Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

SCHAUFFERT v. U.S.

September 18, 2005.

STELLA & JOHN SCHAUFFERT, Plaintiffs,
v.
UNITED STATES OF AMERICA, Defendants.



The opinion of the court was delivered by: COLLEEN KOTELLY, District Judge

MEMORANDUM OPINION

Plaintiffs brought this medical malpractice action against Defendant United States of America pursuant to the Federal Tort Claims Act ("FTCA"), 28 U.S.C. §§ 1346(b) and 2671 et seq., based upon the alleged negligent acts and omissions of military personnel and staff physicians employed by the United States of America at Walter Reed Medical Center ("Walter Reed") in Washington, D.C. Pursuant to the terms of the FTCA, which does not provide for a jury trial, a three-day bench trial commenced on October 26, 2004, continued on October 27, 2004, and concluded on October 29, 2004. This Memorandum Opinion details the Court's findings of fact and conclusions of law, as required by Federal Rule of Civil Procedure 52(a). See Fed.R.Civ.P. 52(a) ("In all actions tried upon the facts without a jury . . . the court shall find the facts specially and state separately its conclusions of law thereon"); see also 28 U.S.C. § 2402. Venue is appropriate pursuant to 28 U.S.C. § 1391(b)(2) because the acts of negligence and omission alleged in the Complaint took place at Walter Reed, which is located within the District of Columbia. Plaintiffs exhausted their administrative appeals as required by 28 U.S.C. § 2675(a). Based upon the credible evidence adduced at trial and all reasonable inferences to be drawn from the testimony of the witnesses and the documentary evidence in the case, the Court concludes that the physicians employed by Defendant at Walter Reed (1) properly obtained Ms. Schauffert's informed consent before performing surgery on her, and (2) met the standard care of reasonably prudent practitioners in the District of Columbia acting under the same or similar circumstances in providing care to Mrs. Schauffert. As such, pursuant to Federal Rule of Civil Procedure 58, the Court shall enter judgment in favor of Defendant and shall dismiss this action with prejudice.

I: PRELIMINARY FINDINGS OF FACT

  At trial, Plaintiffs narrowed the claims originally forwarded in their Complaint to essentially an action seeking to recover for a failure by the relevant physicians to obtain her informed consent when conducting an operation on Mrs. Schauffert that ultimately constituted a bilateral salpingo-oophorectomy and total abdominal hysterectomy, which involved the complete removal of Mrs. Schauffert's ovaries, fallopian tubes, and uterus. Essentially, Plaintiffs assert that (1) the physicians at Walter Reed failed to inform Mrs. Schauffert of the nature of the operative plan, 10/27/04 Tr. at 173:12-20, and (2) failed in their duty to inform her of the option to retain as much ovarian tissue as possible, id. at 163:24-25, 164:1-6, 166:14-167:25. After listening to the testimony in the case, reviewing the evidentiary record, personally observing the demeanor and credibility of the witnesses, and making all reasonable inferences to be drawn therefrom, the Court sets forth the following findings of fact. A. Undisputed/Uncontroverted Facts

  Background

  1. Plaintiff Stella Schauffert is the spouse of Plaintiff John Schauffert, a retired Air Force Lieutenant Colonel who was stationed in Naples, Italy in July 1999. 10/27/05 Tr. at 177:2-20. While on active duty in the Air Force, Lieutenant Colonel Schauffert was a military policeman and served as a commander of military police units during four (4) of his military assignments. Id. at 193-94.

  2. While Mrs. Schauffert's native language is Italian, she began studying English when she was eleven (11) years-old, has lived in the United States for significant periods of time since she was twenty-six (26) years-old, and is fluent in English. 10/26/07(a) Tr. at 28:5-6, 20.*fn1 Prior to marrying her husband, Lt. Col. John Schauffert, Mrs. Schauffert received formal legal training in Italy. J. Tr. Ex. 24 at 26. Mrs. Schauffert and her husband have been married to each other three (3) times extending over a period of roughly twenty (20) years. 10/26/04(a) Tr. at 21:21-23.

