VICP Registry Case Source Bundle Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_14-vv-00032 Package ID: USCOURTS-cofc-1_14-vv-00032 Petitioner: Anthony Ragusa Filed: 2014-01-15 Decided: 2017-10-10 Vaccine: influenza Vaccination date: 2010-11-30 Condition: transverse myelitis Outcome: dismissed Award amount USD: AI-assisted case summary: Anthony Ragusa filed a petition on January 15, 2014, alleging that he suffered from transverse myelitis as a result of an influenza vaccination received on November 30, 2010. Mr. Ragusa was represented by attorney Mark Kreuger. He initially stated that his symptoms began in mid-January 2011. The respondent, the Secretary of Health and Human Services, filed a report and motion to dismiss, asserting that the claim was barred by the statute of limitations because the medical records indicated an earlier onset of symptoms. Following an onset hearing, the Special Master found that Mr. Ragusa's painful urination began around January 4, 2011, his numbness began around January 8, 2011, and pain in his legs began on January 16, 2011. The Special Master's findings were issued on September 18, 2015. Mr. Ragusa's attorney, Mark Kreuger, later withdrew from the case, and Mr. Ragusa indicated he would proceed pro se. On April 4, 2017, Mr. Ragusa filed a report from Dr. Herman Dick, who stated that the transverse myelitis could have been caused by an upper respiratory infection in November 2010 or the flu vaccination on November 30, 2010. However, Dr. Dick also stated that painful urination was not a manifestation of transverse myelitis but was due to a prostate infection. The respondent filed a second motion to dismiss on June 5, 2017, reiterating that the petition was filed outside the 36-month statute of limitations, citing the Special Master's earlier findings of fact. The respondent also argued that Dr. Dick's report did not present a sufficient medical theory linking the flu vaccine to the transverse myelitis. Mr. Ragusa did not file a response to this motion. Special Master Christian J. Moran reviewed the case. The Special Master noted that the petition was filed on January 15, 2014, which is more than 36 months after the onset of numbness around January 8, 2011. The Special Master also noted the absence of any equitable tolling arguments. Consequently, the case was dismissed as untimely filed. The decision was issued on October 10, 2017. Theory of causation field: Petitioner Anthony Ragusa alleged that an influenza vaccination received on November 30, 2010, caused him to suffer transverse myelitis. The petition was filed on January 15, 2014. The respondent argued the claim was barred by the statute of limitations. The Special Master found that Mr. Ragusa's numbness began around January 8, 2011, which was more than 36 months prior to the petition filing date. Dr. Herman Dick provided a report stating the transverse myelitis could have been caused by the flu vaccine or an upper respiratory infection, but also noted painful urination was due to a prostate infection, not transverse myelitis. The respondent argued Dr. Dick's report did not establish a sufficient causal link. The Special Master dismissed the case as untimely filed, finding no applicable exception to the statute of limitations and no equitable tolling arguments presented. The outcome was dismissal. Special Master Christian J. Moran issued the decision on October 10, 2017. Petitioner was represented by Mark Kreuger. Respondent was the Secretary of Health and Human Services. Public staged source text: ================================================================================ DOCUMENT 1: USCOURTS-cofc-1_14-vv-00032-0 Date issued/filed: 2015-10-20 Pages: 6 Docket text: PUBLIC ORDER/RULING (Originally filed: 09/18/2015) regarding 45 Findings of Fact & Conclusions of Law. Signed by Special Master Christian J. Moran. (tpj) Copy to parties. -------------------------------------------------------------------------------- Case 1:14-vv-00032-UNJ Document 49 Filed 10/20/15 Page 1 of 6 In the United States Court of Federal Claims OFFICE OF SPECIAL MASTERS * * * * * * * * * * * * * * * * * * * * * ANTHONY RAGUSA, * * No. 14-32V Petitioner, * Special Master Christian J. Moran * v. * * SECRETARY OF HEALTH * Filed: