THOMAS B. RUSSELL, Senior District Judge.
On the damp afternoon of January 25, 2012, Plaintiff Regina Ann Fulcher traveled to the United States Post Office located at 225 West Broadway in Mayfield, Kentucky, ("the Post Office"), to check her mail. When she entered through the wheelchair accessible door, she stepped onto a floor mat allegedly saturated with rain, causing her to slide, lose her balance, and fall forward onto the wet floor. She struck a display shelf before ultimately landing on her right side. Fulcher contends that as a result of this fall, she suffered serious and permanent injuries to her right side and right foot.
Fulcher brings this lawsuit against the United States pursuant to the Federal Tort Claims Act ("FTCA"), 28 U.S.C. § 2671 et seq. She alleges that the Government, though employees of the United States Postal Service ("USPS"), failed to exercise ordinary care by neglecting to replace the wet floor mat with a dry one. She also alleges that USPS employees negligently failed to comply with agency regulations requiring the use of signs to caution customers of a wet floor. (Docket No. 1, ¶¶ 7-12.)
A bench trial was conducted before this Court on December 30, 2014 to resolve Fulcher's claims. Having considered the testimony of various witnesses, the exhibits admitted into evidence on behalf of both parties, the arguments of counsel, and the remainder of the record, the Court finds as follows.
1. This case involves a slip and fall at the Mayfield, Kentucky Post Office operated by the United States Postal Service. The accident from which this action arises
2. A rubber-bottomed, corrugated floor mat sits just inside the entrance from the wheelchair ramp to the Post Office lobby. These floor mats were provided by a commercial rental company, which was contracted to replace them approximately twice weekly during the winter months.
3. The USPS Supervisor Safety Handbook requires supervisors to ensure that employees abide by certain procedures to prevent potential slip, trip, or fall accidents. Specifically, postal employees should "secure carpets, rugs, and mats" and "[a]rrange them to prevent slipping. Repair or replace those with wrinkles, turned up edges, or tears." The manual provides further guidelines concerning wet floors, instructing employees to maintain a dry area for pedestrian traffic and requiring them to mop any excessive moisture on lobby floors. Employees are further required to rope off wet areas with wet floor signs or high visibility safety barricades. (Handbook EL-801, Plaintiff's Trial Exhibit 12.)
4. Additional safety instructions require USPS employees to "[i]nspect floor mats often. If curling occurs ... tape down the edges with pressure-sensitive or duct tape to prevent tripping." Employees are further advised to provide extra mats at customer entrances during inclement weather. (Handbook MS-10, Plaintiff's Trial Exhibit 13.)
5. At approximately three o'clock in the afternoon, Fulcher entered the Post Office from the wheelchair ramp entrance, where the floor mat was positioned. She testified that the weather was "misting" at this point in the afternoon. Upon Fulcher's first step onto the floor mat, she slipped and fell forward onto the wet floor, striking the display shelf before landing on her right side. She described her fall as follows: "I came up the wheelchair ramp. I opened the door. I stepped in. The — I stepped in on the rug, slid. I fell, landed on my right side, hit my shoulder up against the display shelf.... I hit the floor." After the fall, Fulcher noticed that accumulated moisture had accumulated on both the floor mat and the floor itself and concluded that this accumulation caused her fall. She then arose and walked to her post office box to retrieve her mail.
6. No named witnesses observed the accident or complained of a wet floor. However, Stan Rogers, a postal employee, was stationed at the customer service desk at the time of Fulcher's fall. As Rogers served customers, he heard a noise in the lobby and observed a woman stand up from the floor. (Stan Rogers Statement, Plaintiff's Trial Exhibit 15.)
7. No warning signs cautioned customers of the wet floor.
8. Fulcher then left the Post Office and returned to the truck where her husband, Larry Wayne Fulcher, had been waiting for her. Fulcher shared the story of her accident with her husband, who then entered the building and noticed that the floor mats and the surrounding surfaces were wet and observed footprints on the floor. He testified that when he stepped on the floor mat, he "could see water on the inside sole of [his] shoe." No customers, including Fulcher, complained that day of a wet floor or rain-saturated rug. However, Larry Fulcher spoke with a postal employee who advised him that the janitor was not working that day. The Post Office's janitorial service was generally limited to approximately four hours each day, from eight o'clock in the morning until noon.
