See 28 U.S.C. § 1346(b)(1)
    (providing that district courts shall have original jurisdiction of claims under the FTCA
    “if a private person, would be liable to the claimant in accordance with the law of the
    places where the act or omission occurred”). Under Michigan law, a plaintiff alleging
    a claim of negligence must demonstrate the following four elements: 1) a duty owed to
    the plaintiff by the defendant, 2) breach of that duty, 3) causation, and 4) damages. Case
    v. Consumers Power Co., 
    615 N.W.2d 17
    , 6 (Mich. 2000).
    On appeal, appellants assert that the VA owed them a duty to diagnose Mr.
    Brown with Leishmaniasis and to inform him of the risks of transmitting the disease to
    his family. The district court disagreed, holding that “[g]enerally, Michigan tort law
    does not recognize a duty to third parties; and the court finds no exception to that rule
    here, despite the unfortunate facts of this case.” Surface v. United States, No. 04-73411,
    
    2008 WL 2761246
    , at *2 (E.D. Mich. July 15, 2008).
    Under Michigan law, “the question of whether a duty exists is one of law for the
    court’s resolution.” Welke v. Kuzilla, 
    375 N.W.2d 403
    , 250 (Mich. Ct. App. 1985).
    No. 08-2506        Brown, et al. v. United States                                  Page 6
    Duty “arises from the relationship of the parties and involves a determination of whether
    the defendant has any obligation to avoid negligent conduct for the benefit of the
    plaintiff.” Duvall v. Goldin, 
    362 N.W.2d 275
    , 277 (Mich. Ct. App. 1984). The existence
    of a duty is a separate inquiry from “the nature or extent of the actor’s obligation” with
    respect to that duty. 
    Id. “Generally, a
    party has no duty to protect another who is endangered by a third
    person.” Shepard v. Redford Cmty. Hosp., 
    390 N.W.2d 239
    , 245 (Mich. Ct. App. 1986);
    see also 
    Welke, 375 N.W.2d at 250
    . There is an exception to this general rule, however,
    where the defendant has a “special relationship with either the dangerous person or the
    potential victim.” 
    Shepard, 390 N.W.2d at 245
    ; see also 
    Welke, 375 N.W.2d at 250
    ;
    
    Duvall, 362 N.W.2d at 278
    . In addition to a special relationship, whether a duty exists
    also depends upon “the foreseeability that the actor’s conduct would create a risk of
    harm to the victim.” 
    Duvall, 362 N.W.2d at 278
    .
    In Shepard, for example, a physician failed to diagnose a woman’s spinal
    meningitis, and she subsequently passed it on to her infant son, Eric, who died two days
    later. The defendant hospital argued that it owed no duty to Eric because he was never
    a patient. The court held that a physician-patient relationship is a special relationship
    that may give rise to a duty of reasonable care to third parties. 
    Shepard, 390 N.W.2d at 241
    . Thus, the physician’s special relationship to Eric’s mother gave rise to a duty that
    also extended to Eric, who was, “[a]s plaintiff’s son and a member of her household,”
    a “foreseeable potential victim of [the physician’s] conduct.” 
    Id. Similarly, in
    Welke,
    the court concluded that a duty existed for the benefit of a third party where a physician
    injected his patient with an unknown substance, let the patient drive his vehicle, and the
    patient subsequently killed another individual while 
    driving. 375 N.W.2d at 406
    . The
    third party, the court held, was “an innocent driver within the scope of foreseeable risk”
    by virtue of the physician’s relationship with his patient. Id.; see also 
    Duvall, 362 N.W.2d at 279
    (holding that psychiatrist had duty to protect individuals endangered by
    his epileptic patient); Davis v. Lhim, 
    335 N.W.2d 481
    , 489 (Mich. Ct. App. 1983)
    (holding that a psychiatrist owed a duty to a person foreseeably injured by his patient).
    No. 08-2506             Brown, et al. v. United States                                               Page 7
    In this case, it is undisputed that there was a special relationship between the VA
    and Mr. Brown, a patient. The disputed question is whether Mrs. Brown and the two
    Brown children were foreseeable victims of any failure on the part of the VA to diagnose
    Mr. Brown with Leishmaniasis.
    A third party is a foreseeable victim “where [a] physician determines or, pursuant
    to the standard of care, should determine that his patient poses a serious threat of danger
    to a third person.” 
    Welke, 375 N.W.2d at 406
    ; see also 
    Duvall, 362 N.W.2d at 279
    (“[I]t
    is foreseeable that a doctor’s failure to diagnose or properly treat an epileptic condition
    may create a risk of harm to a third party.”); 
    Davis, 335 N.W.2d at 489
    (holding that
    “when a psychiatrist determines or . . . should determine that a patient poses a serious
    threat of danger” to a third party, the psychiatrist has a duty of reasonable care to that
    party). We must therefore decide whether the VA should have known that Mr. Brown
    had Leishmaniasis and, if so, whether the VA should have also known that his infection
    with the disease posed a serious threat of danger to his family.3
    First, appellants have not alleged any facts indicating that the VA should have
    known Mr. Brown had Leishmaniasis. A VA rating decision dated August 3, 1999,
    indicates that Mr. Brown presented the VA with symptoms of headaches, nausea, light
    sensitivity, chest pain, muscle pain, neck pain, gastrointestinal difficulties, and fatigue.
    But appellants have failed to offer any evidence that a reasonable physician faced with
    these fairly common symptoms should have determined, pursuant to the standard of care,
    that Mr. Brown was suffering from Leishmaniasis. Dr. Forstall, Mr. Brown’s own
    physician, never gave any testimony to that effect. In fact, Dr. Forstall testified that Mr.
