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Disabled Man Dies After Hospital Discharge
ISSUE: Is sending a patient home after discharge an action that can only be understood with the aid of expert testimony?
A 19-year-old male was transported by ambulance to a medical center for treatment for a series of seizures. At 3:00 a.m., an employee of the medical center contacted the boy's mother and advised that the patient was being discharged and that someone needed to pick him up from the emergency department. The mother requested that the medical center not release her son until she was able to come pick him up, explaining that he was "mentally disabled, had a history of seizures and could not come home on his own." The mother also told the medical center employee that she would be unable to obtain transportation for several hours because it was very early in the morning.
When the mother arrived at the medical center several hours later, she was informed that the patient had been released and left the emergency department. The son never returned home. A month later, the patient's remains were found in a ravine about a half of a mile from the medical center.
The mother sued, alleging ordinary negligence against the medical center and several of its employees. The hospital argued that the decision to discharge the patient was medical care and that the mother was required to provide expert testimony that the care was substandard. In this state, a medical malpractice action was "a civil action for damages for personal injury or death arising out of the furnishing or failure to furnish professional services in the performance of medical . . . or other health care by a health care provider."
The mother made no claim that the medical center failed to furnish professional services or provide treatment to her son, nor did she allege that the decision by healthcare providers concerning her son's medical fitness after treatment was unsound. Instead, she claimed only a breach of direct duties owed to the patient by the medical center and that ordinary negligence standards applied. In addition, she did not challenge the medical center's professional judgment in determining that the patient required no further medical treatment. Rather, she alleged that the medical center failed to supervise a person in its care and custody, despite being on notice that he could not care for himself, and permitted him to leave the premises without being accompanied by a responsible adult.
A 19-year-old male was transported by ambulance to a medical center for treatment for a series of seizures. At 3:00 a.m., an employee of the medical center contacted the boy's mother and advised that the patient was being discharged and that someone needed to pick him up from the emergency department. The mother requested that the medical center not release her son until she was able to come pick him up, explaining that he was "mentally disabled, had a history of seizures and could not come home on his own." The mother also told the medical center employee that she would be unable to obtain transportation for several hours because it was very early in the morning.
When the mother arrived at the medical center several hours later, she was informed that the patient had been released and left the emergency department. The son never returned home. A month later, the patient's remains were found in a ravine about a half of a mile from the medical center.
The mother sued, alleging ordinary negligence against the medical center and several of its employees. The hospital argued that the decision to discharge the patient was medical care and that the mother was required to provide expert testimony that the care was substandard. In this state, a medical malpractice action was "a civil action for damages for personal injury or death arising out of the furnishing or failure to furnish professional services in the performance of medical . . . or other health care by a health care provider."
The mother made no claim that the medical center failed to furnish professional services or provide treatment to her son, nor did she allege that the decision by healthcare providers concerning her son's medical fitness after treatment was unsound. Instead, she claimed only a breach of direct duties owed to the patient by the medical center and that ordinary negligence standards applied. In addition, she did not challenge the medical center's professional judgment in determining that the patient required no further medical treatment. Rather, she alleged that the medical center failed to supervise a person in its care and custody, despite being on notice that he could not care for himself, and permitted him to leave the premises without being accompanied by a responsible adult.
From your analysis of the case, assess whether the following statesments are true or false:
* | Every decision regarding the release of a patient when care is completed is a medical decision. | True or False |
* | Evaluating whether a disabled patient's discharge from the emergency department care was negligent may not require expert explanation. | True or False |
* | A pre-discharge personal safety mental status examination performed by a healthcare professional could be considered medical care requiring expert explanation to a jury. | True or False |
Expand to check answers
GENERAL PRINCIPLE: When a negligence claim arises out of policy, management or administrative decisions, it is derived from ordinary negligence principles. Determining whether care is needed is a medical decision; sending a patient out of the facility after that decision is made is an administrative decision that can be understood by a jury.
APPLIED PRINCIPLE: Hospitals usually make decisions regarding patient activities based on medical needs and potentially adverse results of not receiving necessary treatment. Whether a patient can safely be discharged or should remain for care or observation is a typical medical decision. Once the decision is made that the patient no longer needs care or observation, determining how and when the patient will return home may or may not be made by medical professionals.
The evaluations of whether the patient's seizures required treatment and of the necessity for further observation were medical decisions. Once a medical provider had determined that the patient no longer needed observation or treatment in a hospital setting, his medical care had essentially ended. If the hospital personnel had determined that he should be taken to the hospital exit in a wheelchair, there could be differing determinations as to whether that transport was or was not medical care, if somehow he had been injured while being transported.
The medical center was not asked to make an evaluation of the patient's ability to return home on his own; although, it could have been interpreted as a medical decision. The medical center was informed that the patient could not do so, ignored the information and allowed him to leave. The decision to send the patient out alone was not a medical decision, but even if it was, a jury would not need expert testimony to understand the issues, nor would an expert have any greater ability to understand the issues than would the jury.
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APPLIED PRINCIPLE: Hospitals usually make decisions regarding patient activities based on medical needs and potentially adverse results of not receiving necessary treatment. Whether a patient can safely be discharged or should remain for care or observation is a typical medical decision. Once the decision is made that the patient no longer needs care or observation, determining how and when the patient will return home may or may not be made by medical professionals.
The evaluations of whether the patient's seizures required treatment and of the necessity for further observation were medical decisions. Once a medical provider had determined that the patient no longer needed observation or treatment in a hospital setting, his medical care had essentially ended. If the hospital personnel had determined that he should be taken to the hospital exit in a wheelchair, there could be differing determinations as to whether that transport was or was not medical care, if somehow he had been injured while being transported.
The medical center was not asked to make an evaluation of the patient's ability to return home on his own; although, it could have been interpreted as a medical decision. The medical center was informed that the patient could not do so, ignored the information and allowed him to leave. The decision to send the patient out alone was not a medical decision, but even if it was, a jury would not need expert testimony to understand the issues, nor would an expert have any greater ability to understand the issues than would the jury.
* | Every decision regarding the release of a patient when care is completed is a medical decision. | False |
* | Evaluating whether a disabled patient's discharge from the emergency department care was negligent may not require expert explanation. | True |
* | A pre-discharge personal safety mental status examination performed by a healthcare professional could be considered medical care requiring expert explanation to a jury. | True |