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February 13, 2001


The opinion of the court was delivered by: Kollar-kotelly, District Judge.



Plaintiff Norman Raflo is a retired U.S. Army serviceman residing in the Commonwealth of Virginia. See Amended Compl. ("Comp.") at ¶ 11. Plaintiff appears on his own behalf, and as personal representative of the Estate of Allyn Raflo. Norman Raflo's deceased wife. See id.

On or about August 27, 1996, Allyn Raflo, went to a primary care facility known as the Burke PRIMUS in Burke, Virginia.*fn1 See Compl. ¶ 13. Mrs. Raflo complained of abdominal pain, nausea, and a mild fever. See id. Without conducting any laboratory work, her treating physician prescribed a smooth muscle relaxer and sent her home. See id. However, because these symptoms continued and grew more acute, the following day, Mrs. Raflo went to the emergency room at the DeWitt Army Community Hospital at Ft. Belvoir, Virginia. See id. ¶ 14. Laboratory tests revealed that she had abnormal levels of monocytes. See id. On August 31, 1996, Mrs. Raflo returned to the Burke PRIMUS facility because she was exhibiting the following symptoms: orange urine, nausea, abdominal cramps, vomiting, fever, cough with whitish-yellow sputum, and runny nose. See id. ¶ 15. Kiran Patel, M.D., a former defendant in this case, allegedly diagnosed Mrs. Raflo's ailment as bronchitis. See id. ¶ 16. Subsequently, on or about September 1, 1996, Mrs. Raflo was taken to the emergency room at the DeWitt Army Community Hospital and was diagnosed with thrombotic thrombocytopenic purpura ("TTP") and/or hemolytic uremic syndrome ("HUS"). See id. ¶ 17. On that day, Mrs. Raflo was transferred to Walter Reed Medical Center ("Walter Reed") in the District of Columbia, where she began treatment for TTP/HUS, including plasma pheresis and kidney dialysis. See id. ¶ 18. Mrs. Raflo continued to receive treatment for TTP/HUS until September 7, 1996, when she allegedly suffered a subdural hemorrhage and cerebellar herniation. See id. ¶ 19-20. She died on September 8, 1996 at Walter Reed. See id. 22.

Plaintiffs, Norman Raflo and the Estate of Allyn Raflo, filed a five-count action on August 22, 1997, which was amended to add a sixth-count on February 18, 2000, against the United States and PHP Health Care Corporation (hereinafter "PHP"). PHP is incorporated in Delaware but conducts business in the District of Columbia and Virginia. Plaintiffs' Complaint alleges that Defendants committed a series of negligent actions in failing to properly diagnose the medical condition of Mrs. Raflo. In this motion, Defendants United States and PHP ask the Court to rule that Virginia law applies to this action.


A. As to Defendant PHP, District of Columbia Substantive Law Applies

In diversity cases, a federal court must follow the choice of law rules of the forum state in which it is sitting to determine which state's law to apply. See Klaxon Co. v. Stentor Electric Mfg. Co., Inc., 313 U.S. 487, 496-97, 61 S.Ct. 1020, 85 L.Ed. 1477 (1941); Day & Zimmermann, 423 U.S. 3, 4, 96 S.Ct. 167, 46 L.Ed.2d 3 (1975); Ideal Electronic Co. v. International Fidelity Insurance Co., 129 F.3d 143, 148 (D.C.Cir. 1997). Accordingly, in exercising diversity jurisdiction over Defendant PHP, this Court must apply District of Columbia choice of law rules. District of Columbia choice of law rules dictate that the District's substantive law should govern Plaintiffs' case against PHP.

In determining which state's substantive law to apply to a tort case, the District of Columbia's choice of law rules require this Court to use the "governmental interests" analysis approach. See Kaiser-Georgetown Community v. Stutsman, 491 A.2d 502, 509 (D.C. 1985) (hereinafter Stutsman I); Hercules & Co. v. Shame Restaurant, 566 A.2d 31, 40-41 (D.C. 1989). This approach adheres to a two-step inquiry: 1) identifying the governmental policies underlying the applicable laws; and 2) determining which state's policy would be most advanced by having its law applied to the facts of this case. See Stutsman v. Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., 546 A.2d 367, 373 (D.C. 1988) (hereinafter Stutsman II); Williams v. Williams, 390 A.2d 4, 6 (D.C. 1978). To evaluate which state has the stronger interest, the four factors enumerated in the Restatement (Second) of Conflict of Laws § 145 are also considered: 1) the place where the injury occurred; 2) the place where the conduct causing the injury occurred; 3) the domicile, residence, nationality, place of incorporation and place of business of the parties; and 4) the place where the relationship is centered. See Hercules, 566 A.2d at 40-41.

