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DUTCHER v. UNITED STATES

March 20, 1990

CORNELIA F. DUTCHER, Plaintiff,
v.
UNITED STATES OF AMERICA, Defendant



The opinion of the court was delivered by: PRATT

 JOHN H. PRATT, UNITED STATES DISTRICT JUDGE

 This Federal Tort Claims Act case was tried before the Court without a jury on July 25, 26, and 27, 1989. Pursuant to Rule 52 of the Federal Rules of Civil Procedure, the Court enters the following findings of fact and conclusions of law.

 I. FINDINGS OF FACT

 1. Plaintiff, Cornelia Dutcher, is the mother of the deceased, Jeffrey Miller, and is the duly authorized Administratrix of his estate.

 2. On April 8, 1985, plaintiff's decedent, Jeffrey Miller, was voluntarily admitted to the Veterans Administration Medical Center in Washington, D.C. (VAMC). In 1979, when he was first admitted to the VAMC, where he was an inpatient for five months, he was diagnosed as being afflicted with schizophrenia, paranoid type. From that time on, he was in and out of various VA hospitals for the treatment of this illness. He was discharged from the United States Marine Corps in 1984 with a service connected disability rating of 50%, later reduced to 30%.

 3. At the time of his admission in April 1985, he was diagnosed as suffering from psychosis; he was out of touch with reality and some of his thoughts surrounded persecutory ideas. He was noted to be paranoid and delusional with auditory hallucinations.

 5. Schizophrenia is a psychosis that takes place in the presence of a clear sensorium. *fn1" Frequently, it first occurs in young adulthood, and those afflicted primarily have disorders of thought content. They have delusional ideas, and they may have disorganized thinking, as well as hallucinations of various types. Paranoid schizophrenia is dominated by paranoia: delusions of persecution, delusions of being influenced by an outside force.

 6. The purpose of Jeffrey Miller's admission to the VAMC in 1985 was to stabilize his psychotic symptomatology; to relieve him of any suicidal and/or homicidal ideation; to assess his strengths and weaknesses; and to invite the participation of his family and to evaluate how the family could be used at a later time when Jeffrey was discharged from the facility.

 7. At the time of his admission, Jeffrey Miller expressed suicidal ideations and some vague homicidal thoughts. He did not, however, express suicidal intent, nor did he have a definitive suicide plan. Subsequent to his admission, Jeffrey Miller repeatedly and consistently denied that he was suicidal or homicidal.

 8. Jeffrey Miller was admitted to an unlocked ward, which is part of a form of treatment known as milieu therapy. An unlocked ward is used in an effort to create a community that will encourage resocialization, reintegration of the personality, calming down and containment of psychiatric symptoms. The doors are unlocked because, when a door is locked, patients have less of a sense of responsibility in controlling themselves, in growing and in overcoming their illnesses.

 9. The care and treatment rendered Jeffrey Miller by the VAMC met the medical standard of care appropriate for such patients. He was admitted to an open ward for milieu therapy; he was treated with neurologic medication; he received group therapy, individual therapy, and supportive therapy, and efforts were made to include family therapy. It was a very typical regimen of treatment for this patient's affliction.

 10. There was no evidence presented at trial by the plaintiff that the care and treatment rendered Jeffrey Miller by the VAMC between April 8 and April 12, 1985, was not within the applicable standard of medical care.

 11. On April 12, 1985, at 11:30 a.m., Dr. Ian Goldberg lifted the ward restriction and granted Jeffrey Miller "buddy privileges," which permit a patient access to areas outside the ward so long as he is in the company of another patient on the ward.

 12. At or before 4:00 p.m. on April 12, 1985, Jeffrey Miller met with Dr. Goldberg, his treating physician, and stated that he wanted to leave the hospital, which would be against medical advice. Dr. Goldberg spoke with Jeffrey for some time and, at about 4:30 p.m., he also called Jeffrey's mother, Cornelia Dutcher, asking her to intervene and to encourage Jeffrey to stay in the hospital. She spoke to her son, who agreed with both Dr. Goldberg and his mother to stay in the hospital and not to leave against medical advice as he had planned.

 13. On the same day (April 12, 1985), shortly after this meeting, Jeffrey Miller left the VAMC without being discharged and against medical advice. At 6:00 p.m., when his absence was discovered, he was placed on AWOL status. At this time the nurse on duty, Debra Thomas, called Jeffrey's mother's home to inform the family that Jeffrey had left the hospital. Previously, she had reported Jeffrey's absence to the duty officer and called VA Security and the Medical Administration.

 15. At approximately 7:00 p.m., having just arrived home without any luggage, Jeffrey Miller himself called the VAMC from his mother's residence. During the conversation between Jeffrey and Debra Thomas, the nurse on duty, Jeffrey reported that he was feeling better and that he felt his medication was working better. He denied having hallucinations, problems with God or religion, or that he wanted to harm himself. Ms. Thomas encouraged him to return to the hospital but Jeffrey stated ...


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