Court Opinion

ID: 9908828
Source: CourtListenerOpinion
Date Created: 2023-12-11 21:00:50.369985+00
Date Added: 2024-06-11T12:49:32.053365
License: Public Domain

NOT RECOMMENDED FOR PUBLICATION
                                File Name: 23a0515n.06

                                            No. 23-5240

                           UNITED STATES COURT OF APPEALS
                                FOR THE SIXTH CIRCUIT                                    FILED
                                                                                       Dec 11, 2023
 JUDITH COLLINS, individually and as executor of )                             KELLY L. STEPHENS, Clerk
                                                 )
 the estate of Michael N. Collins,
                                                 )
         Plaintiff-Appellant,                    )                ON APPEAL FROM THE
                                                 )                UNITED STATES DISTRICT
 v.                                              )                COURT FOR THE EASTERN
                                                 )                DISTRICT OF KENTUCKY
 UNITED STATES OF AMERICA,                       )
         Defendant-Appellee.                     )                                        OPINION
                                                 )

Before: BATCHELDER, GRIFFIN, and LARSEN, Circuit Judges.

        ALICE M. BATCHELDER, Circuit Judge. Judith Collins appeals the district court’s

grant of summary judgment to the government on Collins’s medical malpractice claim brought

under the Federal Tort Claims Act (FTCA). Mrs. Collins alleged that the Veteran’s Affairs (VA)

doctors in Hazard and Lexington, Kentucky, breached the standard of care when treating her late

husband. On appeal, she argues that her proffered medical expert established the relevant standard

of care for lung cancer treatment, and the district court erred by finding that the expert did not. We

AFFIRM.

   I.      Background and Procedural History

        Michael Collins smoked a pack of cigarettes a day for 47 years. He passed away on January

19, 2020, at the age of 67. Mr. Collins primarily received care at a VA outpatient clinic in Hazard,

Kentucky, and he occasionally visited the VA Medical Center in Lexington, Kentucky.
No. 23-5240, Collins v. United States

        Relevant to this appeal, Mr. Collins’s medical history begins in September 2014, when he

received a chest x-ray, revealing a “clear chest” with no “acute cardiopulmonary pathology.1 Then,

from 2015-17, Mr. Collins saw doctors John Furcolow and Billy Banks who each counseled

Collins to stop smoking. In 2016, Dr. Furcolow administered chest x-rays, which still reported a

clear chest. In 2017, Dr. Banks dispensed nicotine gum to Mr. Collins to curb his smoking

addiction. Later, in June and July of 2019, Mr. Collins saw Nurse Kim Gayheart to whom he

complained of coughing and congestion. In August, Mr. Collins went back to Dr. Banks and told

Dr. Banks that his coughing and congestion had improved. In September, Mr. Collins told Dr.

Banks that his breathing had returned to a baseline level and that he had no chest pain, shortness

of breath, coughing, or wheezing.

        In December 2019, Mr. Collins’s health rapidly deteriorated. That month, Mr. Collins went

to the Lexington VA Medical Center emergency department with transient neurological deficits.

He was transferred to the Lexington VA Medical Center where he was diagnosed with atrial

fibrillation, treated with blood thinner, and discharged. A short time later, Mr. Collins coughed up

blood and returned to the emergency center where a CT scan revealed a right lung mass. On

January 16, 2020, at the Lexington VA Medical Center, Mr. Collins underwent a bronchoscopy

with endobronchial ultrasound and endobronchial biopsy for the mass.

        After returning home, Mr. Collins coughed up blood again. He went to Whitesburg

Appalachian Regional Hospital. Whitesburg transported him to the Lexington VA Medical Center

by ambulance on January 17 where, upon arrival, he began having a massive hemoptysis with

significant respiratory distress. He was emergently intubated. The VA determined that there was a

1
  Mr. Collins also experienced lower back pain, mixed hyperlipidemia, hypertension, and chronic obstructive
pulmonary disease at various times during his visits to the VA.

                                                   -2-
No. 23-5240, Collins v. United States

clot on his lung mass, and his bronchoscopy and biopsy revealed that he had stage IIIc or IVa

squamous cell carcinoma. On January 19, Mr. Collins was transported to the University of

Kentucky Medical Center. He died later that day from a large-volume pulmonary hemorrhage.

       Judith Collins brought suit against the United States on behalf of herself and her husband’s

estate, asserting a medical malpractice action under the FTCA, 28 U.S.C. § 2671. She argued that

if Mr. Collins’s VA primary care physicians had provided low-dose computed tomography (LDCT)

scans, Mr. Collins’s cancer would have been detected earlier, furthering his life, and preventing

subsequent complications that led to his death.

