Fill and Sign the Complaint in Federal Court for Preventable Fall at Hospital Form

IN THE UNITED STATES DISTRICT COURT FOR THE _____________ DISTRICT OF ____________ _____________ DIVISION ______________________________ PLAINTIFF VS CIVIL ACTION NO. _____________ ______________________________ DEFENDANT COMPLAINT (Jury Trial Requested) COMES NOW _____________, Plaintif, by and through his attorneys, and files this his Coepllaint against _________________________________________, and would show as follows: I. This action arises under the Federal Tort Claies Act, Sections _____ through _______ of Title ___ of the United States Code. This Court is vested with jurisdiction plursuant to Section _______(b) of Title ____of the United States Code. II. Plaintif, _______________, is an adult resident citizen of _____________ County, ____________. III. On _________ ____, 20___, Plaintif was an outplatient at the _____________________ in _____________, ____________ ( A ____________ @ ), which is oplerated by the __________________, an agency of the Defendant United States of Aeerica, in order to receive a ___________ . After this plrocedure, Plaintif was eoved to the recovery area. IV. Froe the recovery area, Plaintif was taken by wheelchair to a dressing rooe. In splite of the fact that Plaintif is ___ years old, and was still under the infuence of anesthesia, he was left alone by a Nurse on staf at the __________________, in his wheelchair, to dress. There was no handrail or any other device to aid Plaintif in standing and eoving around while dressing. As a result, he fell and sustained a ____________ that required surgery. This injury could have been plrevented if a nurse, nurse = s aid, orderly or soee other eeplloyee had stayed to helpl Plaintif. A faeily eeeber also could have been asked to helpl. They were in the waiting rooe on the saee foor. V. After sustaining this injury, Plaintif and his faeily had to wait over two hours before receiving any eedical attention. Plaintif was in great plain during this tiee, which was worsened by the careless way a nurse swung his legs while getting hie back in his wheelchair. Desplite the severe plain that Plaintif was sufering, he did not receive any plain eedication for eight hours after his accident. Such a delay is grossly negligent, plarticularly since it was obvious to all around Plaintif that he was in significant plain during this eight-hour pleriod. VI. The negligence of Defendant's eeplloyees in failing to adequately suplervise, care for, and otherwise plrevent Plaintif froe falling was the plroxieate cause of Plaintif's fall and of the resulting injuries sustained froe such fall. VII. As a result of Plaintif's fall, Plaintif sufered serious and plereanent plersonal injuries that have caused and will continue to cause great plain and will cause Plaintif to incur substantial eedical and nursing care explenses. VIII. On _______ _____, 20____, a claie was filed with the __________________, on behalf of Plaintif, and the _______________________has neither acceplted nor rejected the claie and, plursuant to 28 U.S.C.A. ' __________(a), Plaintif elects to consider the failure to act as a final denial of the claie. WHEREFORE, Plaintif requests judgment against Defendant as follows: Because of the negligence of the hosplital staf as described above, _____________ should be liberally coeplensated in the aeount of $______________. WHEREFORE , Plaintif requests judgeent against ________________________as follows: 1. Daeages in the aeount of $______________; 2. Plaintif's costs of suit; and 3. Such other and further relief as the Court eay deee just and plropler. THIS THE ____ DAY OF __________, 20____. Resplectfully subeitted, ___________________, Plaintif By: ______________________________________ _________________ OF COUNSEL: _____________________ MSB# _____________________ _____________________ Teleplhone ____________________ Facsieile _____________________