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Legal Review & Commentary: Attack in a psychiatric facility leads to $100,000 judgment
By Edward J. Carbyne,
Esq., Jan J. Gorrie, Esq., and Richard Oliver, Esq.
Buchanan Ingersoll Professional Corp.
News: A 42-year-old woman was involuntarily transferred from a community hospital to psychiatric facility after her attempted suicide. At the receiving facility, she was placed in an all-male ward, where she said she was sexually assaulted. A jury returned a verdict of $150,000, that was offset by her contributory negligence.
Background: On Nov. 25, the plaintiff was admitted to the emergency department of a community hospital. The treating physician determined that she had intentionally overdosed on prescription medication. As provided in the jurisdiction, the patient was involuntarily transferred to a psychiatric facility for 72-hour psychiatric evaluation and treatment. Her admitting diagnosis at the psychiatric center was major depression, alcohol dependence, and status post-suicide attempt by an overdose.
At the receiving facility, she was placed in a private room on an all-male ward. She said she received inappropriate sexual comments, mostly from a male patient who, according to the facility’s records, had been admonished several times for inappropriate sexual conduct.
She underwent detoxification and was checked every 15 minutes. After two days of hospitalization, she was taken off 15-minute checks, which was the normal routine and acceptable standard for patients. She was given a sedative to help her control her withdrawal symptoms. Later that day, the male patient who had verbally harassed her entered her room. She said he allegedly dragged her into the bathroom and sexually assaulted her.
She was discharged the next day.
The plaintiff provided evidence indicating multiple injuries that pointed to the viciousness of the attack, including vaginal infection, an anal tear, laceration of the anus, bite marks and dark red marks on a wrist, forearm, upper arm, and neck. She also claimed she suffered from post-traumatic stress disorder consistent with nonconsensual sexual activity.
The plaintiff’s adult psychiatric medical expert testified that the defendant’s facility failed to meet the requisite standard of care by not providing the mentally and emotionally impaired plaintiff with a safe environment and by allowing a male patient who had previously received staff warnings for inappropriate sexual conduct to enter the plaintiff’s room and sexually assault her. The plaintiff claimed that this deviation of the standard of care was the direct and proximate cause of the rape.
The defendant said the incident was consensual. The facility also maintained that the harm claimed was the result of the negligence on the part of third parties.
The jury returned a verdict in favor of the plaintiff and awarded $150,000 in gross damages. However, the jury found the plaintiff 40% negligent, so the judgment was reduced to $100,000.
What this means to you: This case is disturbing in the sense that one of our primary responsibilities as health care providers is the duty to provide, maintain, and enhance a safe environment for our patients. Several important questions are prompted by this scenario:
The protection and treatment of persons who have an intent or ideation to harm themselves or others may be prescribed by jurisdiction law, as in this case.
"Certainly those operating receiving facilities in those jurisdiction should be well versed in the prevailing rules and regulations. At a minimum, frontline staff should be familiar with the particular patient rights associated," says Patricia Specian, risk manager, of HCA Inc. in Lawnwood, FL.
At a minimum, a well-developed patient safety communication plan would have instructed staff on the need to be alert for potentially harmful situations such as this one.
"If there were no other alternative available other than to place this patient on an all-male ward, then the safety plan and basic education staff are required to receive should have triggered the necessity of implementing additional safe guards for this woman. Simple alternatives would include placing her in a room nearest the nursing station for easy observation and continuing the frequent observations as a means of ensuring her safety, even though the standard of care allowed for relaxing of the 15-minute checks," Specian says.
Although the scenario does not state whether the male patient was on frequent observations as a result of his noted inappropriate behavior, common sense would dictate that considering the presence of a female on the ward coupled with the sexual comments, the staff would have realized the need to monitor this patient more closely.
"With the potential for an escalating sexually charged environment, the prudent course of action would have been to attempt to transfer the female patient off of the unit. The scenario does not indicate whether or not this was an option but, at any rate, something should have been done by the staff in this situation to guarantee safety. The standard of care would require that this sort of assault be prevented. All psychiatric units have a measure of frequency by which they physically observe their patients and similarly as noted above the situation may have called for the male as well as female to be more routinely observed," states Specian.
This incident would also likely require a report to a state agency that has jurisdiction over the reporting of abuse. Further, the scenario does not suggest whether the woman was taken to the emergency department for an evaluation after the assault, which would be an ordinary precaution.
"An internal investigation would be required as well. The outcome would hopefully show a change in policy regarding placement of female patients on an all-male ward, education of staff on safety issues related to frequency monitoring, and the need to manipulate the environment to allow close observation of specific patients when warranted," concludes Specian.