Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-4_03-cv-00073/USCOURTS-azd-4_03-cv-00073-0/pdf.json

Nature of Suit Code: 362
Nature of Suit: Medical Malpractice
Cause of Action: 28:2671 Federal Tort Claims Act

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IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF ARIZONA 

JAMES E. ENDTRICHT, ET AL., 

 Plaintiffs, 

v. 

UNITED STATES OF AMERICA 

 Defendant. 

Case No: 03-CV-0073 TUC RCC (BPV) 

REPORT AND RECOMMENDATION 

 

 Defendant brings this motion, (Document #95) pursuant to Rule 56, Federal 

Rules of Civil Procedure, for an order granting summary judgment to the Defendant and 

dismissal of the complaint with prejudice. 

 On March 3, 2003, this case was referred to Magistrate Judge Carruth, and on March 

25, 2005, due to the retirement of Magistrate Judge Carruth, it was randomly reassigned to 

Magistrate Judge Velasco for all pretrial proceedings and report and recommendation. On 

August 18, 2006, Magistrate Judge Velasco heard arguments on Defendant United States of 

America's Motion for Summary Judgment (Document # 95). For reasons which follow, the 

Magistrate Judge recommends that the District Court, after its independent review, grant 

Defendant United States of America's Motion for Summary Judgment. 

PROCEDURAL BACKGROUND 

 On January 31, 2003, Plaintiffs James and Diane Endtricht filed a complaint for 

damages under the Federal Tort Claims Act (FTCA), alleging medical malpractice, pursuant to 

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28 U.S.C. §§2671-2680. (Document #1.) On June 2, 2003, Defendant filed a motion to 

dismiss Plaintiff Dianna Endtricht. (Document #6.) Judge Collins granted the motion on 

September 18, 2003. (Document #13.) A year later, on March 30, 2006 Defendant filed a 

motion for summary judgment (Document #95). Plaintiff filed a response in opposition on 

May 19, 2006 (Document #109.). Defendant filed a reply on June 02, 2006. (Document 

#113.) Magistrate Judge Velasco held a hearing on August 18, 2006 on the motion for 

summary judgment and issued an oral order taking the motion under advisement. 

STATEMENT OF FACTS1

 Plaintiff James Endtricht is a 61 year-old man with a history of medical problems 

relating to his back, neck, and cervical spine. (Plaintiff's Statement of Facts ("PSOF") 10, 16.) 

 From 1985 to March 2000, Plaintiff has had at least four documented accidents related to his 

neck and back. (PSOF 11.) After the last injury, Plaintiff was dragging his foot and suffered 

intense pain on the left side of his neck. Prior to the last injury, Plaintiff had already had four 

other operations on his neck, and the Social Security Administration had declared him 100% 

and permanently disabled, mainly due to his neck and back. (PSOF 11, 15, 17.) 

 With this history, Plaintiff was taken to see Dr. Martin Weinand at the Tucson VA 

Medical Center for treatment. Dr. Weinand diagnosed Plaintiff with multiple levels of cervical 

stenosis, which is a narrowing of the spinal canal in the area of the neck. Plaintiff also had 

significant compression at the C6-C7 level of his spine, due to an osteophyte, which is a bony 

 

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 Where the facts are essentially uncontested, they will not be referenced. When a dispute as to the facts is present and 

relevant, the factual reference will be noted. 

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structure that had formed on the vertebral body in the area of Plaintiff's neck. The osteophyte 

was in the front ("ventral") part of the spinal column. (PSOF 18-22.) 

 Dr. Weinand, a Board Certified Neurosurgeon on staff at the Tucson VA, recommended 

surgery to decompress the C6-C7 spinal area. (PSOF 4, 9.) Dr. Weinand planned to 

decompress the area by removing part of the osteophyte. Before the surgery (Plaintiff's fifth), 

Plaintiff was in a wheelchair, had an acute weakness in his left lower extremity, and some 

weakness in his right lower extremity; he also had "increased weakness in his upper 

extremities." (Exhibit 2, Excerpt 103.) He also complained of "loss of sensation to pain in 

both lower extremities all the way up to his umbilicus." (PSOF 29-30.) He also had bowel 

and bladder control problems. (Exhibit 18, page 2). 

Prior to the surgery, Plaintiff was also told that the risks associated with the surgery were no 

improvement in pain or sensation, some improvement, or a possible decline into further pain or 

numbness. Plaintiff acknowledged that he understood these risks. (PSOF 31, 77.) 

