MARTIN L.C. FELDMAN, District Judge.
Before the Court are two motions by Alliance Marine Services, LP: (1) motion for partial summary judgment on the
This lawsuit arises from a seaman's claim that he injured his lower back during a rescue drill operation.
In the summer of 2015, Gary Youman was hired several days after applying for employment with Alliance Marine Services, LP. In his employment application, Mr. Youman denied having any "physical handicap" or illness that may affect his work. As part of the hiring process, AMS sent Mr. Youman for a United States Coast Guard Pre-Employment Physical. In completing a medical history form as part of this examination, Mr. Youman denied any history of back injuries or back pain. AMS submits that it relied upon the medical history form in hiring Mr. Youman.
About one year into his employment, on July 29, 2016, Mr. Youman asserted that he was injured during a Fast Response Craft drill, claiming that he hurt his back when he was thrown to the deck of the vessel during the drill.
On August 5, 2016, Mr. Youman was diagnosed with a lumbar sprain. AMS retained Aucoin Claims Service, Inc. to investigate Mr. Youman's alleged injury and administer any necessary maintenance and cure benefits.
AMS was in frequent contact with Mr. Youman after the alleged injury. AMS attempted to have a claims adjuster meet with Mr. Youman to help determine his financial situation and assess what happened on board the Fast Response Craft. The claims adjuster, Patrick Aucoin, spoke with Mr. Youman on the telephone and a meeting was scheduled for August 26, 2016. The day before the meeting, Mr. Youman cancelled the appointment. On August 29, 2016, Mr. Youman retained an attorney. AMS informed Mr. Youman's attorney that its authorization for Mr. Youman to treat with Dr. Amy Thompson was "under protest," but still agreed to provide prompt payment for his treatment.
After the alleged incident, AMS began maintenance payments of $35.00/day and funded Mr. Youman's medical care. During its investigation, AMS learned that Mr. Youman began having back pain, starting in late 2012 (after presenting to the emergency room after an injury at work) and lasting through at least 2013 or mid-2014.
On May 21, 2013, Mr. Youman slipped on the galley deck of a Maersk vessel, claiming to injure his back again. On July 1, 2013, Maersk sent Mr. Youman to George Washington Hospital, where he reported constant pain since May 21 at a 9/10 level and that "nothing help[s]." The doctors at George Washington believed Mr. Youman had a "low back strain," and opined that "he cannot return to work at this time given his level of discomfort." On July 3, 2013, Mr. Youman was admitted to the emergency room at Orange Park Medical Center in Jacksonville, complaining of abdominal pain; he reported chest pain and shortness of breath, which he attributed to his back pain.
On July 24, 2013, Mr. Youman was treated for the first time at Southern Orthopedic by Dr. Heekin. He claimed to have pain at the level of 10/10, and he described the pain as persistent and radiating into his upper back, and aggravated by climbing stairs, bending, lifting, lying/rest, sitting, standing, and straining. Dr. Heekin's diagnosis was "lumbar spondylosis without myelopathy: likely facetogenic versus annular tear.
On August 30, 2013, Mr. Youman was examined by Dr. Heekin for his low back pain; he complained of lumbar spine pain on an 8/10 level, describing the pain as persistent and included ache and discomfort. He noted that physical therapy was not helping, and he requested the doctor's prognosis to assist with "ongoing litigation issues."
In December 2013 and January 2014, a few weeks after joining Liberty Maritime, Mr. Youman complained of pain in his left thigh; he was diagnosed with an ACL tear in early 2014, leading to arthroscopic knee surgery in November 2014. Mr. Youman admitted to concealing a prior 2001 knee injury in college and his later knee injury at Crowley on his Seaman's Declaration of Health, and the Crowley injury was discovered by Liberty, which sought reimbursement and recommended that Mr. Youman be permanently suspended from sailing with Liberty Maritime.
On July 14, 2014, Mr. Houman completed a medical history questionnaire to secure a "declaration of fitness for duty" for employment by Overseas Ship Management, Inc. On the fitness for duty form, Mr. Youman denied having back or neck pain, and he denied ever having any injury or illness for which he received medical treatment exceeding seven days.