       In 2013, the U.S. Preventative Services Task Force and the American Cancer Society issued

similar recommendations, stating that 55 to 80-year-olds with a 30-pack-year smoking history who

currently smoke or have quit within 15 years should get annual lung cancer screenings with

LDCTs. And in 2014, the Task Force created a shared decision making document for lung cancer

screenings outlining the recommendations for lung cancer annual screenings, but it is unclear how

it was distributed. In 2015, the Centers for Medicare and Medicaid Services decided to adopt

similar recommendations for lung cancer screening with LDCTs. The VA National Leadership

Council approved recommendations for lung cancer screening with LDCTs in August 2016.

       The Lexington VA Medical Center began the process of purchasing an LDCT scanning

machine in 2016. It was installed in 2017, becoming operational in 2018. In September 2018, the

VA had a preplanning meeting to discuss LDCT implementation, and LDCT scans became

available there in January 2019.

       In discovery, Mrs. Collins offered Dr. John Daniel as her medical expert to establish the

standard of care in Kentucky for LDTC scans, setting out the basis of her claim. The government

moved to exclude Dr. Daniel’s testimony and, alternatively, for summary judgment. The district

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No. 23-5240, Collins v. United States

court did not exclude Dr. Daniel’s testimony; rather the court discussed Dr. Daniel’s qualifications,

his testimony, and then considered whether Dr. Daniel’s testimony established the standard of care.

         The district court explained that Dr. Daniel principally relied on secondary sources

discussing screening recommendations when asked about what established the standard of care for

primary care providers. And as for the sources Dr. Daniel relied on, the district court highlighted

that Dr. Daniel stated that recommendations “could be the goal, but they’re not . . . the standard.”

Collins v. United States, No. 5:22-008-DCR, 2023 WL 2394638, at *4 (E.D. Ky. Mar. 7, 2023).

The district court also pointed out that Dr. Daniel did not have any knowledge about how the VA

was going to implement LDCT lung cancer screening.

         The district court explained that Dr. Daniel did not cite “any facts supporting his assertion

that the accepted standard of care for reasonable primary care providers during the relevant period

was to order yearly LDCTs for patients like Collins.” Collins, 2023 WL 2394638, at *5. The court

pointed out that Dr. Daniel did not discuss LDCT screening with his own patients. Dr. Daniel did

not know how the availability of LDCTs affected the standard of care. He did not provide

information on whether LDCTs were available in the surrounding area or in more remote locations.

And he conceded that he was unaware of the University of Kentucky Medical Center’s use of

LDCTs. The district court explained that Dr. Daniel may have suggested that the VA “lagg[ed]

behind” its counterparts, but he did not establish the standard of care. Id. The district court granted

summary judgment to the government, and Mrs. Collins appealed.

   II.      Legal Standard

         We review the district court’s grant of summary judgment de novo. Garza v. Lansing Sch.

Dist., 972 F.3d 853, 872 (6th Cir. 2020). Summary judgment is appropriate where the movant

demonstrates that there is no “genuine dispute” regarding any “material fact,” and the movant is

                                                  -4-
No. 23-5240, Collins v. United States

entitled to judgment as a matter of law. Fed. R. Civ. P. 56(a). Essentially, we look to “whether the

evidence presents a sufficient disagreement to require submission to a jury or whether it is so one-

sided that one party must prevail as a matter of law.” Anderson v. Liberty Lobby, Inc., 477 U.S.

242, 251–52 (1986). And while reviewing a motion for summary judgment, we view the evidence

and all inferences drawn from the facts “in the light most favorable” to the nonmovant. Matsushita

Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986) (quotation omitted).

    III.      Discussion

           Mrs. Collins argues that the district court erred by holding that her expert did not establish

the relevant standard of care for this FTCA Kentucky medical malpractice suit.2 Because we

conclude that Mrs. Collins’s expert did not establish the relevant standard of care in this action, we

affirm the district court’s opinion.3

           In lawsuits under the FTCA, the United States stands in as a party to the suit. See 28 U.S.C.

§ 1346. “The FTCA was designed . . . to remove the sovereign immunity of the United States from

suits in tort.” Millbrook v. United States, 569 U.S. 50, 52 (2013). And when a suit is brought under

the FTCA, the substantive law of the state in which the allegedly tortious conduct occurred

controls. 28 U.S.C. § 1346(b)(1); see also Mynatt v. United States, 45 F.4th 889, 895 (6th Cir.

2022). Therefore, because Collins brought her medical malpractice claim in Kentucky, the

substantive law of Kentucky governs.

2
  Collins also argues that the District Court erred by concluding that her expert was not qualified and excluding his
testimony. This argument is meritless as the District Court did not exclude Collins’s proffered expert. See Collins,
2023 WL 2394638, at *3–4 (discussing the expert’s qualifications, implicitly recognizing that he was qualified).
3
  Collins further argues that the district court should have had a Daubert hearing if the court wanted more information
as to her expert and his reliability. But Collins should have requested such a hearing after the government first moved
to exclude her expert witness. In any event, the court did not exclude the expert witness. This argument also lacks
merit.

