Motion for Summary Judgment Success - Maximum Medical Improvement

The Plaintiff, a Jones Act seafarer, suffered systolic heart failure working on board the Defendant’s vessel. When the condition deteriorated, he underwent surgery for a heart transplant at Cedars-Sinai Hospital, California.

The Plaintiff’s medical expenditure was covered primarily via Medicare, but the Defendant agreed to pay for a secondary health policy which allow the Plaintiff to meet the criteria for the Cedars-Sinai organ donation program and aid him until the court determined maximum medical improvement (MMI) had been achieved. The vessel owner also supported the Plaintiff's move to California from New York to facilitate a timely heart transplant since California operates its organ donation program on an “opt-out” basis; however, the State of New York requires organ donors to opt into a donation program. MMI is the stage in an individual’s recovery where they have either recovered fully or their current condition and/or symptoms will no longer improve as a result of curative treatment currently available. At this point a Jones Act employer, who has a strict liability to provide maintenance and cure benefits for its seafarers until MMI is achieved, would no longer be liable for curative treatment as any further treatment would be considered palliative in nature.

Post-transplant care is necessary for all transplant patients admitted to Cedars-Sinai. For the Plaintiff, anti-rejection medication would be required for the rest of his life, with periodic examinations by medical experts to monitor his progress, medication, and treatments. As part of a settlement by which the heart transplant was facilitated but the issue of MMI was left open for future motion practice, the parties agreed that the incurable heart condition would be assessed under Maritime Law, in conjunction with the obligations of a shipowner to a seafarer “afflicted with an incurable disease, permanent condition or chronic illness which manifests itself during the seaman’s employment aboard a vessel but is not caused by it.” It was agreed that the ongoing examinations, and need for anti-rejection medication, would not be determinative of whether the Plaintiff had achieved MMI.

During the Plaintiff’s post-transplant deposition, he complained of ongoing leg numbness, shingles, and nerve damage. While he claimed to suffer from increased fatigue post-transplant, he conceded that his overall strength and stamina had improved. However, post-transplant, the Plaintiff had been recorded on social media, atop of his roof using a saw on tree branches. The Plaintiff stated he could conduct similar tasks on good days but struggled on his bad days. In addition, he said: - he had been advised by his doctors that due to the anti-rejection medication required he was “statistically certain” to develop cancer in the future; and - In December 2020, whilst he was employed as an engineer in a hotel and casino, completing routine electrical and plumbing tasks, due to fatigue he often had to call in sick and was anxious over his job security.

The Vessel Owner's Post-Transplant Motion for Summary Judgment on the Issue of Maintenance and Cure

Medical Expert Witnesses

The treating physician, Dr. Evans Kransdorf, stated that post-transplant the Plaintiff would require long term surveillance, blood evaluations, medication management, and periodic visits with the transplant team, over the initial six years post-transplant. He concluded that failure to follow these procedures would increase the chances of organ rejection, advanced heart failure, and death.

Cardio-thoracic surgeon, Dr Brian Lima M. D. outlined the plan of the plaintiff’s follow-up care. This report was consistent with the treatment explained within the Plaintiff’s deposition and that of the treating physician. Schedules were outlined to monitor organ rejection, heart biopsy visits, annual blood work, cancer screening, heart catheterization and assessments to monitor coronary artery disease.

Aaron M. Woodson Ph. D. met with the Plaintiff to prepare a life care plan where he calculated the expenditure of currently prescribed follow-up care and medications based upon a life expectancy of a 36-year-old male - approximately 42.4 years (which could change upon additional medical input from treating physicians). This preliminary report did not comment on the issue of MMI, and it was not relied upon by the Court, despite being retained and relied upon by the Plaintiff.

Dr. Jonathan D. Rich, a heart failure and transplant physician, retained by the defendant, summarised the Plaintiff’s medical history, in addition to reviewing the reports post-transplant. In conclusion, Dr. Rich stated that the Plaintiff “thrived following his heart transplant and should be expected to have a long-term outcome at least as favourable to those who also do well during the first year following heart transplantation,” the records revealed that the Plaintiff suffered no post-transplant complications, no hospitalisation, and no evidence of cardiac rejection. Overall, the opinion was consistent with the other experts, with the caveat that if the Plaintiff continued to adhere to his schedule for assessments, the risk of complications or death was “overall low.” Dr Rich concluded that:

• the Plaintiff’s condition was akin to that of an otherwise “healthy” patient with diabetes mellitus. 
• the Plaintiff “appears to have done as well as could be possibly expected following his 2019 transplant”. 
• the only medical treatment that was potentially curative in nature to treat the pretransplant medical conditions was the heart transplant itself, therefore with no further curative treatment available, the condition was incurable, with any ongoing medication or treatment considered maintenance of the current condition.

The Motion

The Defendant filed a Motion for Summary Judgment asserting that the obligations under the settlement agreement were fulfilled, as the Plaintiff had achieved MMI.

The Plaintiff’s Counsel citied Costa Crociere, S.p.AV. Rose (S.D. Fla. 1996) to dispute MMI. In this case, the seafarer suffered kidney failure, requiring dialysis. The ongoing dialysis was considered sufficient to dispute that the seafarer had reached MMI. Like Stemmle, the curative treatment was instrumental for his recovery; however, the significant difference is that Rose had not exhausted all available curative treatment – notably a kidney transplant, therefore he was not considered at MMI. 

The Decision

Messier v Bouchard Transport (2nd Cir. 2012) defines cure as “the reasonable medical expenses incurred in the treatment of the seaman’s condition”, until he reaches MMI, whether that is recovery from an injury, or a condition permanently stabilises, or further improvement is not possible. In circumstances where the condition is deemed permanent, or it is medically confirmed that further improvement is impossible, the liability of the shipowner ceases – supported by Haney v Miller’s Launch Inc. 
The 2nd Circuit recognises there are clear distinctions between curative treatment, and relapse medication. Lindgren v. Shepard S.S. Co (2nd Cir. 1940) ruled that a seafarer requiring ongoing maintenance medication, to prevent relapse only, had reached MMI.

Accordingly, the U.S. District Court for the Eastern District of New York granted the Motion for Summary Judgement and agreed that while the anti-rejection/maintenance medication was vital for the plaintiff’s on-going care it was not curative and MMI had been achieved,

Conclusion

This is a favourable decision for Jones Act employers, showing that once a seafarer has exhausted all available treatment, including transplants, the ongoing prescription of maintenance medication to prevent relapse of the new organ is only considered curative in the preliminary stages post-transplant. The Court was persuaded by the fact that the seafarer 's health had stabilized, and he was active following the heart transplant three years prior; noting that had the motion been brought immediately following the transplant its ruling may have been different. Therefore, Jones Act employers should be mindful that immediate termination of maintenance and cure post-transplant will likely not be accepted by the courts, and a seafarer’s condition should have stabilised before MMI can be considered and termination of maintenance and cure benefits is approved.