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News: The plaintiff, an adult (but non-elderly) male, initially sought treatment at an acute care medical center for his mental health issues. Upon transfer to the defendant behavioral health hospital, plaintiff was put into a room with another patient, who suffered from psychiatric problems that caused him to act violently. The plaintiff said that upon being placed in the room with the other patient, the other patient promptly attacked him and struck him in the head, resulting in the plaintiff sustaining a fractured skull. At trial, the plaintiff was awarded about $6 million in damages.
Background: In this matter the plaintiff was a teacher and private tutor, and he presented at an acute care medical center complaining of suicidal thoughts and depression. The medical center transferred the plaintiff to the defendant behavioral health facility, which is a private, fully accredited, full-service acute psychiatric hospital that offers behavioral health, substance abuse, and eating disorder treatment options for the local communities. Once admitted to the behavioral health facility, the plaintiff was put into a room with another patient, who is said to have been suffering from acute psychosis causing him to engage in violent behavior, such as a self-inflicted stab wound to the chest. Almost immediately the other patient attacked the plaintiff, which resulted in the plaintiff sustaining a fractured skull.
Discovery in the case revealed that the other patient reportedly had been diagnosed as a paranoid schizophrenic who had been off his medications for several months. When admitted, the other patient had demonstrated erratic behaviors such as ripping out his IV and attempting to escape, according to records. The plaintiff further claimed that he was placed into the same room as the other patient based upon an error in judgment made by the facility charge nurse. During the admission assessment process, the nurse overlooked the other patient’s medical records and assessed him as low risk based on his statements during an interview in which he was sedated, the plaintiff contended.
The plaintiff alleged that his encounter with the other patient resulted in the plaintiff sustaining numerous skull fractures and permanent brain injury, as well as jaw fractures and hearing loss. He remained comatose and on life support for several days, and he had to spend a month in the intensive care unit. The plaintiff said that he now suffers from extreme mood and personality issues and cognitive function deficits that resulted in losing his jobs as a teacher and a tutor, due to inappropriate and unprofessional behaviors that he said he cannot control.
The plaintiff claimed medical negligence, dependant adult abuse, violation of patient’s rights, and willful misconduct. The defendant facility denied that it was liable, and said that it did not know of the other patient’s propensity of violence toward other people. After a seven-day jury trial, the plaintiff was awarded about $6 million in damages. Court records also indicate that his number was reduced to $2.3 million pursuant to a "high-low" agreement to which the parties had stipulated in advance, although the plaintiff also recovered about $334,000 in attorney’s fees and about $118,000 in court costs.
What this means to you: Stripped of the legalese, the primary issue for the hospital was to what degree, if any, it was negligent because it behaved unreasonably in pairing the plaintiff with a patient who had a demonstrated history of mental problems and thus likely posed significant dangers to himself and others. Highlighting the problem here for the defense is that the behavioral health facility provides primarily psychiatric care, and staff members certainly should have known better than to pair someone like the plaintiff with someone like the other patient.
Nonetheless, the case still serves as a good object lesson reinforcing the need to constantly drill physicians and staff of all levels on the importance of not only completing medical charts promptly and accurately, but also taking the time to read and understand patient charts available when performing a patient evaluation or otherwise treating a patient. Patient assessment, whether on admission or at the start of a shift, begins with the medical record. Not knowing a patient’s history, including what other providers have documented about the patient in the remote as well as recent past, places the caregiver at risk of missing critical information essential to patient care.
Moreover, today most patients needing psychiatric care present themselves (as the plaintiff here apparently did) or are brought by family or rescue ambulance to acute care facilities that don’t have behavioral health units. Finding accepting psychiatric facilities for these patients can be difficult, as the few facilities that remain open often will accept only insured patients who don’t have any medical care issues. Housing these patients in emergency departments or in acute care beds until a facility can be found is challenging and extremely high risk. Where do they safely place a violent patient? How are visitors, physicians, staff, and other patients to be kept out of harm’s way? To these ends, some hospital emergency departments have established a "safe area" where these patients can be closely observed by staff members and hospital security officers trained in dealing with psychiatric and assaultive behaviors. These seem to be constructive steps in the right direction.
Note also that this case illustrates the successful use of a stipulated "high-low" agreement, in which the parties had agreed before trial that defendant’s liability would be capped at a certain number should the jury’s verdict exceed that number, while plaintiff’s ability to secure a certain amount of recovery would be guaranteed even if the jury were to return a defense verdict or award only minimal damages on a plaintiff’s verdict. High-low agreements are commonly employed in arbitrations and other alternative dispute resolution contexts. Although it would be critical to check with counsel before employing a high-low agreement in any particular case, high-low agreements often are viewed with approval by courts. At least one state court system (California) has a statutory scheme dedicated to employing high-low agreements. (See Cal. Civ. Proc. Code Sections 630.01 et seq.) High-low agreements generally are worth considering for hospitals and providers when it appears unlikely, although not impossible, that the hospital or provider will escape liability completely and the goal is to contain damages. The plaintiff and especially the plaintiff’s counsel, if operating on a contingency fee, might be willing to trade the shot at a runaway jury verdict for certainty that there will be at least some recovery. Finally, parties contemplating a high-low agreement might also consider a derivative dispute resolution structure called "pendulum" arbitration. It also is known as "baseball" arbitration, in light of its use in salary disputes for professional baseball players. The parties present their respective cases and then submit competing resolution proposals, of which the arbitrator must pick one.
Los Angeles County Superior Court Case No. SC110387