In a recent opinion from the Maryland Court of Special Appeals, the three-judge panel held that a Maryland hospital had a duty to prevent a man with schizophrenia from leaving the emergency room, reversing a trial court decision.
In a decision filed June 27, 2013, the Court of Special Appeals found that Maryland General Hospital (MGH) owed a legal duty to Richard Crise, a schizophrenic man who had been treated in their emergency room. The judges found that his emergency room visit fell under the scope of their duty of care, and that the case should have been heard by a jury.
Crise, 30, was diagnosed with bipolar disorder when he was 17. Since that diagnosis, he has also been diagnosed with depression, schizoaffective disorder and schizophrenia. Due to his conditions, he had been admitted to the psychiatric unit at MGH on at least four occasions.
On December 31, 2008, Crise was taken to MGH's emergency room by his mother and sister because he complained of heart palpitations and chest pain. His mother informed the emergency room nurses about his diagnoses and mentioned that he was experiencing a psychiatric crisis. Further, she informed them that he had not eaten, slept or taken his psychiatric medications for the past five days. During the initial assessment, the nurse made notations in Crise's chart, indicating that he suffered from bipolar disorder and acute mania. His mother informed the nurse about Crise's past suicide attempts and indicated that he may be suicidal.
Concerned that Crise might run away, a nurse kept watch to make sure he stayed in his room. When hospital staff informed her that a patient was seen walking out the back door, the nurse notified security and called the Baltimore City Police Department (BCPD). The BCPD notified MGH staff that Crise had been located on the Howard Street Bridge.
As the police approached Crise, he jumped over the side of the Howard Street Bridge, a fall of 30 to 40 feet. He fractured his pelvis, right arm, right leg and left wrist in the fall. When questioned, Crise said that he simply wanted to walk home and jumped off the bridge to get away from the police. He thought "it wouldn't be such a big deal."
On September 22, 2009, Crise filed a lawsuit alleging medical negligence by MGH. He claimed that MGH owed him a duty of care, and breached that duty by failing to closely monitor him. He says that this breach of duty was the direct cause of the injuries he sustained when he jumped off the bridge in a manic and psychotic state.
A trial was scheduled to begin on October 5, 2010. Before the jurors were brought into the courtroom, the trial judge declared that he was raising certain issues under Maryland Rule 2-502 that needed to be addressed for the case to proceed. He found that, because Crise was voluntarily admitted into the hospital, MGH did not have the authority to prevent him from leaving if he chose to do so. Both Crise and MGH appealed the decision.
The Maryland Court of Special Appeals reversed, finding that the committee notes for Rule 2-502 make it clear that a legal question is not appropriate for decision under that rule and the issue of whether MGH had a duty to Crise should have been put before a jury.