MacOn-bibb County Hospital Authority v. Appleton

Evans, Judge,

dissenting. Plaintiff was admitted to the Macon Hospital for psychiatric treatment, and fell from a 7th story window approximately 50 feet to the ground and suffered serious injuries. He filed suit against the hospital, and verdict and judgment were rendered in his behalf. During the trial defendant moved for a directed verdict and for a judgment n.o.v., which motions were overruled by the trial judge and defendant appeals to this court. The majority opinion holds that there was a jury question as to whether plaintiff was responsible for his actions as a normal adult. The majority opinion further holds that it must be presumed that patient was a pay-patient and entitled to have the hospital exercise reasonable care in looking after and protecting him, to the extent that his condition as known to the hospital might require. The majority opinion then holds that although plaintiff had announced his intention of "breaching the physical barrier” (escaping from the hospital) that to require the hospital to maintain continuous surveillance of plaintiff’s activities would, in effect, "impose a duty of insuring his safety, and would far exceed the standard of reasonable care, under the circumstances here shown.” The majority opinion states that it recognizes that *453negligence is for a jury’s determination but that the evidence in this case does not show the hospital failed to exercise reasonable care for the safety of plaintiff, and reverses the trial court in refusing to direct a verdict for defendant and in refusing to grant a judgment n.o.v.

It is difficult to follow the reasoning of the majority. The majority correctly states: "It is well established that a hospital owes a duty to a pay-patient to exercise such reasonable care in looking after and protecting the patient as his condition, known to the hospital through its agents and servants charged with the duty of looking after and supervising him, may require. . .”

What was the condition of the plaintiff as known to the hospital? What was reasonable care on the hospital’s part in looking after and supervising him, with such knowledge?

The transcript shows that plaintiff had been a patient in this same hospital on prior occasions for shock treatment and that such treatments are "what they call last resort when medicine doesn’t help.” He was last admitted on January 17, 1969, suffering with "psychotic depressive reaction,” which means that he could not even distinguish right from wrong. The admitting physician entered on the hospital records as to this plaintiff: "27 year old white male was first seen in my office in an acute state of agitated depression stating that he can’t sleep, can’t eat, feels angry, feels like he is going to explode inside. He doesn’t care about anything, cannot make decisions, feels suicidal at times. He is frightened that he might hurt himself.” (Emphasis supplied.)

The language emphasized is very important — proving the patient was "out of his mind” and needed constant attention. This was indeed a signal for alarm and was quite prophetic.

The policeman who brought him to the hospital had received a Signal 16, which means a "demented person,”’ and at the time and place of taking him in custody, saw scattered clothing, displaced furniture, a broken guitar, and noted that he was wild-eyed. When he brought the patient to the hospital he told the officials that he had one that could give some trouble; that he is wild and tore up his apartment. The policeman told the hospital that it would have to watch him. At the desk the policeman told the lady in charge: "If he hurts someone we cannot be responsible — we *454have done all we can do. Don’t blame the police department if something happens. I am sorry, this is all we can do.” The patient was quick — jumpy—nervous.

Thus, at this point the hospital fully knew that it had in its care a wild man who was frightened and might hurt himself, and for whom the police refused to accept responsibility in the event that he hurt someone. What "reasonable care” did the hospital then exercise under these unusual circumstances?

About 4 o’clock on that day a hospital guard found the patient (plaintiff) standing in Room 710 with the screened window open. The screened window opened onto the roof. This was on the 7th floor. The nurse in charge (Miss Joan Elizabeth Reynolds) assumed that the patient opened the window himself, so she put him in another room, to wit: Room 701, which had the same type of screen on the window, that is, the same type of screen that she assumed he had just opened in Room 710. This unusual occurrence had never happened before in this hospital. One of the first statements he made to her was that he was going to get out of the hospitál that day; and he continued to make that statement to the various hospital personnel with whom he came in contact. He was given 200 milligrams of Thorazine, which is a heavy dose. The nurse testified that she did not bind him down or use restraining devices to keep him in the bed, although she had such devices available. At 6 p.m. he refused to take his prescribed dosage of Thorazine and five attendants were called and he then took the medicine and repeated that he was going to get out of the hospital. He was not searched, nor was his bathrobe searched when he was placed in the room, although he continued to maintain that he was going to get out. It was determined by Glen Woolfolk, a hospital employee, and the head nurse, that the patient had opened the,window in Room 710 and had determined to try to get out of the hospital. Glen Woolfolk expected him to try to get out and when he later heard that someone had fallen, he knew who it was. The chief engineer testified that the type of screen used on the 7th floor of the hospital was not designed for psychiatric wards, but was for protection type in use of less than maximum detention. It was testified that Central State Hospital uses the same type of screen, but also uses bars on the windows, *455whereas no bars or locks on the windows were used in the Macon Hospital. Instead of maintaining constant surveillance over him by placing a guard in his room, and instead of confining him to his bed by the devices which were available for that purpose, the hospital contented itself with checking on him every 15 minutes. During one of the 14-minute periods when he was not being checked on, the plaintiff, in his demented state of mind, tied bed sheets together and tied them to the bed, removed the screen window as he had done in Room 710 and went through the window and fell approximately 50 feet to the ground.

