Pursuant to 5 T H C IR . R. 47.5, the court has determin ed that thi s opinio n should not * be publishe d an d is not precede nt except und er the limit ed circu mstance s set forth in 5 T H C IR . R. 47.5 .4. 

### INTHE U NI TED S TATESCOU RT OFAPPEALS

FORTHE FIFTH CIRCU IT

N o. 08- 61105 Su m m ar y Cal endar

PE RCY AP PL EW HI TE ; L OUI S E AP PL EW HI TE P l a i n ti ffs - A p p ell a n ts

v. DE P AR T M ENT OF V ET ER ANS A F F AI RS , UNI T ED S T AT ES OF A M E R I C A , V et er ans H eal t h A dm i ni st r at i on; JO H N D O E S; JA N E D O E S, 1- 15 D efen da n t s - A pp el l ees

A p p ea lf

rom the U n i ted S tates D i stri ct C ou rt fo r th e S o u th e r n D is tr ic t o f M is s is s ip p i

U SD C N o. 3: 07- C V

- 162

B ef ore K IN G , ST E W A R T , an d H AY N E S , C i rcui t Ju dg es. P E R C U R I A M: * F o ll o w in g a b e n ch tria l, A p p e ll a n ts, M r. P e rc y A pp l ew h i t e an d M rs. L ou i se A pp l ew h i t e, app eal t h e j u dg m en t entered a g a inst t h em on thei r i n f orm ed
consen t an d l o ss of consort i u m cl ai m s un der t h e F ederal T ortC l ai m s A ct ( “ FT CA” )

. W e AF FI RM

. United States Court of A pp eals Fifth Circuit 

### F I L E D Februar y 3, 2010 Cha rl es R. F ulb ru g e II I Clerk Case: 08-61105 Document: 00511019286 Page: 1 Date Filed: 02/03/2010N o. 08- 61105

Appe lla nts b rought othe r cl aims ag ain st th e United State s, but theyapp ealonlyth e 1 dis tri ct court ’s dis mi ss al of their inform ed conse nt and los s of cons ort iumclaim s. Acco rd ingly, wea ddre ss onlyth os e cl aim s. 2

I . F ACT S AND PROC EDURAL HI S TORY I n 2 00 2, M r . Appl e w hi t e w as di ag no s e d wi t h pr o s t at e c anc e r a nd s o ugh t t r e at m e nt a t t he G

. V. M o nt go m e r y Vet e r ans Af fai r s M e di c alCent e r i n J ac ks o n, M i ssissi p p i( “VA ”)

. A t t h e V A , M r. A p p l ew h i te m et w i th D r. S tev en R i gg s to di sc uss t r eat m ent opt i ons , i ncl udi ng a s urgi c alpr oc edur e c al l ed Radi c al R et ropu bi c Prost atec t om y ( “ R R P ” ) , w h i ch i s a procedure desi gn ed to rem ove a p a ti en t’ s p rosta te. B eca u se of h i s p h ys i ca lco n d i ti on a t t h e ti m e, M r. A p p l ew h i te
w as consi dered an ex cel l en t can di da t e fora n R R P

. T h e U n i t ed S t ates presented evi den ce t h at, af

t er being i n f

orm ed of

cer t ai n ri sks i n vol ved w i t h t h e procedu re and t he al t er nat i ves t o i t , M r . A ppl ew hi t e a gr ee d t o und er go t he s urge r y by
s i gni ng a c o ns e nt f

o r m . M r . Appl e w hi t e und e r w e nt t he RR P dur i ng w hi c h he suff ered a l acerat i on t o hi s r ect al w al l , w h i ch al l eged l y cau sed h i m t o suf fer fr o m s e v e r a l s e r io u s co n d itio n s . A ppel l ant s t hen br ought t hi s sui t agai nst t he U ni t ed St at es , all egi ng,
am on g ot h er t h i n gs, t h at t h e U n i t ed S t ates w as l i able f or m edi calm al practi ce
u n der t h e F T C A

. Sp eci f i cal l y, M r. A p p l ew h i t e al l eged t h at t h e U n i t ed S t ates
com m i t t ed m edi calm al practi ce by fai l i n g t o obtai n hi s i n f orm ed consen t bef

ore p e r fo r m in g th e R R P , a n d M r s . A p p le w h ite a lle g e d lo s s o f c o n s o r tiu m a s a re s u lt
o f th e U n ite d S ta te s ’ n e g lig e n c e . M r . A p p le w h ite a s s e r ts th a t h e w a s n e v e r to ld 1 t hat i nj ury t o hi s r ec t alw al lw as a r i sk of the R R P and , t her ef or e, he nev ergave i n f orm ed consen t f

or t h e surgery. A f

t er a bench t ri al , t h e di st ri ctcourt entered j u dg m en t i n favor of t h e U n i t ed S t ates an d d i sm i ssed a ll o f t h e A pp l ew h i t es’ cl ai m s w i t h prej u d ic e. Th e di st ri ctcourt f ou n d that M r. A pp l ew h i t e ha d been Case: 08-61105 Document: 00511019286 Page: 2 Date Filed: 02/03/2010N o. 08- 61105