September 18, 2015 AND HUMAN SERVICES, * Fact Finding; onset. * Respondent. * * * * * * * * * * * * * * * * * * * * * * Mark L. Krueger, Krueger & Hernandez, S.C., Baraboo, WI, for petitioner; Justine E. Walters, United States Dep’t of Justice, Washington, DC, for respondent. RULING FINDING FACTS1 The petitioner, Anthony Ragusa, alleges that an influenza vaccine caused him to suffer a neurologic disorder known as transverse myelitis. He seeks compensation pursuant to the National Childhood Vaccine Injury Compensation Program, 42 U.S.C. § 300aa–10 through 34 (2012). Although the parties agree with the diagnosis of transverse myelitis, they disagree about when Mr. Ragusa first started to suffer symptoms associated with that disorder. To resolve these factual disputes, a hearing was held to receive testimony from percipient witnesses. See Campbell v. Sec'y of Health & Human Servs., 69 Fed. Cl. 775, 779-80 (2006). Mr. Ragusa and his mother, Betsy Drillon, testified. Following the submission of additional documentary evidence, the 1 The E-Government Act of 2002, Pub. L. No. 107-347, 116 Stat. 2899, 2913 (Dec. 17, 2002), requires that the Court post this ruling on its website. Pursuant to Vaccine Rule 18(b), the parties have 14 days to file a motion proposing redaction of medical information or other information described in 42 U.S.C. § 300aa-12(d)(4). Any redactions ordered by the special master will appear in the document posted on the website. Case 1:14-vv-00032-UNJ Document 49 Filed 10/20/15 Page 2 of 6 parties proposed findings of fact. With those submissions, the matter is ready for adjudication. Basic Chronology of Undisputed Facts In 2010, Mr. Ragusa was working at the corporate headquarters of State Farm Insurance. He also had been taking Paxil for approximately two years. A few days before Thanksgiving, Mr. Ragusa developed problems in his upper respiratory tract. Consequently, he did not celebrate Thanksgiving with his mother that year. Tr. 75. This was unusual because Mr. Ragusa and his mother had (and have) a relatively close relationship. On November 30, 2010, Mr. Woods had an appointment with his primary care physician, Dr. Woods. Exhibit 8 at 26. The purpose of this appointment was to follow up on Mr. Ragusa’s anxiety and depression. Id. at 26. Mr. Ragusa also told Dr. Woods about his “respiratory infection.” Id. Dr. Woods increased the Paxil dosage to 60 mg a day. Dr. Woods also administered a flu vaccine to Mr. Ragusa. Id. at 27. On Sunday, January 9, 2011, Mr. Ragusa traveled to Indianapolis, Indiana, where he stayed through January 13, 2011. Exhibit 16 at 4-6. He was working with focus groups for State Farm. Tr. 61. On Friday, January 14, 2011, Mr. Ragusa returned to Dr. Woods. Exhibit 8 at 25. Mr. Ragusa described several problems, which are discussed in more detail below. On Sunday, January 16, 2011, Mr. Ragusa flew to Los Angeles, California, to conduct another focus group. Exhibit 16 at 7; Tr. 61. He returned on Friday, January 21, 2011. Id. On January 22, 2011, Mr. Ragusa went to an emergency room and then was admitted to a hospital. His chief complaints were difficulty with urination, numbness, and pain. During the hospitalization, Mr. Ragusa gave several histories about the symptoms and when the symptoms started. Although the histories are not perfectly exact, they are relatively consistent about the main events. Mr. Ragusa generally disagrees with these reports, preferring his recollection that his problems with urination started on January 16, 2011, when he was on a plane to California. Pet’r’s Proposed Findings, filed June 2 Case 1:14-vv-00032-UNJ Document 49 Filed 10/20/15 Page 3 of 6 29, 2015, ¶ 13. Mr. Ragusa also recollects that his leg problems started a few hours later on a walk to his hotel from a location where the Golden Globes were being awarded. Id. ¶ 15. This is the crux of the dispute: when did Mr. Ragusa experience problems with urination, numbness, and pain in his legs. Mr. Ragusa, as just stated, proposes January 16, 2011. Id. The Secretary, in contrast, proposes approximately two weeks earlier.2 Resp't's Proposed Findings, filed Aug. 19, 2015, ¶ 8. Standards for Adjudication The standards for resolving findings of fact are sufficiently established that they