9. The following day, Fulcher returned to the Post Office and reported her accident to USPS customer service supervisor Amanda Wallace, who was not typically assigned to the Mayfield branch but occasionally
10. Wallace recorded the circumstances that Fulcher conveyed to her as follows: "Aprox. 3 pm on 1-25 — 12 came in door w/wheelchair ramp — had been raining — floor was wet — rug was there. She states no sign said wet floor — shoes — diabetic shoes — black (I looked at her shoes. Slipped on wet floor. Rug slipped as soon as she walked on door — boom — went down — no one assisted — states Stan saw her fall." (Plaintiff's Trial Exhibit 14.)
11. Wallace prepared the required accident investigation worksheet and report for the USPS following her interview with Fulcher. On the forms, Wallace indicated that the weather was rainy and that the surface condition was wet. Wallace recorded Fulcher's complaints of shoulder pain; no mention was made of foot or ankle injury. (USPS Accident Investigation Worksheet, Plaintiff's Trial Exhibit 10; USPS Form 1769/301 Accident Report, Plaintiff's Trial Exhibit 11.)
12. Fulcher testified that subsequent to the fall, her foot began to hurt. Medical records indicate that Fulcher had previously complained of right foot pain in November 2010 and March 2011, when her internist, Dr. Patrick Finney, ordered x-rays of the foot. (Medical Records of Dr. Finney, Defendant's Trial Exhibit 18.)
13. On January 27, 2012, Fulcher was seen at Dr. Finney's office, where she treated with Nurse Practitioner Amanda Hale. The resultant medical records indicate that Fulcher reported having fallen two days prior and complained pain in both shoulders and down the right side of her body.
14. On March 6, 2012, Fulcher was seen by pulmonologist Dr. Jeffrey S. Clarke for follow-up care regarding a previous lung surgery. Although Fulcher reported her fall to Dr. Clarke, the medical record from this appointment reflects no mention of either the accident or any foot pain. (Medical Records of Dr. Clarke, Defendant's Trial Exhibit 21.)
15. Fulcher again presented to Nurse Practitioner Hale on March 7, 2012, with complaints of side pain from her previous fall. Hale also noted "questionable claudication" related to "[d]ark pigmented areas on bilateral ankles and feet." (Docket No. 15-1, Deposition of Amanda Hale, Defendant's Exhibit 3.) Dr. Finney ordered a bone scan of Fulcher's right foot. (Docket No. 15-1, Deposition of Amanda Hale, Defendant's Exhibit 3.) This record does not indicate that Fulcher complained of foot or ankle pain resulting from her accident.
16. Fulcher underwent a three-phase bone imaging of the foot on April 13, 2012.
17. On June 4, 2012, Fulcher was treated by Nurse Practitioner Barbara Finney for continued complaints of side pain resulting from her fall. Nurse Practitioner Finney noted a rash on Fulcher's right foot and right axilla, prescribed an anti-itching medication, and ordered a bone density study and arterial studies of Fulcher's right lower extremities. The record does not indicate that Fulcher complained of an injury to her foot associated with a fall.
18. On September 5, 2012, Fulcher reported continued pain and swelling in her right foot to Nurse Practitioner Finney, who ordered an x-ray of the ankle. (Plaintiff's Trial Exhibit 5I.) The subsequent report indicated an "[i]ndeterminate age medial malleolus fracture" that "appear[ed] to be chronic though there is overlying soft tissue edema." (Plaintiff's Trial Exhibit 5-J.)
19. Dr. Finney ultimately referred Fulcher to Dr. Adams of the Orthopaedic Institute of Western Kentucky. On October 8, 2012, Dr. Adams ordered x-rays on her right ankle, tibia-fibula, and right foot. He diagnosed a "nondisplaced medial malleolus fracture" and prescribed immobilization of Fulcher's right leg using a pneumatic walking boot that extended up to her kneecap. (Plaintiff's Trial Exhibit 5-L.) Dr. Adams conducted monthly follow-up examinations of Fulcher until February 8, 2013.
20. At a second visit with Dr. Adams on November 5, 2012, Fulcher complained of continued ankle pain. X-rays continued to reflect a nondisplaced fracture with no significant increase in consolidation. (Plaintiff's Trial Exhibit 5-M.)