Was this reasonable care "under the circumstances?” Was it even simple care? No, in my opinion, it was gross negligence. The majority opinion states that the "evidence amply demonstrates it would be impossible to break one of these screens unless one was possessed of Gargantuan strength, or was ingenious enough, using any materials at hand, to devise some means of unlocking a screen.” How can the majority so contend when this same patient had opened an identical screen in an identical room during the same afternoon? The hospital knew he had opened the screen in Room 710; why should it not have expected that he would open the one in Room 701? The hospital knew that he was frightened and that he might hurt himself, and that the Police Department of the City of Macon was not willing to be responsible for him, and yet it failed to take proper steps to prevent his injuring himself.

The majority opinion asserts that the hospital was not required to maintain a continuous surveillance of plaintiff’s activities, and to impose such duty on the hospital would impose a duty of insuring his safety, and would thus exceed the standard of reasonable care under the circumstances here. In support of this contention the majority opinion cites 26 AmJur 595-596, Hospitals and Asylums, § 14. But a careful reading of that section reveals this pertinent and meaningful language, to wit: "In some cases the failure of a nurse to give constant attention may amount to negligence.” Citing Wetzel v. Omaha Maternity & General Hospital Assn., 96 Neb. 636 (148 NW 582, AC 1915B 1224). We feel this completely disproves the correctness of the position assumed by the majority opinion. Further, our Georgia courts have held to the same effect, *456that is, that in some cases constant surveillance is necessary in order to exercise reasonable care. In the case of Emory University v. Shadburn, 47 Ga. App. 643 (2) (171 SE 192), the patient in a private hospital became delirious, which condition was known to the hospital, and this court held: ". . . the inference is authorized that the hospital authorities in charge of the patient and having knowledge of these facts should, in the exercise of due care, anticipate that the patient, should the opportunity be presented, would endeavor to leave the hospital by some means, as by jumping out of a window. Where the hospital authorities, with such knowledge, neglect and fail to guard the patient and safeguard her against harm to herself, by failing to have a nurse on guard and in constant attendance on the patient, and where by reason of such failure the patient leaves her bed and jumps out of a window and suffers physical injuries, an inference is authorized that the hospital is guilty of a negligent failure to exercise the duty owing to the patient, and is liable to the patient in damages therefor.” (Emphasis supplied.) Again, in the case of Lathan v. Murrah, Inc., 121 Ga. App. 554, 557 (174 SE2d 269) the question of a hospital’s duty was discussed, and this court held: "However, if there be evidence from which the jury might find that the defendant owed a duty, under the circumstances, not to leave the decedent unrestrained, and that this duty was breached and was responsible for a fall, and that a fall did result, which caused or contributed to the decedent’s death, the lower court would have erred in granting a directed verdict. There was evidence from which the jury could have determined the defendant owed a duty, under the circumstances, not to leave decedent unrestrained, even momentarily; that this duty was breached; and that defendant was responsible for the fall of plaintiff’s mother.” (Emphasis supplied.) Seven judges concurred in this opinion, and two dissented.

Reasonable care as to one person may be gross negligence as to another. There is no reason to try to guard the hospital room of a perfectly normal person whose mind is sound and who is not under the influence of drugs. But as to one who is out of his mind, likely to hurt himself, and has announced his intention to escape, and who has already demonstrated that he can escape, surely reasonable care required that he be restrained or that he be guarded.

*457The law is plain and needs no citation of authority here that negligence is to be decided by juries and not by judges. Further, a directed verdict must not be granted on motion if there is a conflict in the evidence, nor if the reasonable deductions and inferences do not demand it. Code Ann. § 110-104 (Ga. L. 1961, p. 216); §50, CPA (Ga. L. 1966, pp. 609, 656; 1967, pp. 226, 237; 246, 248; Code Ann. §81A-150). See also Pritchard v. State, 224 Ga. 776, 779 (164 SE2d 808). Further, all deductions and inferences arising from the evidence must be construed most favorably toward the party opposing the motion for directed verdict. Jones v. Mayor &c. of Athens, 105 Ga. App. 86 (1) (123 SE2d 420); Curry v. Roberson, 87 Ga. App. 785, 786 (75 SE2d 282). The question of directing a verdict is further compounded when we remember that a jury has the right to believe a part of what a witness testifies and to disbelieve a part thereof, especially where the witness has an interest in the case (such as an employee of the hospital or a physician). Campbell v. State, 157 Ga. 233, 235 (121 SE 306); Adams v. Adams, 218 Ga. 67 (4) (126 SE2d 769); Powell v. Blackstock, 64 Ga. App. 442 (5) (13 SE2d 503). How would the trial judge have known which parts of the testimony of defendant’s witnesses, who had an interest in the case, to credit or discredit? For after all, it is only the jury that may believe in part and disbelieve in part, and not the judge. And how can this court know which parts of the testimony would have been believed by the jury, and which parts disbelieved?

For all of these reasons I would affirm the trial court in this case.

I also concur in the dissent by Judge Pannell.