  The Discovery of Mrs. Schauffert's Medical Issues

  3. In early May 1999, Mrs. Schauffert experienced excruciating pelvic pain after intercourse. Her pain was so intense that her husband had to pick her up and carry her to the car, and then carry her into the emergency room of the United States Naval Hospital in Naples, Italy. 10/27/04 Tr. at 199:3-7; J. Tr. Ex. 9 at 3-6. At the time of her admission, Mrs. Schauffert was forty years-old (40), had an eighteen (18) year-old son by her husband, and did not intend to have any further children. 10/26/04(a) at 31:12-15; J. Tr. Ex. 1 (Treatment Record Cover); J. Pre-Tr. Stmt., J. Undisputed Fact #1. Upon examination, her attending physicians believed that Mrs. Schauffert was suffering from Pelvic Inflammatory Disease ("PID") and prescribed an antibiotic treatment regimen for that condition. J. Tr. Ex. 9 at 3.

  4. Mrs. Schauffert was given a referral that ultimately led to an appointment with Dr. Lauren Bales, an Obstetrician and Gynecologist ("OB/GYN") at the Navy clinic in Naples, Italy. Id. On June 24, 1999, Mrs. Schauffert underwent an ultrasound of her pelvic area. Id. at 7. When Mrs. Schauffert met with Dr. Bales to discuss the results of the ultrasound on July 6, 1999, it was revealed that the ultrasound detected a mass on Mrs. Schauffert's right ovary. Id. at 1, 7. Dr. Bales described the mass as a "large complex cystic mass," measuring 5.6 × 4.1 × 7.1 cm, with septations — i.e., the mass had compartments or walls within the cyst. Id. at 7. At the time, Dr. Bales believed that it was likely that Mrs. Schauffert was suffering from a complex hemorrhagic cyst. Id. at 1; J. Pre-Tr. Stmt., J. Undisputed Fact #4.

  5. Dr. Bales ordered a CA-125 blood test for Mrs. Schauffert in order to test for cancer markers and ascertain whether the cystic mass may be cancerous. Mrs. Schauffert's test received a score of 46, which is considered an "elevated" score. J. Tr. Ex. 9 at 8; J. Pre-Tr. Stmt., J. Undisputed Fact #5. Based on her examination, symptoms, ultrasound, and CA-125 findings, Dr. Bales informed Mrs. Schauffert that she had a small chance of having cancer. J. Tr. Ex. 9 at 1; J. Pre-Tr. Stmt., J. Undisputed Fact #7. Plaintiffs' expert, Dr. Charles Seigel, testified in his trial deposition that the percentage chance of a forty (40) year-old woman with a complex ovarian cyst having cancer is approximately thirty percent (30%). J. Tr. Ex. 20 (Seigel Dep.) at 54:10-13; J. Pre-Tr. Stmt., J. Undisputed Fact #11. 6. Despite her belief that Mrs. Schauffert had a relatively small chance of having cancer, Dr. Bales suggested that Mrs. Schauffert have surgery due to the presence of pain and laboratory abnormalities. J. Tr. Ex. 9 at 1; 10/29/04 Tr. at 20:12-15. Dr. Bales also counseled Mrs. Schauffert on the option of follow-up and close observation without surgical intervention, but did not recommend it. J. Tr. Ex. 9 at 8; 10/26/04(b) Tr. at 48:22-24. Dr. Bales told Mrs. Schauffert that surgery would entail the removal of the right ovary and an evaluation of the left ovary. 10/29/04 Tr. at 20:16-19. Dr. Bales did not inform Mrs. Schauffert that she would attempt to remove the cyst from the right ovary and allow her to retain as much tissue as possible because Dr. Bales did not consider that course of action to be a medically viable option within the standard of care. Id. at 20:20-21:2.

  7. During discussions with Dr. Bales, Mrs. Schauffert asked several questions regarding what the planned surgery entailed, and agreed to undergo the proposed surgery. Id. at 21:5-10. As such, Mrs. Schauffert left Dr. Bales's office on July 6, 1999 with the understanding that she was going to have surgery, 10/26/04(a) Tr. at 58:7-10, and surgery was scheduled for a later point in July 1999 at the Naples hospital, id. at 48:17-19, 49:1-9. However, Mrs. Schauffert ultimately decided against having surgery at the Naples facility due to its relatively small size and the fact that it was not staffed with OB/GYN oncologists. Id. at 59:6-13.

