## Facts

- Ronald Arpin, a 54-year-old man with diabetes, suffered worsening severe pain after a workplace fall and sought medical care multiple times.
- He was evaluated at the Belleville Family Practice Clinic, jointly operated by the U.S. Air Force and St. Louis University, where residents worked under Air Force attending supervision.
- Dr. Asra Khan, a second-year resident employed by St. Louis University, examined Arpin, diagnosed a muscle strain, and discharged him.
- Dr. Khan did not order diagnostic testing (e.g., imaging or lab work) and did not consult Dr. James Haynes, an Air Force attending responsible for supervising residents.
- Arpin actually had a psoas abscess; his condition worsened, and he was later hospitalized with septic shock and multi-organ failure and died within two weeks.
- Jeannine Arpin (wife) and the couple’s four adult children presented evidence of close family relationships and sought substantial loss-of-consortium damages.
- After a bench trial, the district court found malpractice/wrongful death and awarded over $8 million, including $4 million to the spouse and $750,000 to each adult child (total $7 million) for loss of consortium, with limited explanation.

## Issues

1. Whether the district court clearly erred in finding that the resident and supervising physician breached the standard of care and that the negligence proximately caused Arpin’s death.
2. Whether the $7 million loss-of-consortium award was excessive or inadequately explained, requiring reduction or remand.

## Decision

- The Seventh Circuit affirmed the district court’s liability findings; the negligence and causation determinations were not clearly erroneous.
- The court vacated the loss-of-consortium damages award and remanded for reconsideration and a fuller explanation.
- The court directed the district court to justify any consortium award with a reasoned method, likely requiring a substantial reduction.

## Legal Principles

- In medical-malpractice cases involving residents, a resident may breach the standard of care by failing to investigate symptoms inconsistent with a benign diagnosis, failing to order appropriate tests, and failing to seek supervisory input when indicated.
- Supervising physicians may be liable for inadequate oversight; residents are not treated as independent practitioners when supervision is required by the clinical setting.
- Proximate cause may be established where competent evaluation and timely diagnosis would likely have identified a treatable condition before the patient’s deterioration and death.
- In bench trials, especially where the court sets non-economic damages, the court must provide an articulated, reviewable explanation connecting evidence to the dollar amounts awarded.
- Large loss-of-consortium awards should be supported by principled reasoning, including reference to comparable cases and proportional assessment across multiple beneficiaries, rather than conclusory statements that the loss is “priceless” or “immeasurable.”

## Conclusion

The Seventh Circuit upheld the finding that negligent evaluation and supervision caused the patient’s death, but it required the district court to re-determine and explain the large loss-of-consortium award using a reasoned, evidence-linked approach consistent with comparable awards.


Arpin v. United States, 521 F.3d 769 (7th Cir. 2008)