Legal Review & Commentary

Psychiatric patient wins $2.175 million rape verdict

News: A 15-year-old patient who was raped while in a Texarkana, AR, psychiatric hospital won a $2.175 million verdict, including $1 million in punitive damages against the hospital.

Background: The incident occurred on Aug. 10, 1994. Two minor male patients allegedly coerced the girl to come down to their floor. When she was standing in the hall in front of the door to their room, they pulled her inside. Each boy raped her once, then the first boy raped her again. The boy who planned the rape had sketched a "rape plan" to show the other boy how they could get the girl down to their room while staff were not looking. The girl did not tell anyone about the rape until three days later, when she informed a female staff member. The staff member and the nurse on duty conducted an investigation. The nurse manager called the police; however, the "rape plan" and the internal investigation were not mentioned.

The plaintiff alleged that the hospital tried to cover up the rape incident, failed to supervise its patients, and should not have placed the female patient in such proximity with the males. The hospital maintained that the nurse on duty was sitting at the desk during the incident but did not hear anything because the patient did not scream. The hospital argued that the sexual contact was consensual, that all three patients broke the hospital's rules, and that the female patient had had sexual relations twice before.

This hospitalization was the patient's first. She has been an inpatient six times since the incident. She had two diagnoses before entering the hospital, but left with six. The jury assessed $2.1 million in damages against the hospital, $50,000 against the first male patient, and $25,000 against the second patient.

What it means to you: This case would raise several concerns for any risk manager, says Mary O'Mara, RN, MPA, assistant vice president for St. Joseph's Medical Center in Yonkers, NY. "A primary concern for every psychiatric patient, regardless of age, is safety. Patients need to be made safe from harming themselves or others. A safety program should include appropriate monitoring policies, camera surveillance, and door alarms, especially if a facility houses male and female adolescent patients in the same building."

O'Mara notes that camera surveillance is often available in psychiatric units. In her facility, cameras are positioned on hallways and certain rooms. Staff members then watch the screens at the nurses' stations so they can see any activity in the unit's hallways and public areas, as well as in certain rooms.

Preventing easy access to unit

O'Mara wonders whether the unit's doors had alarms. "It is not common to have easy access to the unit as apparently happened in this case. It's very surprising." She adds that hospitals usually put alarms on the back doors that will sound if anyone opens them. The alarms will alert the staff that someone is entering or exiting the unit without authorization.

O'Mara's facility also has a policy addressing patient control in the event of a fire on a locked unit. "In most hospitals, the doors unlock automatically during fire alarms so the patients can get out. Our policy is to assign a staff member to every back door. As soon as the fire alarm sounds, the staff members go straight to their assigned doors and guard [the doors]. That serves two purposes: No one leaves the unit during a fire drill, and staff can direct patients appropriately if there is a fire."

Safety precautions apply to visitors as well. "Our hospital's unit has a main entrance, and visitors are signed in and permitted to stay with patients in only one main area, so they are not allowed free access to any room in the unit," O'Mara explains.

Avoid predictable work schedules

O'Mara's next concern is whether any regular rounds were done on this unit. "If the patients were able to draw up a 'rape plan,' it indicates that the staffing work patterns were too consistent. On our unit, normal rounds are made every 30 minutes. That schedule may step up to every 15 minutes for certain patients who need closer observation. More acute patients may be placed in sight of certain staff members, or they may be within arm's reach, depending on how intensely they need to be watched."

As for security guards, they are not commonly used or needed on locked psychiatric units, O'Mara says. "They make the unit seem like a jail, which is not conducive to therapy. The only time we would use a security guard in the unit is if a patient were [to be] out of control, and we needed extra hands to help stabilize that patient. We also might place a guard with a person in the psychiatric ER who is awaiting admission to the unit if the person is considered at risk for harming themselves or others."

Finally, the suggestion in the case that the boys should be housed in a different building from the girls is not always financially feasible, O'Mara points out. "In New York, pediatric and adolescent beds tend to be at a premium, so sometimes it is not possible to put them in separate buildings. That's why monitoring, alarms, and camera surveillance are so crucial. Often, they can prevent these types of incidents."


Black, Guardian v. Charter Behavioral Health Services of Texarkana, Inc., Bowie County (TX) District Court, Case No. 96C1132-005.