Court Opinion

ID: 9477503
Source: CourtListenerOpinion
Date Created: 2023-08-05 06:25:12.065408+00
Date Added: 2024-06-11T17:45:54.915947
License: Public Domain

WELLFORD, Circuit Judge,
dissenting.
This is a difficult and a confusing case. There is ample room for sympathy for the deceased and his family in light of the defendant’s less than admirable manner of handling this particular patient’s case. A result has been reached holding defendant liable which may accord with equitable impulses, but I can find no consistent basis or reasoning by the district court, nor by my brother judges, that establishes a legal foundation for the very substantial judgment approved on appeal. I do not recite the facts in detail because I believe Judge Merritt has adequately treated the facts as well as the purported rationale of the district court in concluding that plaintiff had carried the burden of showing actionable negligence and proximate causation.
Judge Merritt observes in his opinion agreeing with the result reached but not for the reasons stated by the district judge, that “[i]n its findings of fact and conclusions of law, the District Court largely rejected plaintiff’s theory in favor of defendant’s_” He noted that Judge Ber-telsman “found ... no infection anywhere ... in Mr. Welsh’s head before early September.” I believe that there is substantial evidence to support that finding of fact, and in this respect I agree with Judge Merritt that the consequence of this and other district court findings was effectively to reject plaintiff’s theory of liability including the expert opinion of plaintiff’s principal medical witness. Judge Nelson, in his concurring opinion, states “[n]one of the findings of fact made by the district court was clearly erroneous, in my view....” 1 Following the district court’s rationale, Judge Merritt, I believe correctly, concludes that “the July and August clinic visits [by the deceased] ... could not have represented occasions for negligence by failure to diagnose the infection, because the infection had not yet arisen in the gallbladder, much less seeded in the skull.” (emphasis added).
Judge Merritt observed, moreover, that “The District Court found that Mr. Welsh’s ‘gall bladder problems’ had their onset on August 25 and that ‘shortly before’ September 15 the E. Coli infection traveled from ‘the gall bladder, the liver, or a combination’ and seeded in his brain.”
Judge Merritt proceeds, accurately again I believe, to discuss the “District Court’s theory of the case, [which] ... turned upon its findings of fact that a clinic visit occurred approximately on September 25....” The district court determination of liability did not accept plaintiff’s contentions and plaintiff’s expressed basis for recovery, and it did in my view rest upon a finding that such a visit occurred despite the fact that there was no hospital or other *1253record of such a visit. There was no evidence or hint that the defendant had done away with or concealed such a record of a September 25 visit. No one familiar with YA records and the file in the case testified that such a September 25 visit occurred or that the record had been misplaced, and plaintiff’s witnesses were very ambivalent about such a visit, whether it occurred, and its date.2 The district court had to infer that there were “missing records” of such a visit and to make an adverse inference against the VA Hospital because a doctor allegedly then present did not testify. That doctor was no longer at the time of trial with VA, but was equally available to both parties. Mrs. Welsh, the district judge found, “opines that she probably saw Dr. Guidry on this visit. [Dr. Guidry] did not testify.” (emphasis added).
No one specifies any other so-called “missing record” in this case. The district court inferred that the September 25 visit took place and points to “failures to take proper vital signs” as if this was evidence of a missing record. I harbor a definite conviction that the district court’s finding about a September 25 visit was erroneous. “A finding is clearly erroneous when although there is evidence to support it, the reviewing court on the entire evidence is left with the definite and firm conviction that a mistake has been committed.” United States v. U.S. Gypsum Co., 333 U.S. 364, 395, 68 S.Ct. 525, 542, 92 L.Ed. 746, reh’g denied, 333 U.S. 869, 68 S.Ct. 788, 92 L.Ed. 1147 (1948) cited in Ward v. United States, 838 F.2d 182 (6th Cir.1988). Furthermore, I am in agreement with Judge Merritt concerning his conclusion that “the September 25 ‘visit’ seems a very slender reed upon which to hang liability.” Judge Nelson concludes that the district court’s finding of “acts of negligence occurring ‘during July, August and September 1980’ were substantial factors in causing the catastrophe that occurred in October” was supported by substantial evidence. He ignores, however, the fact that the district court found as an ultimate fact that the fatal infection seeded “shortly before” September 15. (He also refers to a return to the hospital in September). Judge Merritt, furthermore, disagrees with Judge Nelson that failure to discover the infection in October, by not taking temperature or otherwise, was necessarily a causative factor because a discovery at that time came too late “to prevent Mr. Welsh’s subsequent rapid deterioration.” Here, again, I would be inclined towards Judge Merritt’s reasoning in that respect.3 I cannot accept on the record in this case Judge Nelson’s conclusion that complaints made by Welsh during July and August were somehow “telltale” of gall bladder problems with an onset date of August 25.