  Travel to Walter Reed Army Medical Center in the United States

  8. As an alternative, Mrs. Schauffert chose to travel to Walter Reed Army Medical Center in Washington, D.C., where gynecologic oncologists would be available to conduct her surgery. Id. Mrs. Schauffert was flown via medical evacuation at government expense to Walter Reed. Id. at 59:1-18, 62:3-9; J. Tr. Ex. 4 at 29. Prior to her flight, Dr. Bales contacted Dr. Michael Sundborg, the Gynecological Oncology Fellow at Walter Reed, to discuss Mrs. Schauffert's treatment and to ensure that Walter Reed would receive her. J. Tr. Ex. 9 at 8; J. Tr. Ex. 4 at 30. Mrs. Schauffert also spoke to Dr. Sundborg on the telephone regarding her treatment and the plans for her evacuation to Walter Reed. 10/26/04(b) Tr. at 62:14-25. Prior to her arrival at Walter Reed, Mrs. Schauffert conducted research and reviewed the medical literature concerning her condition, and considered herself "educated" on the issues surrounding her surgery. J. Tr. Ex. 2 at 31:1-25.

  The July 20, 1999 Examination and Counseling Session

  9. Mrs. Schauffert arrived at Walter Reed on July 20, 1999, and met with Dr. Jay Carlson, an experienced, well-published, board-certified gynecologic oncologist, J. Tr. Ex. 15 at 4, and Dr. Shad Deering, a resident in his third year of his OB/GYN rotation, 10/29/04 Tr. at 45:8-10. See 10/26/04(b) Tr. at 63:1-25. Drs. Carlson and Deering performed a physical examination of Mrs. Schauffert, which included a pelvic vaginal ultrasound. 10/29/04 Tr. at 53:7-12. Dr. Remenga, another board-certified gynecological oncologist, was also present for the examination and signed off on the report of the physical examination. The ultrasound revealed that Mrs. Schauffert now had bilateral complex adnexal masses, both with septations. J. Tr. Ex. 1 at 11. The left cyst was estimated to be 5.2 × 4.3 cm, and the right cyst was estimated to be 5.6 × 3.1. cm. Id. Moreover, the ultrasound revealed a small 1.6 cm polyp on the interior posterior of the uterus. Id.

  10. The Walter Reed physicians considered the fact that the ultrasound showed two (2) ovarian cysts to be very significant, as the previous ultrasound — conducted by Dr. Bales in Italy — had revealed only one complex cyst. 10/27/04 Tr. at 56:23, 57:6; J. Tr. Ex. 20, Seigel Dep. at 26:23, 27:1-5. The presence of bilateral masses is an indicator for cancer. 10/27/04 Tr. at 108:4-17. Upon conclusion of this examination, Drs. Carlson, Deering, and Remenga had a discussion with Mrs. Schauffert regarding the examination results and possible courses of treatment at roughly 10:00 a.m. that day, i.e., July 20, 1999. Id. at 57:23, 58:6. During this discussion, which was led by Dr. Remenga in Walter Reed's OB/GYN clinic, id. at 96:13-25, 97:1-22, Mrs. Schauffert was informed that her evaluation revealed that she had bilateral adnexal masses whose appearance suggested a possible ovarian malignant neoplasm. J. Tr. Ex. 1 at 9-10. Mrs. Schauffert was also told that she had a suspicious mass in her uterus that was evaluated on sonohysterogram. 10/26/04(b) Tr. at 67:13-15.

  11. Mrs. Schauffert was informed that, based on the examination findings, her age, and an elevation in her CA-125 count, there was a thirty percent (30%) risk that she had cancer. 10/26/04(b) Tr. 67:21-24. Mrs. Schauffert was very scared at the prospect of having cancer. Id. at 68:12-14. The physicians inquired as to whether Mrs. Schauffert planned on having more children, and were told by her that she did not plan on any future pregnancies. 10/27/04 Tr. at 59:18-21.

