Carl Anderson and Tammy Anderson v. United States of America

CASE: Carl Anderson and Tammy Anderson v. United States of America, File No. 21-CV-02088 (JMB/LIB), United States District Court, District of Minnesota. JUDGE: Jeffrey M. Bryan. DATE: December 11, 2025.

BACKGROUND: Carl Anderson, a veteran honorably discharged from the Army in 1979 following a back injury, received a VA disability rating in 1998. In 2018, he underwent surgery at the Minneapolis VA Medical Center to repair a paraesophageal hernia (PEH) — a condition where part of the stomach pushes up through the diaphragm into the chest cavity. The surgery was performed by Dr. Archana Ramaswamy, an attending surgeon and Chief of Bariatric and Minimally Invasive Surgery at the Minneapolis VA with approximately 1,000 prior hiatal hernia repairs. The surgery lasted approximately eight hours and involved significant difficulty due to scar tissue and tight adhesions around Anderson's diaphragm.

The next day, April 26, 2018, Anderson experienced clinical deterioration, and Dr. Ramaswamy performed emergency exploratory surgery revealing a leak in Anderson's stomach, which was repaired. On April 27, 2018, his condition worsened further. A third exploratory surgery revealed necrosis (tissue death) of his upper stomach and lower esophagus. Dr. Ramaswamy consulted Dr. Madhuri Rao, an on-call thoracic surgeon who was a government contractor at the Minneapolis VA. Dr. Rao was simultaneously on call at and operating at the University of Minnesota's Fairview Hospital. The parties dispute what instructions Dr. Rao gave and who made the ultimate decision to transfer Anderson to Fairview.

Dr. Ramaswamy prepared Anderson for transfer by cutting across his mid-stomach (separating viable from necrotic portions), but left the necrotic upper portion of the stomach attached to the necrotic esophagus inside his body. She sealed his open abdomen with a temporary vacuum-assisted closure (VAC) dressing. Anderson was transported by North Memorial Ambulance, whose oxygen monitoring equipment was not functioning during transport, so his oxygen levels during the ambulance ride were unrecorded. Upon arrival at Fairview, Anderson was described as 'grey and moribund' and 'in extremis,' with oxygen saturation in the 30% range. He required stabilization before surgery could resume. Dr. Rao performed surgery that night focused on damage control rather than full resection, and Anderson spent weeks at Fairview undergoing more than twelve surgeries. Since September 2022, he has undergone weekly wound care at St. Luke's Wound Care Center in Duluth for an abdominal wound that was never fully closed.

In March 2020, the Andersons filed administrative claims with the VA under the Federal Tort Claims Act (FTCA), 28 U.S.C. § 2671 et seq., seeking $10,000,000 in damages. The VA denied the claims. In September 2021, the Andersons filed suit in federal court. Their original expert, Dr. Daniel Tseng, later withdrew, and the Andersons sought and received permission from the Magistrate Judge (affirmed by Judge Bryan) to substitute a replacement expert, Dr. Nikolai A. Bildzukewicz, limited to the same scope and theories as Dr. Tseng's opinions.

THEORIES OF LIABILITY: The Andersons assert three theories of negligence under the FTCA, for which the United States is vicariously liable as Dr. Ramaswamy's employer: (1) Dr. Ramaswamy accidentally divided Anderson's left gastric artery during the April 25 PEH repair, causing ischemia (loss of blood supply) and subsequent necrosis of his upper stomach and lower esophagus; (2) Dr. Ramaswamy failed to remove the necrotic tissue upon discovering it during the April 27 surgery; and (3) Dr. Ramaswamy transferred Anderson to Fairview when he was too medically unstable for transfer.

MOTION TO DISMISS — SUBJECT MATTER JURISDICTION:

1. Administrative Presentment: The FTCA requires that a plaintiff file an administrative claim with the relevant federal agency before bringing suit. 28 U.S.C. § 2675(a). The government argued the Andersons' administrative claim only raised the first theory (left gastric artery) and not the second and third. The court disagreed, applying the rule that a claim must give the agency sufficient information to investigate — including the facts supporting the claim — not necessarily the precise legal theories. The court found the administrative claim's detailed description of the April 27 surgery, the discovery of necrosis, the decision not to remove necrotic tissue, Anderson's critical condition at transfer, and his near-death arrival at Fairview was more than sufficient to allow the VA to investigate and evaluate negligence claims related to the second and third theories. The motion to dismiss on this ground was denied.

