He was negligently standing in the wrong place, behind the door, when a nurse opened it. COURT OF APPEAL OF LOUISIANA, 1998.

   The patient was in his fourth day in the alcohol detox unit of a state hospital. After breakfast he and others lined up to be escorted out for a smoking break. This was the eighteenth time this patient had waited there to take a smoke break.

   According to the Court of Appeal of Louisiana, the patient was leaning against a wall right by a door with no door handle. He was right in front of the doorstop. All the other patients were standing by the wall on the opposite side.

   A nurse opened the door from the other side. The door struck the patient. A doctor examined him immediately and found him unhurt, but he sued the nurse and the facility for negligence.

   The court ruled the nurse was not negligent and threw out the lawsuit. If anyone, it was the patient who was negligent, the court felt. He knew the door could and would open directly toward him.

   The court cited other cases in its written opinion. A 1979 case reiterated the familiar rule. A healthcare facility is bound to exercise the requisite amount of care toward a patient that the particular patient’s condition may require, and is required to protect the patient from dangers resulting from the patient’s physical and mental incapacities.

   However, that 1979 case was different. It involved a seventy-three year old post-surgery patient who was confused and heavily sedated. She fell out of bed because the side rails were up only part-way. The hospital was negligent in that case.

   That patient had had a stroke several years earlier which resulted in persistent dizziness. Her physician had written a note that she did not have clear sentorium due to her narcotic pain medications, in addition to her deficits from her stroke.

   The court believed a 1976 case was a better analogy. An elderly arthritic patient had been told to ring for assistance to get up to the bathroom. Instead, he made the decision to get up on his own, fell and broke his hip. He had a certain degree of physical impairment, but nevertheless was in full possession of his mental faculties. He knew what he was doing when he decided to get up. What happened was highly unfortunate, as the patient died during surgery to repair his hip. Yet this patient’s caregivers were not legally responsible for the patient’s own negligence.

   In the present case, the court said the fact the detox patient was ambulatory and elected to walk outside to smoke demonstrated that he was not physically or mentally incapacitated.

   The court noted there was a nursing progress record two hours before the incident that the patient was "calm, steady and aloof."

   When he arrived three full days earlier the patient was chemically dependent to the point of needing inpatient medical detoxification. He was significantly impaired at that time. But by the time of the incident, the court believed, he was capable of looking out for his own safety and had been correctly assessed by the nurses in that regard. Lopez v. Health Center, 721 So. 2d 518 (La. App., 1998).