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THOMAS v. UNITED STATES

April 30, 1987

Calvin Thomas, Plaintiff,
v.
United States of America, Defendant



The opinion of the court was delivered by: SPORKIN

 STANLEY SPORKIN, UNITED STATES DISTRICT JUDGE

 The plaintiff, Calvin Thomas brings this medical malpractice action under the Federal Torts Claim Act, 28 U.S.C. § 1346 (b), §§ 2671 et seq., to recover for injuries sustained as the result of the alleged negligence of employees of the Veterans Administration Medical Center ("VAMC") in Washington, D.C. After a bench trial in this matter, I make the following findings of fact and conclusions of law. *fn1"

 Findings of Fact

 1. Plaintiff, a 39 year old black male, went to the Veterans Administrations Medical Center in Washington, D.C. on October 5, 1983, complaining of an injury to his left hand. *fn2"

 2. Plaintiff was initially seen in the hospital's emergency room. The emergency room physician believed the injury was serious enough to admit plaintiff to the hospital's orthopedic ward for observation and treatment. On his forwarding report, the admitting doctor diagnosed an infection and additionally directed the treating physician to "rule out compartment syndrome." *fn3"

 3. Plaintiff spent a great deal of time at trial attempting to establish that he did in fact have compartment syndrome. I am not prepared, based on all of the evidence, to find that plaintiff did have compartment syndrome. However, regardless of whether the syndrome was present, once the admitting doctor made the notation to rule it out, a specific duty arose on the part of the doctors. The medical standard requires that when compartment syndrome is a possible diagnosis the patient must be reevaluated every 4 to 6 hours until the possibility of this condition is "ruled out."

 4. Between October 5 and October 12, 1983, plaintiff remained in the hospital's Orthopedic Service and was treated with antibiotic medicine. There is no indication in the medical records that any single doctor was principally responsible for the plaintiff's medical care. He was seen by a number of different doctors during his stay.

 5. Instead of getting better plaintiff's infection worsened and an "abscess" developed in the hand. This condition was not detected by the hospital staff until the morning of October 12.

 6. Defendant contends that plaintiff's condition was not noticed until October 12th because there was no clinical manifestation until that time. Whether there was or was not a clinical manifestation before the 12th is difficult to reconstruct because of the paucity of the records kept on the plaintiff. Accordingly, I find that the condition was not detected until the morning of October 12, because during the October 5 through October 12 period, plaintiff's condition was not carefully monitored nor was his progress properly recorded. In this regard, defendant clearly breached its duty of care to the plaintiff.

 a. During this time, he was examined by doctors no more than twice a day, and on one day, not at all.

 b. The treating doctors detected a tingling in plaintiff's hand on October 7, 1983, but no steps were taken to determine the cause of this condition. If such steps had been taken, it would have alerted the examining staff to plaintiff's deteriorating condition substantially before it was discovered on October 12th.

 7. Standards of care for the medical community are promulgated by the Joint Commission of Hospital Accreditation ("JCAH"). These standards require that a hospital like the VAMC properly monitor a patient's condition and that the hospital keep proper records. Such proper records are defined as the presence of notes written by the attending physician concerning the details of a patient ...


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