Papa v. U.S.

MEMORANDUM DECISION AND ORDER I. INTRODUCTION On August 16, 2017, Plaintiffs Matthew Papa and Elizabeth Reusswig filed a complaint alleging various medical malpractice claims arising out of the hospitalization of the decedent, Joseph Alfred Papa (“Mr. Papa”) at the Albany Veterans Affairs Medical Center (“Albany VA”).¹ See Dkt. No. 1. The Court held a bench trial on March 27, 2023, and March 28, 2023. At trial, the only remaining claim was for medical malpractice arising out of Dr. Dianna Langdon’s use of a GlideScope, a video laryngoscope, during Mr. Papa’s intubation on July 22, 2015. See Dkt. Nos. 59, 70; Pls.’ Ex. 8. Plaintiffs Matthew Joseph Papa and Elizabeth Marie Reusswig testified, and the parties stipulated to the admission of the transcript of videotaped testimony of Plaintiffs’ expert witness Dr. Robert W. Irwin. The Government called Dr. Langdon,² and expert witness Dr. Vivek Moitra, the division chief of critical care medicine at Columbia University Medical Center. Having reviewed the parties’ pre-trial submissions, the trial transcript and exhibits, and the parties post-trial briefs, the Court makes the following findings of fact and conclusions of law. II. FINDINGS OF FACT³ A. The Parties and Jurisdiction 1. Plaintiff Matthew Joseph Papa is a resident of Albany, New York. See Tr. 3/27 at 13. He is Mr. Papa’s son. See id. 2. Plaintiff Elizabeth Marie Reusswig is a resident of Pennsylvania. See id. at 89. She is Mr. Papa’s daughter. See id. at 13. 3. Defendant United States of America owns and operates the Albany VA. 4. Plaintiffs sued the United States of America pursuant to the Federal Tort Claims Act, 28 U.S.C. §§1346, 2671. This Court has jurisdiction pursuant to 28 U.S.C. §§1331, 1346(b)(1). B. Medical History 5. Mr. Papa’s medical history included: coronary artery disease, congestive heart failure, type II diabetes, hypertension, gastritis, nephrolithiasis, stage IIIa chronic kidney disease, chronic mycrocytic anemia, recurrent gastrointestinal bleeding, and chronic blood loss anemia, which required recurrent blood transfusions. See Dkt. No. 71 at 18; Tr. 3/27 at 71. 6. Mr. Papa was treated in March 2015 at the Albany VA with blood transfusions and had “a couple periods” of inpatient hospital stays during the spring of 2015. See Tr. 3/27 at 16-17, 48-49. 7. Mr. Papa did not have upper teeth. See Dkt. No. 71 at 35. 8. Mr. Papa was not on dialysis prior to July 22, 2015. See Tr. 3/27 at 47. 9. Mr. Papa was 86 years old on July 22, 2015. See Dkt. No. 71 at 17. C. Emergency Department (“ED”) Arrival 10. Plaintiff Matthew Papa testified that Mr. Papa’s health on July 21, 2015, seemed “fine.” See Tr. 3/27 at 18. 11. Elizabeth Reusswig described Mr. Papa’s health as “pretty normal” in the week prior to July 22, 2015. See id. at 48. 12. Plaintiff Elizabeth Reusswig spent July 22, 2015, with Mr. Papa, and had seen him roughly every day during the week prior. During those visits, they would eat, and discuss and research assisted living centers for Mr. Papa and Emma Papa. See id. at 47. 13. Mr. Papa and Plaintiff Reusswig had lunch together on July 22, 2015, and spent the afternoon together until 8:00 p.m. Plaintiff Reusswig believed Mr. Papa seemed tired but otherwise normal. See id. at 49. 14. At approximately 10:00 p.m. on July 22, 2015, Mr. Papa called Plaintiff Matthew Papa while Plaintiff Matthew Papa was with Plaintiff Reusswig. Mr. Papa told Plaintiff Matthew Papa that he was not feeling well, and Plaintiff Matthew Papa testified that he picked up Mr. Papa and drove him to the Albany VA emergency department. See id. at 18-19, 50. Plaintiff Reusswig arrived at the hospital around an hour and a half later. See id. at 50. 15. There is a discrepancy as to whether Mr. Papa arrived by ambulance or whether Plaintiff Matthew Papa drove him. Compare Dkt. No. 71 18 with Tr. 3/27 at 50. 16. Mr. Papa told Plaintiff Matthew Papa that he was experiencing chest pain and pressure. See Tr. 3/27 at 18-19. 17. Mr. Papa arrived at the emergency department at approximately 11:06 p.m. and “complained of shortness of breath and mid-sternal chest pain.” Dkt. No. 71 at

16, 20. 18. Mr. Papa was placed on a cardiac monitor and a non-rebreather 100 percent facemask, received an EKG, two IV lines, and had blood drawn. See Tr. 3/27 at 72. 19. Mr. Papa’s oxygen saturation levels dropped to the mid-seventies while supplemental oxygen was being administered with a 100 percent oxygen non-rebreather mask. See Dkt. No. 71 at 23; Tr. 3/28 at 15. 20. Mr. Papa’s blood pressure was ninety-six over fifty-seven. See Dkt. No. 71 at 21. 21. Mr. Papa was in critical condition from shock and acute respiratory failure, see id. at 24, and had a low oxygen saturation of eighty-five percent, an elevated respiratory rate of thirty-eight, rhonchi in his lungs, and labored breathing. See id. at 22; Tr. 3/27 at 72-73. 22. A portable chest x-ray showed a pulmonary edema with bilateral pleural effusions and increased pulmonary vascular congestion. See Dkt. No. 71 at 25. D. Intubation 23. At approximately 11:07 p.m. on July 22, 2015, Dr. Dianna Langdon, the attending physician for the department that evening, evaluated Mr. Papa. See id. at 26; Tr. 3/27 at 69. 24. Dr. Langdon noted mottled skin and extremities and labored breathing. Mr. Papa stated he was experiencing chest pain and other issues. See Tr. 3/27 at 73. 25. Nursing staff and respiratory therapy staff were with Dr. Langdon at Mr. Papa’s bedside. See id. at 72. 26. Dr. Langdon received a verbal consent for intubation and blood transfusion by medical proxy from Matthew Papa. See id. at 98. 27. Plaintiffs waited in the waiting room. See id. at 20.⁴ 28. Due to an impending respiratory failure, Dr. Langdon performed an emergent intubation at 11:35 p.m. See Dkt. No. 71 at