  12. Given their findings and Mrs. Schauffert's age, CA-125 count, and desire for no further children, the physicians discussed several courses of treatment with Mrs. Schauffert. 10/27/04 Tr. at 59:22, 60:8. Mrs. Schauffert was not on any medication at the time of this counseling. 10/26/04(b) Tr. at 89:2-6. Three options were discussed at length. 10/29/04 Tr. 59:11-60:8, 98:4-11; J. Tr. Ex. 1, 17, 86; J. Pre-Tr. Stmt., J. Undisputed Fact #13. First, Mrs. Schauffert and the physicians discussed the possibility of close physician follow-up and monitoring, which would have entailed serial ultrasounds, examinations, and possible therapy with tumor markers. 10/27/04 Tr. at 59:25, 60:2. Mrs. Schauffert rejected this option, as it could not guarantee that she would be free of cancer. 10/26/04(b) Tr. at 76:17-23. Second, because Mrs. Schauffert had a suspicious mass inside her uterus, the physicians discussed with her the option of having a hysteroscopy, using a transvaginal approach. 10/27/04 Tr. at 60:3-5. This approach would allow the surgeon to look inside the uterine cavity, evaluate the uterine mass, potentially remove it and see if that was a focus of cancer, and then perform an abdominal procedure to evaluate the ovaries. Id. Mrs. Schauffert rejected this option as well. Id. at 61:9-14. Third, the physicians discussed with Mrs. Schauffert the option of (1) a laparotomy, which is an abdominal incision, to remove any visible tumors, (2) with an abdominal hysterectomy, which was explained as the total removal of the uterus, (3) and also with a bilateral salpingo-oopherectomy, which was explained as the total removal of both ovaries and associated tubes, and (4) possibly a staging procedure to see if the cancer had spread, with the addition of chemotherapy-radiation as needed. 10/27/04 Tr. at 61:18-23, 66:6-19, J. Tr. Ex. 1 at 17.

  13. Upon discussion with Mrs. Schauffert, the physicians at Walter Reed believed that she had selected the third option. As such, on 3:20 p.m. that day — July 20, 1999 — Dr. Deering presented Mrs. Schauffert with a form entitled "A Request for Administration of Anesthesia and for Performance of Operations and Other Procedures." J. Tr. Ex. 11. On this "consent" form, Dr. Deering outlined the planned surgical procedure in detail. Id. In the block entitled "Operation and Procedure," Dr. Deering wrote "exploratory laparotomy, bilateral salpingo-oopherectomy, total abdominal hysterectomy, possible staging operation." Id. In the section labeled "Statement of Request," Dr. Deering wrote: "To make incisions in the abdomen to evaluate and remove one or both ovaries/the mass/possibly uterus/fallopian tubes/lymph nodes/omentum/pelvic washings." Id. The form continued: "Risks to include bleeding/transfusion/damage to other organs with need for more surgery/infection." Id. Dr. Deering also wrote that the operating team was to include Drs. Deering, Rose, and Remenga. Id. Below the section filled out by Dr. Deering, a block reads: "I understand the nature of the proposed procedure(s), attendant risks involved, and expected results, as described above, and hereby request such procedure(s) be performed." Id. In this section, Mrs. Schauffert signed her name in the presence of a witness after reading the entire contents of the form. Id.

  The July 21, 1999 Counseling Session and Operation

  14. The next day — July 21, 1999 — Mrs. Schauffert was examined by Dr. Cynthia Macri, the United States Navy's Senior Gynecologic Oncologist at Walter Reed and a board-certified OB/GYN oncologist. J. Tr. Ex. 12. Dr. Macri was going to be the operating surgeon on Mrs. Schauffert. Id. With Dr. Deering present, id., 10/26/04(b) Tr. at 89:7-12, Dr. Macri discussed the nature of the surgery with Mrs. Schauffert, who indicated that she wanted and consented to the procedure discussed the previous day. J. Tr. Ex. 12; 10/27/04 Tr. at 11-12. Mrs. Schauffert's only concern during this counseling session was whether her surgery ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.