The opinion of the court was delivered by: BECHTLE
1. This action was brought under the Federal Tort Claims Act, 28 U.S.C. §§ 1346(b), 2671 et seq. Plaintiff is at the present time, and plaintiff's decedent and plaintiff also were at all times material hereto, citizens of the Commonwealth of Pennsylvania residing at the address above captioned.
2. Plaintiff, Harold Polischeck, is the surviving spouse of Geraldine R. Polischeck, deceased ("decedent"), who died on October 30, 1978. See Exhibit P1. Plaintiff was appointed Administrator of the decedent's estate by the Register of Wills of Montgomery County, Commonwealth of Pennsylvania on September 27, 1979. See Exhibit P2.
3. During October, 1978 and for sometime prior thereto, defendant, the United States, controlled, staffed and operated a medium size hospital and emergency room facility known as the Naval Regional Medical Center ("NRMC"), located at the Philadelphia Naval Base, Philadelphia, Pa. At the NRMC, defendant undertook to provide medical care, hospital care and emergency room services to, among others, its retired military personnel and their dependents.
4. The Naval Regional Medical Center was not at any time material hereto a "teaching hospital," as that term is generally understood in the medical profession, nor is it directly affiliated with any medical school or university. Stipulation of Facts, Docket Entry No. 38, P 9.
5. Each day, during the sixteen hour time period from 4:00 o'clock p.m. to 7:00 o'clock a.m., the defendant's emergency room was staffed by corpsmen, nurses, physician's assistants and one of defendant's naval hospital staff doctors.
6. At all times material hereto, the defendant did not have a neurosurgeon or neurologist on the hospital staff at the NRMC. Patients requiring such neurological care and attention would first be seen by the staff internist and would be referred to a civilian hospital if further medical attention or care were required.
7. A physician's assistant is a paramedically trained member of armed forces personnel. To become a physician's assistant, a person receives one year of classroom instruction at physician's assistant school, studying a variety of basic medical topics, followed by one year of clinical rotation in a hospital or hospitals alongside full-time medical students. Testimony of Steve Garman.
8. At all times material hereto, the defendant, as a general practice, had its physician's assistants examine and treat approximately 50 to 65% of its emergency room patients. Testimony of Steve Garman. Approximately 50 to 100 patients would be seen daily at the defendant's emergency room.
9. The defendant permitted its physician's assistants to perform all of the following without the intervention or participation of any physician then on duty in the emergency room:
(a) Take and record medical histories from patients;
(b) Investigate and record the patients' complaints;
(c) Perform physical examinations and order diagnostic tests such as blood counts and urinalysis;
(e) Prescribe routine medication;
(f) Counsel and advise patients regarding follow-up medical care;
10. Physician's assistants were authorized to exercise their own judgment when treating patients in the emergency room as to whether or not they would require the assistance or intervention of the emergency room physician. Id.
11. At all times material to this action, defendant did not have in effect any regulation, procedure or policy requiring that each emergency room patient be seen by a medical doctor before the patient's discharge. Testimony of Dr. SanFelipe; Testimony of Steve Garman.
12. At all times material to this action, defendant did not have in effect any regulation, procedure or policy requiring that the medical chart or emergency room treatment record of each emergency room patient be reviewed by a medical doctor before or after the patient's discharge. Testimony of Dr. SanFelipe; Testimony of Steve Garman.
13. With the exception of a prior hysterectomy, the plaintiff's decedent had always been in good health.
14. Plaintiff's decedent became ill while she and her husband were enroute to a furniture convention in North Carolina. Plaintiff's decedent first complained of a headache in Virginia on either Monday or Tuesday, October 23 or October 24, 1978, prior to her visiting the defendant's emergency room. The plaintiff's decedent also developed an elevated temperature, began to experience nausea, was vomiting and complained that the top of her head was blowing off and of pressure behind her eyes.
15. On Wednesday, October 25, 1978, plaintiff and plaintiff's decedent discontinued their trip and drove to the NRMC, where they arrived at approximately 6:45 p.m. Testimony of Harold Polischeck; Exhibit P3.
16. When they arrived, the initial information and plaintiff's decedent's complaints were taken down by a corpsman or nurse. Exhibit P3, blocks 3-16. In doing so, the corpsman or nurse who completed block 16 of Exhibit P3, entitled "chief complaint and present illness," was not required to record remarks made by plaintiff's decedent verbatim but was allowed to abbreviate the symptoms recited. The corpsman or nurse also took the vital signs of plaintiff's decedent and marked them down on the chart. Exhibit P3, block 17.
17. Plaintiffs were next seen by physician's assistant Garman, who was dressed in whites, wore a name tag which stated, "Steve Garman, P.A.," and saw plaintiffs in an office or examination room with the same name and initials posted on the door. Garman told them that he was ...