2. Contractor Exception: Under 28 U.S.C. § 2671, the FTCA excludes liability for acts of independent contractors. The government argued that because Dr. Rao (a contractor) was the key decision-maker on the second and third theories, those claims actually lie against a contractor and are barred. The court rejected this argument because the Andersons' complaint names only Dr. Ramaswamy — a VA employee — as the tortfeasor. Any argument about Dr. Rao's conduct, the court held, is properly raised as a defense to the duty or causation elements of the malpractice claim, not as a jurisdictional bar. The motion to dismiss on this ground was denied.

3. Discretionary Function Exception: Under 28 U.S.C. § 2680(a), the FTCA preserves the government's immunity for claims based on the exercise of discretionary functions grounded in social, economic, or political policy. The government argued that Dr. Ramaswamy's transfer decisions involved discretionary governmental judgments. The court applied the two-step test from United States v. Gaubert, 499 U.S. 315 (1991): (1) whether the conduct involved judgment or choice, and (2) whether the conduct is the kind the exception was designed to protect. While the court assumed the first step was satisfied, it held that the second step was not met because the challenged conduct — medical decisions about whether to remove necrotic tissue and whether a patient was stable for transfer — involved professional, nongovernmental medical judgment, not legislative or administrative policy. The court cited multiple circuits and district courts for the principle that the discretionary function exception does not apply to ordinary medical malpractice by government doctors. The motion to dismiss on this ground was denied.

MOTION FOR SUMMARY JUDGMENT:

The court applied the standard that summary judgment is proper only when there is no genuine dispute of material fact and the moving party 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 Andersons) and may not resolve credibility disputes between experts.

As a threshold issue, the government argued that Dr. Bildzukewicz's report exceeded the scope permitted by the Magistrate Judge's order and should be disregarded. The court disagreed, finding that Dr. Bildzukewicz's three opinions (on the left gastric artery, failure to remove necrotic tissue, and unstable transfer) corresponded directly to Dr. Tseng's three theories. The court also noted that the Andersons had agreed not to offer at trial any portions of Dr. Bildzukewicz's opinion that might exceed the permitted scope.

Under Minnesota law (applicable because the FTCA requires courts to apply the substantive law of the state where the tort occurred), a medical malpractice plaintiff must prove: (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, 216 (Minn. 2007).

On all three elements, the court found genuine disputes of material fact:

— Standard of care: Dr. Bildzukewicz opined on what surgeons must do to identify and protect the left gastric artery during PEH repair, the imperative to achieve 'source control' (removal of necrotic tissue) in patients in septic shock, and the parameters for assessing transfer stability. These opinions were sufficient to create a triable issue.

— Departure from standard of care: Plaintiffs presented indirect evidence that Dr. Ramaswamy may have inadvertently divided the left gastric artery, including Dr. Ramaswamy's own 'high index of suspicion' reflected in her differential diagnosis notes, the difficulty of the surgery, Dr. Ramaswamy's statement that she did not pay close attention to the left gastric artery during the eight-hour procedure, and post-operative imaging showing surgical clips consistent with dividing the artery. Plaintiffs also presented evidence that Dr. Ramaswamy left necrotic tissue in Anderson's body contrary to Dr. Rao's instructions, and that Anderson was hemodynamically unstable at the time of transfer.

— Causation: Dr. Bildzukewicz opined that compromising the left gastric artery more likely than not caused the gastric necrosis; that leaving necrotic tissue in place allowed the necrosis to go untreated during transfer; and that transferring Anderson in an unstable condition exposed him to a prolonged period of hypoxia (dangerously low oxygen) and caused him to arrive at Fairview 'in extremis.' He opined all three were proximate causes of Anderson's ongoing severe disability.

The government cited contrary evidence and argued for different inferences, but the court correctly noted that resolving such disputes is the function of the fact-finder at trial, not the court on summary judgment.

RULING: The government's Motion to Dismiss or for Summary Judgment (Doc. No. 179) was DENIED in its entirety. The case will proceed to a bench trial (under the FTCA, there is no right to a jury trial) on all three theories of negligence.