Facts

Plaintiff, a 27-year-old woman was discharged from White Memorial Medical Center where she had been held on a 5150 psychiatric 72 hour hold for suicidal ideation. She had had at least two prior suicide attempts. Her diagnosis was of paranoid schizophrenia. That night, while at home, Ms. Ruano told her mother of her desire to run out in traffic and hurt herself. Her mother had her brought by ambulance to the emergency room at Queen of Angels where she was admitted at 7:49 a.m. Ms. Ruano was seen by the nurse at 0750 and triaged as urgent. At 8:00 a.m., Dr. Hall saw the patient and noted a history of paranoid schizophrenia and major depression. She was told that voices were telling the plaintiff to step into traffic and hurt herself.

The patient was then moved to a bed where she was cared for by a new LVN. At 0900 the patient seemed to be in no acute distress, however there were no further notes until 10:00 a.m., when vital signs were normal. At sometime before 10:10 a.m., the patient left the hospital against medical advice, but was brought back by security. Unfortunately there was no notation that the patient had eloped. At 10:10, or 10:15 Dr. Hall was told of the elopement and ordered that the patient be placed in soft restraints and that there be “continuous observation” of the patient.

Ms. Ruano was put in soft restraints, however this was never documented in the records contrary to regulations and the hospitals policies and procedures. A psychiatric social worker saw the plaintiff between 10:15 and 10:30, and called the psychiatric emergency triage team at another facility to come and evaluate the patient for another 5150 hold because she was a danger to herself.

There is nothing further in the records until 10:45 when the supervising RN charted that she found the patient missing from her bed and learned that the patient had again eloped unnoticed. This time the plaintiff escaped and eventually that morning jumped off a freeway abutment and severely injured herself, although she was not hit by a vehicle.

Plaintiff called Dr. Hall under C.C.P. §776 and elicited testimony that Dr. Hall was critical of nursing personnel for not doing what was necessary to make sure that the patient was safe and protected in light of her psychiatric condition. She had asked the nurses at the time “how could this have happened.”

PLAINTIFF'S CONTENTIONS:
Plaintiff’s experts testified that hospital personnel fell below the standard of care by not documenting restraints, or the first elopement, by failing to follow their own policies and procedures concerning observation of a patient in restraints with suicidal ideation, and by failing to follow the physicians orders for continuous observation. The defendants should have been more involved with this patient given her first attempt to escape, her previous suicide attempts, and her threat to run out in front of traffic. Part of plaintiff’s contentions was supported by the defense nursing expert, Karen Pierce who was called by plaintiff during plaintiff’s case and made several concessions.

Plaintiff alleged that Dr. Hall had a duty to see to it that the patient did not elope again, and that she was securely restrained. Plaintiff’s expert, testified that soft restraints were insufficient since a patient can easily get out of them. He said that the standard of care required chemical restraints and an order for a security person to watch the patient because of her risk of eloping again, her threats to run out in front of traffic, and her suicidal ideation. Dr. Hall allegedly failed to properly supervise the nurses.

DEFENDANT’S CONTENTIONS:
Queen of Angels emergency room expert contended that hospital personnel complied with the standard of care. The order for “continuous observation” did not require that the patient be watched every minute. Instead it required reasonable observation in a busy emergency room. The defense developed a timeline which showed that there were frequent observations of the patient even though there was virtually no documentation.

According to the defense expert who conceded that the documentation was poor, the emergency room personnel did what they could and the standard of care did not require that there be a “sitter” to be with the patient at all times.

The expert for Dr. Hall testified that Dr. Hall acted within the standard of care and that her orders were appropriate under the circumstances.

Settlement Discussions

Prior to trial, Queen of Angels offered $250,000 per C.C.P. 998. At the start of trial, plaintiff demanded $350,000. No offer was made by Dr. Hall.

Specials in Evidence

$141,178; $625,684 to $841,094 present value; $180,609;

Damages

Plaintiff asked for $125,000 past and $500,000 future pain and suffering.

Injuries

Plaintiff claimed multiple sacral compression fractures resulting in permanent back pain, right calcaneal fracture, right peroneal nerve damage, right leg pain and numbness, right foot pain numbness and swelling, right big toe pain, and disfigurement, bilateral gluteal pain and numbness, right inferior pubic ramus fracture, loose rectal tone, cauda equina syndrome, bladder problems, emotional distress, nightmares, memory problems, irritability, scarring and weight gain. Plaintiff’s experts testified that she will need future back surgery and foot surgery. She walks slowly with a cane, or AFO brace. During recovery she developed a perisacral abscess from a Stage IV decubitus.

Result

Defense verdict.

Other Information

Queen of Angels filed a cost bill in the amount of $64,659. The cost bill for Dr. Hall was approximately $42,000. Plaintiff's motions for new trial/JNOV were denied. Plaintiff has filed a notice of appeal. Plaintiff's appeal is only as to Queen of Angels.

Deliberation

two hours

Poll

10-2 in favor of QOA; 12-0 in favor of Dr. Hall

Length

3.5 weeks