The opinion of the court was delivered by: HUYETT
This action tried without a jury charges medical doctors employed by defendant, United States of America, at the Coatesville Veterans Administration Hospital with malpractice in treating plaintiff, Frank R. Ciccarone, in July 1963. Defendant denies malpractice, and also asserts the affirmative defense of the statute of limitations. The trial was bifurcated. Only the issue of liability was tried.
1. Plaintiff, Frank R. Ciccarone, is a resident of Philadelphia, Pennsylvania.
2. Defendant, United States of America, through its agents, servants and employees and through the Veterans Administration, an agency of defendant, at all times hereafter mentioned, operated a hospital at Coatesville, Pennsylvania.
3. Plaintiff in July of 1963 was a 39 year old white male.
4. Prior to July 1963 plaintiff had been employed as a "wood sawer" in the same factory since 1956.
5. Plaintiff had an eighth grade education and when examined by Dr. S. E. Strum gave the impression that he was intellectually restricted and had memory difficulties.
6. Plaintiff in every visit to a physician at all times hereinafter mentioned in connection with his medical problems was always accompanied by his wife, a person of average intelligence, who actively participated in all discussions and decisions.
7. While on duty with the U.S. Army in September 1945 plaintiff following an accident in which he was thrown out of a jeep developed acute meningitis and as a result was hospitalized until December 8, 1945.
8. From July 4, 1956 to July 16, 1956 plaintiff was hospitalized in the Philadelphia General Hospital for meningitis.
9. From December 23, 1961 to January 4, 1962 and from January 26, 1962 to January 29, 1962 plaintiff was hospitalized in the Misericordia Hospital for recurrent bacterial meningitis.
11. Plaintiff, on May 8, 1963, because of his three previous attacks of meningitis, was faced with the possibility of death and he and his wife were so advised by the staff of the Veterans Administration Hospital.
12. Plaintiff was on leave from the Veterans Administration Hospital from June 28, 1963 to July 14, 1963.
13. In July 1963 Dr. S. E. Strum was a full-time staff neurologist at the Veterans Administration Hospital.
14. Dr. S. E. Strum served a medical residency at Worcester City Hospital where he spent three months attending and caring for neurological and neuropsychiatric patients; he trained in neurology for two years at the Boston Veterans Administration Hospital and for one year at the Bronx Veterans Administration Hospital, thereby completing three years of neurological training.
15. Plaintiff returned to the Veterans Administration Hospital on July 10, 1963 for evaluation at which time he was examined by Dr. S. E. Strum.
16. In 1963 plaintiff required a complete investigation to determine the cause of the repeated attacks of meningitis.
17. Since in 1963 plaintiff had fractures of the frontal sinus as well as fractures extending into the maxillary sinuses and because plaintiff had many attacks of sinusitis, it was essential at that time to consider the possibility of a cerebro-spinal fluid leak into the frontal sinus or other sinuses and to determine whether such leak was the source of the attacks of meningitis.
18. If the source of such infection could not be found at that time, the usual history of such patients was that death would occur in attacks of meningitis and therefore the determination of a cerebro-spinal fluid leak into the nasal cavity was entirely justified.
19. On July 10, 1963 Dr. S. E. Strum developed a careful and elaborate written plan to investigate the possibility of communication of the subarachnoid space and the outside to determine the reason for plaintiff's recurrent attacks of meningitis. Such plan included a detailed analysis and evaluation of plaintiff's condition.
20. Dr. Strum's plan of July 10, 1963, inter alia, involved an intrathecal injection of methylene blue (methylene blue procedure), other studies and tests, and presentation of the results to consultant physicians of the Veterans Administration Hospital.
21. Prior to implementing the methylene blue procedure Dr. S. E. Strum discussed his plan with other physicians at the Veterans Administration Hospital including Dr. Gigliotti, then a resident in neurology, and Dr. M. P. Rosenblum, then acting chief of neurology and concurrently Chief of Staff of the Veterans Administration Hospital.
22. Plaintiff, on July 10, 1963, was asked to return to the Veterans Administration Hospital on July 14, 1963.
23. On July 14, 1963, which was a Sunday, plaintiff and his wife discussed the methylene blue procedure with Dr. S. E. Strum who advised plaintiff and his wife substantially as follows:
24. Plaintiff and his wife understood the explanation of Dr. S. E. Strum on July 14, 1963 concerning the proposed test procedure.
25. Following Dr. Strum's explanation of the methylene blue procedure, the plaintiff and his wife orally agreed and consented to have the procedure performed although no formal written authorization was obtained.
26. Prior to the injuries sustained in the Veterans Administration Hospital by plaintiff on July 16, 1963, plaintiff had virtually full use of his legs and normal bowel and urinary functions and sexual ability.
27. The most feasible method to determine a leak from the intra-cranial cavity into the nasal cavity was use of the methylene blue procedure.
28. Dr. S. E. Strum, in July 1963 in respect to plaintiff, was faced with the necessity of balancing the hazards of the methylene blue procedure, and the potentiality of death from an attack of meningitis.
29. Dr. S. E. Strum had participated in the intrathecal injection of methylene blue on at least two prior occasions without any adverse effects while serving at the Boston Veterans Administration Hospital.
30. The methylene blue procedure was taught to the staff of the Boston Veterans Administration Hospital at the time Dr. S. E. Strum trained there for a two-year period, and during such period no one at that hospital or at the associated teaching facilities of Harvard, Tufts or Boston University reported to the staff of the Boston Veterans Administration Hospital adverse effects from such procedure.
31. Dr. S. E. Strum, when he administered the methylene blue procedure on July 16, 1963, was unaware of any method to determine plaintiff's sensitiveness to methylene blue dye.
32. Dr. M. P. Rosenblum, in 1963, was certified by the American Board of Psychiatry and Neurology in the fields of both psychiatry and neurology.
33. Dr. M. P. Rosenblum concurred with the methylene blue procedure proposed by Dr. S. E. Strum for plaintiff.
34. In 1963 Dr. M. P. Rosenblum was not aware of any other commonly used tests in lieu of the methylene blue procedure proposed by Dr. S. E. Strum.
35. The methylene blue procedure proposed by Dr. S. E. Strum was essentially a diagnostic procedure.
36. Dr. Robert A. Groff of Philadelphia, Pennsylvania, is a physician who is Board certified in the fields of ...