Brandvain v. Ridgeview Institute, Inc., 76331

• Decision Date: 11 July 1988
• Docket Number: No. 76331,76331
• Citation: 188 Ga.App. 106,372 S.E.2d 265
• Parties: BRANDVAIN v. RIDGEVIEW INSTITUTE, INC. et al.
• Court: Georgia Court of Appeals

Page 265

372 S.E.2d 265

188 Ga.App. 106

BRANDVAIN v. RIDGEVIEW INSTITUTE, INC. et al.

No. 76331.

Court of Appeals of Georgia.

July 11, 1988.

Rehearing Denied July 28, 1988.

Certiorari Granted Oct. 6, 1988.

Robert C. Lamar, David W. Davenport, Atlanta, for appellant.

Rush S. Smith, Jr., R. Jerry Kirkpatrick, Brynda S. Rodriguez, Atlanta, for appellee.

Jack S. Schroder, Jr., James F. Owens, Atlanta, Thomas W. Bennett, Macon, Don C. Keenan, Atlanta, David S. Bills, amici curiae.

BEASLEY, Judge.

Deborah Brandvain appeals the trial court's grant of the defendants' j.n.o.v. in this medical malpractice case. The issues on appeal relate to legal duty, causation, and preliminarily, j.n.o.v. procedure. Mrs. Brandvain sued individually and in her capacity as administratrix of her husband's estate for his wrongful death by suicide while a patient at Ridgeview.

Viewed in the light favorable to the verdict and judgment, as we are required to do, Pendley v. Pendley, 251 Ga. 31, 31(1), 302 S.E.2d 554 (1983), the evidence showed the following. Ridgeview Institute is a hospital specializing in the treatment of alcohol and drug abuse. It has a renowned program, including a component aimed specifically at health care professionals. One of the defendants, Dr. Douglas Talbott, an internist and addictionologist, is director of Ridgeview's health professionals program which he began in 1976. He is a recovering alcoholic as is defendant Dr. Blevins, a psychiatrist, who was Walter Brandvain's primary physician at Ridgeview. Walter Brandvain was a 31-year-old doctor in his second year of residency at Elmhurst Hospital in New York City. He and plaintiff were married in 1976. Plaintiff was aware of his frequent marijuana use and LSD experimentation over the years, but was unaware of other drug use until 1982, when he advised her that he had taken drugs from Elmhurst for his own use and was about to be discovered. The drugs included morphine. As a result of this, he was monitored by the doctors at the hospital, including drug testing, but allowed to complete his residency work that year. He was required to go into therapy, which he did with Dr. Brower beginning in April 1982, and to sit out a year of his residency at Elmhurst. During that year, he went into a psychiatric residency at Brookdale Hospital.

On Valentine's Day 1983, Walter told plaintiff that he had been injecting drugs which he had ordered after obtaining his medical license and DEA number. He had used all of these, including Demerol and morphine, and had no more. She took him to Payne Whitney where he was admitted as an inpatient and stayed for two to three weeks. He then went to Hazelden, which specializes in alcohol and drug abuse. He left that program early due to his dislike of its Christian emphasis, he being Jewish. He then was admitted to the Mayo Clinic where he was treated for a chronic bladder problem, including shots of Demerol. He did not advise them of his drug abuse.

His new psychiatrist, Dr. Karkus, put him on methadone due to his cocaine and heroin addictions.

In November 1983, he and plaintiff went to Mexico, where Walter had attended medical school, for a month's vacation. There, he began "acting strange." After their return home, he began disappearing for long periods of time, using street heroin and cocaine even though still on methadone. Walter told his wife he had been considering suicide. She called another psychiatrist, Dr. Lefer, who admitted Walter that day to Roosevelt Hospital with a tentative diagnosis of manic depression. He placed him on Lithium and Walter was released. Walter then acknowledged to plaintiff that he had a drug problem and needed help. They checked various programs, all of which required patients to be detoxed from methadone before entering. Walter checked himself into the locked ward of the Smithers Institute of Roosevelt Hospital for detoxification on December 27. There, while attending an Alcoholics Anonymous meeting, he ran out of the meeting and was pursued by Dr. Gallegos, a recent patient of the Ridgeview program who was attending the meeting to assist his AA sponsor. He told Walter about Ridgeview and Walter called plaintiff who talked to Dr. Gallegos, who was in the process of moving to Atlanta to join the Ridgeview staff. She talked to Walter's parents about the program and they were interested but concerned about the expense.

