Psych Patient Causes Car Crash Out on Pass: Nurses, Physician Not Responsible
Legal Eagle Eye Newsletter for the Nursing Profession
June 1999
Quick Summary: Nurses who care for mentally ill persons have legal responsibilities to persons who can be harmed by dangerous patients who are permitted to escape, released prematurely or inappropriately allowed out on pass.
Healthcare professionals have a legal responsibility to keep patients in secure custody as long as they pose a danger to others, and must warn persons in harm’s way when a dangerous patient has left secure custody.
On the other hand, when a patient has been competently assessed only to pose a danger to self, and competently assessed as capable of handling an off- grounds pass, a person harmed by the patient’s unforeseeable violent or self-destructive act has no basis for a lawsuit against the members of the patient’s treatment team.
SUPREME COURT OF KANSAS, 1999.During the twenty-four hour period before he was to go out on a weekend pass with his parents the patient appeared to be doing well, according to the testimony of the unit’s supervising nurse.
It was the nurse’s customary practice to observe carefully any patient about to go out on a pass for significant behavior problems that might signal the need to reconsider letting the patient leave the unit. This patient was talking and interacting with others, was not pacing, did not seem overly anxious about going home with his parents and verbalized that he was excited about going home.
He had handled a four-hour pass to have lunch with his parents without incident five days earlier.
The evening before his weekend pass he asked for his medication. That was taken as a sign he understood the need to take his medication to control his mental illness and wanted to take care of himself.
On his weekend pass, while riding with his parents he suddenly grabbed the steering wheel, forcing the car into a head-on collision with an oncoming car, killing one occupant and injuring several others. The injured parties and the estate of the deceased sued the nurse, the physician and the psychiatric facility for negligence.
The Supreme Court of Kansas approved the lower court’s dismissal of the case. There was no solid basis to foresee this patient posed a risk of harm to another person.
Although he had been diagnosed as a paranoid schizophrenic, he had never been assessed as a danger to others and there was no basis for anyone on the treatment team to anticipate he could or would commit a sudden violent or self-destructive act, the court ruled. Hesler v. Hospital, 971 P. 2d 1169 (Kan., 1999).