need not be repeated here. For a detailed account, see Bayless v. Sec'y of Health & Human Servs., No. 08-679V, 2015 WL 638197, at *2 (Fed. Cl. Spec. Mstr. Jan. 15, 2015). Analysis Painful urination. Mr. Ragusa began having pain when urinating around January 4, 2011. Several records support this finding. The most important record is the report to Dr. Woods on January 14, 2011. There, Dr. Woods indicates that Mr. Ragusa had “Dysuria for 1.5 weeks.” Exhibit 8 at 25. This is a record created contemporaneously and Mr. Ragusa’s history is presumably accurate. Cucuras v. Sec’y of Health & Human Servs., 993 F.2d 1525, 1528 (Fed. Cir. 1993). In his oral testimony, Mr. Ragusa did very little to undermine the reliability of Dr. Woods’s report. Mr. Ragusa denied using the term “dysuria,” saying that in 2011, he did not know that dysuria means painful urination. Tr. 20. However, in the undersigned’s experience, doctors often use specific medical terminology when a patient has used more common language. In addition to Dr. Woods’s January 14, 2011 report, another piece of evidence that supports finding Mr. Ragusa’s painful urination started on January 4, 2011, is a report to a urologist, Dr. Leak. Dr. Leak saw Mr. Ragusa in the hospital. Dr. Leak was also the first doctor whom Mr. Ragusa saw after discharge. Exhibit 2 The parties may also have a dispute about the duration of Mr. Ragusa's transverse myelitis. See Resp't's Proposed Findings, filed Aug. 19, 2015, ¶ 12-15. However, that issue is beyond the scope of this ruling. 3 Case 1:14-vv-00032-UNJ Document 49 Filed 10/20/15 Page 4 of 6 9 at 2-5; Tr. 47. In the context of seeing Dr. Leak in his office, Mr. Ragusa completed a “PATIENT HISTORY FORM” describing his problems. Exhibit 9 at 2. The form included the question “When did you 1st notice the problem?” and provided three choices plus the category “other.” Id. at 2. The three options were “2 days ago,” “2 weeks ago,” and “1 month ago.” Id. Mr. Ragusa circled “1 month ago.” Id. This answer indicates that the trouble urinating began approximately January 4, 2011. If Mr. Ragusa’s problems actually started around January 16, 2011, as he claims in this litigation, then Mr. Ragusa would have circled “2 weeks ago.” Dr. Woods’s January 14, 2011 report (exhibit 8 at 26-27) and Dr. Leak’s February 4, 2011 patient history form (exhibit 9 at 2-5) served as bookends to Mr. Ragusa’s acute problem. Both point to the same onset date: January 4, 2011. Between those two bookends, Mr. Ragusa gave other histories about the onset of his problems and these are relatively consistent with this finding. Numbness. Mr. Ragusa started experiencing numbness around January 8, 2011. In the hospital, Mr. Ragusa told a specialist in infectious diseases that after having urinary symptoms for several days, he began “to experience some pain from the hips down.” Exhibit 7 at 74. At the emergency room, Mr. Ragusa reported that, “about 2 weeks ago he felt his feet getting numb or [a] different type of sensation and over the last 2 weeks and especially over the last couple of days, he had this numbness sensation extending up to his lower thoracic cavity region.” Id. at 87. A potentially contradictory piece of evidence is Dr. Woods’s January 14, 2011 report. Exhibit 8 at 26-27. Arguably, if Mr. Ragusa were experiencing numbness, he would have reported this problem to Dr. Woods. Dr. Woods does not use the term “numbness.” But, Mr. Ragusa did tell Dr. Woods that he was experiencing “stiffness in legs.” Exhibit 8 at 26. When asked about stiffness, Mr. Ragusa could not explain what he meant. See Tr. 40.3 Under these circumstances, 3 Mr. Ragusa suggested that he may have been sore from exercising at a CrossFit gym. However, documentary evidence later showed that Mr. Ragusa did not join this gym until later in 2011. Exhibit 15 at 23-24. Mr. Ragusa's recollection that he was a member of a CrossFit gym in January 2011, testimony that appeared to be given in good faith, illustrates the weakness of his memory. Mr. Ragusa's oral testimony was not sufficiently clear, cogent, and compelling to overcome the 4 Case 1:14-vv-00032-UNJ Document 49 Filed 10/20/15 Page 5 of 6 the report from Dr. Woods does not effectively undercut the reports from other doctors given