July 5, 2013

162017_132140396847214_292624_nThe Court of Special Appeals of Maryland (“the Appellate Court”) rendered its written opinion on June 27, 2013 in a case that held that the trial judge in a Maryland medical malpractice claim against a Baltimore hospital alleging serious injuries suffered by a patient with psychiatric issues who was treated in the hospital’s emergency room, was wrong to summarily enter judgment in favor of the hospital.

The Appellate Court noted that “Maryland law is clear that, as a patient in the [hospital’s emergency room], [the medical malpractice plaintiff] was owed a duty of care by the [hospital’s] health care providers who were assigned to and participated in his care … the nature and scope of [the hospital’s] duty of care to [the plaintiff] required resolution of factual disputes that were intertwined with factual disputes regarding the breach, vel non, of that duty and the causal connection between any breach and [the plaintiff’s] injuries. All of these disputes were within the province of the jury, not the court, to decide.”

The Underlying Facts

The now 30-year-old medical malpractice plaintiff was diagnosed with bipolar disorder at age 17, and with schizoaffective disorder, schizophrenia, and depression on various subsequent occasions. He had been admitted to the defendant hospital’s psychiatric unit at least four times in the past. On the last occasion in June 2008, he was brought to the defendant hospital’s E.R. because he was “non-compliant with treatment” and was “becoming increasingly psychotic.” At that time he was admitted into the defendant hospital’s psychiatric unit for eight days during which time the hospital kept him “physically safe” and monitored him “close[ly] . . . to prevent any harm to himself or others.”

On December 31, 2008, the plaintiff was brought to the defendant hospital’s emergency room, complaining of chest pain and heart palpitations, and the nurses were told by the plaintiff’s family who accompanied him that the plaintiff had bipolar disorder and was experiencing a psychiatric crisis, having not taken his prescribed psychiatric medications and having not eaten or slept for five days.

The hospital’s psychiatric assessment indicated that the man was reportedly suicidal and had a history of prior suicide attempts; the “auditory hallucinations” box was also checked on the Nursing Assessment form. A hospital physician reviewed the man’s medical records from his prior visits to the defendant hospital and noted the previous diagnoses of schizoaffective disorder, schizophrenia, bipolar disorder, and hypertension. The physician found the man at that time to be oriented, with normal mood and affect, alert, and in “no acute distress,” but also observed that the man appeared “anxious.” However, the physician did not speak with the man’s family members who had brought him to the E.R. The physician’s clinical impression was that the man was suffering from “anxiety, bipolar, mania, [and] chest pains.” He concluded that the likely cause of the heart palpitations was anxiety.

Later, the hospital nurse responsible for the man’s care observed him “climbing off of the stretcher [in his room] and being restless”; “pacing” around his room; and “occasionally venturing out and looking at the other patients.” On several occasions, the nurse or other hospital staff redirected the man back to his bed. The nurse subsequently administered a sedative to the man, as ordered by a physician.

Immediately after receiving the sedative, the man asked to use the bathroom. The nurse escorted him to the bathroom and noted that the man had removed his IV when he exited from the bathroom. The nurse did not reinsert the IV.

About 45 minutes after the man received the sedative, the nurse saw that the man was no longer in his room. While looking for the man in the hospital, the nurse was advised that a patient had just walked out an alarmed rear door of the E.R. that leads to a city road. The nurse called the police, who called the E.R. within 10 to 15 minutes to report that they had located the man in his hospital gown several blocks from the hospital, on a bridge that crossed over a busy highway. The hospital staff requested that the police bring the man back to the E.R.

As the police slowly approached the man, and when they were within 2 to 3 feet from him, the man jumped over the side of the bridge, falling 30 to 40 feet onto concrete, causing him to sustain a fractured pelvis, left wrist, right arm, and right leg.

The Maryland Medical Malpractice Claim

The man’s medical malpractice lawsuit alleged that the hospital owed him a duty of care; that it breached that duty by, among other things, failing to thoroughly assess his psychiatric condition and “supervise, observe and/or closely monitor” him; and that the breach of duty was the direct and proximate cause of the injuries he sustained when he jumped off the bridge while in a manic and psychotic state.

The defendant hospital subsequently filed a motion for summary judgment, alleging that there was no evidence that compliance with the standard of care would have prevented the man from leaving the E.R.; that the hospital complied with its duty to notify the police; and, that since the man jumped off the bridge to elude the police, the chain of causation was broken when the police arrived on the bridge.

The plaintiff responded to the defendant’s motion that the defendant hospital owed him a duty of care to use one of several options to ensure that he was safe and secure while he awaited crisis evaluation and likely admission to the hospital’s psychiatric unit, including assigning a sitter to observe him one-on-one who would have alerted E.R. staff if he tried to leave; placing him in a locked and secure room; or using effective chemical restraints.

After the Maryland medical malpractice jury was sworn in but before the trial testimony began, the trial judge held, “Thus, under the facts before the Court, it is clear that [the hospital] did not have the authority to prevent [the plaintiff], a voluntarily admitted patient, from voluntarily choosing to leave the hospital when he chose to leave. Therefore, as a matter of law, under Rule 2-502, the Maryland Rules of Procedure, the Court, considering the matter sua sponte, finds that [the hospital] cannot be negligent for [failing to] prevent[] [the plaintiff] from leaving the hospital, nor can they be liable for any injuries or damages occurring after he left the hospital’s care. And a judgment will be entered in favor of the defendants for those reasons.”

The Appellate Decision

After discussing the underlying facts in detail and the trial judge’s decision, the Appellate Court held, “We conclude that the issue decided by the trial court, while framed by it as a purely legal question, was not; that, to the extent that any part of the issue was legal, the court incorrectly decided it; that the issue required factual determinations that were for the jury to decide, and therefore the court decided an issue that was not within its sole province and thus was not susceptible to a Rule 2-502 decision; and, beyond that, the court abused its discretion not only by invoking Rule 2-502 but also by doing so without affording the parties prior notice and an opportunity to be heard. For all these reasons, the judgment of the circuit court shall be reversed.”

Source  Richard Glenn Crise v. Maryland General Hospital, Inc., D/B/A Maryland General Hospital, Case No. 2562, Court of Special Appeals of Maryland, September Term, 2011.

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