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Suicidal Patient's Bathroom Door `Unlocked': Suicide Results.

CASE ON POINT: Wuest v. McKennan Hospital, 619 N.W.2d 682 -SD (2000)

ISSUE: If a suicidal patient's bathroom door is left unlocked and the patient hanges himself in the bathroom, is that negligence per se? Does Res Ipsa Loquitur (RIL) apply?

CASE FACTS: On the afternoon of November 19, 1993, Perry Carver walked into the Sioux Falls police station, claiming he was suicidal. Police officers transported him to McKennan Hospital's emergency room where he was immediately admitted into the hospital's Acute Adult Unit on a 24-hour mental illness hold. He was diagnosed with depression, suicidal thoughts, and alcohol intoxication. At 6 p.m., a nurse in the Acute Adult Unit assessed the patient who continued to express suicidal tendencies. Later that evening, another nurse heard a loud noise in the patient's room. Upon investigating, she found a chair lying on its side and the patient sitting on his bed. The patient had removed his hospital gown, tom it into pieces, and tied them back together. The patient told the nurse that if the chair had not slipped, he would have been dead by the time she found him. The nurse viewed this incident as a suicide attempt and, after consulting with the patient's physician, imposed a continuous one-on-one observation over him. The one-on-one observation continued until 11:30 p.m., when the observing nurse's shift ended. After that time, the patient was checked every 15 minutes. In addition, the nurse on duty positioned her chair so that she could see into the patient's room. The patient slept for the remainder of the night. At 7 a.m., on November 20, the morning shift arrived for duty. The staff continued making observations of the patient every 15 minutes. At 8 a.m., the patient expressed suicidal tendencies to a nurse. She encouraged him to take a shower. She believed that he would feel much better if he cleaned up. The bathroom door in the patient's room was unlocked in order to allow him to clean up. At approximately 8:45 a.m., a psychiatrist went into the patient's room to conduct an assessment of his condition. After the nurse noticed the psychiatrist writing his report, she checked on the patient. She discovered the patient in the unlocked bathroom hanging by his bath robe. He was not breathing and his heart had stopped. He was resuscitated, but had suffered severe, permanent brain damage. The patient currently resides in a nursing home. George Wuest, as the patient's guardian, brought suit against the hospital, the attending physicians, and others involved in the patient's care. After trial in the Second Judicial Circuit, judgment was entered for the defendants. The guardian appealed.

COURT'S OPINION: The Supreme Court of South Dakota affirmed the judgment of the lower court. On appeal, the plaintiff raised the following issues: 1) Did the trial court err by refusing to instruct the jury on the adverse inference rule? 2) Did the trial court err by refusing to instruct the jury on the doctrine of RIL? 3) Did the trial court fail to clearly instruct the jury regarding liability and causation? The court found that the trial court did not err by failing to instruct the jury on the adverse inference rule. The Court reviewed the trial court's refusal to give an instruction under the abuse of discretion standard. To establish error, a party must establish that a proffered instruction was a correct statement of law. In South Dakota, the court recognizes the "adverse inference rule." The rule provides that if a party has evidence under its control and does not present this evidence, an inference may be drawn that the evidence would not support that party's claim. The court concluded that the plaintiff failed to establish that the suicide attempt was such that, according to knowledge and experience, does not happen if those having management or control had not been negligent. The court addressed the allegation that the hospital violated its policy that required the bathroom door to be locked when not in use. The plaintiff argued that the trial court erred by failing to clearly instruct that a violation of hospital's policy was evidence of negligence. The instruction given simply advised the jury to "consider these policies" when determining the standard of care. The court could find no error in the instructions given. For proximate cause to exist there must be proof that the harm suffered was a "foreseeable consequence of the act complained of."

LEGAL COMMENTARY: The court was hard pressed to find that there was any responsibility on behalf of the hospital which proximately resulted in the patient's suicide. The court was satisfied that the hospital's nursing staff, as well as other health care providers, met the appropriate standard of care applicable under the circumstances. Editor's Note: Many might argue that the phsychiatrist, who was the last to see the patient alive, had a responsibility to ensure that the appropriate persons were notified that he left the patient's room. There is a question as to whether or not the psychiatrist had a responsibility to ensure that the bathroom was locked either directly or by immediately notifying staff that he had left the room and directing that the room be secured to ensure the patient's safety.
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Article Details
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Author:Tammelleo, A. David
Publication:Nursing Law's Regan Report
Article Type:Brief Article
Geographic Code:1USA
Date:Jan 1, 2001
Words:878
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