but . . . not . . . for interest prior to judgment or for punitive damages." 28 U.S.C. § 2674. In a District of Columbia medical malpractice case, the plaintiff bears the burden of presenting evidence "which establishes the applicable standard of care, demonstrates that this standard has been violated, and develops a causal relationship between the violation and the harm complained of." Kosberg v. Washington Hospital Center, Inc., 129 U.S. App. D.C. 322, 394 F.2d 947, 949 (D.C.Cir. 1968), quoted in Haven v. Randolph, 161 U.S. App. D.C. 150, 494 F.2d 1069, 1070 (D.C.Cir. 1974); Walker v. United States, 600 F. Supp. 195 (D.D.C. 1985); Snead v. United States, 595 F. Supp. 658 (D.D.C. 1984).
In this case, the standard of care owed to the plaintiff emanated primarily from three sources: first, a duty of care exists for doctors, as for defendants generally, which requires that the doctor act as a reasonably prudent person, Robbins v. Footer, 179 U.S. App. D.C. 389, 553 F.2d 123, 126 (D.C. Cir. 1977); second, the Joint Commission of Hospital Accreditation (JCAH) requires certain specific standards be met in terms of monitoring and keeping records on patients, Finding 7, supra ; and third, because the admitting physician had indicated on the medical records that compartment syndrome had to be "ruled out," a duty arose on the part of the defendant to be especially vigilant in its monitoring of the plaintiff. Finding 3, supra.
I conclude that the plaintiff has clearly met his burden of showing that defendant breached these duties owed to him. What happened in this case closely resembles a res ipsa loquitur case. See Burke v. Washington Hospital Center, 154 U.S. App. D.C. 253, 475 F.2d 364, 365 (D.C.Cir. 1983) ("The jury could infer negligence without any further showing, under the doctrine of res ipsa loquitur, because the event complained of is clearly one which 'ordinarily would not happen in the absence of negligence . . .'") (citations omitted). The plaintiff was admitted to the hospital for observation on October 5th with a relatively minor hand infection which was clearly treatable; his care was in the hospital's control from October 5th until October 12th; on the morning of the 12th he had to undergo major emergency surgery. Instead of plaintiff's treatable condition getting better, it in fact worsened to the extent of becoming extremely critical. Under ordinary circumstances this should not have occurred.
Plaintiff has been able to further establish that during those crucial seven days of observation, the hospital failed at several important tasks. First, the doctors failed to monitor the plaintiff with any consistency. Finding 6(a), supra. Whether he had compartment syndrome or not, had the plaintiff been monitored for compartment syndrome -- as he should have been after the admitting doctor ordered it be "ruled out," Finding 3, supra -- his worsening condition would have been diagnosed long before it was and the serious permanent injuries plaintiff suffered could have been avoided.
Second, those who did monitor the plaintiff's condition did not keep adequate records of what they saw. Hospital records must be complete enough to alert the attending physician on the next hospital shift of a patient's ongoing condition. Finding 7, supra. Because no one doctor was assigned to the plaintiff, it was especially important that the records kept be thorough, so that different doctors could adequately understand the progress of his condition and treat him accordingly. That is not what happened in this case: visits to the plaintiff were not adequately recorded in the medical records. This absence of adequate medical records meant that doctors who made subsequent visits to the plaintiff were unable to keep proper track of his progress, and thus were essentially forced to guess in their treatment of him. Finding 6(c), supra. The records here simply did not provide the detail required by the standards of care in the medical community. Finding 7, supra. The treating physicians were thereby negligent in their monitoring of plaintiff.
Third in those instances when visits were made, and notes taken, it appears that the plaintiff's complaints were not adequately addressed. Finding 6(b), supra. Thus, the hospital was also negligent in that it did not adequately follow up demonstrable signs of plaintiff's worsening condition as a prudent person would have.
The plaintiff has presented a series of circumstances which amount to clear negligence in the defendant's treatment of him. Moreover, it is clear that defendant's failure to treat plaintiff in a capable and timely manner was not only a breach of the standard of care but also the proximate cause of the substantial injuries suffered by plaintiff.
Plaintiff is entitled to be compensated for those injuries suffered as a result of defendant's negligence. He has proven a loss of function of his hand, Finding 11(a), supra, which has circumscribed his ability to take part in a number of physical activities as well as his ability to accept certain employment opportunities. Finding 11(b), supra.4 The loss of function also inhibits plaintiff's ability to enjoy certain recreational and social activities. Finding 11(c), supra. Additionally, plaintiff has encountered a great deal of pain and suffering. Finding 12, supra. He will encounter even more pain and suffering -- as well as future medical expenses -- because he must undergo plastic surgery to correct the unsightly scars the past operations have left him with. Findings 13, supra.
I conclude that plaintiff is entitled to an award of $ 85,000. Finding 15, supra. Because of the plaintiff's past history of drug usage and his inability to manage his life, it has been agreed between the parties that any award I make be partially in the form of a life time annuity. The $ 85,000 award to the plaintiff shall be allocated as follows:
1. $ 25,000 payable to plaintiff, out of which attorney's fees and expenses can be paid.
2. $ 60,000 to be used to purchase a life time annuity for plaintiff.