On August 3, 2014, Jacksonville Fire and Rescue was called to Mr. Youman's house where Mr. Youman appeared to be having a panic attack or emotional breakdown. The EMT records indicate that "the patient states the [sic] he has had chest and back pain for three years[,]" but the EMT on scene could not confirm whether Mr. Youman was having back pain on that date. The next day, Mr. Youman was admitted for treatment at TBJ Behavior Center a/k/a River Point Behavioral. The River Point Discharge Summary indicates excessive alcohol consumption had initiated Mr. Youman's breakdown, and that "[t]he patient endorsed all symptoms of depression[.]" His treatment included medication management and group therapy, and he was prescribed 500 mg of Tylenol three times per day as needed for pain. Among the discharge diagnoses indicated by Dr. Thomas Thommi, Mr. Youman was diagnosed with "low back pain," "major depressive disorder," and "alcohol abuse." However, Dr. Thommi testified in this litigation that he listed "low back pain" as a past history complaint, not a present diagnosis.
On August 21, 2014, Mr. Youman completed a merchant mariner medical history form in which it appears that he wrote "injury lower back resolved." On a December 10, 2014 Merchant Mariner Credential Medical Evaluation Report, used to determine whether an applicant seeking to renew a credential is physically capable of performing their duties, Mr. Youman denied a history of chest pain, limitation of any major joint, joint surgery, recurrent back pain, depression, anxiety, alcohol or substance abuse, and any psychiatric disease or counseling. He acknowledged a back injury in July 2013, but he noted "no treatment (p.t.) since 8/2013 for lower back."
After the alleged injury on the rescue boat while working for AMS on July 29, 2016, Mr. Youman came under the care of Dr. Donald Dietze, who made a medical causation determination in his first meeting with Mr. Youman that his low back and intermittent leg pain was attributable to his alleged work injury on July 29, 2016; Dr. Dietze recommended surgery. During his deposition testimony, Dr. Dietze admitted that he made the medical causation determination without having viewed the video of the incident, but stated that he was shown the video prior to his deposition testimony. Dr. Dietze admitted that he made the medical causation determination without having been informed of Mr. Youman's prior lower back injury lawsuit against Maersk and his orthopedic lawsuit against Crowley. Dr. Dietze admitted that Mr. Youman never informed him that he had suffered a prior work-related injury while employed by AMS while pulling a strap from under a crate. Dr. Dietze admitted that he made no effort to inquire into Mr. Youman's past prescription history related to prior injuries. Dr. Dietze testified that he did not view the MRI results from Mr. Youman's prior back injuries in 2012 and 2013, but that he instead relied on the radiologist's report. Dr. Dietze admitted that he made the medical causation determination based in part on the assumption that Mr. Youman's 2012-2013 back injuries had resolved based in part on Mr. Youman's statements and in part on the MRI scan.
Dr. Gabriel Tender, a board-certified neurosurgeon, conducted an independent medical exam on Mr. Youman. Dr. Tender reviewed Mr. Youman's medical history, including past MRIs, and issued a report dated May 3, 2017. Dr. Tender "do[es] not believe that [Mr. Youman] has a primary pain generator in the lumbar spine[, and that] [t]here is no objective evidence of acute traumatic injury to [Mr. Youman's] lumbar spine related to the July 29, 2016 accident." Dr. Tender does not believe that the surgery recommended (and ultimately performed) by Dr. Dietze was warranted.
On October 10, 2017, Mr. Youman underwent an L4-5 anterior lumbar discectomy and artificial disc replacement performed by Dr. Dietze. Prior to the surgery, Mr. Youman's attorney requested authorization from AMS and, following the surgery, he requested reimbursement for the surgery as well as the discogram and postdiscogram CT. AMS declined to fund the surgery pending its ongoing investigation of Mr. Youman's claim for maintenance and cure.