only two weeks later. Pain in legs. Mr. Ragusa first started to experience pain in his legs on January 16, 2011. The main support for this finding is a record from a telephone call that Mr. Ragusa made from California to Dr. Woods’s office on January 19, 2011. Tr. 51; Exhibit 19 at 1.4 Mr. Ragusa informed an assistant that “he’s having ‘excruciating’ pain in legs, can hardly walk” and requested pain medication. Exhibit 19 at 1. Although this record does not contain any direct information about how long Mr. Ragusa was having this severe pain, it seems reasonable to infer that Mr. Ragusa endured some pain for some days because he told Dr. Woods’s assistant that over the counter medications were not helping with his pain. Additional information about the onset of pain comes from a January 23, 2011 report created by a neurologist. Exhibit 7 at 67. Dr. Dalal recorded that Mr. Ragusa “presented for [a] three-week history of worsening numbness and weakness in his extremities starting in the lower extremities and moving upward. He states over the past week the numbness has been accompanied by bilateral lower extremity pain.” Id. If it is assumed that the phrase “the past week” means seven days, this report means that the pain started on January 16, 2011. Mr. Ragusa, too, testified that the pain in his legs started on January 16, 2011. Tr. 21-23. Because this testimony is corroborated by Dr. Dalal’s contemporaneously created medical record, Mr. Ragusa’s testimony can be credited. Conclusion The parties are ordered to provide these findings of fact to any expert whom they have retained to testify. Expert opinion inconsistent with these findings of fact is not likely to be persuasive. See Burns v. Sec’y of Health & Human Servs., 3 F.3d 415, 417 (Fed. Cir. 1993) (holding that the special master did not abuse his discretion in refraining from conducting a hearing when the petitioner’s expert “based his opinion on facts not substantiated by the record”); Brooke Group Ltd. v. Brown & Williamson Tobacco Corp., 509 U.S. 209, 242 (1993) (“When an expert presumption that the medical records created in January 2011 accurately described his health that month. 4 The record from the telephone encounter was produced after the hearing. 5 Case 1:14-vv-00032-UNJ Document 49 Filed 10/20/15 Page 6 of 6 opinion is not supported by sufficient facts to validate it in the eyes of the law, or when indisputable record facts contradict or otherwise render the opinion unreasonable, it cannot support a jury’s verdict.”); Perreira v. Sec’y of Health & Human Servs., 33 F.3d 1375, 1376 n.6 (Fed. Cir. 1994) (“An expert opinion is no better than the soundness of the reasons supporting it.”); see also Bradley v. Sec’y of Health & Human Servs., 991 F.2d 1570, 1574 (Fed. Cir. 1993) (the assumption of an expert about the accuracy of a fact witness’s testimony does not “substantiate” the fact witness’s testimony). A status conference is set, sua sponte, for Tuesday, October 6, 2015 at 11:00 A.M Eastern Time. The parties should be prepared to propose the next step in this case. Any questions may be directed to my law clerk, Shannon Proctor, at (202) 357-6360. IT IS SO ORDERED. s/ Christian J. Moran Christian J. Moran Special Master 6 ================================================================================ DOCUMENT 2: USCOURTS-cofc-1_14-vv-00032-2 Date issued/filed: 2017-10-10 Pages: 5 Docket text: PUBLIC DECISION (Originally filed: 9/7/17) regarding 78 DECISION of Special Master. Signed by Special Master Christian J. Moran. (MRG) Copy to parties. -------------------------------------------------------------------------------- Case 1:14-vv-00032-UNJ Document 79 Filed 10/10/17 Page 1 of 5 In the United States Court of Federal Claims OFFICE OF SPECIAL MASTERS * * * * * * * * * * * * * * * * * * * * * ANTHONY RAGUSA, * * No. 14-32V Petitioner, * Special Master Christian J. Moran * v. * * Filed: September 7, 2017 SECRETARY OF HEALTH * AND HUMAN SERVICES, * Dismissal decision; * Statute of limitations; Respondent. * 42 U.S.C. § 300 aa-16(a)(2). * * * * * * * * * * * * * * * * * * * * * UNPUBLISHED DECISION DENYING COMPENSATION1 Anthony Ragusa filed a petition under the National Childhood Vaccine Injury Act, 42 U.S.C. §300a-10 through 34 (2012) on January 15, 2014. The petition alleged that hesuffered from transverse myelitis as a result of the influenza (“flu”) vaccination he received on November 30, 2010. Mr. Ragusa cannot prevail because he filed the petition outside of the statute of limitations of the Vaccine Act. I. Procedural History Represented by an attorney, Mark Kreuger, Mr. Ragusa filed a petition on January 15, 2014. Mr. Ragusa alleged that he suffered transverse myelitis caused- in-fact by the flu vaccine he received on November 30, 2010. Petition at 1. Mr. Ragusa stated that on January 22, 2011, he presented to the hospital with “shakes, night sweats, barely able to walk, itchiness, tingling in waist, groin, legs, headaches, side, back and leg pain, no balance and energy.” Petition. Mr. Ragusa filed medical records over the next few months, as required by 42 U.S.C. § 300aa- 1 The E-Government Act, 44 U.S.C. § 3501 note (2012) (Federal Management and Promotion of Electronic Government Services), requires that the Court post this ruling on its website. Pursuant to Vaccine Rule 18(b), the parties have 14 days to file a motion proposing redaction of medical information or other information described in 42 U.S.C. § 300aa-12(d)(4). Any redactions ordered by the special master will appear in the document posted on the website. Case 1:14-vv-00032-UNJ Document 79 Filed 10/10/17 Page 2 of 5 11(c). The respondent filed a status report requesting additional medical records to support onset as well as to complete the record. Resp’t’s Status Rep., filed May 29, 2014. Petitioner amended his petition to state that his symptoms of transverse myelitis began in mid-January 2011. See Am. Pet., filed Additional medical records were obtained over the next several months and filed September 8, 2014, completing the record. Respondent filed a combined Rule 4 report and motion to dismiss on October 31, 2014. In this report, respondent did not dispute the diagnosis of transverse myelitis but asserted that the medical records indicated that the claim was barred as untimely filed. Resp’t’s Rep’t, filed Oct. 31, 2014, at 2. Respondent argued that while the amended petition alleged symptoms of transverse myelitis that began January 15, 2011, the medical records documented an earlier onset. Id. 8-9. A status conference was held on December 2, 2014, to discuss respondent’s report and motion to dismiss. The resulting order required petitioner to file affidavits regarding onset of symptoms and any additional affidavits. See order, filed Dec. 2, 2014. Petitioner filed his affidavits. Exhibits 12, 13. During the ensuing status conference, the parties agreed that an onset hearing was needed. Order, filed Jan. 22, 2015. An onset hearing was held on April 9, 2015. The primary issue was when Mr. Ragusa first started to suffer symptoms associated with transverse myelitis. Mr. Ragusa and an additional witness appeared via videoconference. Following the hearing, petitioner filed additional fact evidence and medical records to support his claim. Exhibits 23-37. The parties filed proposed findings of fact over the next few months. The undersigned issued Findings of Fact. The undersigned found that Mr. Ragusa’s painful urination, numbness, and pain in his legs began around January 4, 2011, around January 8, 2011, and on January 16, 2011 respectively. Ragusa v. Sec’y of Health & Human Servs., No. 14-32V, 2015 WL 6150880, at *2-3 (Fed. Cl. Spec. Mstr. Sept. 18, 2015). During the ensuing status conference to discuss these findings, petitioner stated that a neurologist was being consulted regarding an alternate cause for the symptoms and that an equitable tolling argument would be considered if the painful urination was found to be due totransverse myelitis. Order, filed Oct. 6, 2015. On November 4, 2015, petitioner filed a status report indicating that an expert report would not be filed and next steps were being considered. Mr. Kreuger then informed the undersigned that he would be withdrawing from the 2 Case 1:14-vv-00032-UNJ Document 79 Filed 10/10/17 Page 3 of 5 case and Mr. Ragusa wished to proceed with another attorney or pro se. Pet’r’s Status Rep., filed Nov. 17, 2015. A status conference was held on December 2, 2015, during which Mr. Ragusa, Mr. Kreuger, and