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Knox v. United States

United States District Court, D. South Carolina, Rock Hill Division

July 3, 2018

Zekiya Knox, Plaintiff,
The United States of America; Amisub of SC, Inc., d/b/a Piedmont Medical Center; South Carolina Emergency Physicians; Jeffrey Warden, MD; Brian Fleet, PA; Piedmont General Surgery Associates, LLC; Alex Espinal, MD; Bret Garretson, MD; and Digestive Disease Associates, Defendants.



         Through this action, Zekiya Knox (“Plaintiff”) seeks recovery for alleged medical malpractice by a variety of medical providers involved in her care between September 2013 and May 2014.[1] Plaintiff alleges these providers failed to properly and timely diagnose and treat her underlying condition, Crohn's disease, and that this failure led to the development of sepsis. Plaintiff further alleges various Defendants failed to properly treat her sepsis and that the collective errors led to Plaintiff's loss of three limbs. Plaintiff asserts a single claim for medical negligence against all Defendants, though the specifically alleged errors vary between Defendants. See ECF No. 88 (Second Amended Complaint).

         The matter is before the court on motion of Defendant United States' for partial summary judgment on the issue of damages. ECF No. 120. The United States argues a damages limitation applies because NCFMC is a tax-exempt charitable organization providing medical care to underserved patient populations, and under South Carolina law, liability of a private charitable organization is capped at $1.2 million when physicians are involved in the alleged tort. ECF No. 120-1. Plaintiff agrees the United States is entitled to a limitation of damages, but argues there were multiple different occurrences of negligence and therefore the United States' exposure exceeds $1.2 million. ECF No. 132. In reply, the United States argues there were not multiple instances of negligence and the $1.2 million damage cap applies. ECF No. 138. For reasons set forth below, the motion is denied as the court is unable to find as a matter of law there was only one occurrence of negligence.


         Plaintiff alleges injury after abdominal pain, which she alleges was never properly treated, developed into “significant damage to her intestines and caused a life threatening infection, ” sepsis. ECF No. 88, Sec. Am. Compl. ¶ 37. Plaintiff originally presented to the Piedmont Emergency Room (“Piedmont ER”) on September 13, 2013, complaining of persistent abdominal pain. Id. at ¶ 9. She was seen by Defendant Dr. Warden, who performed a physical examination and ordered lab testing, ultrasound of the lower abdomen, and CT scan. Id. at ¶¶ 9-11. Plaintiff was discharged from the ER with narcotic pain killers and an instruction to follow up with a gastroenterologist. Id. at ¶ 14. On September 19, 2013, Plaintiff was seen by Defendant Dr. Garretson, a gastroenterologist, who scheduled and conducted a colonoscopy on September 25, 2013. Id. at ¶¶ 15-16. Dr. Garretson was unsure if his findings represented “appendicitis or IBD” (id. at ¶ 16), so he referred Plaintiff to a surgeon, Defendant Dr. Espinal, that same day. Id. at ¶ 17. Dr. Espinal ruled out acute abdominal process and ordered a CT scan, but Plaintiff alleges she was never informed of that appointment. Id. at ¶¶ 18, 18.1.

         The next day, September 26, Plaintiff went to see April Logan, a physician's assistant at NCFMC, a federally funded community health care center, complaining of abdominal pain. Id. at ¶ 19. Ms. Logan ordered an ultrasound, which was performed September 30, 2013 and showed “prominent bowel loops . . .with a somewhat thickened appearance.” Id. at ¶¶ 19.1, 20. Ms. Logan took no action in response to this finding. Id. at ¶ 20. Plaintiff was next seen by Ms. Logan on January 14, 2014, for abdominal pain. Id. at ¶ 24. Ms. Logan referred Plaintiff back to Dr. Espinal, who saw Plaintiff in February 2014.[2] Plaintiff was prescribed prednisone at that appointment and “the records reflect there was to be an appointment scheduled with Dr. Garretson, [but] this was never made known to Ms. Knox.” Id. at ¶ 26.

         On March 21, 2014, Plaintiff returned to NCFMC complaining of abdominal pain. Id. at ¶ 28. The physician she saw ordered another ultrasound, which was performed on April 4, 2014, and “noted tubular structures and encouraged a CT scan.” Id. at ¶¶ 29, 30. Plaintiff was to follow up at NCFMC on April 14 for ultrasound results, but instead returned to the Piedmont ER by ambulance that day. Id. at ¶ 31. Tests and examination showed an elevated white count, lower quadrant pain, and “what was then believed to be bacteria in her urine.” Id. at ¶ 32. Dr. Warden “remarked her presentation was similar to her presentation in September, ” and accessed those records, but the only treatment rendered was a prescription for an antibiotic for a urinary tract infection. Id. at ¶¶ 33-34. Defendant Fleet, a physician's assistant in the ER, ordered an additional antibiotic after reviewing results of a vaginal culture on April 18, 2014. Id. at ¶ 36.

         On May 4, 2014, Plaintiff returned to the Piedmont ER. Id. at ¶ 37. She was diagnosed with “either an infected inflamed appendix or a flare up of IBD that was never properly discovered or treated.” Id. She went into septic shock and ultimately lost three limbs. Id. at ¶ 39.


         Summary judgment should be granted if “the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(a). It is well established that summary judgment should be granted “only when it is clear that there is no dispute concerning either the facts of the controversy or the inferences to be drawn from those facts.” Pulliam Inv. Co. v. Cameo Properties, 810 F.2d 1282, 1286 (4th Cir. 1987). The party moving for summary judgment has the burden of showing the absence of a genuine issue of material fact, and the court must view the evidence before it and the inferences to be drawn therefrom in the light most favorable to the nonmoving party. United States v. Diebold, Inc., 369 U.S. 654, 655 (1962).


         The Federal Tort Claims Act waives the sovereign immunity of the United States for civil actions in federal court for injuries “caused by the negligent or wrongful act or omission of any employee of the Government while acting within the scope of his office or employment.” 28 U.S.C. § 1346(b)(1). “The United States shall be liable, respecting the provisions of this title relating to tort claims, in the same manner and to the same extent as a private individual under like circumstances . . .” 28 U.S.C. § 2674.

         The South Carolina Solicitation of Charitable Funds Act (“CFA”) limits liability for injury caused by an employee of a charitable organization to “an amount not exceeding the limitations on liability imposed in the South Carolina Tort Claims Act in Chapter 78 of Title 15.” S.C. Code § 33-56-180(A).[3] The South Carolina Tort Claims Act (“SCTCA”) states

         (a) For any action or claim for damages brought under the provisions of this chapter, the liability shall ...

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