Carl Anderson and Tammy Anderson v. United States of America
- Jeffrey Bryan
- 0:21-cv-02088
- U.S. District Court · District of Minnesota
- 32
In Anderson v. United States, Judge Bryan denied the government's motion to dismiss or for summary judgment in a medical malpractice case over surgery at a VA hospital.
Military veterans who receive medical care at VA hospitals and suffer injuries that they believe resulted from negligent treatment; parties litigating Federal Tort Claims Act medical malpractice cases who need to understand the scope of administrative exhaustion requirements and the limits of the contractor and discretionary function exceptions to government liability.
What happened
In Anderson v. United States (No. 21-CV-02088), Carl Anderson and Tammy Anderson sued the federal government under the Federal Tort Claims Act — a law that allows people to sue the government for certain negligent acts by its employees — after Carl Anderson suffered catastrophic injuries following a stomach hernia repair surgery performed by Dr. Archana Ramaswamy at the Minneapolis VA Medical Center in April 2018. Mr. Anderson underwent three surgeries in three days, was transferred in critical condition to a university hospital with his abdomen open, and arrived there near death. He has since undergone more than twelve surgeries and, as of the filing, still has an open abdominal wound requiring weekly treatment.
The government moved to throw out the case entirely, arguing on several grounds: that the Andersons had failed to properly notify the VA of all their claims before filing suit; that certain claims were barred because they really concerned independent contractors (a thoracic surgeon and an ambulance service), not government employees; and that a doctor's professional judgment about how to handle a patient's transfer is the kind of discretionary governmental decision that the law shields from lawsuits. The government also argued that no reasonable fact-finder could rule for the Andersons on the merits. The Andersons' claims focused on three alleged failures by Dr. Ramaswamy: (1) accidentally cutting a key blood vessel to the stomach during the initial hernia repair; (2) failing to remove the resulting dead (necrotic) tissue before transferring Mr. Anderson; and (3) transferring him when he was too unstable to survive the ambulance ride.
Judge Bryan denied the government's motion in full. On the jurisdictional arguments, the court found that the Andersons' original administrative complaint gave the VA enough information to investigate all three theories, that the contractor exception did not apply because the Andersons only sued over Dr. Ramaswamy's conduct as a government employee, and that a doctor's bedside medical decisions are not the kind of government policy choices that the law protects from second-guessing. On the merits, the court found that conflicting expert opinions on each element of medical malpractice — the standard of care, whether Dr. Ramaswamy departed from it, and whether that departure caused Mr. Anderson's injuries — created genuine factual disputes that must be resolved at trial, not on summary judgment. The case will proceed.
The detailed version
- Carl Anderson and Tammy Anderson v. United States of America · No. 0:21-cv-02088
- Jeffrey M. Bryan
- Dec. 11, 2025
Background
Plaintiff Carl Anderson, a U.S. Army veteran with service-connected disability status, presented at the Minneapolis VA Medical Center on April 25, 2018, for a paraesophageal hernia (PEH) repair — a surgery to return a herniated stomach from the chest cavity back into the abdomen. The surgery was performed by Dr. Archana Ramaswamy, described in the opinion as a highly experienced board-certified surgeon with approximately 1,000 prior hiatal hernia repair procedures. The surgery was unusually difficult due to tight scarring and an hourglass-shaped stomach displacement, lasted approximately eight hours, and required a mid-surgery switch from robotic to laparoscopic instrumentation.
Mr. Anderson deteriorated rapidly over the following days. On April 26, emergency exploratory surgery revealed and repaired a leak in his stomach. On April 27, a third surgery revealed necrosis (tissue death) of his upper stomach and lower esophagus. Dr. Ramaswamy contacted Dr. Madhuri Rao, a thoracic surgeon on call under a contractor arrangement, who was simultaneously performing surgery at a university hospital. Dr. Rao recommended transfer. Dr. Ramaswamy prepared Mr. Anderson for transfer by cutting across his mid-stomach, leaving the necrotic upper portion in his body connected to the necrotic esophagus, and sealing his abdomen with a temporary vacuum dressing. He was transported by North Memorial Ambulance (a contractor), whose oxygen-monitoring equipment was not functioning during transport. Mr. Anderson arrived at the University of Minnesota's Fairview Hospital near death, with oxygen saturation in the 30% range. He underwent more than twelve subsequent surgeries. As of the filing, he has an open abdominal wound requiring weekly treatment.
