Baker v. United States

• Decision Date: 13 February 1964
• Docket Number: Civ. 2-546.
• Parties: Mrs. Kenneth BAKER, as Legal Guardian of Kenneth Baker, and Mrs. Kenneth Baker, Individually, Plaintiffs, v. UNITED STATES of America, Defendant.
• Court: U.S. District Court — Southern District of Iowa

226 F. Supp. 129

Mrs. Kenneth BAKER, as Legal Guardian of Kenneth Baker, and Mrs. Kenneth Baker, Individually, Plaintiffs, v. UNITED STATES of America, Defendant.

Civ. 2-546.

United States District Court S. D. Iowa, Davenport Division.

February 13, 1964.

D. C. Nolan, J. T. Nolan, Iowa City, Iowa, and E. A. Hicklin, Wapello, Iowa, for plaintiff.

Donald A. Wine, U. S. Atty., and Leo Gross, Asst. U. S. Atty., for defendant.

STEPHENSON, Chief Judge.

This action was brought by Mrs. Kenneth Baker as legal guardian for Kenneth Baker, an incompetent, against the United States of America under the provisions of the Federal Tort Claims Act, Title 28 U.S.C.A., § 1346(b) and §§ 2671-2680. Plaintiff seeks to recover damages in the sum of $100,000 for injuries allegedly sustained by her ward in attempting to commit suicide by jumping into a concrete window well on the grounds of the Veterans Administration Hospital at Iowa City, Iowa, where said ward was under psychiatric treatment. In addition plaintiff, individually, seeks damages in the sum of $25,000 for loss of consortium. Plaintiff charges the V. A. Hospital staff with specific acts of negligence in failing to: (1) maintain sufficient physical restriction over said patient; (2) maintain proper supervision over said patient; (3) exercise ordinary and due care for said patient in his existing mental and physical condition; (4) properly diagnose the patient's illness and mental condition and to reasonably determine that he was in such condition that he might be reasonably expected to commit suicide if not properly supervised and restrained; (5) heed the information and warning from the patient's attending physician and family regarding his condition; and in (6) maintaining a deep pit or window well uncovered in close proximity to the area provided for mental patients and freely accessible to them. Plaintiff also charges negligence under the doctrine of res ipsa loquitur. The government denied its hospital staff or employees were negligent as charged.

Counsel for both parties presented this matter vigorously and furnished the Court with excellent briefs.

This cause was tried to the Court sitting without a jury as provided by Title 28 U.S.C.A. § 2402. The injury having occurred in Iowa the law of this State controls, Title 28 U.S.C.A. §§ 1346 (b), 2674; Massachusetts Bonding & Ins. Co. v. United States, 352 U.S. 128, 77 S.Ct. 186, 1 L.Ed.2d 189 (1956). The State law controls: as to liability for negligence, Fair v. U. S., 234 F.2d 288 (5 Cir. 1956); as to the doctrine of res ipsa loquitur, White v. U. S., 193 F.2d 505 (9 Cir. 1951); as to the doctrine of respondeat superior, William v. U. S., 350 U.S. 857, 76 S.Ct. 100, 100 L.Ed. 761 (1955); Callaway v. Garber, 289 F.2d 171 (9 Cir. 1961); as to damages, Massachusetts Bonding & Ins. Co. v. United States, supra; Montellier v. United States, 315 F.2d 180 (2 Cir. 1963).

It is clear that under Iowa law charitable institutions must respond for the negligence of their employees. Haynes v. Presbyterian Hospital Ass'n, 241 Iowa 1269, 45 N.W.2d 151 (1950). Cf. White v. U. S., 317 F.2d 13 (4 Cir. 1963) reversing, 205 F.Supp. 662 (E.D. Va.). In the matter at hand the United States must respond in damages for the negligence, if any, of its staff and employees at the Veterans Hospital. In determining the issue of negligence a review of the facts is necessary.

Plaintiff's ward, Kenneth Baker (hereinafter referred to as the patient) was referred to the Veterans Administration Hospital in Iowa City, Iowa, on August 23, 1960, by his attending physician, Dr. C. E. Schrock, M.D. The patient, then 61 years of age, had been under Dr. Schrock's care for approximately 60 days prior thereto. In a medical certificate accompanying the patient's written application for admission to the V. A. Hospital, Dr. Schrock indicated the following:

Brief History: Progressive symptoms of depression past three months. Suicidal content evident, no real response to imipramine medication to date.

Symptoms: Depressed, self accusatory, sleep disturbance and periods of confusion. Suicidal content.

Diagnosis: Involuntary psychotic reaction.