Mr. Applewhite challen ge s bo th the distric t co urt’s info rmed co nsent a nd cau satio n 2 finding s. We don ot r eachth e i ssue o f whether Mr. Applewhite actuallyg ave informe d conse nt, because we fin d th at the distric t co urt properly foun d for the Unit edStates o n the b a si s o f cau sati on . 3 i n f orm ed of

the ri sk of

a rect al tear a n d gav e i n f orm ed consen tt o t h e procedu re. A l t erna t i vel y, t h e di st ri ct court f ou n d t h at, even i f M r. A pp l ew h i t e ha d n ot gi ven i nf o r m e d c o ns e nt , t he U ni t e d St at e s w as s t i l le nt i t l ed t o a fav o r ab l e j udg m e nt b eca u se M r. A p p l ew h i te fa i l ed to pro ve tha t t h e U n i ted S tates’ all eg ed fa i l u re to i n f orm w as t h e cause of hi s i nj u ri es. T h e court di sm i ssed M rs. A pp l ew h i t e’ s l oss of consort i u m cl ai m becau se it c o u l d n ot be m ai n t ai n ed i n dep en den t l y of M r. A p p le w h ite ’ s cla im

. A p p e lla n ts th e n b r o u g h t t h is a p p e a l. I I . S TA NDARD OF RE VI EW

“ T h e st an da rd of

revi ew f

or a bench t ri al i s w el le sta b l i shed : f i n di n gs of fact are rev i ew ed f

or clear erro r an d le g a l is s u e s are rev i ew ed de n ov o.” K o na T e c h . Co r p . v . S

. Pac. Tran sp. C o. , 2 2 5 F .3d 5 9 5 , 6 0 1 (5t h C ir. 2 0 0 0 ). I I I . DI S CU S S I ON A. M i s s i s s i ppi Law G ov e r ns S ta te s u b s ta n tiv e la w a p p lie s in s u its b r o u g h t u n d e r th e F T C A , Si m on v. Un i t ed S t ate s , 8 91 F. 2d 1 15 4, 11 56 ( 5t h Ci r . 19 90 ) , and w e a ppl y t he l aw of t he
s ta te in w h ic h t h e s u it a r is e s , L u cas v. Un i t ed S t ate s , 807 F

. 2d 414 , 417 ( 5th C i r. 1 9 8 6 ). B e c a u s e th is s u it a r o s e in M is s is s ip p i, its to r t la w g o v e r n s . B . In fo rm e d C o n se n t In ord er to su ccee d on h i s i n form ed con sen t cl a i m , M r. A p p l ew h i te h a d to p rov e th a t his i nj u ri es w ere cau sed by the U n i ted S tates’ all eg ed fa i l u re to i n f orm hi m of

t h e ri sk of

a rec t al t ear. L a th a m v. Hayes , 495 So. 2d 453 , 458 2 (M i ss. 198 6) ( “ [ T ] h ere [ m u st be a] cau sal conn ect i on betw een t h e lac k of Case: 08-61105 Document: 00511019286 Page: 3 Date Filed: 02/03/2010N o. 08- 61105

Inado ptin g the reaso nab le patie nt standard, th e Mi ssissippi Supre me C ourtcited 3 thisC alifo rniaS u pr em e C ourtc a se . Reikes v. Ma rt in , 4 7 1 S o. 2 d 3 8 5 , 3 9 2 (Mi ss. 1 9 8 5 ).

Intheir bri ef, Appell ant s state : “J udge B arb our foun d th at Perc y Ap plew hitewoul d 4 have beenunrea sonablenot to haveh ad the surgerygiven the facts.” (emph asis added). The distric t co urt, however, analyz ed th e questi on obj ectively . I t fou nd that area sonablypru dent personwhenpro perlyinformed of t he r is k s of an RRP, inc ludingth e ri sk of arec tal tear , wo u ldh av e co n se nte d toth e op er ati on .