Shortly thereafter, Walter called her and told her he had attempted to go out an upper floor window at Roosevelt and that he was very distraught and upset. On New Year's Eve, he knocked down a guard and ran out without any coat, taking a cab to his parents' home. When they saw him, they told plaintiff to get him into Ridgeview and they would pay for it. She called Ridgeview and Dr. Talbott told her to bring Walter to Atlanta immediately. She did so and was met at the airport near midnight by Dr. Talbott, who drove them to Ridgeview. She saw Walter again on New Year's Day and spoke with Dr. Talbott. She was advised not to accept any phone calls from Walter for the first ten days of his treatment. She told Dr. Talbott about the suicide attempts, although he had no recollection of that. She returned to New York.

Walter was admitted to one of the unlocked alcohol and drug units, Cottage A, by Dr. Talbott. Dr. Talbott's notes of January 1 reflect a diagnosis of cocaine, opiate, and THC (marijuana) addiction, and knowledge of Walter's Hazelden and Roosevelt stays. He also diagnosed dysthymic disorder. Dr. Talbott was not to be Walter's primary physician, but had merely signed him in as an emergency admission, originally on Dr. Browne's service. Talbott dictated his admission history on Sunday, January 1 and it was transcribed on January 3. It contained no mention of suicidal ideations or prior attempts. Because of the holiday, Dr. Talbott, who was on call for all patients, continued to prescribe medications for Walter for his withdrawal symptoms, including tremors and cramps.

During the day on Monday, January 2, Walter became more agitated, demanding to be released. He began to turn over tables and as a result of this behavior, Dr. Talbott ordered him transferred to Cottage C, a locked unit for psychiatric patients. Since Dr. Browne had not seen Walter, he was transferred to Dr. Blevins, who saw him and noted a probable diagnosis of opiate and cocaine dependence and "near toxic psychosis." While in C on January 2, Walter was placed initially in the seclusion hall, where all rooms entering it can be locked to prevent the patient's entry and the patient can be observed through locked glass doors closing off the hallway from the rest of the unit. In the hall, Walter began kicking the doors and attempting to leave, so he was placed in the seclusion room with only a mattress and a locked door through which the patient can be observed until allowed to leave. He remained there for an hour and was seen by Dr. Blevins.

On January 3, Walter was transferred to Cottage B, the other alcohol and drug unit. Prior to that transfer he had signed a request to be released, which he later withdrew. After the transfer, he signed a second request, which he also withdrew after attending a meeting of Caduceus, a group of doctors undergoing treatment at Ridgeview. He continued to show withdrawal signs, including cramping, panic feelings, dehydration, and increasing agitation. He slept only three hours that night.

On the morning of January 4, Walter refused to attend any groups and became more agitated. Around noon on January 4, Dr. Blevins signed a form 2014 on Walter, certifying that he was in need of involuntary treatment, was drug or alcohol dependent, could present a substantial risk of injury to himself or others, and should be transferred to an evaluating facility. This began the process of involuntary commitment. OCGA §§ 37-7-64; 37-7-81; see Davis v. Charter By-The-Sea, 183 Ga.App. 213(1), 358 S.E.2d 865 (1987). It was based partially on the staff's consensus that Walter might "wander off cottage and into harm's way." Walter was transferred back to Cottage C. He signed a request for a court-appointed attorney and writ of habeas corpus. He appointed plaintiff as his representative but refused to authorize Ridgeview's staff to discuss his treatment with her.

He was examined by Dr. Udell, the consulting psychiatrist for Ridgeview on January 4 at the request of Dr. Blevins. Dr. Udell noted Walter's "starey look, stiff walk, dehydration, and depressed and angry mood." While he noted no evidence of thought disorder, he did note Walter's poor judgment and recommended that he be kept on the closed unit and encouraged to participate in the C programs. His diagnosis was "toxic brain syndrome, mixed." At that time, he did not believe Walter was suicidal. He was unaware of Walter's previous expressions of suicidal intent.

During the night of January 4, Walter did not sleep and was noted by June Davis, the night shift nurse, to be angry and hostile.

On the morning of January 5, Walter violated phone restrictions by attempting to call his wife. Due to his continued agitation and pushing of limits, he was placed on the seclusion hall. Greg Thomas was one of the clinical assistants, non-medical personnel who assist nurses in the care of patients. While observing Walter on the hall at approximately 11:45 a.m., he saw Walter go into the alcove where the bathroom was located. Thomas could not see Walter and went to investigate. He found Walter with one arm of his sweater around his neck and the other caught in an upper corner of the bathroom door. The sweater was taut and Walter's knees were bent. Thomas and Glenn McCoy, another clinical assistant who arrived seconds after Thomas, removed the sweater from Walter's neck. Walter ran from the seclusion hall, grabbed a ping pong net and began swinging the metal ends of the net at staff. He had to be subdued with foam tipped poles used for such incidents. He...