 On May 16, 2000, Dr. Weinand operated on Plaintiff's spinal cord, removed some of the 

osteophyte, and decompressed the C6-C7 spinal area from 10mm to 3.5mm. (PSOF 38-39.) 

This decompression should have put the cervical canal within normal ranges. (PSOF 23-24.) 

After the surgery, Plaintiff's legs were stronger. Unfortunately, 5 to 10 days later, Plaintiff 

began experiencing the same problems again, this time with bilateral lower extremity 

weakness, and increasing right upper extremity weakness. (PSOF 43-44; Exhibit 10, page 45, 

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lines 9-11.). He continued to have episodes of bowel and bladder control problems. (Exhibit 

18, page 2). 

 Plaintiff's condition had not improved, and on July 26, 2000, Dr. Sonntag and Dr. 

Theodore at the Barrow Neurological Institute of St. Joseph's Hospital, in Phoenix, again 

operated on Plaintiff. They performed a C5-C7 laminectomy, which is a removal of the bone 

lamina off the back of the spinal canal. Two disk spaces were decompressed this way, C5-C6 

and C6-C7. (PSOF 57.) This was Plaintiff's sixth neck operation. Plaintiff improved shortly 

after discharge, but again he did not get relief. Today Plaintiff still suffers from the same type 

of symptoms, including weakness and numbness in his extremities and chronic pain in the 

neck; generally, "paralysis-legs and hands; pain." He noted no improvement after the sixth 

surgery, and he continues to have bowel and bladder problems. (Exhibit 13, page 97, lines 8-

11; Exhibit 18, pages 2-4.) 

 Plaintiff filed his complaint on January 31, 2003. Plaintiff retained one expert, Dr. 

Edward Smith, who is a surgical assistant in California. (Exhibit 13, page 32. lines 8-14). Dr. 

Smith is no longer a practicing surgeon (an "attending physician"), but since 1985 he has been 

a surgical assistant. (Exhibit 13, pages 42-44; PSOF 62-65). Dr. Smith testified at deposition 

that Dr. Weinand fell below the standard of care because "he did not adequately remove the 

osteophyte on the C6 vertebral body . . . [therefore] the spinal cord compression was not 

relieved because of significant amounts of the osteophyte remained." (Exhibit 13, page 58, 

lines 18-21; Exhibit 13, page 60, lines 15-18). Additionally, at deposition, Dr. Theodore (the 

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surgeon at the sixth operation) characterized Dr. Weinand's previous operation (the fifth) as 

"unsuccessful" and "inadequate." Although he stated that "an inadequate decompression ... 

might be below the standard of care," he would not comment on whether the previous (fifth) 

operation fell below the standard of care. (Exhibit 10, page 68, lines 21-24). 

 Defendant's expert, Dr. Philip Carter, is a retired Board Certified Neurosurgeon. (PSOF 

79, 82.) Dr. Carter believed the fifth operation was successful and not below the standard of 

care, since the patient showed some improvement after the operation. Also, Dr. Carter stated 

that it is common for some residual osteophyte to remain at the operation site after a 

decompression. (PSOF 85-86.) 

 Regarding further harm from the fifth operation, Plaintiff's expert Dr. Smith claimed 

that Dr. Weinand's operation "did do further harm to [Endtricht], and that's the point of this 

lawsuit." (Exhibit 13, page 94, line 7 to page 95, line 7.) When asked to elaborate, however, 

Dr. Smith admitted that Mr. Endtricht would not have necessarily gotten better ever after a full 

decompression: 

 Q. Is it your opinion that, despite achieving decompression [after the sixth 

 surgery], Mr. Endtricht didn't get any better? 

 A. He got a little better. He got improvement in his bowel and bladder function, 

 and he got some benefit from pain, although not a lot, and it didn't hold up... [emphasis added] 

Q. Is it your opinion, Doctor, that with any degree of medical certainty, that had 

Dr. Weinand fully removed the offending osteophyte, there would have been 

full decompression? 

 A. Yes... 

 Q. But it is not your opinion that he would have necessarily -- Mr. Endtricht 

 would have necessarily gotten better? 

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 A. That's correct also. (Exhibit 13, pages 82-83, lines 24-35 and lines 1-3.) 

Furthermore, Plaintiff's expert Dr. Smith admitted that the risks of the operation included that 

"the patient may lose not only strength and sensation, but may gain pain that they didn't have 

before, or a pain that they already have may get worse." (Exhibit 13, page 88, lines 7-10.) 

