Riddlesperger v. United States

• Decision Date: 14 January 1976
• Docket Number: Civ. A. No. 75-G-0134-S.
• Citation: 406 F. Supp. 617
• Parties: Willie Louise RIDDLESPERGER, Administratrix of the Estate of Douglas S. Riddlesperger, Deceased, Plaintiff, v. UNITED STATES of America, Defendant.
• Court: U.S. District Court — Northern District of Alabama

406 F. Supp. 617

Willie Louise RIDDLESPERGER, Administratrix of the Estate of Douglas S. Riddlesperger, Deceased, Plaintiff, v. UNITED STATES of America, Defendant.

Civ. A. No. 75-G-0134-S.

United States District Court, N. D. Alabama, S. D.

January 14, 1976.

Steven D. Pugh, Birmingham, Ala., for plaintiff.

Wayman G. Sherrer, U. S. Atty., and Bill L. Barnett, Asst. U. S. Atty., Birmingham, Ala., for defendant.

FINDINGS OF FACT AND CONCLUSIONS OF LAW

GUIN, District Judge.

By this action, Willie Louise Riddlesperger seeks damages against the United States (acting through the medical personnel of the Veterans Administration Hospital, operated by the United States, at Birmingham, Alabama), hereinafter referred to as Veterans Hospital, for malpractice, alleging that her husband's death was caused by the failure of medical personnel to use reasonable care and skill in diagnosing and treating her husband's condition and by the hospital's allegedly permitting her husband to fall from his bed. Her husband entered the hospital as a patient on May 7, 1973, for treatment and was pronounced dead on May 14, 1973, while still a patient therein.

ISSUES INVOLVED

The complaint states that on May 7, 1973, the deceased, hereinafter referred to as "Riddlesperger," was admitted at the Veterans Hospital and suffered a misdiagnosis, and because of this was treated with improper care. This raises the following three issues:

(1) Whether treatment with anticoagulants should have been instituted upon formulation of a "working diagnosis;"

(2) Whether a brain scan was required prior to institution of a treatment program; and

(3) Whether there was negligence on the part of the hospital relating to or causing Riddlesperger's fall from his bed.

The essential facts of the case are as follows: Riddlesperger, age 56, was admitted to the Veterans Hospital on May 7, 1973. He complained of weakness on the right half of his body, difficulty walking and using his right hand during the three days previous to admission, and falling to the floor on many occasions during this period. There was no history of convulsions, headaches, or vomiting. A lumbar puncture was performed which showed the spinal fluid to be clear and of normal pressure, though the protein count was 132 milligrams per cent, which was abnormal. Based upon this information, the attending physician formulated a working diagnosis of right hemiparesis, hereinafter referred to as "incomplete stroke," and prescribed treatment of anticoagulants (heparin, coumadin, and, to increase blood supply, rheomacrodex). Skull and chest X-rays were negative and the following tests were ordered: echoencephalogram, electroencephalogram and brain scan.

Riddlesperger was never placed in hard restraints after admission to the neurology ward on May 7, 1973, though the family requested them. The family was not permitted to stay with him outside the normal visiting hours. The evidence was that Riddlesperger was rational and cooperative when he entered the ward and this was considered sufficient reason not to use the restraints. He entered an eight-man ward and constant visitation was contraindicated due to his condition on admission, the fact that he showed improvement, and the size of the ward.

On May 8, 1973, he showed slight improvement of his motor powers. The electroencephalogram (hereinafter referred to as "EEG") was abnormal with a diffuse delta. It showed a left to right shift of two degrees but was found compatible with the working diagnosis. Improvement was noted on May 9, 1973, as "fairly good" and on the 10th as "very significant improvement," rating the use of the right hand as 4/5 and the right leg as 4/5 . It was on the 10th that the echoencephalogram (hereinafter referred to as "echo") was interpreted to show a 4 millimeter shift from left to right of the midline of the brain. The attending physician considered the test results as inconsistent with the clinical findings of Riddlesperger's improvement.

On the morning of May 11, 1973, at 7:40 A.M., Riddlesperger raised up onto his knees in his bed, leaned out over his raised bedside rails and fell to the floor, striking his head on the bedside table, and causing a one-centimeter cut on the right of his forehead. A one-stitch suture closed the wound but almost immediately a neurological deficit was noted. At 11:00 A.M. a lumbar puncture was performed which revealed a bloody fluid. Riddlesperger, having been placed on respiratory assist, was transferred to an intensive care unit at 1:00 P.M., and an angiogram was scheduled shortly thereafter. The angiogram revealed a large malignant brain tumor (glioblastoma). His condition deteriorated until his death on May 14, 1973.