When the policy of "State A" would be advanced by application of its own State A law, and the policy of the other state, "State B," would not be advanced by application of State B's law, a so-called "false conflict" appears and the law of the interested state, State A, prevails. See Stutsman I, 491 A.2d at 509. In contrast, when both states have a genuine interest in applying their own laws, a "true conflict" exists and the court must weigh the competing interests in order to determine which state has the stronger interest. See Biscoe v. Arlington County, 738 F.2d 1352, 1360 (D.C.Cir. 1984) (holding that where a true conflict exists, "the law of the jurisdiction with the stronger interest will apply"); District of Columbia v. Coleman, 667 A.2d 811, 816 (D.C. 1995) (Where a true conflict exists, "the forum law will be applied unless the foreign [state] has a greater interest in the controversy."). An analysis of the competing interests held by the District of Columbia and Virginia in applying their own laws and in furthering their separate public policies in this case reveals no real conflict.

Defendant PHP argues that Virginia's governmental interest is more significant than the District's interest, given that the Virginia legislature has capped the amount of damages recoverable in medical malpractice cases like the one before this Court. Virginia has undoubtedly expressed a public policy interest in limiting the liability of health care providers operating within the state. See Virginia Medical Malpractice Act, 2 VA. CODE ANN. §§ 8.01-581.1 to 8.01-581.20 (Michie Supp. 1984) (hereinafter the "Act"). The Act modifies the law of negligence in malpractice cases in Virginia by creating a mediation process, see 2 VA. CODE ANN. §§ 8.01-581.2, and limiting the amount of recovery permitted against health care providers in malpractice actions, see 2 VA. CODE ANN. §§ 8.01-581.15. The Act was passed with two intended goals: 1) to lower the high cost of medical malpractice insurance which the legislature believed was responsible for driving health care providers from the profession, and 2) to ensure that the residents of Virginia benefitted from adequate health care that is both available and affordable. See Lewis v. Group Health Association, Inc., 1992 WL 25877, *3 (D.D.C. 1992); Etheridge v. Medical Center Hospitals, 237 Va. 87, 376 S.E.2d 525, 527-28 (1989).*fn2

However, Virginia's interest in protecting its health care providers and its residents are substantially reduced in this particular case. First, Virginia's interest in the application of its statute becomes attenuated when its intended beneficiary is a foreign corporation with its principal places of business outside Virginia. See Stutsman I, 491 A.2d at 511. Here, Defendant PHP is a national health care corporation, incorporated in Delaware. See Plaintiffs Opposition to the Government's Motion to Apply Virginia Law ("Pl.Opp."), Ex. 7. Although PHP conducts business in Virginia, Virginia is only one of 26 states in which PHP operates. See id. Therefore, the weight of any financial impact upon PHP which results from a finding of liability in excess of the statutory cap will be spread among the various states in which PHP operates, and will not fall solely, nor even primarily, upon the care PHP provides in Virginia. See Stutsman I, 491 A.2d at 511.

In addition, Virginia's interest in ensuring that its residents can obtain adequate and affordable health care is not contravened by application of District of Columbia law in this case. When passing the Act, the Virginia legislature concluded that, without the cap, Virginia health care providers could not be expected to continue providing medical care for its citizens, given the increase in medical malpractice claims, which the Virginia legislature viewed as directly affecting the premium cost for and the availability of medical malpractice insurance. See Etheridge, 376 S.E.2d at 527. Here, however, PHP, through its contract with, the United States, which has a statutory obligation to provide health care coverage to retired soldiers and their families, must continue to provide adequate medical care to such covered Virginia residents, irrespective of increasing costs. In other words, Virginia residents who are retired soldiers or their families, like the ...

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