21. Fulcher reported continued pain at her next visit, and x-rays indicated no significant healing of the fracture. As a result, Dr. Adams ordered an MRI evaluation of Fulcher's right ankle on December 20, 2012. (Plaintiff's Trial Exhibit 5-N.)
22. Dr. Harold Halfhill of the Orthopaedic Institute reported the results of the MRI, finding a nonunited fracture involving the medial malleolus with minimum displacement. Dr. Halfhill reported that because the MRI reflected "[n]o associated marrow edema[,] suggesting this is at least several weeks to months in age." (Plaintiff's Trial Exhibit 5-O.)
23. During an office visit on January 11, 2013, Fulcher complained of continued pain in her right ankle and reported that the immobilization regimen had not improved her pain. For the first time, Dr. Adams reviewed Fulcher's MRI with her and presented her with two treatment options: either long-term ankle bracing or surgery to extract the fractured fragment and reattach her deltoid ligament.
25. On December 4, 2013, Dr. Marissa Stewart-Jaynes of Mercy Primary Care-Paducah also recommended that Fulcher undergo physical therapy. Fulcher began a physical therapy regimen on January 7, 2014, which lasted until March 5, 2014. (Plaintiff's Trial Exhibit 5U.)
26. Although Fulcher now reports improved strength, she alleges that her ankle pain persists.
27. Fulcher's medical records dating prior to her accident indicate a history of swelling and other issues with her right foot. On a March 1, 2011, appointment at Dr. Finney's office, Fulcher complained of swelling in her right foot. (Docket No. 15-1, Deposition of Amanda Hale, Defendant's Exhibit 4.) Dr. Finney ordered an x-ray of the right foot. She underwent x-rays on two separate pre-fall occasions, the first on January 27, 2006, and the second on March 10, 2011. Neither indicated a fracture of either her right ankle or her right foot. Nurse Practitioner Hale postulated that Fulcher's well-settled diagnoses of diabetes and osteoporosis rendered her vulnerable to such chronic foot injuries, even without a traumatic triggering event. (Docket No. 15-1, Deposition of Amanda Hale, at 62, 73.)
28. On December 7, 2012, Fulcher timely submitted an administrative claim form SF95 to the USPS for $47,417.02, including $12,385.46 for medical expenses and $35,000.00 for personal injury. (Form SF95-109, Plaintiff's Trial Exhibit 3.) The USPS denied her claim on March 15, 2013. Fulcher then submitted a request for reconsideration on March 20, 2013, which was denied nine days later. The instant lawsuit was timely commenced on September 20, 2013.
29. Fulcher now seeks to recover sums exceeding the amount designated in her administrative claim. She alleges that additional medical needs caused her expense to increase from $12,385.46 to approximately $14,056.86 — a difference of $1,671.40. Throughout Fulcher's treatment, her care was covered by a BlueCross Medicaid Advantage insurance policy, and its payments were generally accepted as payment in full. (See Plaintiff's Trial Exhibit 7, Itemized Medical Expenses.)
The Court must now determine whether Fulcher has proven her negligence case.
1. Claims against the United States are generally barred except for those tort claims for which Congress has waived sovereign immunity and granted consent for the United States to be sued. Therefore, Fulcher's exclusive remedy against the United States is pursuant to the Federal Tort Claims Act. See 28 U.S.C. § 2679.
2. Pursuant to 28 U.S.C. § 1346(b)(1), the Court will determine liability "in accordance with the law of the place where the act or omission occurred." 28 U.S.C. § 1346(b)(1). Because Fulcher's injury occurred in Mayfield, Kentucky, Kentucky negligence law applies.
3. Fulcher claims that the USPS was negligent in its duty to maintain safe facilities. For Fulcher to prevail, she must prove (1) a duty of care owed by the defendant, (2) a breach of that duty; and (3) actual and proximate causation of an injury to the plaintiff. Helton v. Montgomery, 595 S.W.2d 257, 258 (Ky.App.1980); Mullins v. Commonwealth Life Ins. Co., 839 S.W.2d 245, 247 (Ky.1992).