THE GOVERNING LAW

The Federal Tort Claims Act¹ sets aside the sovereign immunity of the United States in cases where it is alleged, as in this case, that federal employees have tortiously caused personal injury. Thus, by the statute, the government's liability is the same as that of a private person under similar circumstances. The law of the state in which the negligent act occurs determines liability.² Briefly, the applicable Alabama law of malpractice is outlined as follows.

The standard of care required of hospitals in Alabama is one of "ordinary care" as defined in South Highlands Infirmary v. Galloway, 233 Ala. 276, 171 So. 250, 253 (1936):

". . . that care which persons of common prudence exercise under like conditions . . .. This implies a care having regard to the conditions of the particular case, and to the fact that the subjects of ministry are sick people. It implies an obligation to have such training and possess such skill as will enable the nurse to give reasonable and ordinary care to the patient. . . .

"It is not to be construed as imposing a greater `degree of care, skill, and diligence' than that `used by hospitals generally in that community' . .."

In Cooper v. Providence Hospital, 272 Ala. 283, 130 So.2d 8 (1961), the plaintiff alleged negligence whereby the deceased was permitted to get up from his bed in the night and then fall to the floor, suffering injuries which resulted in his death. No evidence was shown that the hospital failed to exercise the required degree of care.

The standard is not broadened by the patient's illness where, as in Mobile Infirmary v. Eberlein, 270 Ala. 360, 119 So.2d 8 (1960), the patient was under psychiatric care; there the standard of care required was expressed in this manner at 270 Ala. 367, 119 So.2d 15:

"The care required of the hospital is not that care which persons of prudence exercise under like conditions, but that care which persons of common prudence, engaged in the hospital business, exercise under like conditions."

A hospital is not an insurer of its patients' safety.³

The standard of care required of a physician in treating a patient is to possess and "to exercise such reasonable care, diligence, and skill as physicians . . . in the same general neighborhood, in the same general line of practice, ordinarily have and exercise in a like case." Orange v. Shannon, 284 Ala. 202, 206, 224 So.2d 236, 239 (1969). A physician is not an insurer of the successful issue of his treatment or service.⁴

It is clear that a physician is not liable for an honest mistake or error of judgment in making a diagnosis, or prescribing a mode of treatment, when the proper course is subject to reasonable doubt.⁵ Evidence that an unfortunate result followed the prescribed treatment does not of itself show negligence.⁶ The physician is not restricted to a particular method of care and treatment if more than one course is recognized by the profession in the same line of practice and in the same general neighborhood.⁷ Further, a physician is not liable for an error of judgment in making a diagnosis, or in prescribing a mode of treatment, when the proper course is subject to reasonable doubt.⁸

The sufficiency of the evidence required in malpractice actions is well stated in Waddell v. Jordan, 293 Ala. 256, 260, 302 So.2d 74, 77 (1974), where the Alabama Supreme Court, quoting from Orange v. Shannon, 284 Ala. 202, 224 So.2d 236, 239 (1969), said:

"`. . . There must be something more than a mere possibility — something more than one possibility among others — that the negligence complained of was the cause of the injury. There must be some evidence to the effect that such negligence probably caused the injury. . . .'"

Finally, damages are recoverable under the Alabama wrongful death statute.⁹ The beneficiaries of such actions are the heirs at law of the deceased, since the statute provides that the damages recovered are not subject to the payment of debts or liabilities of the intestate, but must be distributed according to the statute of distribution.¹⁰

In actions where the administratrix sues, she must produce evidence that the heirs in whose behalf the suit is brought were receiving financial aid, or would have in the future, or else there is no pecuniary injury.¹¹ Though the Alabama statute provides only for punitive damages, Congress substituted actual or compensatory damages.¹²

Calculation of pecuniary loss is best defined in Hoyt v. United States, 286 F.2d 356 (5th Cir. 1961), where the court said that pecuniary damages do not include grief or loss of society or companionship; in Hoyt the court applied the standard of compensatory damages provided for in the Federal Employers' Liability Act as that Act was construed in Chesapeake & Ohio Ry. Co. v. Kelly, 241 U.S. 485, 489, 36 S.Ct. 630, 631, 60 L.Ed. 1117 (1916):

". . . The damages should be equivalent to compensation for the deprivation of the reasonable expectation of pecuniary benefits that would have resulted from the continued life of the deceased."

THE PROVEN FACTS

A working diagnosis of incomplete stroke was developed on May 7, 1973. Treatment immediately was prescribed with anticoagulants and continued until May 10, 1973. Plaintiff's expert, Dr. Walter R....