Finally, Dr. Smith admitted that Plaintiff's problems after the sixth operation were the same 

problems Plaintiff had after the fifth: 

 Q. But didn't [Endtricht] have similar problems following the [sixth] surgery, 

 even if they were in a delayed fashion? 

 A. Yes, he did. (Exhibit 13, page 97, lines 8-11.) 

DISCUSSION 

Standard of Review

 A party is entitled to summary judgment when "the pleadings, depositions, answers to 

interrogatories, and admissions on file, together with affidavits, if any, show that there is no 

genuine issue as to any material fact and the moving party is entitled to a judgment as a matter 

of law." Fed. R. Civ. P. 56(c). The moving party has the burden of showing no genuine issue 

of material fact exists; if this burden is met, and the moving party has established that the other 

party has failed to make a contrary showing sufficient to establish an essential element to his 

case, the judge must grant the motion. United States v. Carter, 906 F.2d 1375, 1377 (9th Cir. 

1990). The judge must determine whether there are "any genuine factual issues that properly 

can be resolved only by a finder of fact because they may reasonably be resolved in favor of 

either party." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 255 (1986). For an issue to be 

"genuine," there must be enough evidence that a "reasonable jury" could reach a verdict in 

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favor of the nonmoving party. Id. at 248. Finally, in weighing a motion for summary 

judgment, the judge must draw all evidentiary inferences in the light most favorable to the 

non-moving party. See King County v. Rasmussen, 299 F.3d 1077, 1083 (9th Cir. 2002). 

However, the "court need not draw all possible inferences in [the nonmoving party's] favor, 

but only all reasonable ones." See Villiarimo v. Aloha Island Air, Inc., 281 F. 3d 1054, 1065 

n. 10 (9th Cir. 2002). 

Federal Tort Claims Act

 This action arises under the Federal Tort Claims Act ("FTCA"), 28 U.S.C. §1346(b) 

and 2671 et seq. Under the FTCA, the United States may be held liable for injury caused by 

the negligent act of an employee under circumstances where a private person would be liable 

to the claimant, under the law of the place where the act or omission occurred. 28 U.S.C. 

§1346(b), See also Mundt v. U.S., 611 F.2d 1257 (9th Cir. 1980). Therefore, we must examine 

the law of medical malpractice in Arizona. 

Medical Malpractice

 In Arizona, liability for medical malpractice is set by the Arizona Revised Statutes 

("A.R.S."), Section 12-561 et seq. Specifically, A.R.S. § 12-561(2) defines medical 

malpractice as follows: 

. . . an action for injury or death against a licensed health care provider based 

upon such provider's alleged negligence, misconduct, errors or omissions, or 

breach of contract in the rendering of health care, medical services, nursing 

services or other health-related services or for the rendering of such health 

care, medical services, nursing services or other health-related services, 

without express or implied consent. 

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Plaintiff must establish certain elements of proof under A.R.S. § 12-563 to support a medical 

malpractice action: 

Both of the following shall be necessary elements of proof that injury 

resulted from the failure of a health care provider to follow the accepted 

standard of care: 

1. The health care provider failed to exercise that degree of care, 

skill and learning expected of a reasonable, prudent health care 

provider in the profession or class to which he belongs within the 

state acting in the same or similar circumstances. 

2. Such failure was a proximate cause of the injury. 

Under these standards that control the situation, we turn to the merits of Plaintiff's claims. 

First Issue: Duty of Care

 The first issue is whether summary judgment is appropriate regarding Dr. Weinand's 

duty of care. In Arizona, the medical malpractice statute states that the accepted standard of 

care is: 

 [the] degree of care, skill and learning expected of a reasonable, prudent 

health care provider in the profession or class to which he belongs within 

the state acting in the same or similar circumstances. A.R.S. § 12-563. 

"The standard of care must be established by specific evidence. It cannot rest on conjecture or 

inference." Valencia v. United States, 819 F.Supp. 1446, 1463-64 (D. Ariz. 1993). When 

negligence is not apparent, a claimant must present expert evidence to establish this element. 

Bell v. Maricopa Medical Center, 157 Ariz. 192, 194-95 & n.1 (App. 1988). 