The district court also made no finding that deferring the second operation, including removal of the skull flap, to October 15 was negligent. The district court found that there was a departure from accepted medical practice in failing to send the skull flap to pathology for examination. This negligent act, however, had no bearing on the fact that an infection had then progressed into Mr. Welsh’s brain bringing about his subsequent death despite efforts to remove that infection. Once defendant’s theory about the source of the infection is accepted, as did the district court, it is indeed “doubtful that any negligence on the part of the government substantially contributed to the infection or the patient’s condition because the infection would have arisen entirely independently of any proven act by the government,” to use Judge Merritt’s words.
Judge Merritt proceeded then to indulge in presumptions about the basis of inferences by the district court to cure or overcome what he recognized as plaintiffs failure to carry the burden of proving “(1) that the E. Coli infection [was] seeded in Mr. *1254Welsh’s head by September 15, and (2) that the infection could have been diagnosed and treated on September 25 and October 10.” I believe Judge Merritt indulges in his own medical conclusions based upon authority not cited by either party concerning association between “focal osteomyeli-tis” and “subdural empyema.” Judge Nelson and I do not seem to be in disagreement that we would not hold that “the hospital’s negligent destruction of the skull flap ... created any presumption as to the existence of a causal relationship between the hospital’s earlier negligence and the medical disaster that ensued.”4 In brief, the failure to send the skull flap to the pathologist for examination on October 15 did not harm the plaintiff, who was by then past effective medical help. I respectfully disagree with Judge Merritt that it is proper to draw adverse inferences from this situation or to indulge in presumptions which would relieve plaintiff from the customary burden of proof. See Ward v. United States, 838 F.2d 182 (6th Cir.1988), for an example of our reluctance to adopt such presumptions of malpractice. From what has been cited from the opinions of the district court and from the opinions of Judges Merritt and Nelson, it seems clear that none of them agree on a common basis or rationale for a determination that the YA was guilty of causative negligence as theorized and claimed by plaintiff, nor that proven negligence of VA, if any, was a proximate cause of the unfortunate death of Mr. Welsh. Judge Merritt’s and Judge Nelson’s expressed reasons for affirmance are mutually inconsistent and conflicting. Neither can agree that the district court’s basis for finding liability after accepting defendant’s theory about the onset of infection is inherently reconcilable or defensible.
Under these circumstances, I see no rational choice but to reverse the decision of the district court.

. Judge Merritt characterizes plaintiffs theory as "logical and internally consistent." The district court heard the plaintiffs expert, gauged his credibility, and did not find it so. Neither did the district court find the facts in the record to support the theory, and we cannot disregard the district court's findings, particularly its credibility determination.

. Judge Merritt described it accurately: "the testimony of the various interested witnesses was in conflict over whether it had actually taken place_”

. Judge Merritt is perturbed that Judge Nelson’s “rationale for affirming the District Court would require this Court to approve inconsistent findings by the District Court based upon its acceptance" of defendant’s theory about its source and time the skull became infected. I share this concern.

. The doctrine of “spoliation”, especially arising out of a negligent act, is not a substitute for substantive proof of essential facts, and the plaintiff normally retains the normal burden of proving a prima facie case. A "presumption” against a spoliator usually at most is a persuasive factor rather than a probative one. WIGMORE ON EVIDENCE, § 3.93 at p. 329 (1970); McCORMICK ON EVIDENCE, note 7 at p. 809, n. 17 (E.W. Cleary 3d. ed. 1984).