## Facts

- Daniel D. Christopher was a 29-year-old Army veteran diagnosed with tuberculosis in both lungs after a December 1958 examination at a Veterans’ Administration (VA) clinic in Philadelphia.
- On the VA’s recommendation, Christopher entered the Loch Raven VA Hospital in Baltimore, Maryland, on January 6, 1959.
- On March 23, 1959, VA surgeons performed a partial resection of Christopher’s right lung; his recovery was uneventful.
- VA physicians later determined Christopher needed surgery on his left lung: a resection of the upper lobe, performed on May 4, 1959, by VA surgical staff.
- The May 4 operation required opening the chest and working near the thoracic vertebrae; the surgeons stripped periosteum and disarticulated ribs from the transverse processes using an osteotome and then used a rib-spreader to open the operative field.
- After the May 4 surgery, Christopher suffered a spinal cord injury and became paraplegic.
- As a paraplegic, Christopher experienced severe and lasting physical and psychological harms, including muscle spasms, pain and burning sensations, bowel-control problems, sexual dysfunction, and depression.
- Christopher received VA disability payments of $725 per month.
- Christopher brought a nonjury action against the United States under the Federal Tort Claims Act (FTCA), alleging the VA’s negligent surgical conduct caused his paraplegia and seeking money damages.

## Issues

1. Under the FTCA and the substantive tort law of Maryland (the place of the alleged negligence), did the VA surgical team fail to use reasonable care in performing the May 4, 1959 thoracic operation?
2. If so, did that negligence more likely than not cause Christopher’s spinal cord injury and resulting paraplegia?
3. What damages were recoverable for Christopher’s permanent paraplegia, and how (if at all) should his VA disability payments affect the award?

## Decision

- The district court (bench trial) entered judgment for Christopher under the FTCA.
- Applying Maryland negligence standards, the court found the VA surgical care during the May 4, 1959 operation fell below the required level of medical care.
- The court found causation, concluding the paraplegia was attributable to trauma associated with the operative technique and forces used near the rib-vertebra articulation and spinal structures, rather than an unrelated, non-negligent condition.
- The court awarded damages for Christopher’s permanent paraplegia and its consequences and took account of his ongoing VA disability payments in determining the proper recovery.

## Legal Principles

- Under the FTCA, the United States is liable for negligent acts or omissions of its employees to the same extent a private person would be liable under the law of the state where the negligence occurred.
- In a medical-negligence case, the plaintiff must prove the applicable standard of care, a departure from that standard, and that the departure was a factual and legal cause of the injury, typically through medical evidence.
- Causation may be proven by showing the plaintiff had no comparable neurologic deficit before surgery, the deficit appeared immediately after the procedure, and the medical proof supports operative trauma as the most probable explanation.
- Damages for catastrophic injury may include compensation for pain and suffering, loss of earning capacity, and long-term disability; courts may consider government disability payments to avoid duplicate recovery for the same loss.

## Conclusion

In this FTCA nonjury case, the court held the United States liable because VA surgeons performing a May 1959 left-lung resection at a Baltimore VA hospital failed to use reasonable care in operative steps near the thoracic spine, and that negligence more likely than not caused Daniel Christopher’s paraplegia; the court awarded substantial damages for his permanent disability and related harms while considering his VA disability payments.


Christopher v. United States, 237 F. Supp. 787 (1965)