                                                         -5-
No. 23-5240, Collins v. United States

         To establish a medical malpractice case in Kentucky, plaintiffs must put forth expert

testimony to establish the relevant standard of care. Blankenship v. Collier, 302 S.W.3d 665, 667

(Ky. 2010).4 The expert must prove that the medical practitioner provided care that was below the

degree of care and skill expected of a reasonably competent practitioner of the same class and in

similar circumstances. Hyman & Armstrong, P.S.C. v. Gunderson, 279 S.W.3d 93, 113 (Ky. 2008).5

In Kentucky, the standard of care for medical professionals is established by the medical profession

itself, considering “elements of locality, availability of facilities, specialization or general practice,

proximity of specialists and special facilities as well as other relevant considerations.” Blair v.

Eblen, 461 S.W.2d 370, 373 (Ky. Ct. App. 1970) (explaining that the standard is a professional,

not community, standard); see also Lake Cumberland Reg’l Hosp., LLC v. Adams, 536 S.W.3d 683,

695 (Ky. 2017) (explaining the duty “to exercise that degree of care ordinarily used by hospitals

under circumstances like or similar to those shown in this case” (citation omitted)).

         Here, the district court found that Dr. Daniel did not establish the relevant standard of care

for lung cancer screenings with LDCTs. We agree. The district court explained that Dr. Daniel

relied on recommendations and secondary sources, rather than his own experience, to opine on the

standard of care. See Collins, 2023 WL 2394638, at *3–5 (explaining secondary source reliance,

lack of experience, and recommendations reliance, respectively). Even Dr. Daniel acknowledged

that recommendations will not always establish a standard of care. The district court further

explained that Dr. Daniel did not address “the screening practices of other primary care providers

4
  Kentucky law recognizes that “no expert testimony is needed in situations ‘where the common knowledge or
experience of laymen is extensive enough to recognize or to infer negligence from the facts.’” Vance ex rel. Hammons
v. United States, 90 F.3d 1145, 1148 (6th Cir. 1996) (quoting Perkins v. Hausladen, 828 S.W.2d 652, 655–56 (Ky.
1992)).
5
  The medical expert must also establish causation, i.e., that the negligence was the proximate cause of the plaintiff’s
injury. Reams v. Stutler, 642 S.W.2d 586, 588 (Ky. 1982). Here, Dr. Daniel did not testify to causation.

                                                          -6-
No. 23-5240, Collins v. United States

in Kentucky or elsewhere.” Collins, 2023 WL 2394638, at *5. Moreover, Dr. Daniel did not discuss

the availability of LDCTs in the community or in more remote locations.6 Dr. Daniel did not know

whether the University of Kentucky’s medical center, a leading research hospital in Kentucky, had

LDCT scanning availability.

         Dr. Daniel’s testimony did not establish the relevant standard of care for medical

malpractice in Kentucky. His reliance on recommendations, by his own admission, is not enough

to establish a standard of care. Cf. Lake Cumberland Reg’l Hosp., LLC, 536 S.W.3d at 696

(explaining that even a hospital’s bylaws will not establish the standard of care for a given

hospital). Under Kentucky law, a medical expert must discuss locality, facility availability,

specialization or general practice, and proximity of specialists and special facilities, amongst other

relevant inquiries. Blair, 461 S.W.2d at 373. Dr. Daniel did not testify to his own experience with

LDCTs, LDCT availability in Kentucky at large or in remote locations of Kentucky, or even

whether Kentucky’s lead research hospital had LDCTs. As the district court explained, Dr. Daniel

may have suggested that the VA lagged behind other hospitals, but his testimony was not sufficient

to establish the standard of care for lung cancer screenings with LDCTs. Mrs. Collins therefore

failed to establish this element of a medical malpractice claim.

                                                   CONCLUSION

         For the foregoing reasons, we AFFIRM the district court’s grant of summary judgment to

the United States.

6
  In dicta, the district court elaborated that the United States’s medical expert did more to establish the standard of care
than did Collins’s proffered medical expert. Collins, 2023 WL 2394638, at *5. The district court analyzed Dr. Jeffrey
Honeycutt’s testimony in light of the Kentucky rules for establishing the standard of care, finding that Honeycutt’s
testimony discussed factors relevant to the standard of care analysis including that LDCTs were not commonly
available at the time, and the VA did not actually have one operational until 2019, id., long after the time that Mrs.
Collins contends the standard of care required the LDCT scans. In other words, Dr. Honeycutt testified as to the
standard of care for a competent medical practitioner of the same class and under similar circumstances. Hyman &
Armstrong, P.S.C., 279 S.W.3d at 113.

                                                            -7-