Anna Chronis v. United States
Opinion of the Court
Before bringing a tort claim against the United States, a plaintiff must first exhaust her administrative remedies by presenting her claim to the appropriate federal agency. This means, among other things, that the plaintiff must demand a sum certain from the agency. Anna Chronis did not make such a demand before she sued, so the district court properly dismissed her complaint.
I.
In June 2015, Anna Chronis visited the University of Illinois Mile Square Health Center for her annual physical examination. The examination included a pap smear-a procedure used to detect cervical cancer-that Chronis alleges caused her pain and bruising. She claims that she tried to follow up on the examination with the physician, Dr. Tamika Alexander, but was unable to get in touch with her. She also says that the Health Center did not return her calls or allow her to make a follow-up appointment. Chronis filed a written complaint with the Health Center's grievance committee, requesting $332 for the expenses that she incurred because of the injury. But after reviewing her complaint, the Health Center rejected her request.
After her request was denied, Chronis sent a letter to the Centers for Medicare and Medicaid Services (CMS), an agency within the U.S. Department of Health and Human Services. In her letter, she requested "assistance in resolving a frustrating process of delay, unfulfilled promises, and documented willful ignorance of policy and procedures." Though her letter mentioned the injuries that she allegedly sustained during her examination, it devoted most of its attention to the Health Center's lack of responsiveness to her complaints. It also included a general statement that she wanted assistance in "receiving the restitution." The conclusion of her letter summarized what she was asking for: "I have enclosed all relevant, previous correspondence between UIC Health, and myself, and look forward to your guidance on how to proceed." Chronis also attached roughly sixty pages of documents relating primarily to the correspondence between Chronis and the Health Center. One of the pages included the fact that Chronis had previously sought $332 from the Health Center.
Believing that Chronis was seeking advice about how to make an administrative complaint against the doctor and Health Center, CMS replied by directing her to contact the Illinois Department of Financial and Professional Regulation so that *546she could file a formal complaint. CMS also invited Chronis to follow up if she needed any additional assistance.
More than six months later, Chronis filed a pro se complaint in state court, alleging malpractice against Alexander and the Health Center. Because the Health Center receives federal funds from the Public Health Service and Alexander is a Health Center employee, the United States substituted itself as the sole defendant and removed the case to federal court to proceed under the Federal Tort Claims Act. See
The district court granted the government's motion and dismissed the complaint. It explained that Chronis's letter to CMS notified the agency only that she was pursuing "professional regulation allegations," as opposed to making an administrative demand-and thus failed to present a claim.
Chronis timely appealed pro se, and we appointed amicus curiae to assist in her appeal.
II.
Under the Federal Tort Claims Act, a plaintiff may bring a medical malpractice claim against the United States only after exhausting administrative remedies.
Even liberally construed and read through the eyes of a "legally sophisticated reader," Chronis's letter does not contain a demand for money damages in a sum certain. See Buechel v. United States ,
To be sure, failing to put a number on the amount demanded is not necessarily fatal. See Smoke Shop, L.L.C. v. United States ,
Take the facts here: believing that Chronis's letter was simply requesting advice *548about how to file an administrative complaint against the Health Center, the agency responded by providing information about how to file a formal complaint with the Illinois Department of Financial and Professional Regulation. The agency didn't have a chance to begin the settlement process because nothing in the letter put it on notice that Chronis was asserting a claim against it. Chronis's failure to make a clear demand of CMS "frustrate[d] the process of conciliation and settlement that the administrative demand is supposed to initiate." See Kanar ,
Indeed, the letter shows that Chronis wanted something other than money from CMS. The conclusion of her letter said it best: she wanted "guidance on how to proceed." Requesting guidance is different than requesting money. And we have emphasized that a letter requesting "something other than money" fails to constitute an administrative demand for money. See Khan ,
In a final effort to show that Chronis actually made a demand for monetary damages, amicus points to a single phrase in her letter stating that she had to "pay out of pocket for follow up that resulted from [Dr. Alexander's] malpractice and gross negligence." But this wasn't a demand. It was just background information, explaining Chronis's frustration with her care. Especially in light of the rest of the letter, which made clear that Chronis was seeking advice, this alone could not have put the agency on notice that Chronis intended to file an administrative demand. See Palay v. United States ,
We stress that our precedent does not make it difficult for pro se plaintiffs to sue the federal government. In almost any other circuit, Chronis's claim would have failed for not including a sum certain. See, e.g. , White-Squire v. U.S. Postal Serv. ,
In short, Chronis "simply did not tell the government that [she] intended to bring a tort suit against it." See Smoke Shop ,
We conclude with a final observation. This case has been litigated as if it is about Chronis's frustrated effort to put the Department of Health and Human Services (through its sub-agency, CMS) on notice that she was demanding money from it. The real problem, however, is that Chronis had no idea that the Department might owe her money. It is unsurprising that Chronis, a pro se plaintiff, didn't know that the Health Center and Alexander would be treated as Public Health Service employees covered by the Federal Tort Claims Act. That is a mistake that even an experienced medical malpractice lawyer can make. See , e.g. , Phillips v. Generations Family Health Ctr. ,
Because the district court correctly held that Chronis failed to satisfy the exhaustion requirement, its judgment is AFFIRMED.