respondent participated. The undersigned discussed Mr. Ragusa’s options in light of Mr. Kreuger’s intention to withdraw. Mr. Ragusa expressed his intent to proceed pro se to which the respondent stated he may challenge reasonable basis going forward. Order, filed Dec. 4, 2015. On April 21, 2016, Mr. Kreuger filed his motion to withdraw indicating in the certificate of service that the motion was provided to Mr. Ragusa. The undersigned granted Mr. Krueger’s motion to withdraw and ordered Mr. Ragusa to file a status report indicating whether he would be retaining a new attorney or filing an expert report. Order, filed May 11, 2016. Over the next several months, Mr. Ragusa filed status reports stating that an attorney had not been retained. The case did not progress. On January 12, 2017, the undersigned ordered Mr. Ragusa to obtain a report from an expert presenting the opinion that the influenza vaccine caused him to suffer transverse myelitis. Mr. Ragusa filed the report of Dr. Herman Dick on April 4, 2017. Exhibit 20. This report stated that the painful urination was not a manifestation of transverse myelitis, but due to a prostate infection. Dr. Dick also stated that the transverse myelitis could have been caused by the November 23, 2010 upper respiratory infection or November 30, 2010 flu vaccination. Id. A status conference was held to discuss Dr. Dick’s report. The respondent maintained his position that Mr. Ragusa’s petition is time-barred and that Dr. Dick did not present a medical theory linking the flu vaccine to transverse myelitis. The respondent proposed filing a motion to dismiss based on the statute of limitations. Mr. Ragusa was urged to seek counsel and timely respond to the respondent’s motion. Order, filed May 4, 2017. The respondent filed his second motion to dismiss on June 5, 2017, arguing that the case was filed after the expiration of the statute of limitations. Citing the undersigned’s Findings of Facts, the respondent stated that Mr. Ragusa filed his petition outside of the time allotted by the Vaccine Act. The respondent further stated that Dr. Dick’s report was insufficient to satisfy Mr. Ragusa’s burden under Althen as it did not present a theory linking the flu vaccine to Mr. Ragusa’s injury. Resp’t’s Mot. to Dismiss, filed June 5, 2017, at 7-8. Mr. Ragusa did not file a response making the matter ripe for adjudication. 3 Case 1:14-vv-00032-UNJ Document 79 Filed 10/10/17 Page 4 of 5 II. Legal Standard Pursuant to 42 U.S.C. § 300aa-16(a)(2), the Vaccine Act provides that “no petition may be filed for compensation…after the expiration of thirty-six months after the date of the occurrence of the first symptom or manifestation of onset or of the significant aggravation of such injury.” The Federal Circuit has held that there is no explicit or implied discovery rule under the Vaccine Act. Cloer v. Sec’y of Health & Human Servs., 654 F.3d 1322, 1338-40 (Fed. Cir. 2011) (en banc). The date of the occurrence of the first symptom or manifestation of onset “does not depend on when a petitioner knew or reasonably should have known anything adverse about [his] condition.” Id. at 1339. III. Analysis Mr. Ragusa alleged that the flu vaccine caused him to suffer transverse myelitis. Mr. Ragusa received the flu vaccination on November 30, 2010. Exhibit 2. Mr. Ragusa’s numbness began around January 8, 2011. Ragusa, 2015 WL 6150880, at *2-3. Dr. Dick’s report states that the numbness, weakness, and pain in Mr. Ragusa’s lower extremities as reported on January 22, 2011 were manifestations of his transverse myelitis. Exhibit 20. Mr. Ragusa filed his petition on January 15, 2014. January 15, 2014 is more than 36 months after January 8, 2011. Therefore the petition was filed out of time. In addition, Mr. Ragusa has not presented any argument regarding equitable tolling. IV. Conclusion It is clear from the record in this case that that there is no applicable exception to the statute of limitations. Thus, this claim is DISMISSED on the ground that it is barred pursuant to section 300 aa-16(a)(2) of the Vaccine Act. The Clerk shall enter judgment accordingly. 4 Case 1:14-vv-00032-UNJ Document 79 Filed 10/10/17 Page 5 of 5 IT IS SO ORDERED. ____________________ Christian J. Moran Special Master 5