    Brown came to him specifically to rule out Leishmaniasis. When asked what drew him
    3
    Obviously, it is impossible to show that the VA should have known Mr. Brown was infected
    with Leishmaniasis and posed a serious danger to appellants if there is insufficient evidence that he ever
    had the disease. Although the government maintains that Mr. Brown did not have Leishmaniasis, there
    is at least some evidence in the record that he did: two of his blood tests returned positive results, and Dr.
    Forstall testified that he believed Mr. Brown was suffering from the disease in 1998. See Forstall Dep. 74
    (Q: “At the time that you treated Arvid Brown so this is late 1998, did you at that point believe that he in
    fact had leishmaniasis? . . . A: “I’d say yes.”). Moreover, on February 17, 2006, the VA’s Board of
    Veterans’ Appeals found that Mr. Brown has “experienced active visceral Leishmaniasis since October
    27, 1994” and was accordingly entitled to service-related disability benefits as of that date. We therefore
    assume for purposes of our analysis that Mr. Brown was infected with Leishmaniasis.
    No. 08-2506         Brown, et al. v. United States                                    Page 8
    to the possibility of Leishmaniasis, Dr. Forstall responded, “[p]art curiosity and part just,
    you know, what do you have to lose.” The record does not support a conclusion that the
    VA’s physicians should have known from Mr. Brown’s presentation of symptoms that
    he was infected with Leishmaniasis.
    Even if the VA should have known that Mr. Brown had Leishmaniasis, Mrs.
    Brown and the two children were foreseeable victims only if the VA also should have
    known that Leishmaniasis posed a “serious threat of danger” to them. 
    Welke, 375 N.W.2d at 406
    . In Shepard, for example, there was clearly a serious threat that the
    plaintiff’s spinal meningitis, gone undiagnosed, would spread to Eric. 
    Shepard, 390 N.W.2d at 241
    .      Here, appellants contend that they were at risk of contracting
    Leishmaniasis from Mr. Brown because the disease is transmissible from person to
    person. Specifically, they allege that Mrs. Brown contracted Leishmaniasis from Mr.
    Brown through their daily personal and sexual contact, and that Mrs. Brown transmitted
    the disease to their children in utero.
    On the issue of whether there was a serious risk that Mr. Brown would transmit
    Leishmaniasis to his wife, the government offers an affidavit from Dr. Jose Vazquez
    stating that “[t]o date, no form of leishmaniasis can be transmitted sexually.” Vazquez
    Aff. ¶ 6. Appellants, however, argue that “there are many modes of transmission that
    could have caused Mrs. Brown’s infection.” They cite to medical literature documenting
    the spread of Leishmaniasis through needlestick injuries, oral mucosa exposure, nasal
    and oral secretions, urine, and the handling of contaminated specimens. But these
    articles describe rare and experimental transmission of Leishmaniasis, much of it
    occurring at low levels in mice and hamsters. One article, for example, states that
    “[s]exual transmission from a man to his wife has been reported” and goes on to cite
    only two documented probable cases of sexual transmission. Alan J. Magill, M.D.,
    Epidemiology of Leishmaniasis, 13 DERMATOLOGIC CLINICS 505, 517 (1995). The same
    article notes only that “person-to-person transmission . . . via contact with infected fluids
    is theoretically possible.” 
    Id. Another article
    concluded that nasal discharge “could
    provide a possible, though minor, source of infection by body contact.” Yemane B.
    No. 08-2506        Brown, et al. v. United States                                  Page 9
    Mebrahtu et al., Leishmania Donovani Parasites in the Nasal Secretions,
    Tonsillopharyngeal Mucosa, and Urine Centrifugates of Visceral Leishmaniasis Patients
    in Kenya, 48 Am. J. of Tropical Medicine & Hygiene 530, 535 (1993) (emphasis added).
    Finally, one article found “a low level of nonvector transmission” of Leishmaniasis in
    mice. Alexa C. Rosypal & David S. Lindsay, Non-Sand Fly Transmission of a North
    American Isolate of Leishmania Infantum in Experimentally Infected BALB/C Mice, 91
    J. of Parasitology 1113 (2005). This experimental and theoretical evidence does not
    show that the VA should have known Leishmaniasis posed a serious threat of danger to
    third parties at the time of its alleged failure to diagnose Mr. Brown with the disease.
    On the issue of in utero transmission of Leishmaniasis, the government concedes
    that, “[t]hough very rare, there have been several documented cases of congenital
    transmission of leishmaniasis from mother to unborn child.” 
    Id. Indeed, one
    of the
    articles cited by appellants provides a case study of congenital transmission from a
    mother to her child, and notes that “[o]nly 8 cases of congenital acquired disease have
    been described before 1995, when our case occurred.” Christoph K. Meinecke, M.D. et
    al., Congenital Transmission of Visceral Leishmaniasis (Kala Azar) From an
    Asymptomatic Mother to Her Child, 104 Pediatrics 1, 5 (1999). For the same reasons
    as those discussed above, however, these rare instances of congenital transmission do
    not indicate that there was a serious threat of danger to the two Brown children, nor do
    they show that the VA should have known that a serious threat of congenital
    transmission existed.
    Because there is insufficient evidence that Mr. Brown presented the VA with
    symptoms of Leishmaniasis such that a reasonable physician should have known that he
    was infected with the disease, and because there is also insufficient evidence that the VA
    should have known Leishmaniasis was readily transmissible from Mr. Brown to his
    family members, appellants were not foreseeable victims of any failure by the VA to
    diagnose Mr. Brown with Leishmaniasis. Accordingly, we hold that the VA did not owe
    a duty to appellants under Michigan law.
    No. 08-2506      Brown, et al. v. United States                          Page 10
    III. CONCLUSION
    For the foregoing reasons, we AFFIRM the district court’s grant of summary
    judgment to the government.