Failure to warn pt. not to drive: is hospital responsible for accident? (Hospital Law Case of the Month).

CASE ON POINT: Hoehn v. United States, 2002 WL 1964049 A.2d--DC

ISSUE: Hospitals often treat patients with high doses of chemotherapy and other drugs in treating cancer and other serous illnesses. In many cases, the effect of the drugs impairs the ability to operate motor vehicles. In this interesting case, suit was brought against the United States under the Federal Tort Claims Act (FTCA) alleging that personnel in a government hospital failed to warn a patient, who was heavily medicated, not to operate a motor vehicle. Unfortunately, serious damages resulted when the patient was involved in an accident.

CASE FACTS: Emiko Wiscott, a 70-year-old breast cancer patient at Walter Reed Army Medical Center (WRAMC), was scheduled to receive her first chemotherapy treatment on October 30, 1998. Allegedly, the patient's oncologist told her that it was not necessary for her to arrange for alternate transportation following her October 30 chemotherapy session, and that she could drive herself home "if she felt OK." Mrs. Wiscott allegedly was informed by the staff day that she could drive her car home after her chemotherapy treatment. Following her treatment, Mrs. Wiscott's oncologist told her that she could go home. No one warned Mrs. Wiscott not to drive or asked her how she was doing, or asked her how she was going to return home. Although originally she planned to take a bus home from the hospital, she believed that she had medical approval to drive. Accordingly, she proceeded to drive her vehicle home. Mrs. Wiscott ultimately blacked out and lost control of her vehicle, causing it to collide with a vehicle in which Marie Rosalind Salcedo Hoehn and Victoria Hoehn were passengers. As a result of the accident, Marie Hoehn sustained a traumatic brain injury. She is permanently impaired, mentally and physically, is confined to a wheelchair, and is unable to walk, feed herself, or control her bowel or bladder. Her minor daughter, Victoria Hoehn, sustained relatively minor physical injuries from which she recovered. Marie Hoehn (by her co-guardian) individually and on behalf of Victoria Hahn, and Gary Hoehn, on behalf of his daughter Victoria Hoehn, brought suit against the Untied States under the FTCA alleging that WRAMC negligently (1) failed to prohibit Mrs. Wiscott from driving her motor vehicle, (2) failed to suggest alternate transportation for her, and (3) permitted Mrs. Wiscott to drive her motor vehicle. Plaintiff sought damages in the amount of $15 million. Victoria Hahn sought damages in the amount of $1 million. The defendant moved to dismiss the complaint and for summary judgment.

COURT'S OPINION: The United States District Court for the District of Columbia granted the defendants' motion in part and denied it in part.

LEGAL COMMENTARY: The issue of whether a hospital owes a duty to the general public in circumstances such as those in this case was undecided in the District of Colombia. The court found that whether a duty was owed was a question of law to be determined by the court. The court found that there were two analytically distinct theories of duty relevant here: (1) an alleged duty owed by WRAMC to unidentified third parties to control a heavily medicated patient, and specifically, to prevent her from driving an automobile upon her discharge or release; and (2) an alleged duty owed by WRAMC to unidentified third party to warn a heavily medicated patient about the dangers of driving upon release. The court considered each duty in turn. The court found that there is no general duty in tort law "to control the conduct of a third person so as to prevent him from causing physical harm to another." An exception exists, however, when there is a "special relation" between either the actor (here, WRAMC) and the third person (here, Mrs. Wiscott) or the actor and others (here, plaintiffs). The court reviewed the duty of those in charge of persons having dangerous propensities. The court found that WRAMC had not "taken charge" of Mrs. Wiscott within the meaning of applicable law. The court cited a decision from highest court of Maryland which the court found persuasive in this case of first impression. That case held that only custodial circumstances give rights to a duty to control. Deciding that the imposition of a duty under the instant circumstances might be extremely burdensome to hospitals generally. They might be driven to extend hospital stays beyond what is medically necessary. Accordingly, the court concluded that under the circumstances of brief outpatient care WARMC owed no duty to unidentified third parties to control Mrs. Wiscott's driving and prevent her driving upon release.

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 Rhode Island law 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.