Meier v. Ross General Hospital

Citation69 Cal.2d 420,445 P.2d 519,71 Cal.Rptr. 903
Decision Date04 October 1968
Docket NumberS.F. 22607
CourtUnited States State Supreme Court (California)
Parties, 445 P.2d 519 Erika MEIER et al., Plaintiffs and Appellants, v. ROSS GENERAL HOSPITAL et al., Defendants and Respondents

John G. Buresh and Buresh, Garety, Vallarino & Costamagna, San Rafael, for plaintiffs and appellants.

Spridgen, Moskowitz, Barrett & Achor, John H. Moskowitz, Santa Rosa, Bledsoe, Smith, Cathcart, Johnson & Rogers and Robert A. Seligson, San Francisco, for defendants and respondents.

TOBRINER, Justice.

Plaintiffs, the widow and minor children of decedent Kurt Meier, brought this action against defendants Ross General Hospital and James M. Stubblebine, to recover damages for the alleged wrongful death of the decedent. While a patient in the psychiatric wing of the hospital and under the care and supervision of Dr. Stubblebine, decedent committed suicide by jumping headfirst through an open window of his second floor room. Following a trial before a jury, the verdict favored both defendants. Plaintiffs appeal from the judgment.

The assignment of errors includes the following question: Did the trial court commit prejudicial error in rejecting a requested instruction which explained that plaintiffs were not to be deprived of the benefit of a res ipsa loquitur presumption because of decedent's 'voluntary action or contribution' (cf. Ybarra v. Spangard (1944) 25 Cal.2d 486, 489, 154 P.2d 687, 162 A.L.R. 1258) if such action or contribution were not the 'responsible cause' of death? (See Vistica v. Presbyterian Hospital (1967) 67 Cal.2d 465, 470--471, 62 Cal.Rptr. 577, 432 P.2d 193.) We hold that such a refusal constituted error, 1 because Vistica requires such an explanation whenever the facts of a case support a theory of liability based on a duty to protect plaintiff (decedent) from his own actions, voluntary or involuntary. (Vistica v. Presbyterian Hospital, supra, 67 Cal.2d 465, 470--471, 62 Cal.Rptr. 577, 432 P.2d 193.)

Furthermore, we hold that the conditional res ipsa instruction, properly pualified, should be given in this case. If those charged with the care and treatment of a mentally disturbed patient know of facts from which they could reasonably conclude that the patient would be likely to harm himself in the absence of preclusive measures, then they must use reasonable care under the circumstances to prevent such harm. (Wood v. Samaritan Institution (1945) 26 Cal.2d 847, 853, 161 P.2d 556.) Given this duty and the fact that defendants placed decedent, following an attempted suicide, in a second floor room with a fully openable window, the jury could find from the fact of decedent's suicidal plunge through this window that defendants more probably than not breached the duty of care owed to decedent. Even in the absence of expert testimony which describes the probability that the death or injury resulted from negligence, the jury may competently decide that defendant more probably than not breached his duty of care when the evidence supports a conclusion that the cause of the accident (here, the openable window) was not inextricably connected with a course of treatment involving the exercise of medical judgment beyond the common knowledge of laymen.

Finally, we conclude that we must reverse the judgment and remand for a new trial because the jury's verdict may have been based on the erroneous instruction; prejudice appears from the probability of a determinative application of an erroneous instruction, and this court should not speculate upon the actual basis of the verdict. (Robinson v. Cable (1961) 55 Cal.2d 425, 428, 11 Cal.Rptr. 377, 359 P.2d 929.)

On July 5, 1962, decedent Kurt Meier attempted to commit suicide by slashing his wrist. After treatment for his physical injury, the decedent's family brought him to the Ross General Hospital. Defendant Stubblebine, director of the hospital's psychiatric wing, attended decedent upon his admission and during his hospitalization became his personal physician.

The hospital had adopted the 'open door' policy for its psychiatric patients. This method of treatment de-emphasizes physical restraint by providing a 'homelike' atmosphere in the hospital. The patients are free to move about and even to leave the hospital if they are so inclined. No mechanical security devices are regularly used; the doors are not locked; the windows are not barred.