Appe lla nts also cont end that th e district court’s reason abl e pe rson findingfailed to 5 satisfyF ederal Ru le o f Civil Pro cedur e (“Rule”) 5 2’s requirement th at factu al finding s be suff icie ntlyd ef

init e fo r a pp ellater evie w. See Ch and ler v. Cit y of Dallas , 95 8 F .2d 8 5, 8 8-90 (5thC ir. 1 992 ). Appellants contend that th e di strict court’s fi ndin g fail s to satisfyRule52 because the court stated its findin g in thefollowin g mann er: “Th e co urt furth er finds th at a reaso nab lypru dent person , when presented with that info rmatio n, would conse nt to procee d with the operation in spite of th e ri sks.” Appell ant s assertth at the distric t co urt’s findingis not suffici ently definite for appell ate review b ecaus e iti s u ncl ear what the phra se “th at 4 i nf or m at i on and the i nj ury. ” )

. I n or derto prove causat i on, M r . A ppl ew hi t e had t o s h o w t h a t a r e a s o n a b l e p a t i e n t w o u l d ha v e w i t h h e l d hi s c o n s e n t t o t h e RRP h a d h e b e e n p r o p e r ly in fo r m e d o f th e r is k o f a re c ta l te a r . S ee Palm er v. B i l oxi R eg’lMed. C t r. , 5 64 So

. 2d 13 46 , 13 64 (M i s s . 19 90 ) ( s t at i ng t hatund e r o ne o f t he

“ t w o s ube l e m e nt s o f c aus at i o n [ a] pl ai nt i f f m us t s ho w t hat a r e as o nab l e pa t i e nt
w ou l d h ave w i t h h el d consen t ha d sh e been properl y i n f orm ed of

t h e ri sks,
a lte r n a tiv e s , a n d s o fo r th ”); G ol em an v. O rgl er , 77 1 S o. 2 d 37 4 , 37 7 (M i ss. C t. A pp. 2000) ( sho w i ng t hat a pl ai nt i f f m ustes t abl i sh t hat c ons ent w oul d not have b e e n g ive n h a d th e u n d isclo se d risk b e e n k n o w n ); s e e als o Cob bs v . G r ant , 502 P

. 2d 1, 11-12 (C al

. 1 972 ) (“ S u ch cau salconn ect i on ari ses on l y i f i t i s es t abli shed t h at had revel ati on been m ad e consent t o t reat m e n t w ou l d n ot ha ve been gi ven . ” )

. Th e di st ri ctcourt f ou n d that a reasonab l y pru den t pati en t w h en 3 p rese n ted w i th the ri sk o f a recta ltea r w ou l d n ot h a ve w i th h eld h i s con sen t t o th e s u r g e r y . M r . A p p le w h ite co n te n d s th a t t h e d is tr ic t c o u r t’s fin d in g is cle a r ly 4
e r r o n e o u s . W e d is a g r e e .

5 Case: 08-61105 Document: 00511019286 Page: 4 Date Filed: 02/03/2010N o. 08- 61105

info rmat ion” re ferenced. This argument i s meritless a s thecontext makes clear th at the phra se“th at info rm ati on” re fe rst o th e info rm ati onat th e h eart of thisc a se—th e ri sk of a rectal tear. We reject App ell ant s’ assertionth at the court’s fi ndin g fail ed tosati sfy Rule 52. See Ch and ler , 95 8 F .2d at 8 8 (stating th at oneof the purpose s of Rule 52 is toprovi de “f in di n g s e xplicite n ou ght o en ab leapp ellatec ourt s t o carryo u t ame a nin gful revie w”)

. Mr. Appl ewhite reli es heavily on the fact that, ingene ral, twentyto thirty percent 6 of all prostate cancer patie nts choo se n ot t o u ndergo an RRP. This ge neral fact, h oweve r, doe s not show th e causalconnectionrequir ed b y Mississippi law; without more, this fact do es n ot sh owth at th e di strictcourt ’srea so n ab lepati ent fi n di n gwa s c le arlye rron eo u s. Lat ham , 49 5 So. 2d at 4 58 (“[T]h ere [must b e a] causalconnectionbe tween the lack of informationan d th e in j u ry .”). 5 M r . Appl e w hi t e , a s t he pl ai nt i f f, ha d t he bur de n of

pr o o f on c aus at i o n, a nd th e d is tr ic t c o u r t fo u n d th a t h e fa ile d to m e e t h is b u r d e n . W e w i l lonl y overt u rn t h e d is t r ic t c o u r t ’s d e t e r m in a t io n a s c le a r ly e r r o n e o u s if th e c o u r t ’s d e te r m in a tio n is im p la u s ib le in lig h t o f th e re c o r d a s a w h o le

. See B art m e s s v. Fe d. Cr o

p I ns . Cor p. , 845 F

. 2d 125 8, 126 1 ( 5th C i r. 198 8) ( “ If, how ever,
c ons i der i ng t he e nt i r e r ec or d, t he di st r i c t c onc l usi on i s p l a u sibl e, i t m ustbe
u p h e ld .”). T h e r e c o r d h e r e d o e s n o t s h o w th a t t h e d is tr ic t c o u r t’s fin d in g is i m pl aus i bl e . To t he c o nt r ar y, t he r e c o r d c o nt ai ns a w e al t h o f e vi de nc e pr o vi ng l ac k o f c a u s a t i o n . Th e t e s t i m o n y o f Dr