Plaintiffs filed administrative claims with the VA in March 2020 under the Federal Tort Claims Act (FTCA), 28 U.S.C. § 2671 et seq. — a statute waiving the federal government's usual immunity from suit for certain negligent acts by its employees. The VA denied those claims. Plaintiffs filed suit in September 2021.
The Government's Motion
The government moved to dismiss (for lack of subject-matter jurisdiction) or, in the alternative, for summary judgment (arguing no genuine dispute of material fact existed on the merits). The motion targeted all three of Plaintiffs' negligence theories: (1) Dr. Ramaswamy's alleged cutting of Mr. Anderson's left gastric artery during the April 25 PEH repair; (2) her alleged failure to remove necrotic tissue when she discovered it on April 27; and (3) her alleged decision to transfer Mr. Anderson when he was not medically stable.
The government raised three jurisdictional arguments against the second and third theories, and a separate summary judgment argument against all three.
Ruling on Motion to Dismiss
Administrative Presentment
The FTCA requires a plaintiff to file an administrative claim with the relevant federal agency before suing in court, 28 U.S.C. § 2675(a). The government argued that Plaintiffs' administrative claim addressed only the cut blood vessel theory and did not encompass the failure-to-remove-necrotic-tissue or unstable-transfer theories.
The court rejected this argument. Applying the Eighth Circuit's pragmatic standard from Mader v. United States, 654 F.3d 794 (8th Cir. 2011), which requires only that the administrative claim give the agency sufficient information to investigate and include a damages amount, the court found that Plaintiffs' administrative filing described the April 27 events in detail: Dr. Ramaswamy discovering necrosis, being unable to access the distal esophagus, consulting Dr. Rao, and transferring Mr. Anderson in critical condition with an open abdomen. The court held this was more than sufficient to allow "a legally trained reader" to anticipate the legal theories now asserted, citing Edwards v. United States, 57 F. Supp. 3d 938, 949 (D. Minn. 2014).
Contractor Exception
The FTCA excludes claims based on acts of independent contractors, 28 U.S.C. § 2671. The government argued that the second and third theories really concerned the conduct of Dr. Rao and North Memorial Ambulance — both contractors — rather than Dr. Ramaswamy.
The court rejected this as a mischaracterization of the complaint. Plaintiffs sued only over Dr. Ramaswamy's conduct. Dr. Rao is not a defendant. The court stated that the government's arguments about Dr. Rao being an intervening or superseding cause were defenses to the elements of duty or causation, not a basis for a jurisdictional bar. Because Plaintiffs' claims concerned a government employee, the contractor exception was inapplicable.
Discretionary Function Exception
The FTCA also retains government immunity for claims "based upon the exercise or performance or the failure to exercise or perform a discretionary function or duty," 28 U.S.C. § 2680(a). Courts apply a two-step test: (1) did the challenged conduct involve an element of judgment or choice; and (2) was that judgment of the kind grounded in social, economic, or political policy that Congress intended to protect from judicial review? United States v. Gaubert, 499 U.S. 315 (1991).
The parties agreed the first step was satisfied (Dr. Ramaswamy's decisions involved judgment). The court held the second step was not satisfied. Citing multiple circuits and district courts, the court concluded that the discretionary function exception is designed to shield legislative and governmental policy decisions, not garden-variety medical malpractice. Dr. Ramaswamy's decisions about whether to remove necrotic tissue and whether Mr. Anderson was stable for transfer were grounded in professional medical judgment, not governmental policy. The court therefore retained jurisdiction.
