A patient was admitted to the intensive care unit of a general acute care hospital following an attempt to commit suicide by drug overdose. The admitting attending physician wanted to stabilize his medical condition while the family were supposed to be making arrangements to admit the patient to a psychiatric facility. That was proving difficult because of lack of insurance coverage.

   At the time of admission, the hospital agreed to accept this patient to give him the medical care he acutely needed, but, realizing the hospital’s limitations, a recommendation was made that the patient should be institutionalized at once in a specialized psychiatric facility. After the fact it surfaced that a psychologist had strongly recommended to the admitting physician that he not admit this patient to an acute-care facility, but at psychiatric hospital instead.

   Meanwhile, the patient was becoming increasingly paranoid and delusional. A nurse sat at the bedside and tried to calm the patient. The nursing staff deliberated whether to restrain the patient in bed, but decided against it, fearing it would only compound the situation by raising his paranoia and his level of agitation. The patient got out of bed, knocked down the nurse in his room, fought his way past two other nurses who were trying to corral him, ran off the unit, kicked out a third-story window and jumped, fracturing his arm and sustaining other relatively minor injuries.