Did Early Release of Psych Pts. Result in Auto Accident Death & Injury?

CASE ON POINT: Mason v. IHS Cedars Treatment Center, 2001 WL 915215 S.W.3d - TX

ISSUE: A recurring theme which is seen in situations in which psychiatric patients are released prematurely is the unfortunate harm and injuries that are incurred both by patients as well as by others who are injured or killed by such patients. Hospitals should have protocols to ensure that before a patient's release is authorized, a physician has a clear and compelling case for the release of the patient. Unfortunately, that was not the fact in this Texas case.

CASE FACTS: Three people who were voluntarily admitted to Cedars Hospital for psychiatric treatment were involved in an automobile accident. One was killed and two were seriously injured. On July 26, 1993, Jodi Mason was admitted to IHS Cedars Treatment Center for depression under the care of Dr. Teofilo Ramos. Subsequently Richard Cleveland and Cynthia Thomas were admitted, and both were under the treatment of Dr. Paul Meier. On the evening of August 16, 1993, Mason and Thomas informed Nurse Sandra Marx that they wanted to be released. Nurse Marx telephoned both Drs. Ramos and Meier to obtain permission for the respective patients' unscheduled discharges. Each physician gave his authorization and Mason and Thomas were discharged at the same time. The following day, Cleveland asked for a pass to go riding with Mason and "another former patient." Dr. Meier refused Cleveland's pass request and discouraged Cleveland's early release. Cleveland agreed to stay but later left the hospital. On August 18, 1993, Mason, Thomas, and Cleveland were involved in a single-car accident in a vehicle owned and operated by Thomas. As a result of the accident, Cleveland was killed. Mason and Thomas sustained serious injuries. Mason and her family brought suit against the hospital and the treating physicians. The plaintiffs alleged, inter alia, that the hospital failed to have adequate policies and procedures in place and failed to take action to prevent inappropriate conduct between the patients. The defendants moved for summary judgment asserting that they owed no duty to Mason and that their conduct was not a proximate cause of her injuries. The trial court granted summary judgment for the defendants on the grounds that the defendants' negligence, if any, was not a proximate cause of the injuries. The plaintiffs appealed.

COURT'S OPINION: The Court of Appeals of Texas reversed the summary judgment granted in favor of Drs. Ramos, Meier and the hospital and remanded the plaintiffs' claim to the trial court for further proceedings.

LEGAL COMMENTARY: It is not necessary that the hospital foresee a particular accident or injury which, in fact, occurs. Nor must a hospital anticipate just how the injury would grow out of a particular situation. All that is required is that the injury be of such a general character as might reasonably have been anticipated and that the injured party be so situated with relation to the wrongful act that injury might reasonably have been foreseen. It was the opinion of Nurse Marx and others at the hospital that the relationship between Mason and Thomas was detracting from their respective progress. The plaintiff expert Dr. Stephen Kramer opined that the failure to investigate and intercede in the interaction and relationship between Mason and Thomas was also a proximate cause of Mason's injuries. Dr. Kramer opined that it was reasonably foreseeable that one mental patient leaving a facility with another mental patient would result in harm to one, if not both. Dr. Kramer further opined that allowing Mason to be discharged with Thomas was a proximate cause of Mason's injuries. Dr. Kramer's affidavit placed additional emphasis on the evidence related to inadequate discharge procedures at the hospital. According to Dr. Kramer, Nurse Marx did not review Mason's records, properly interview her for discharge, require her to sign a discharge request or sufficiently advise either physician about the two patients leaving the hospital together. Another expert witness, Celia Wintz, made affidavit as to the standard of care applicable to nurses in the psychiatric facilities. Nurse Wintz analyzed Mason's and Thomas' medical records and opined that Nurse Marx should have realized that Mason was severely ill. Moreover, Nurse Marx was aware of the inappropriate bonding between Mason and Thomas and was aware that the two patients planned to spend time together. Nurse Wintz opined that Nurse Marx deviated from the applicable standard of care in various ways and that her acts or omissions were a proximate cause of Mason's injuries. Nurse Wintz also opined that the hospital failed to provide adequate training to its psychiatric nurses and that the hospital's policies and procedures were inadequate and prevented a proper nursing assessment of Mason and the conveyance of pertinent information to Dr. Ramos. Dr. Kramer further opined that the inadequate policies and procedures were also a proximate cause of Mason's injuries. Because Nurse Marx was an employee of the hospital, the proximate causation resulting from her negligence, if any, would be imputed to the hospital. The court concluded that the negligence raised a fact issue for a jury. This precluded summary judgment.

Meet the Editor & Publisher: A. David Tammelleo, JD, is a nationally recognized authority on health care law. Practicing law for nearly 40 years, he concentrates in health care law with the Providence, R.I., firm of A. David Tammelleo & Associates. He has presented seminars on medical, nursing and hospital law throughout the United States. In addition to his writings as Editor of Medical Law's, Nursing Law's & Hospital Law's Reagan Reports, his legal articles have been published in the most prestigious health law journals, A prolific writer, his thousands of articles, as well as his achievements as an attorney and lecturer, have won him recognition in Martindale-Hubbell's Bar Register of Preeminent Lawyers and Marquis Who's Who in American Law.