 Here Dr. Smith testified as an expert witness that in this particular case he believed that 

leaving the residual osteophyte fell below the standard of care because "the spinal cord 

compression was not relieved." (Exhibit 13, page 60, lines 15-18). Assuming arguendo that 

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Dr. Smith as a surgical assistant is a reasonable, prudent health care provider in the same 

profession, his expert testimony fulfills the statutory requirement for the duty of care.2

 Also, 

Dr. Smith points to relevant, specific evidence to support his claim. While Dr. Carter's 

testimony contradicts Dr. Smith's testimony, the former cannot overcome the latter as to the 

issue of summary judgment. There is a genuine issue of material fact as to whether the 

accepted standard of care was met or not, and a reasonable jury could make a reasonable 

decision either way. Thus summary judgment is not appropriate regarding the issue of duty of 

care. However, even if there is a triable question regarding the duty of care, if Defendant 

shows summary judgment is proper on the issue of proximate cause, we must dismiss this case. 

Second Issue: Proximate Cause

 The second issue is whether summary judgment is appropriate regarding Dr. Weinand's 

treatment of Endtricht as a proximate cause to any injuries Endtricht suffered. 

To show proximate cause, Plaintiff must prove that a natural and continuous sequence of 

events stemming from the defendant's act or omission, unbroken by any efficient intervening 

cause, produced the injury, in whole or in part, and without which the injury would not have 

occurred. Barrett v. Harris, 207 Ariz. 374, 378 (App. 2004). Mere unsuccessful treatment 

will not give rise to negligence. Gaston v. Hunter, 121 Ariz. 33, 50 (App. 1978). Absent 

some negligence by the physician, there is no malpractice when the plaintiff suffers an adverse 

 

2 A possible issue for trial would be whether Dr. Smith in his capacity as a surgical assistant meets the Arizona 

statutory definition of a "reasonable, prudent health care provider in the profession or class to which he belongs," 

under A.R.S. § 12-563.

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result which is an inherent risk of the procedure. Gaston, 121 Ariz. at 50. A court will 

generally defer to an expert's judgment on causality and not rule on summary judgment, since 

credibility decisions are not appropriate for summary judgment. See McLaughlin v. Liu, 849 

F.2d 1205, 1207 (9th Cir. 1988). However, a "court is not required to defer to the contrary 

opinion of [an] 'expert'" where the evidence clearly indicates the contrary. See In re Apple 

Computer Securities Litigation, 886 F.2d 1109, 1116 (9th Cir. 1989); Robinson v. G. D. Searle 

& Company, 286 F.Supp.2d 1216, 1218-20 (N.D. Ca. 2003). 

 Here Defendant argues there is no proximate cause; he argues there is no evidence that 

Dr. Weinand's treatment made Plaintiff Endtricht's condition worse. While the Plaintiff's 

expert Dr. Smith claims there was proximate cause (the operation "did do further harm" to 

Plaintiff), Dr. Smith's own testimony in the deposition obviates this claim. Dr. Smith admits 

that Endtricht's relief after the sixth operation "didn't hold up". (Exhibit 13, pages 82-83, lines 

24-35 and lines 1-3.) He further admits that the relief after the sixth operation was fleeting, 

just like the relief after the fifth. (Exhibit 13, page 97, lines 8-11.) Finally, he admits that the 

patient would not necessarily have gotten better, and that a risk inherent to the operation is 

worse pain or numbness. (Exhibit 13, pages 82-83, lines 24-35 and lines 1-3.) Most 

importantly, Dr. Smith does not point to any damage or injury which he can link to Dr. 

Weinand's operation as a proximate cause. There is no adverse risk, injury, or worsened 

condition that was not a risk of the operation. (See Exhibit 18, pages 2-4.) Plaintiff also does 

not point to any evidence of injury that may come from a non-inherent risk but which is 

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similar to or may be confused with injury from an inherent risk. Rather, the evidence 

presented shows that Plaintiff's condition remained the same from before the fifth operation to 

after the sixth operation. Here Defendant as the moving party has made a showing that no 

genuine issue of material fact exists as to proximate cause; Dr. Weinand caused no additional 

injury to Endtricht. Plaintiff as the nonmoving party has failed to make a contrary showing 

sufficient to establish proximate cause. Hence even if one draw's all evidentiary inferences in 

the light most favorable to Plaintiff as the non-moving party, as a matter of law, summary 

judgment is appropriate on the issue of proximate cause. 

CONCLUSION 

 This Court recommends that Defendant's Motion for Summary Judgment (Document # 

95) be GRANTED. 

 Pursuant to Title 28 U.S.C. § 636(b), any party may serve and file written objections 

within 10 days of being served with a copy of this Report and Recommendation. If objections 

are not timely filed, they may be deemed waived. If objections are filed, the parties should use 

the following number: CIV 03-073-TUC-RCC. 

 Dated this 29th day of September, 2006. 

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