Ruling on Motion for Summary Judgment
Expert Opinion
As a threshold issue, the government argued the court should disregard the report of Plaintiffs' replacement expert, Dr. Nikolai A. Bildzukewicz, on the ground that it exceeded the scope of the prior expert's opinions — the Magistrate Judge had conditioned the substitution on the replacement expert staying within the original expert's scope. The court disagreed, finding Dr. Bildzukewicz's three opinions (on the left gastric artery, failure to remove necrotic tissue, and unstable transfer) corresponded to the same three theories offered by the withdrawn expert, Dr. Daniel Tseng. To the extent any portion exceeded that scope, Plaintiffs agreed not to offer those opinions at trial. The court allowed reliance on the report.
The court also noted that the government made passing references to Federal Rules of Civil Procedure 37 and Evidence 702 but filed no formal motions under those rules with developed arguments; accordingly, the court declined to address exclusion under those rules.
Summary Judgment Standard
Summary judgment is appropriate only where there is no genuine dispute of material fact and the movant is entitled to judgment as a matter of law, Fed. R. Civ. P. 56(a). The court must view evidence in the light most favorable to the non-moving party. The court emphasized that even in a non-jury (bench trial) case under the FTCA, it cannot resolve factual disputes on summary judgment as if it were conducting a bench trial, citing Avenoso v. Reliance Standard Life Ins. Co., 19 F.4th 1020 (8th Cir. 2021).
Elements of Medical Malpractice Under Minnesota Law
Because the FTCA requires application of the substantive law of the state where the tort occurred, Minnesota malpractice law applies. Under Minnesota law, a plaintiff must establish: (1) the applicable standard of care; (2) the defendant's departure from that standard; and (3) that the departure directly caused the patient's injury. Becker v. Mayo Found., 737 N.W.2d 200 (Minn. 2007). All three elements typically must be established through expert testimony.
Standard of care
The court found genuine factual disputes on this element. Dr. Bildzukewicz opined, among other things, that the standard of care requires identification of and care to avoid the left gastric artery during PEH repair, that necrotic tissue must be removed as quickly as possible to achieve "source control" (stopping the source of infection), and that treating physicians bear full responsibility for assessing a patient's stability for transfer. The government's expert agreed that avoiding injury to the left gastric artery is required but viewed cutting it as a known risk of the procedure. The court found these differences of opinion on the standard of care were for the fact-finder.
Departure from the standard of care
The court identified substantial evidence creating fact questions. On the left gastric artery theory: Dr. Ramaswamy acknowledged she "didn't pay very close attention" to the left gastric artery during the eight-hour surgery; her own post-operative differential diagnosis included gastric necrosis (which Plaintiffs' expert noted is rare after PEH repair); and post-operative imaging showed surgical clips that Plaintiffs' expert opined were consistent with having divided the artery. On the necrotic tissue theory: Dr. Ramaswamy's own statement confirmed she left the necrotic upper stomach attached to the necrotic esophagus; Dr. Rao testified she instructed Dr. Ramaswamy to exclude or remove the necrotic portion; and Dr. Bildzukewicz opined that Dr. Ramaswamy, as an experienced foregut surgeon, could have explored and resected the necrosis. On the transfer theory: Dr. Bildzukewicz opined Mr. Anderson was "clearly too unstable" for transfer, citing continued reliance on two vasopressors, mechanical ventilation with high oxygen requirements, and large undrained bilateral pleural effusions.
Causation
The court found that Plaintiffs' expert adequately described the causal chain: the compromised left gastric artery caused gastric necrosis; failure to remove necrotic tissue allowed ongoing septic shock; and transferring an unstable patient exposed him to a prolonged period of hypoxia, causing him to arrive at Fairview "in extremis." Dr. Bildzukewicz opined that all three departures were "significant factors that proximately caused the substantial and continued disability" of Mr. Anderson. The court found this sufficient to create genuine fact questions on causation, noting that Plaintiffs are not required at summary judgment to exclude all other possible causes.
Disposition
The court denied Defendant United States of America's Motion to Dismiss or for Summary Judgment in its entirety. The case will proceed toward trial. Under the FTCA, the trial will be a bench trial (before the judge, without a jury), and only money damages — not punitive damages — may be awarded.
Read the full 32-page opinion on CourtListener, the free public archive maintained by the Free Law Project.