The Massachusetts Supreme Judicial Court has ruled that Steward Carney Hospital does not have a duty of care after a patient released from an involuntary psychiatric commitment fatally stabbed his neighbor.
The court found the order of civil commitment to hold the patient did not impose an independent duty on the hospital for his treatment and did not require the hospital to exercise any medical judgment regarding his release.
This case came about after the patient’s family took him to Steward Carney Hospital for a psychiatric evaluation on January 7, 2012. The Boston-area emergency services program recommended that he be admitted for stabilization and a medical evaluation, which noted the patient said he had threatened to kill a family member.
The evaluation form stated he had a history of psychiatric illness, including a previous episode in which he had been brought to the hospital after police responded to a report that he was threatening his mother with a knife.
The patient remained in the emergency room until a bed in the hospital’s psychiatric unit became available, and his treating physician filed a petition for emergency restraint and hospitalization for a period of three days.
At the end of the three-day period, the superintendent of the hospital filed a petition for commitment. Massachusetts law allows the superintendent of a psychiatric facility to seek an initial commitment of up to six months, along with an extension of that commitment for up to one year when the superintendent “determines that the failure to hospitalize would create a likelihood of serious harm by reason of mental illness.”
Following a hearing, a judge of the Boston Municipal Court found the patient was mentally ill and failure to retain him in a facility would create a likelihood of serious harm. As a result, the judge ordered him to “be committed to the [hospital] for a period not to exceed six months or until there is no longer a likelihood of serious harm by reason of mental illness, whichever period is shorter.”
On January 30, 2012, the patient’s treating physician examined him and determined he no longer presented a serious risk of harm due to his mental illness. The physician noted his behavior had improved with medication, he appeared to be at his usual “baseline” level of functioning and his aggression toward other patients had ceased. He was released that day.
On February 21, 2012, the patient broke into the home of Mary L. Miller, his neighbor, and stabbed her to death. Miller’s then eight-year-old granddaughter was present in the apartment at the time, although she was not attacked and was physically unharmed.
The plaintiffs filed a complaint in the Superior Court, claiming wrongful death due to negligence; wrongful death by gross negligence; wrongful death by willful, wanton and reckless conduct; conscious pain and suffering due to willful, wanton and reckless conduct; conscious pain and suffering due to gross negligence; and conscious pain and suffering due to negligence.
The plaintiffs also brought claims on behalf of Miller’s granddaughter for reckless infliction of emotional distress and grossly negligent infliction of emotional distress, and claims on behalf of the granddaughter’s mother for consequential damages for loss of consortium and expenses for mental health care.
The claims were alleged separately against each of the defendants. All of the claims were based on the plaintiffs’ assertion that the hospital violated the January 19, 2012, Order of the Justice of the Municipal Court of the City of Boston ordering the patient be committed to the hospital for a period of up to six months or until there is no longer a likelihood of serious harm by reason of mental illness, whichever period is shorter. They claimed the hospital violated this order by releasing the patient eleven days later.
The defendants filed a motion for summary judgment, arguing that they owed no legal duty to the plaintiffs, there is no cause of action in negligence for violating a court order and there was no special relationship that gave rise to a duty to control the patient. Following oral arguments and a supplemental briefing, a Superior Court judge granted the defendants’ motion for summary judgment.
The judge concluded that the hospital owed no duty of care to the plaintiffs. The plaintiffs appealed, maintaining that the commitment order was directed at the hospital alone, the hospital then delegated the duty to a particular physician, and as a result, the hospital was responsible for the decision to release the patient.
The plaintiffs maintained that the hospital could not delegate this duty to an employee, pointing to the text of the commitment order requiring the patient be committed to the hospital and to the deposition testimony by the superintendent stating he understood the commitment order to be directed at the hospital.
Additionally, the plaintiffs claimed the duty created by the order exists independently of any duty owed by the licensed medical providers who signed the petitions for commitment and release. With this in mind, the plaintiffs contended the hospital violated a nondelegable duty of care.
The court determined, however, that the clinical determination to release the patient could only have been made by an individual mental health professional – in this case, his treating physician.
“…any negligence in authorizing his release under the terms of the order of commitment belonged to this treating clinician, who was required to use professional medical judgment in determining that commitment was required and when it was no longer needed,” Massachusetts Supreme Judicial Court Justice Frank Gaziano wrote in his opinion.
This is because the Massachusetts Legislature has determined a qualified mental health professional can make a clinical determination to release a psychiatric patient without notifying the court that issued the order of commitment, as “a clinician is in the best position to determine whether a patient no longer poses a threat of serious harm,” according to the opinion document.
The Legislature chose not to impose a separate duty on a hospital and not to delay the release of a patient that the hospital no longer has a legal right to confine, the opinion document added.
“Continuing to hold a patient where a mental health professional has determined that there is no threat of serious harm would result in a violation of the patient’s constitutional liberty interest,” Gaziano wrote.
That said, Gaziano added that a hospital is not necessarily free from all liability resulting from a clinical determination that a patient no longer presents a risk of serious bodily harm due to mental illness. A hospital can be liable under a theory of respondeat superior for the actions of its medical professionals arising out of an employment relationship. In addition, a hospital owes third parties a duty of reasonable care in hiring, training and supervising the medical professionals who care for its patients.
In this case, however, the plaintiffs did not raise any claim of vicarious liability, and they did not bring separate claims against the individual medical professionals who provided care to the patient and who ordered his release. The plaintiffs also did not allege negligent hiring, training or supervision in their complaint.
“Nonetheless, the hospital’s duty to control is more narrow than the plaintiffs contend,” Gaziano wrote, adding that the hospital had a duty to hold the patient while he was lawfully committed for up to six months. The hospital’s duty to control the patient, however, ceased when his treating physician reached the clinical judgment that he no longer presented a likelihood of serious harm by reason of mental illness and released him.
“Under the terms of the commitment order, his commitment to the hospital was no longer authorized once the clinical determination was made,” Gaziano wrote in the opinion document. “The hospital’s act of releasing him was not merely proper, it was required by the terms of the order.”
Gaziano added that while Miller’s death was tragic, because the hospital did not owe a duty of care to Miller or to her family at the time of her death, the Massachusetts Supreme Judicial Court affirmed the superior court judge’s decision to grant summary judgment to the hospital.
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