4. Kentucky law does not render an establishment absolutely liable to invitees onto its premises; however, it must exercise ordinary care to prevent injuries. The USPS owes a duty to its patrons to maintain its premises in a reasonably safe condition. Rogers v. Professional Golfers Ass'n of America, 28 S.W.3d 869 (Ky.App.2000). Specifically, Kentucky law requires a property owner to exercise reasonable care to protect invitees from hazardous conditions that he was aware of or should have discovered and that the invitee could not be expected to discover. Under Kentucky law,
See Lanier v. Wal-Mart Stores, Inc., 99 S.W.3d 431, 432-33 (Ky.2003) (quoting Restatement (Second) of Torts § 343 (A.L.I. 1965)).
5. The Post Office, as a possessor of land, had an affirmative duty to maintain the entryway in a reasonably safe manner for its patrons. This duty required the Post Office to discover unreasonably dangerous conditions on its premises and either correct them or warn of them.
6. Admittedly, no medical evidence suggests that plaintiff suffered an actual fracture of the foot until September 12, 2012, eight months after her fall. Despite this delay, however, a preponderance of the evidence suggests that the unsafe conditions at the Post Office were as substantial factor in causing both Fulcher's accident itself and the injuries she subsequently sustained.
7. The Government objects to the admission of Dr. Adams' testimony, arguing that he could not provide legal causation. Because the Court disagrees, it will admit Dr. Adams' testimony. A plaintiff must prove medical causation by a reasonable medical probability by using expert medical testimony. Brown-Forman Corp. v. Upchurch, 127 S.W.3d 615, 621 (Ky.2004). Nevertheless, a physician need not use particular "magic words" to signal that such reasonable medical probability exists. Id. Instead, the Court will look to the "quality and substance" of a physician's testimony to determine "whether it rises ... to the level necessary to prove a particular medical fact." Id. (citing Turner v. Commonwealth, 5 S.W.3d 119, 122-23 (Ky.1999)). Kentucky courts apply a "totality of the medical testimony" standard, wherein "terms such as `distinct possibility' and `high likelihood' [go] beyond speculation and [amount] to substantial evidence of causation." Baylis v. Lourdes Hospital, Inc., 805 S.W.2d 122, 125 (Ky.1991) (citing Stauffer Chemical Co. v. Greenwell, 713 S.W.2d 825 (Ky.App. 1986)).
8. Although Dr. Adams admitted that he had "no way to definitively prove" that the alleged fall caused Fulcher's ankle injury, Dr. Adams stated that such an outcome was "certainly possible," "certainly reasonable," and "consistent with her history."
9. The Government further argues that Fulcher failed to properly disclose Dr. Adams as a retained expert and did not submit an expert report pursuant to Federal Rule of Civil Procedure 26(a)(2). To determine whether a plaintiff must disclose a treating physician as an expert, a court must consider the fundamental "scope of the proposed testimony." Fielden v. CSX Transportation, Inc., 482 F.3d 866, 871 (6th Cir.2007). "[A] report is not required when a treating physician testifies within a permissive core on issues pertaining to treatment, based on what he or she learned through actual treatment and from the plaintiff's records up to and including that treatment." Id. Here, no evidence indicates that Dr. Adams speculated beyond what he observed during his treatment of Fulcher, nor did he form opinions outside the scope of his medical training. Furthermore, any arguable breach of Rule 26(a) did not prejudice the Government, which was amply prepared to cross examine Dr. Adams regarding both medical causation and whether his deposition would constitute expert testimony. See Federal Rule of Civil Procedure 37(c)(1) (allowing the admission of undisclosed expert testimony if "harmless" to the opposing party).
10. Finally, the Court considers whether Fulcher may seek damages exceeding the amount of her administrative claim in light of what she characterizes as newly discovered intervening facts. The instant complaint alleges medical damages of $14,056.86, an increase of $1,671.40 beyond what she alleged on the administrative claim form. Fulcher maintains that at the time she presented her claim to the USPS on December 10, 2012, she remained unaware of the additional medical expenses she would incur. Namely, she contends she did not learn of her future treatment alternatives, including surgery and long-term ankle bracing, until January 11, 2013. Because she did not yet realize the full extent of her expenses when she filed the initial administrative claim, the Court will allow her to recover damages in excess of the original amount she sought.
