Anestis Ex Rel. Estate of Anestis v. United States
2014 U.S. App. LEXIS 7276
6th Cir.2014Background
- Cameron Anestis, an Iraq veteran, presented at two Lexington VA mental‑health clinics in August 2009 while suicidal; intake staff concluded he was in crisis but was turned away from the Cooper Drive VA for lack of a DD‑214; he later died by suicide.
- Cameron’s VA enrollment had been initially classified as “pending” and then briefly as “Rejected: Below Enrollment Group Threshold,” but was later updated to show combat service and retroactive enrollment.
- VA staff testified that policy required emergency care be provided regardless of enrollment status or possession of DD‑214, and that no veteran should be turned away for lacking the form; intake clerks nevertheless routed walk‑ins to Cooper Drive when no clinician was available.
- Tiffany Anestis sued under the Federal Tort Claims Act (FTCA), alleging VA negligence/medical malpractice in failing to provide emergency care, after exhausting administrative remedies.
- The United States moved to dismiss, arguing (1) the Veterans Judicial Review Act (VJRA), 38 U.S.C. § 511, precluded district‑court jurisdiction because the claims implicate VA benefits determinations, and (2) the FTCA discretionary‑function exception barred suit.
- The district court dismissed for lack of jurisdiction under the VJRA; the Sixth Circuit reversed and remanded, holding VJRA did not bar jurisdiction and the discretionary‑function exception did not apply on the record.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether VJRA §511 bars district‑court jurisdiction over FTCA tort claims challenging VA refusal to provide emergency care | Anestis: claim alleges medical negligence/failure to treat under VA emergency policies, not a challenge to benefits determinations | Government: claims effectively challenge VA benefits decisions and thus fall within exclusive VA/Court of Appeals review under §511 | Court: VJRA does not bar jurisdiction because resolving negligence claim does not require review of Secretary’s benefits determinations; claim is independent of benefits status |
| Whether the discretionary‑function exception to FTCA bars the suit | Anestis: VA policies provided mandatory directives to provide emergency care regardless of eligibility; employee actions not protected discretionary policy choices | Government: staff actions involved judgment/choice; thus discretionary function exception preserves sovereign immunity | Court: exception does not apply — policies contained specific mandatory directives and any judgment (triage) is clinical (not policy) and not the type the exception shields |
| Whether the claim is essentially a benefits claim disguised as malpractice | Anestis: she does not seek to alter benefits status; alleges breach of medical duty under VA policies to treat emergencies | Government: substance over label — look through tort to benefits implications | Court: claim is a non‑benefits tort; resolution does not require altering/enforcing a benefits determination |
Key Cases Cited
- Beamon v. Brown, 125 F.3d 965 (6th Cir. 1997) (§511 precludes district‑court review of claims that require examining how VA processed benefits claims)
- Veterans for Common Sense v. Shinseki, 678 F.3d 1013 (9th Cir. 2012) (broad preclusion under §511 for claims requiring review of VA benefits provision methods)
- Thomas v. Principi, 394 F.3d 970 (D.C. Cir. 2005) (distinguishes benefit‑decision claims from tort claims like malpractice; §511 does not bar non‑benefits tort claims)
- Price v. United States, 228 F.3d 420 (D.C. Cir. 2000) (court must determine whether adjudication would require review of Secretary’s benefits decision)
- United States v. Gaubert, 499 U.S. 315 (1991) (two‑prong test for discretionary‑function exception under FTCA)