## Facts

- Linda Wheeler Tarpeh-Doe, a U.S. citizen employed by USAID, was stationed in Monrovia, Liberia.
- The State Department’s Office of Medical Services operated a medical program for U.S. government personnel abroad and their dependents, including providing Regional Medical Officers (RMOs) and oversight intended to secure the best available care worldwide.
- The assigned RMO in Monrovia was Dr. Theodore E. Lefton.
- On May 18, 1982, Tarpeh-Doe gave birth to Nyenpan Tarpeh-Doe in Monrovia.
- Within weeks, Nyenpan developed a bacterial infection that progressed to spinal meningitis, resulting in blindness and severe neurological injury requiring lifelong, constant care.
- Plaintiffs alleged (1) inadequate overseas care by Dr. Lefton, (2) negligent retention and supervision of Dr. Lefton by State Department officials, (3) failure to inform Tarpeh-Doe of medical benefits and evacuation options, and (4) certain later stateside medical-administration errors that allegedly delayed diagnosis and treatment.
- Claims based solely on negligent acts or omissions occurring abroad were dismissed under the FTCA’s foreign-country bar, and the case proceeded to a bench trial on remaining claims premised on domestic supervision/retention and other U.S.-based acts or omissions.

## Issues

1. Whether the United States owed and breached a duty, under applicable tort law and the FTCA’s private-person standard, to exercise reasonable care in retaining and supervising the RMO assigned overseas.
2. Whether the medical program created a duty to inform an overseas employee about medical benefits and evacuation options, and whether any breach caused the injury.
3. Whether plaintiffs proved causation—i.e., that any U.S.-based negligence was a substantial factor in producing the child’s catastrophic injuries.
4. If liability existed, what damages were recoverable, including future medical costs and lost future earnings.

## Decision

- The court found the United States liable under the FTCA for negligent retention and supervision of Dr. Lefton by State Department medical authorities in the United States.
- The court found that the State Department had notice of deficiencies in Dr. Lefton’s performance and failed to take reasonable corrective action, and that this supervisory failure was a substantial factor in causing the child’s injuries.
- The court rejected causation as to certain other alleged breaches (including failures to fully inform Tarpeh-Doe of benefits/evacuation options and certain later stateside administrative/testing errors), concluding they were not substantial factors because the child was likely beyond meaningful recovery by the time those events occurred.
- The court awarded damages for the child’s care and lost future earnings (initially about $901,162.71, later increased by separate order to about $4.659 million).

## Legal Principles

- Under the FTCA, the United States may be liable to the same extent as a private person for negligent acts or omissions of government employees acting within the scope of employment, applying relevant state tort law.
- The FTCA’s foreign-country exception bars claims arising in a foreign country; claims may proceed when the alleged negligent decision-making or supervision occurred domestically, even if harm materialized abroad.
- When the government affirmatively undertakes to provide and manage a medical program for overseas employees and dependents, it assumes a duty to exercise reasonable care in carrying out that undertaking, including reasonable retention and supervision of key medical personnel.
- Liability requires proof that the negligent supervision/retention (or other domestic negligence) was a substantial factor in causing the injury; later or collateral omissions that did not affect outcome are not actionable for lack of causation.
- Lost-earnings damages must be supported by evidence and reasonable assumptions; the court may reject demographic adjustments it deems improper and use a neutral earnings basis supported by the record.

## Conclusion

The district court held the United States liable under the FTCA based on stateside negligent retention and supervision of an overseas medical officer, finding the supervisory breach substantially caused a dependent child’s catastrophic injuries, while rejecting other alleged informational and administrative failures for lack of causation and awarding substantial damages for lifelong care and lost earning capacity.


Tarpeh-Doe v. United States, 771 F. Supp. 427 (D.D.C. 1991)