Opinion ID: 2978526
Heading Depth: 3
Heading Rank: 2

Heading: Liability Under the FTCA

Text: 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  (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