The Federally Supported Health Centers Assistance Act permits the Secretary of Health and Human Services to deem certain federally funded community health centers, along with certain individuals affiliated with them, to be employees of the federal Public Health Service for purposes of the Federal Tort Claims Act. See 42 U.S.C. §§ 254b & 233(g) ; see also
The court expresses its thanks to Travis S. Andrews for accepting the appointment of amicus curiae and submitting an excellent brief and argument.
The dissent argues that we are wrong to rely on Deloria rather than Palay v. United States ,
There are tools available to help a pro se plaintiff meet the exhaustion requirement. For example, she can fill out Form 95, which spells out the required information and is easily accessible on the Department of Justice website. See, e.g. , Buechel v. United States ,
A plaintiff's ability to pursue this course is enhanced by the Westfall Act, which stops the clock when a plaintiff's suit is dismissed for violating the Federal Tort Claims Act's exhaustion requirement. See Dupree v. United States ,
Dissenting Opinion
Our circuit applies a flexible standard to the exhaustion requirements for plaintiffs making claims under the Federal Tort Claims Act, excusing technical deficiencies so as not to preclude all but the savviest of plaintiffs from receiving a hearing on the merits. See Delgado v. Merit Sys. Prot. Bd. ,
Chronis, a pro se plaintiff, knew little about the complicated legal world of suing the federal government. She was simply looking for a solution to her problem. She alleged that she had been harmed during a medical appointment at a health center that receives federal funds. She looked for a solution by repeatedly telephoning the doctor whom she alleged harmed her, but that doctor did not help, and indeed did not return any of her numerous calls. (R. 10 at 24, 45, 57). She made calls to employees at the health center that employed the doctor, but they would not help.
Chronis' odyssey is reminiscent of the famous children's book by P.D. Eastman. In that book, a baby bird, having fallen out of the nest, is looking for a solution to its problem. Having just hatched, the baby bird knows little about the world, and thus asks for help in all the wrong places-asking a kitten, a hen, a dog, a cow, a boat, and an airplane, "Are you my mother?" Each answers indignantly that the baby bird has come to the wrong place for a solution. The last place the baby bird looks for a solution is with the powerful steam shovel. The steam shovel, knowing the rules and how to get things done, gently places the baby bird back into the nest. Unfortunately for Chronis, the steam shovel in her case just kept rolling along.
The Federal Tort Claims Act requires a plaintiff to exhaust her administrative remedies and give notice to the government of her claim so that the agency can have a chance to settle "meritorious claims more quickly and without litigation." Warrum v. United States ,
And yet the majority appears to be requiring the "punctilious adherence" that our precedent rejects. Our cases make clear that a potential plaintiff's claim needs to meet two requirements: she must specify the facts behind the claim, and make a demand for money. That is it. Khan v. United States ,
No one disputes that Chronis notified the agency of the incident, and with good reason. In her November 7, 2015 submission to CMS, she described her "horrible" visit to the gynecologist, Dr. Alexander, that resulted in an alleged injury "that resulted from [Dr. Alexander's] malpractice and gross negligence." R. 10 at 41. She also enclosed her correspondence with the health center in which she detailed her injuries and her intent to pursue a claim.
*552The majority's decision hangs on its conclusion that Chronis did not make a proper claim for money damages to CMS. Chronis' letter to CMS, however, on the very first page asks for four things in a numbered list set out in its own paragraph, one of which (number 3) is "receiving restitution." R. 10 at 41. The word "restitution" is common parlance for recompense for injury or loss. The OED defines it as "making reparation to a person for loss or injury previously inflicted."