AMS retained a radiologist, Dr. David Fakier, to review Mr. Youman's pre-incident and post-incident MRI images. Dr. Fakier reviewed the images, and opined that there were no changes in Mr. Youman's lumbar spine between the pre-incident and post-incident images. AMS declined to fund the surgery ultimately performed by Dr. Dietze in light of: its assessment of the video footage of Mr. Youman's alleged accident; Mr. Youman's abrupt refusal to be interviewed after the incident, which hindered its investigation; Mr. Youman's significant history of chronic back pain, which Mr. Youman failed to disclose; Mr. Youman's history of suing prior maritime employers for alleged injuries; the lack of evidence that Mr. Youman's back pain complaints in 2012 and 2013 were ever fully resolved; Dr. Tender's opinion that Mr. Youman suffered no traumatic injury and is not a candidate for surgery; and Dr. Fakier's opinion that there is no change in Mr. Youman's lumbar spine after comparing the pre- and post-incident MRIs.
Dr. Tender issued an Addendum Report in October 2018 in which he confirmed his initial opinion that no surgery was warranted and that Youman did not suffer any traumatic spinal injury on July 29, 2016. Dr. Tender also agreed with Dr. Fakier's interpretation of the pre-incident and post-incident MRI studies. Dr. Tender further noted that the surgery ultimately performed by Dr. Dietze did not resolve Youman's pain complaints.
Meanwhile — after Youman filed two separate lawsuits, one which he dismissed and one which was stayed
Federal Rule of Civil Procedure 56 instructs that summary judgment is proper if the record discloses no genuine dispute as to any material fact such that the moving party is entitled to judgment as a matter of law. No genuine dispute of fact exists if the record taken as a whole could not lead a rational trier of fact to find for the non-moving party.
The mere argued existence of a factual dispute does not defeat an otherwise properly supported motion.
Summary judgment is also proper if the party opposing the motion fails to establish an essential element of his case.
"Maintenance and cure is a contractual form of compensation afforded by the general maritime law to seamen who fall ill or are injured while in the service of a vessel."
Maintenance and cure may be awarded "even where the seaman has suffered from an illness pre-existing his employment."
In support of its
Youman does not dispute that the first and third elements of AMS's
Based on Youman's testimony, it is undisputed that he gave false answers regarding his history of back pain/injuries when he underwent a pre-employment physical at Concentra while applying for employment at AMS.
No genuine issue of material fact exists where a plaintiff conceals his prior injury, even if he denies having intentionally withheld the information.
As to the third element, the record demonstrates that there was a causal link between the concealed pre-existing injury to the low back and the injury Youman alleges he sustained to his low back while working for AMS. There is no factual controversy on this point: Youman does not submit any evidence that calls into question this causal link between his prior back injury and the back injury he alleges he suffered during the rescue drill operation while working for AMS. "[T]here is no requirement that a present injury be identical to a previous injury. All that is required is a causal link between the pre-existing disability that was concealed and the disability incurred during the voyage."
Youman's challenge to AMS's
The record indicates that Youman was required to submit to a pre-employment physical and to answer questions concerning his physical fitness for the job before AMS would hire him. In support of the materiality element, AMS offers the unsworn declaration of its President, John Lovell, who states under penalty of perjury that AMS relied upon Youman's representation that he had no preexisting back injuries or back pain when it hired him.
Youman also overlooks case literature instructing that the materiality evidence present on this record supports AMS's submission that it is entitled to judgment as a matter of law on this issue. To be sure, the Fifth Circuit instructs that "[t]he fact that an employer asks a specific medical question on an application, and that the inquiry is rationally related to the applicant's physical ability to perform his job duties, renders the information material for the purpose of this analysis."
Accordingly, on this record, AMS has established a
In its second motion for partial summary judgment, AMS submits that its decision not to approve Youman's discogram procedure and disc replacement surgery was not arbitrary and capricious and, therefore, punitive damages are not recoverable. The Court agrees.
An injured seaman may recover punitive damages for his employer's willful failure to pay maintenance and cure.
In
Here, the record shows that AMS conducted an investigation of Youman's claim, as it was entitled to do. AMS assigned Patrick Aucoin of Aucoin Claims Service to handle the investigation into the incident. AMS's Human Resources Department was in contact with Youman following his return to shore. Mr. Aucoin attempted to meet with Youman, but Youman cancelled his meeting with the claims adjuster. The investigation revealed evidence that Youman had pre-existing back problems that he intentionally concealed from AMS. Once suit was filed, AMS continued its investigation into Youman's maintenance and cure claim. It was both the ongoing nature and the result of the investigation, AMS submits, that informed its decision to not fund the surgery performed by Dr. Dietze. AMS characterizes its conduct and decision as reasonable and it submits that there is no evidence in the record that would support a finding that it acted arbitrarily or capriciously or egregiously or wantonly. The Court agrees.
