Gochenour v. United States

Background

Vicki Sue Gochenour sued the United States individually and as executrix of the estate of Guy Gochenour under the Federal Tort Claims Act. The complaint alleged that healthcare practitioners at Middletown Community Health Center, a federally funded medical provider, committed medical malpractice by failing to properly treat and care for Guy Gochenour’s hepatocellular carcinoma, a type of liver cancer. Guy Gochenour died from that cancer on October 25, 2018.

The dispute focused in part on his August 2017 visit to the medical center. Laboratory tests showed elevated liver-related results. Nurse Practitioner Joyce Hill testified that she told him and Vicki Sue Gochenour about the abnormal results, explained that they could indicate a serious problem, and advised him to see a gastroenterologist. Those conversations and a timely referral were not documented in the medical chart, and the parties disputed whether they occurred. The medical records later showed that referrals were requested in December 2017, after a scan revealed a large liver mass.

Plaintiffs’ experts opined that the medical center departed from the applicable standard of care and that an earlier diagnosis could have increased Guy Gochenour’s chance of survival or allowed earlier palliative care. The United States’ expert disagreed about the effect of the delay, including whether earlier palliative care would have improved his quality of life and whether the delay substantially reduced his chance of survival.

Motions and legal standard

Both sides sought partial summary judgment under Federal Rule of Civil Procedure 56. Summary judgment is appropriate when the evidence shows no genuine dispute over a fact that matters to the outcome and the moving party is entitled to judgment as a matter of law. The court must not weigh evidence or decide witness credibility at this stage; those matters generally belong to the jury.

Applying New York substantive law, the court explained that a medical-malpractice plaintiff must show both a breach of the applicable medical standard and proximate cause—meaning that the breach was a substantial factor in causing the injury. Expert medical evidence was generally required for both elements in this case.

Plaintiffs’ motion

Plaintiffs sought summary judgment on whether the medical center departed from the standard of care in 2017 and whether that departure deprived Guy Gochenour of earlier palliative care, causing additional pain and suffering.

The court denied the motion on the standard-of-care issue. Nurse Hill’s testimony directly contradicted plaintiffs’ claim that she failed to notify Guy Gochenour and Vicki Sue Gochenour about the abnormal results or failed to refer him to a specialist. The court also found that the competing expert testimony did not establish the issue as a matter of law. Whether Nurse Hill’s testimony was credible was for a jury to decide.

The court also denied summary judgment on the claim that earlier palliative care would have improved Guy Gochenour’s quality of life. The parties agreed that an earlier diagnosis would have led to earlier palliative treatment, but they disagreed about whether that earlier treatment would have produced a meaningful benefit. The court found a genuine dispute of material fact on that question.

United States’ cross-motion

The United States sought partial summary judgment on causation related to the medical care provided in August 2017. It argued that the evidence showed the alleged delay reduced Guy Gochenour’s estimated five-year survival chance only from between 5% and 10% to between 0% and 5%, and therefore did not amount to a substantial loss of a chance of a better outcome.

The court granted the United States’ cross-motion. It held that New York’s loss-of-chance doctrine requires evidence of a substantial possibility of a better outcome, even though the lost chance need not exceed 50%. The court concluded that plaintiffs’ expert described only a small and speculative chance of survival—less than 10%—and did not provide evidence from which a reasonable jury could find a substantial loss of the chance of survival. The court rejected plaintiffs’ argument that reducing a 10% chance to as low as 0% represented a complete loss of that chance, explaining that the evidence showed a 5% reduction and that some chance of survival remained.

Disposition

The court denied Plaintiffs’ motion for partial summary judgment and granted Defendant’s cross-motion for partial summary judgment. The order did not state that either motion was granted or denied with or without prejudice. The court directed the parties to appear for a telephonic pretrial conference and directed the clerk to terminate the two motions.