The patient's wife testified that at the time of patient's application for admission she conferred with Dr. James A. Kennedy, M.D. (then acting Chief of the Neuropsychiatric Service at the V. A. Hospital) and advised him that there was a suicidal tendency on the part of her husband and told him about finding a gun her husband had hid in one of the buildings on the farm about three weeks before. Dr. Kennedy interviewed the patient for an hour to an hour and a half, visited with the patient's wife and brother, examined the admitting certificate above referred to, and advised the patient's wife that the patient would be admitted provided certain financial data concerning the patient was furnished (the doctor requested this data for the purpose of confirming that the patient's belief as to his state of poverty was in fact a delusion and completely unfounded). This data was furnished the next day and Dr. Kennedy then ordered his admission to Ward 10E, an open ward, because as the doctor testified "in my opinion he did not present himself as a suicidal risk." The patient remained on this open ward on the 10th floor for the next three days and had free access to go to the 3rd floor for meals, to the canteen, and to go outside. On August 27, 1960, the patient left the ward on the 10th floor voluntarily and went to the grounds immediately outside the hospital building. At about 7:30 p. m., the patient jumped into a window well 13 feet deep in an obvious suicide attempt. He suffered scalp wounds, fractures of the left clavicle, the 8th, 9th and 10th ribs, and the left transverse processes of the 3rd, 4th and 5th lumbar vertebral bodies. About six hours later the patient suffered an occlusion of the left carotid artery. Thereafter the patient suffered a complete paralysis of his right side. On April 19, 1961, the patient was removed to Restopia, a private nursing home, where he now remains. The patient is completely and permanently disabled both mentally and physically and requires constant nursing attendance.

In considering the various allegations of negligence it should first be observed that there is no evidence indicating that hospital employees failed to carry out the orders of Dr. Kennedy or any other physicians in the care of the patient. Failure on the part of hospital employees to carry out the instructions of a patient's physician may constitute a violation of the standard of care required of hospitals. Shover v. Iowa Lutheran Hospital, 252 Iowa 706, 107 N.W.2d 85 (1961). Neither is there evidence indicating any appreciable change in the patient's condition from the time of his admission to the time of the suicidal attempt which might require action on the part of hospital employees not covered by Dr. Kennedy's instructions. Bradshaw v. Iowa Methodist Hospital, 251 Iowa 375, 101 N.W.2d 167 (1960). It should also now be observed that the window well into which the patient leaped was enclosed by a heavy mesh wire fence which was at least three feet high. This was not a case of the patient falling into the window well but the injury was caused by a deliberate leap of the patient over the fence into the window well.

Although it may have been better practice to cover the window well¹ the Court finds that under the evidence in this case the defendant was not negligent in failing to close the window well with a suitable covering.

The negligence, if any, which was the proximate cause of the patient's injuries arises out of the failure of Dr. Kennedy to properly diagnose the patient as a sufficient suicide risk so as to require closer supervision than was furnished by the immediate assignment of the patient to an open ward. A closed ward on the 9th floor was available to which patients were assigned when close supervision was deemed advisable. The issues are: What standard of care was required of the hospital and its staff? Was that standard of care violated in assigning the patient to an open ward?

There appear to be no Iowa cases involving the standard of care required of mental hospitals toward their patients. But it appears generally, that the care required of a hospital includes giving such care to a patient as the hospital knew or in the exercise of reasonable care should have known was required. This duty is measured by the degree of care, skill and diligence customarily exercised by hospitals generally in the community. A hospital is not an insurer of a patient's safety and is not required to guard against that which a reasonable person under the circumstances would not anticipate. Shover v. Iowa Lutheran Hospital, supra, 252 Iowa 712, 107 N.W.2d 85; Bradshaw v. Iowa Methodist Hospital, supra, 251 Iowa 384-385, 101 N.W.2d 167; 41 C.J.S. Hospitals § 8c(3), pp. 349-350.

The standard of care required of mental hospitals in other jurisdictions follow these same general standards. Mounds Park Hospital v. Von Eye, 245 F.2d 756, 70 A.L.R.2d 335 (8 Cir. 1957). It is particularly recognized in the treatment of mental patients that diagnosis is not an exact science. Diagnosis with absolute precision and certainty is impossible. Further the objective is treatment not merely incarceration. Treatment requires the restoration of confidence in the patient. This in turn requires that restrictions be kept at a minimum. Risks must be taken or the case left as hopeless. See Fahey v. United States, 153 F.Supp. 878, 885 (S.D.N.Y.1957), reversed on other grounds, 2 Cir., 219 F.2d 445; Mills v. Society of New York Hospital, 242 App.Div. 245, 274 N.Y.S. 233, 270 N.Y. 594, 1 N.E.2d 346 (1936). The standard of care which stresses close observation, restriction and restraint has fallen in disrepute in modern hospitals and this policy is being reversed with excellent results. See, Perr, Suicide Responsibility of Hospital and Psychiatrist, 9...