Source: https://veteranclaims.net/2009/12/02/ortiz-v-u-s-no-08-16004-tort-claim-involving-suicide/
Timestamp: 2019-04-25 10:28:22+00:00

Document:
The court permissibly rejected Jacobson’s opinion testimony, the only evidence Plaintiff presented that the actions of the VA hospital staff breached the prevailing professional standards of care. For that reason, Plaintiff did not prove her negligence case. And, the court did not err in granting judgment to the United States.
Full Article at: Leagle, Inc.
Before BLACK, WILSON and COX, Circuit Judges.
On Monday, March 17, 2003, Rafael Ortiz-Pagan presented to the emergency room at the Department of Veterans Affairs Hospital in Gainesville, Florida (“the hospital” or “the VA”). Ortiz was a chronic pain patient and had overdosed on his pain medication. The emergency room physician kept Ortiz in the emergency room overnight and ordered a psychiatry consult. The psychiatry resident physician who examined and interviewed Ortiz in the late morning on Tuesday, March 18, invoked The Florida Mental Health Act to involuntarily commit Ortiz to the psychiatric ward of the hospital and placed him on suicide precautions.
Ortiz spent much of the day on Tuesday, March 18, on suicide precautions, in the day room of the psychiatric ward, under constant one-on-one observation by a nurse. During that time, he was evaluated by a staff psychiatrist, Dr. Camilo Martin. In the early afternoon, Martin concluded that Ortiz did not require suicide precautions and downgraded his observational status to close observation. On close observation, patients are assigned a room and observed by a nurse at fifteen-minute intervals.
During the afternoon of March 18, both before and after he had been downgraded to close observation status, Ortiz visited with his wife and sons in the day room of the psychiatric ward. After he was changed to close observation status, the nursing staff checked on him every fifteen minutes. His family departed after 8:00 p.m. Ortiz went to his room and laid in bed. The room Ortiz occupied had several patient beds separated by partitions. There were three other patients in the room. Ortiz was assigned the third bed on the left, a corner bed by a window.
At 11:45 p.m., Ortiz was observed in his bed. At 12:03 a.m. on Wednesday, March 19, 2003, a nurse found Ortiz hanging from a bed sheet attached to the window.[ 1 ] He had committed suicide.
Ortiz’s widow (“Plaintiff”) brought this lawsuit against the United States under the Federal Tort Claims Act, 28 U.S.C. §§ 1346 & 2671-80, alleging that the hospital staff had been negligent in failing to adequately care for and supervise Ortiz. (R.1-1.) At trial, Plaintiff presented expert testimony from Dr. Gary Jacobson. Jacobson had reviewed Ortiz’s medical records and opined that hospital personnel breached the standard of care by negligently failing to conclude that Ortiz was a suicide risk. He further opined that, as a result of the failure to recognize Ortiz was at risk for suicide, the hospital staff failed to monitor Ortiz adequately and failed to place him in an environment that would prevent his suicide. The United States did not present an independent expert witness to rebut Jacobson’s testimony. The treating physicians and nurses who interacted with Ortiz on the psychiatric ward testified about their examinations and interactions with him, their assessment of his medical condition, and the actions they took during his hospital stay.
The court entered judgment for the United States. Plaintiff appeals.
Plaintiff argues that the district court clearly erred by not adopting Jacobson’s opinion that Ortiz was suicidal and by finding that the hospital staff was not negligent and did not cause Ortiz’s death. Plaintiff argues that Jacobson’s testimony was the only expert testimony on the standard of care and the breach thereof and therefore should have been accepted by the district court.
The United States responds that the district court did not commit error by rejecting Plaintiff’s expert witness’s opinions and concluding that the hospital staff had not been negligent. The United States argues that a trier of fact may reject an expert’s opinions based upon any evidence in the record, whether or not that evidence is offered by another expert witness.
We review the district court’s findings of fact for clear error. Whitley v. United States, 170 F.3d 1061, 1068 n.14 (11th Cir. 1999) (citing Horton v. Reliance Standard Life Ins. Co., 141 F.3d 1038, 1040 (11th Cir.1998). “We cannot find clear error unless `we are left with a definite and firm conviction that a mistake has been committed.'” United States v. Crawford, 407 F.3d 1174, 1177 (11th Cir. 2005) (quoting Glassroth v. Moore, 335 F.3d 1282, 1292 (11th Cir. 2003)).
We review a district court’s application of law to the facts de novo. Whitley, 170 F.3d at 1068 (citing Reich v. Davis, 50 F.3d 962, 964 (11th Cir. 1995)).
[T]he claimant shall have the burden of proving by the greater weight of evidence that the alleged actions of the health care provider represented a breach of the prevailing professional standard of care for that health care provider. The prevailing professional standard of care for a given health care provider shall be that level of care, skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar health care providers.
Fla. Stat. Ann. § 766.102(1).
The court did not clearly err. It was within the court’s province as fact finder to conclude that Jacobson’s opinion that the hospital staff breached the standard of care in failing to recognize Ortiz as suicidal should not be credited. Mims v. United States, 375 F.2d 135, 143 (5th Cir. 1967) (“[E]xpert opinion evidence may be rebutted by showing the incorrectness or inadequacy of the factual assumptions on which the opinion is based . . .”);[ 2 ] Easkold v. Rhodes, 614 So.2d 495, 497-98 (Fla. 1993) (jury may disregard a medical expert’s opinion, even in the absence of expert testimony to the contrary, if it finds that the medical record upon which the expert opinion was based is incomplete); see also Fla. Std. Jury Instr. (Civ.) 2.2(b) (“You may accept [expert] opinion testimony, reject it, or give it the weight you think it deserves, considering the knowledge, skill, experience, training, or education of the witness, the reasons given by the witness for the opinion expressed, and all the other evidence in the case.”) (emphasis added).
Having rejected Jacobson’s opinion that the hospital staff negligently failed to diagnose Ortiz as suicidal, the district court did not err in disregarding Jacobson’s opinions that the hospital staff breached the standards of care for observation and placement of a suicidal patient. Those opinions became irrelevant once the district court determined that the hospital staff acted reasonably in concluding that Ortiz was not an acute risk for suicide. And, the district court properly disregarded Jacobson’s opinions about physical aspects of the room in which Ortiz was placed for another reason. There was no evidentiary basis for Jacobson’s opinion that, when paired with monitoring at fifteen-minute intervals, placing Ortiz in a room with a window that opened was a breach of the standard of care. As stated above, there was no evidence that the window was open, only that the bed sheet with which Ortiz hung himself was attached to the top of the window.
2. In Bonner v. City of Prichard, 661 F.2d 1206, 1209 (11th Cir. 1981) (en banc), this court adopted as binding precedent all decisions of the former Fifth Circuit handed down prior to close of business on September 30, 1981.

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