Salis v. United States

Citation522 F. Supp. 989
Decision Date10 September 1981
Docket Number79-1528.,Civ. No. 79-693
PartiesWilliam J. SALIS, and Alice Salis, his wife v. UNITED STATES of America. Alice SALIS v. UNITED STATES of America.
CourtU.S. District Court — Middle District of Pennsylvania

John Paul Curran, Philadelphia, Pa., for plaintiffs.

James Walker, Asst. U.S. Atty., Scranton, Pa., for defendant.

MEMORANDUM AND ORDER

NEALON, Chief Judge.

I. INTRODUCTION

The plaintiffs in this case seek damages for the alleged malpractice of certain physicians employed by the United States Government. William Salis suffered serious injuries, including loss of his left leg, after he underwent an angiogram at the Wilkes-Barre VA Hospital in January 1978. The complainants contend that they may recover because: (1) the decision to employ the procedure constituted negligence, and (2) the patient's rights under the doctrine of informed consent were violated. This matter was tried without a jury on September 29 and October 1-2, 1980. All of the litigants agree that subject matter jurisdiction rests on the Federal Tort Claims Act, 28 U.S.C. § 1346(b) and Pennsylvania law governs the substantive aspects of the suit. Harrigan v. United States, 408 F.Supp. 177, 185 (E.D.Pa.1976); Ciccarone v. United States, 350 F.Supp. 554, 563 (E.D.Pa.1976), aff'd 486 F.2d 253, 257 (3d Cir. 1973). After a careful examination of the two theories, the court finds that although there was no negligence in the application of the angiogram, the defendants did in fact transgress the requirements of informed consent and the patient suffered serious injury as a result of the breach. Accordingly, damages shall be awarded.

II. FINDINGS OF FACT

1. The plaintiffs in this litigation are a married couple. William Salis is a fifty-six year old, life-long resident of Luzerne County, Pennsylvania. Alice Salis is his wife. The plaintiffs have two children, both of whom are adults. Throughout this Memorandum and Order, the name "Salis" shall refer to William Salis unless otherwise indicated.

2. The defendant is the United States of America acting through its agency, the Veterans Administration ("VA").

3. Salis served in the United States Navy during World War II. He saw action in the Atlantic and Mediterranean theaters.

4. With the exception of four years spent working in the mines, Salis's employment career consisted of clerical work.

5. Salis retired in January of 1974 at the age of forty-nine.

6. Prior to retirement, Salis received 60 per cent disability benefits from the VA on the basis of pernicious anemia, which he contracted during his military service.

7. Since his retirement, Salis has received 100 per cent disability benefits from the VA. He cannot work because he suffers from the following service-related illnesses: pernicious anemia, a heart condition, and thyroid problems.

8. Salis suffered from chest pains during 1972-74. His condition became increasingly worse as time progressed.

9. From January to April of 1974, Salis was at the VA Hospital in New York City receiving treatment for this condition.

10. During the course of his hospitalization, Salis twice underwent angiography and cardiac catheterization.

11. Angiography is a medical procedure in which a catheter is inserted into a blood vessel and an iodine-based dye is introduced into the circulatory system. The dye then outlines the vessels which are photographed by x-rays. Cardiac catheterization involves the same procedure with insertion of the catheter in the area near the heart.

12. The first of these procedures, performed on February 5, 1974, was designed to help diagnose a course of treatment for Salis's chest pains. As a result of the procedure, he suffered from chills and required medication.

13. The staff at the New York City VA Hospital determined that Salis suffered from a severe case of arteriosclerotic heart disease, as well as hypothyroidism and pernicious anemia.

14. On April 2, 1974, Salis underwent open heart surgery for five hours and twenty-five minutes including a triple coronary bypass operation.

15. On April 22, 1974, Salis received a second cardiac catheterization to evaluate the results of the triple coronary bypass.

16. Salis again experienced chills after the second catheterization.

17. Salis also suffered an embolism, or clot, in his right leg after the second procedure.

18. The embolism was induced by the catheter used to perform the angiography. Salis suffers from arteriosclerosis, or "hardening of the arteries," which is caused by the buildup of plaque, or fatty material, along the walls of his blood vessels. The catheter caused the clot by either dislodging plaque or in some other way injuring the circulatory system.