AMS submits that it considered at least seven factors in determining whether to fund the back surgery performed by Dr. Dietz: (1) the video of the alleged accident, which AMS characterizes as depicting "a minimal, non-violent incident"; (2) Youman's abrupt refusal to be interviewed after the incident, which AMS contends hindered its investigation; (3) Youman's history of back pain, which Youman concealed when he applied for employment with AMS; (4) Youman's history of suing prior maritime employers for what AMS characterizes as "questionable injuries"; (5) the lack of evidence that would indicate that Youman's back complaints in 2012 and 2013 had fully resolved; (6) Dr. Tender's opinion that Youman suffered no traumatic injury and is not a candidate for surgery; and (7) Dr. Fakier's opinion that there is no change in Youman's lumbar spine as seen in the pre-incident and post-incident MRIs.
Youman counters that AMS's investigation has been "overly lax" and that a question of material of fact exists as to Youman's entitlement to maintenance and cure based upon the differing opinions of Mr. Youman's treating neurosurgeon, Dr. Dietze, and AMS's second medical opinion physician, Dr. Tender. Youman misapprehends the issue raised by AMS in its motion on punitive damages. The issue is not whether Youman is entitled to maintenance and cure,
Youman submits that there is a genuine dispute as to whether AMS's failure to pay for his surgery was arbitrary or capricious, but he fails to submit any evidence that would support a finding approaching arbitrary or egregious or bad faith behavior by AMS. Contrary to Youman's argument, the record demonstrates that AMS did not simply rely on a second medical opinion to deny cure; it conducted an investigation that revealed intentional concealment about prior back injuries. And, given the tactics employed by Youman's counsel in filing suit first in this Court, then dismissing and filing in an improper venue in state court in Baton Rouge, Youman would be hard pressed to show any delay attributable to AMS in deposing Youman and his treating physician. Several of Youman's counsel's requests for authorization for surgery occurred before AMS even initiated this declaratory judgment action; AMS renewed its request to depose Youman and Dr. Dietze back in September 2017, but Youman's counsel failed to execute the waiver of service. AMS wrote to Youman's counsel:
AMS again asked for dates for the depositions of Youman and Dietze in an email dated November 14, 2017. Putting the parties' finger pointing aside, in any event, the "delay" Youman attributes to AMS is absent on this record: both Youman's and Dietze's depositions were completed just over four months after all issues were joined and all parties had appeared in this declaratory judgment proceeding instituted by AMS.
Even if the Court assumes (contrary to the record) that there was some delay attributable to AMS, punitive damages are available to remedy only the most egregious conduct. Although "[n]o bright line separates the type of conduct that properly grounds an award of punitive damages—a ship-owner's willful and callous default in its duty of investigating claims and providing maintenance and cure—from the type of conduct that does not support a punitive damages award[,]"
On this record, there is no genuine dispute as to whether AMS's conduct in declining to fund Youman's back surgery was arbitrary and in bad faith. It was not. The facts presented by this record patently do not approach the high threshold met in other cases where a punitive damages award was warranted, such as "laxness in investigating a claim that would have been found to be meritorious."
Accordingly, IT IS ORDERED: that AMS's motions for partial summary judgment are hereby GRANTED. Youman's claims against AMS for maintenance and cure and for punitive damages are hereby dismissed.
Youman has moved for sanctions against AMS for its untimely disclosure of the Concentra records, which were requested at the outset of discovery, but only disclosed in connection with AMS's motion for summary judgment (albeit produced to Youman before the discovery deadline). At this time, the Court takes no position on Youman's motion for sanctions; the magistrate judge has ordered AMS to explain when and how it received the Concentra records. (AMS initially explained that Concentra previously produced a certificate of no records). Because Youman admitted in his deposition that he underwent the physical at Concentra and that he was dishonest in his answers to the medical questionnaire, the Court need not resolve the admissibility of the Concentra records, which is presently before the magistrate judge.