. Pa u l Al p h o n s e , J r . , who w as t he Appe l l a n t s ’me d i c a le x p e r t , a n d Dr

. Go r d o n, w ho w as M r . Appl e w hi t e ’ s a t t e ndi ng
sur geo n, s how s t hat r ec tal tea rs ar e a r ar e a nd un c om m on c om pl i c at i on o f an R R P

. D r. G ordon , i n accord w i t h D r. D erek M i l es, w h o w as t h e U n i t ed S t ates’ exp erti n urol ogi calsu rgery, test i f i ed t h at h e n ever h ad a pati en t deci de ag ai n st
a n R RP b a s e d o n t h e mi n o r r i s k o f a r e c t a lt e a r . Mo r e o v e r , t h e r e c o r d s h o ws t h a t s e v e n t y t o e i g h t y p e r c e n t o f a l lp r o s t a t e c a n c e r p a t i e n t s , w h o h a v e t h e s a me p a t ho l o g y a nd c o m o r b i d i t i e s a s M r . Ap p l e whi t e , c ho o s e t o u nd e r g o a n RRP. 6 Case: 08-61105 Document: 00511019286 Page: 5 Date Filed: 02/03/2010N o. 08- 61105

6 B ased on t h e recor d befor e us, w e are not f i rm l y convinced that t h e di st ri ct
c o u r t ’ s r e a s o n a b l e p a t i e n t f i n d i n g w a s i m p l a u s i b l e o rmi s t a k e n ; t h e r e f o r e , we h o ld th a t th e d is tr ic t c o u r t’s fin d in g w a s n o t c le a r ly e r r o n e o u s . S ee B art m ess , 845 F. 2d at1261; Ni cholas v. K B R , I n c. , 565 F.3d 9 0 4, 907 ( 5t h C i r . 2009) ( s t at i ng t hat“ fac t ual f i ndi ngs ar e c l e ar l y e r r o ne o us o nl y i f, af t e r r e vi e w i ng t he
r ec or d, w e a r e f

i r m l y c onvi nce d t hat a m i stak e h a s bee n m ade” )

. Acc or di ngl y,
w e fi n d th a t th e d is t r ic t c o u r t d id n o t e r r in r u l i n g a g a i n s t M r . A p p le w h it e ’s i nf or m ed consent c l ai m be c ause M r . A ppl ew hi t e fai l ed t o pr ove c ausat i on as
r e q u ir e d b y M is s is s ip p i la w . S ee B art on v. E st ate of B u ckl ey , 867 So. 2d 271 , 274 (M i ss. C t
. App. 2 00 4) ( af f i r m i ng t he di s m i s s alo f a pl ai nt i f

f ’ s i nf o r m e d c o ns e nt
c l ai m w he n he “ fai l [ e d] t o s ho w t hat a r e as o nab l e pa t i e nt , o nc e i nf o r m e d o f

t he [u n d is c lo s e d ] r is k s , w o u ld h a v e w ith h e ld co n s e n t” ). C . L o s s o f

C o n s o r t i u m M rs. A pp l ew h i t e’ s c l ai m f or l oss of

c o n sort i u m i s deri vati ve of M r. A p p le w h ite ’ s in fo r m e d c o n s e n t c la im a n d ca n n o t b e m a in ta in e d in d e p e n d e n tly
o f h is cla im

. S ee J

& J Ti mb e rC o . v . B r o o me , 932 S o. 2d 1, 6 (M i ss. 200 6) ( “ L oss
o f c o ns o r t i um i s s i m i l ar l y de r i va t i ve , a nd M i s s i s s i ppil aw d i c t at e s t hati f t he
u n d e r ly in g p e r s o n a l inju r y cla im is d is p o s e d o f, th e lo s s o f c o n s o r tiu m cla im
c a n n o t b e m a in ta in e d o n its o w n .”). B e c a u s e th e d is tr ic t c o u r t p r o p e r ly di s m i s s e d M r . Appl e w hi t e ’ s c l ai m o n t he b as i s o f caus at i o n, w e f

i nd t hatt he di st ri ctcourt d id n o t erri n di sm i ssi n g M rs. A pp l ew h i t e’ s c l ai m f or l oss of
c o n s o r tiu m . Id

. I V . C ONC L US I ON F o r th e fo r e g o in g re a s o n s , th e d is tr ic t c o u r t’s ju d g m e n t is A F F IR M E D

. Case: 08-61105 Document: 00511019286 Page: 6 Date Filed: 02/03/2010