19. The embolism was removed surgically.

20. The triple coronary bypass relieved Salis's angina.

21. In 1976, Salis began to experience pains in his right leg while walking.

22. During the early part of 1977, Salis reported these pains to his regular physician, Dr. Jackier of the VA Hospital in Wilkes-Barre.

23. These pains were caused by "intermittent claudication," or pain caused by decreased circulation, which arises when the patient is either exercising or walking. The symptoms are relieved by sitting down or resting. The decreased circulation giving rise to the claudication was caused by Salis's arteriosclerosis.

24. In June 1977, Salis was admitted to the Wilkes-Barre VA Hospital for treatment of the pains in his right leg.

25. During his hospitalization in June 1977, Salis underwent a translumbar aortogram, a type of angiogram in which the dye is inserted through the aorta.

26. After the angiogram, Salis again experienced chills.

27. The results of the translumbar aortogram were not completely satisfactory, because the x-rays did not yield pictures of many small blood vessels. This problem arose because the dye became too diluted to outline these vessels. The Wilkes-Barre VA staff, nonetheless, was able to conclude that Salis's leg pains were primarily caused by his arteriosclerosis. He was discharged and directed to return in six months for further diagnosis.

28. The VA staff prescribed Arlidin for use by Salis during the six month period beginning in June 1977. The physicians took this step to determine if the patient's condition could be treated adequately with drugs and other non-surgical therapy.

29. Due to a good faith misunderstanding between the patient and his physicians, Salis did not take the drug regularly. At this point in time, it cannot be determined if a course of non-surgical therapy would have succeeded.

30. Salis's intermittent claudication essentially remained stable during the six month observation period except that he began to experience pain after shorter periods of walking.

31. In January 1978, Salis returned to the VA Hospital as directed. He was still complaining about the pain in his right leg, which he felt was seriously interfering with his life style. Salis was very interested in receiving effective treatment for the claudication. Nonetheless, his condition was not so desperate that he would have undergone risky surgical and diagnostic procedures before exhausting all reasonable avenues of non-surgical therapy.

32. The Wilkes-Barre VA staff considered surgery a possible form of treatment. Salis's physicians decided that he should undergo an angiogram in order to provide x-rays of the circulatory system in the right leg. These pictures were to be used to assess the possibility of surgery.

33. From their discussions with Salis, the VA doctors were aware of the chills the patient experienced after his previous applications of angiography. Benadryl was prescribed to counteract any allergic reactions that the patient might experience during the test.

34. The attending physicians did not review the records of Salis's 1974 angiography in New York. They did, however, obtain adequate information to proceed from various interviews with the patient. Reference to the New York records would not have affected the decision to resort to angiography.

35. This contemplated procedure involved the following risks for Salis: (1) adverse reaction to the dye, (2) injury from insertion of the catheter, and (3) creation of a clot caused by the breaking off of plaque that had collected along the vessel walls.

36. The risk of significant complications in the case of an average angiogram is in the vicinity of 1 to 2 per cent.

37. Salis was not warned of these dangers although his doctors did discuss with him the possibility of a hematoma.

38. If warned of these dangers, Salis would not have undergone the angiogram.

39. The angiogram was performed on January 12, 1978.

40. The radiologist who performed the angiogram inserted the catheter into Salis's left femoral artery. This action was taken even though the purpose of the procedure was to take x-rays of Salis's right leg.

41. The choice of the left femoral artery was made because the pulse in Salis's right femoral artery was weak. For that reason, the left artery appeared to be a safer point of entry.

42. The angiogram procedure dislodged plaque from the walls of Salis's blood vessels.

43. These plaques showered into Salis's left leg and left foot, thereby causing massive clotting.

44. The angiogram procedure also caused an acute renal shut-down, or kidney failure, because of either the shower of plaque or a reaction of the kidneys to toxic substances in the dye.

45. Late in the evening of January 12th, the lower sections of Salis's left leg began to show signs of the embolism. Specifically, his foot and toes became cold, pale, and painful.

46. The Wilkes-Barre VA staff attempted to remedy the situation, first with drugs and then by performing an embolectomy of the left femoral artery. The embolectomy was performed the day after the angiogram.

47. From a medical point of view, the treatment administered to Salis between January 12th and January 16th was appropriate. Unfortunately, these measures...

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    • United States
    • U.S. District Court — Northern District of Indiana
    • 14 Junio 1988
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    • U.S. District Court — Middle District of Pennsylvania
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