The policy rests upon the premise that freedom of movement and personal responsibility of patients, even potential suicides, improve the process of their rehabilitation and reduce possible emotional stress. The proponents of the 'open door' policy concede, however, that the lessening of physical security exposes a potentially suicidal patient to greater risk. They assert that no amount of security or physical restraint short of rendering the patient unconscious can effectivelly prevent suicide. Nevertheless, recognizing the risk of suicide in certain patients, the proponents of 'open door' therapy normally employ larger staffs to facilitate surveillance and administer chemotherapy to those patients whose symptomatic restlessness and agitation indicate severe depression which may lead to suicide.

The window through which the decedent jumped was not barred in any way; it had no security screen; it was fully openable by means of a crank. The crank could have been removed, and the window secured at a fixed width, by removing a screw. Evidence introduced by plaintiffs at trial indicated that other hospitals employ security windows of a type which would have prevented the accident in this case. Plaintiffs also offered evidence which tended to show that secured windows would not have been incompatible with the 'open door' policy. Defendant physician and other defense experts testified that the operation of the psychiatric facilities at Ross Hospital, including the openable windows, comported with accepted hospital and medical standards. Plaintiffs produced no expert witness.

To alleviate decedent's depression, defendant Stubblebine had prescribed a program of chemotherapy. The record indicates, however, that decedent refused to take the medication as prescribed. Although various members of the hospital staff saw and observed decedent on several occasions, the record does not reveal whether the hospital supplied any formal observation or guard. On July 13, 1962, while decedent was alone in his room, he plunged through the window to his death.

At trial, plaintiffs characterized the openable window in decedent's room as an invitation to commit suicide, a patent violation of defendant's duty of care to the decedent, and a fact of negligence wholly undelated to the 'open door' policy. Plaintiffs also attacked the adequacy of the chemotherapy prescribed and administered to the decedent. In answer, defendants described the treatment and supervision given decedent while in the hospital as exceeding the standard of due care and comporting with good medical practice. Defendants' expert witnesses testified that the 'open door' policy as administered at Ross Hospital complied with accepted professional standards. Defendants suggested that the openable window constituted as much a part of 'open door' therapy as the unlocked doors. Finally, defendants offered evidence of the difficulty, bordering on impossibility, of preventing an attempted suicide by any sort of physical restraint. 2

The trial judge gave three distinct negligence instructions: ordinary negligence, medical malpractice, and the questionable res ipsa loquitur instruction. The jury's verdict (10 to 2) favored both defendants.

The trial judge instructed the jury on the doctrine of res ipsa loquitur: 'With respect to the doctrine of res ipsa loquitur mentioned by counsel we have this question for you to decide in this case. The question is stated in this way: Whether the accident involved occurred under the following three conditions. First, that it is the kind of accident which ordinarily does not occur in the absence of someone's negligence; second, that it was caused by an agency or instrumentality in the exclusive control of the defendants; and third, that the accident was not due to any voluntary action or contribution on the part of the decedent. And only in the event that you should find all these conditions to exist, you are instructed that an inference arises that a proximate cause of the occurrence was some negligent conduct on the part of the defendants.'

Although this instruction meets the requirements set forth by this court in Ybarra v. Spangard, supra, 25 Cal.2d 486, 489, 154 P.2d 687, 162 A.L.R. 1258, we held in Vistica v. Presbyterian Hospital, supra, 67 Cal.2d 465, 468--469, 62 Cal.Rptr. 577, 432 P.2d 193, that an instruction just be measured by the circumstances of the case in which it was given. (Cf. Adams v. American President Lines (1944) 23 Cal.2d 681, 688, 146 P.2d 1; Schroeder v. Baumgarteker (1927) 202 Cal. 626, 629, 262 P. 740.) In the present case, the plaintiffs offered an instruction which would have explained to the jury that 'A plaintiff may properly rely on res ipsa loquitur although he (the decedent) participated in events leading to the accident if the evidence excludes his conduct as the responsible cause.' The trial judge refused to give this pualification. We held in Vistica v. Presbyterian Hospital, supra, 67 Cal.2d at pages 470--471, 62 Cal.Rptr. 577, 432 P.2d 193, that just such a qualification must be given whenever the facts of a case support a theory of liability based on a duty to protect plaintiff (decedent) from his own actions, voluntary or involuntary.

The rationale for our holding in Vistica rested on the probability that the jury would misunderstand the third condition to the res ipsa instruction to mean that the doctrine could never apply when the decedent's voluntary actions contributed to the accident. The purpose of this condition is to eliminate the possibility that the decedent was...

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