11. Fulcher's ability to seek damages beyond those named in her administrative claim hinges upon whether her subsequent care constitutes newly discovered evidence. The Federal Tort Claims Act addresses this question, providing in relevant part:
28 U.S.C. § 2675(b). Fulcher must thus show intervening facts or newly discovered evidence. Allgeier v. United States, 909 F.2d 869, 877 (6th Cir.1990) (citing Kielwien
12. Allgeier sets forth the Sixth Circuit's exacting standard of what constitutes an "intervening fact." Similar to Fulcher's own position, Allgeier involved a plaintiff's administrative claim filed pursuant to the Federal Tort Claims Act. When the district court permitted the plaintiff to increase the amount of her claim, the Government moved to reduce the award to the sum specified in her administrative complaint. The district court denied the Government's motion, concluding that the plaintiff did not know the full extent of her injuries and medical expenses at the time that she filed the administrative claim. Although the Sixth Circuit ultimately upheld the district court's determination in Allgeier, it emphasized that the medical condition at issue improved immediately before she filed her claim — but contrary to her physician's prognosis, the plaintiff's condition worsened significantly over a year after the claim had been filed. This unforeseen and unexpected turn for the worse constituted an "intervening fact," thus satisfying the narrow category of circumstances that do not offend the statute's requirements.
13. Here, Fulcher's initial claim sufficiently advised the USPS that she experienced an ankle fracture resulting in swelling and continual pain that required further treatment. The Court agrees that the information gained from the MRI constitutes newly discovered evidence: at the time she filed the claim, Fulcher had been diagnosed with only a nondisplaced fracture and had not yet undergone the MRI that would reveal her minimal displacement. (See Docket No. 19-1, Record of Dr. Adams, October 8, 2012; Docket No. 21-3, Report of Dr. Harold L. Halfhill, December 20, 2012.) At this stage, Dr. Adams had not mentioned the possibilities of surgery, long-term bracing, or physical therapy; only upon reviewing the MRI on January 11, 2013, were such options discussed. (Docket No. 21-4, Report of Dr. Adams, January 11, 2013.) At this time, Fulcher had no reason to doubt the conservative course of treatment that Dr. Adams initially prescribed and that more aggressive treatment was not reasonably foreseeable.
14. What is more, the claim form itself arguably misled Fulcher by suggesting that she should submit only the "known facts and circumstances attending the ... injury." (See USPS Standard Form 95, Plaintiff's Trial Exhibit 3.) This language impliedly instructed Fulcher to limit her claims to only the injuries and requisite treatment that had been established at the time of its submission. Moreover, the form warns of potential criminal penalties associated with making false statements to a federal agency, reiterating the definite standard apparently demanded by the USPS. (See USPS Standard Form 95, Plaintiff's Trial Exhibit 3 (warning that a $10,000 fine and five years of imprisonment could result from presenting a fraudulent claim).) Fulcher could reasonably have assumed that any amounts exceeding those she had already incurred would have been improper-even potentially illegal.
15. Fulcher noted in her administrative claim that additional tests were forthcoming. In the administrative claim she submitted to the USPS in December 2012, she indicated the following as the basis of her claim:
(See Docket No. 19-1.) This annotation afforded the Government with some notice, however vague, that costs beyond those listed could accrue.
16. In light of the above analysis, the Court concludes that Fulcher's additional treatment constitutes newly discovered evidence or an intervening fact and that she may therefore recover sums exceeding those indicated in her administrative claim.
17. Kentucky's collateral source rule permits Fulcher to recover those amounts charged by her medical providers without reduction by payments made on her behalf by her insurance carrier. As the Kentucky Supreme Court has noted, the fact that a public insurance program contracted with a physician to provide discounted care does not relieve a tortfeasor from negligence or the duty to pay the reasonable value of the resultant medical expenses. Instead, the plaintiff may seek recovery for the reasonable value of medical services without consideration of insurance
18. The Court will award Fulcher money damages that fairly and reasonably compensate her for the injuries that resulted from her fall, including the $14,186.86 in total medical bills that she has reported. (Plaintiff's Trial Exhibit 7, itemizing Fulcher's medical expenses.) Moreover, the Court concludes that Fulcher is entitled to an award for past and/or future pain and suffering in the amount of $15,000.
(Plaintiff's Trial Exhibit 5-Q.)
(Docket No. 23-2, Dr. Adams Deposition, at 15:22-17:17.)
(Docket No. 24-1 at 46-48.) Fulcher, however, had no knowledge that this course of treatment was in store.