Alicia Marie Ramos v. U.S. Department of Health and Human Services, 429 F. App'x 947

Ramos filed an FTCA complaint against DHHS on Feb. 11, 2009 seeking compensation for medical negligence and wrongful death of her father James Ramos.
The district court dismissed as untimely under 28 U.S.C. § 2401(b) for failure to present an administrative claim within two years of accrual.
James Ramos died on Dec. 31, 2004; autopsy showed death by massive pulmonary embolism with records indicating a potential action against Pine Hills.
Ramos learned of the death and its cause on Jan. 10, 2005, but argued the government’s involvement was not known until Apr. 2007 when Pine Hills was identified as federally funded.
Pine Hills provided only partial records (six pages of seventy-seven) despite requests for full records.
Ramos filed a Florida statutory ninety-day extension request in Nov. 2006; she submitted an administrative claim Aug. 2, 2007; reconsideration was denied Aug. 11, 2008; suit followed on Feb. 11, 2009.
The district court held accrual occurred Jan. 10, 2005 and declined equitable tolling due to lack of concealment and lack of due diligence.

Issue	Plaintiff's Argument	Defendant's Argument	Held
FTCA accrual date and trigger for limitations period	Ramos argues accrual did not occur until Apr. 2007 when Pine Hills was identified as federally funded.	DHHS contends accrual occurred Jan. 10, 2005 when death and its cause were known.	Accrual occurred Jan. 10, 2005; knowledge of government status does not delay accrual.
Equitable tolling applicability	Ramos asserts tolling due to Pine Hills withholding records and counsel’s diligence.	Government argues no concealment and counsel failed to diligently pursue records.	Equitable tolling not available; no fraudulent concealment and limited diligence by counsel.
Effect of Florida 90-day extension	Ramos argues state-law extension renders timely.	FTCA limitations are governed by federal law; state extension not applicable.	Ninety-day Florida extension does not toll FTCA limitations.
Pine Hills’ notice obligation	Pine Hills should have notified Ramos of federal status when records requested.	Pine Hills had no obligation to inform of funding status; counsel failed to research.	Pine Hills’ notice obligation not imposed; lack of diligence by counsel persisted.

United States v. Kubrick, 444 U.S. 111 (U.S. 1979) (accrual when plaintiff knows existence and cause of injury)
McCullough v. United States, 607 F.3d 1355 (11th Cir. 2010) (FTCA accrual when decedent’s death and causal connection are known)
Diaz v. United States, 165 F.3d 1337 (11th Cir. 1999) (FTCA accrual for wrongful death claims)
Garza v. U.S. Bureau of Prisons, 284 F.3d 930 (8th Cir. 2002) (accrual does not wait for government awareness of status)
Gould v. United States Dep’t of Health & Human Servs., 905 F.2d 738 (4th Cir. 1990) (reaffirmed duty of diligence; concealment requires affirmative acts)
In re Int’l Admin. Servs., Inc., 408 F.3d 689 (11th Cir. 2005) (fraudulent concealment requires affirmative acts to prevent discovery)
Irwin v. Dep’t of Veterans Affairs, 498 U.S. 89 (U.S. 1990) (equitable tolling as extraordinary relief)
Phillips v. United States, 260 F.3d 1316 (11th Cir. 2001) (six-month after final agency decision for FTCA)
Turner ex rel. Turner v. United States, 514 F.3d 1194 (11th Cir. 2008) (FTCA and limitations interpretation guidance)
Dorsey v. Chapman, 262 F.3d 1181 (11th Cir. 2001) (standard of review for district court factual determinations)
Broward Gardens Tenants Ass’n v. EPA, 311 F.3d 1066 (11th Cir. 2002) (construction of statutes of limitations in administrative contexts)
Baker v. Birmingham Bd. of Educ., 531 F.3d 1336 (11th Cir. 2008) (statutory interpretation of limitations period)