It is true that what Chronis stated in her letter to CMS was "I request your assistance in ... receiving restitution," rather than stating "I want restitution from you, CMS." See R. 10 at 41. The latter would have been more clear, for certain, but there is no legally relevant difference, particularly in a legal posture in which we are required to "deem exhausted any claim fairly implicit in the facts that would be clear to a legally sophisticated reader." Delgado ,
The request for money damages should have been clear from the language of the letter itself-the request for restitution coupled with claims of malpractice and notice about out-of-pocket expenses. But that is not all Chronis did. She also notified CMS that she had "enclosed all relevant, previous correspondence between UIC Health, and myself." R. 10 at 43. Attachments to her Federal Tort Claims Act claim become part of that claim. See, e.g., Palay ,
The majority asserts that we must not force agencies to search for claims buried within lengthy attachments. For this proposition, it cites Deloria v. Veterans Admin. ,
The majority concedes that Chronis made a demand for a sum certain to the health center, but denies that she made such a demand to CMS. But of course the federal agency knew that any claim made against a federally supported health center is a claim against the federal government. See Majority Op. at 545, n.1. That is why the federal government moved to substitute itself in the litigation against the health center and remove the matter to federal court. The fact that the federal government was on the hook for malpractice claims alleged against the health center was information that was in the hands of the agency-an agency that had a duty to investigate Chronis' claim. "After the claimant provides enough information to put a legally sophisticated reader on notice, it is up to the agency 'to fill in the gaps, to the extent possible.' " Delgado ,
The majority states that "Chronis wanted something other than money from CMS ... she wanted 'guidance on how to proceed.' " Majority Op. at 548. It would be more accurate to say that she wanted something more than just money from CMS. We do not disagree that she wanted guidance, but she wanted guidance about how to proceed in order to receive the restitution that was listed as one of four enumerated solutions she requested on the front page of her letter. See R. 10 at 41. Guidance alone would not make her whole or pay the medical bills. The guidance was needed in order to recover for her loss. And when a person wants payment for medical malpractice from a designated federally-funded health center, the legally sophisticated reader (which we assume the agency to be) knows that payment must come from the federal government's coffers.
There is a reason we construe legal pleadings by pro se plaintiffs liberally. See Erickson v. Pardus ,
*555The majority says that all is not lost for Chronis, as there remains some possibility that she could squeeze her claim down another path-re-asserting her claim and relying on the Westfall Act to save any statute of limitations problems or by hoping for equitable tolling. Majority Op. at 549. The Westfall Act tolling provision applies only in very narrow conditions: it applies only if "the claim would have been timely had it been filed on the date the underlying civil action was commenced, and [ ] the claim is presented to the appropriate Federal agency within 60 days after dismissal of the civil action."
We must remind ourselves that a key point of this case is that Chronis is a pro se plaintiff. Therefore the ordinary lenience we give Federal Tort Claim Act claims is magnified all the more. Chronis was unrepresented throughout the administrative process, through removal from state to federal district court, and in this court as well. (We requested and received the capable and helpful assistance of amicus curiae, Travis S. Andrews, for which we are extremely grateful. Chronis, however, still does not have retained counsel and is unlikely to find it for her $332 claim). Chronis struggled to file a simple valid Federal Tort Claims Act claim. The odds of her successfully navigating these more complex alternative pathways that the majority suggests are slim, at best.
Chronis wrote, called, filled out complaint forms, and wrote again. She attached exhibits, correspondence, forms, and e-mail. According to the government, and now the majority opinion, however, this was not enough: Chronis did not ask in the proper way.
The majority's decision has altered the requirements for plaintiffs making a claim pursuant to the Federal Tort Claims Act. No longer will we apply a flexible standard and overlook technical deficiencies; no longer will we construe pro se administrative complaints generously and "deem exhausted any claim fairly implicit in the facts that would be clear to a legally sophisticated reader." Delgado ,
We have also noted that a potential plaintiff must include a title or capacity of the person signing and evidence of the person's authority to represent the claimant (Kanar ,
As we have noted, our cases law requires that we construe pro se administrative complaints generously and deem exhausted any claim fairly implicit in the facts that would be clear to a legally sophisticated reader. Delgado ,
The government asserts that our case law concluding that the lack of a sum certain is not fatal to a claim is incorrect. That is a matter it may take up with the Supreme Court. For now, our case law, with which the majority agrees, stands.
This is a good place to stop and address the elephant in the room. Chronis' allegations might, at times, appear unreasonable to judges who are used to the more staid, logic-driven arguments of lawyers, as opposed to the emotional and personal claims of pro se plaintiffs. Just as in summary judgment, however, we are at a threshold moment where the only question is whether Chronis may proceed with her claim. Cf. Payne v. Pauley ,
OED Online, Oxford University Press, June 2019, www.oed.com/view/Entry/163966. Accessed 2 July 2019.
According to the majority it was both too little and too much, as the claim was "buried within, as many as sixty pages of attachments." Majority Op. at 546. In other words, Chronis failed to make a claim because she provided too much information to CMS.
Reference
- Full Case Name
- Anna CHRONIS, Plaintiff-Appellant, v. UNITED STATES of America, Defendant-Appellee.
- Cited By
- 47 cases
- Status
- Published