Mississippi Dept. of Mental Health v. Hall, No. 2004-CA-01522-SCT.

• Decision Date: 24 August 2006
• Docket Number: No. 2004-CA-01522-SCT.
• Citation: 936 So.2d 917
• Parties: MISSISSIPPI DEPARTMENT OF MENTAL HEALTH v. Julia Renee HALL.
• Court: Mississippi Supreme Court

936 So.2d 917

MISSISSIPPI DEPARTMENT OF MENTAL HEALTH v. Julia Renee HALL.

No. 2004-CA-01522-SCT.

Supreme Court of Mississippi.

August 24, 2006.

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Eugene M. Harlow, Laurel, attorney for appellant.

George L. Follett, Meridian, attorney for appellee.

Before SMITH, C.J., WALLER, P.J., and DICKINSON, J.

WALLER, Presiding Justice, for the Court.

¶ 1. Julia Renee Hall filed a complaint against the East Mississippi State Hospital,¹ alleging that, while she was a patient at East Mississippi, she sustained serious injuries after falling from a third-story window. After conducting a bench trial pursuant to the Mississippi Tort Claims Act, Miss.Code Ann. §§ 11-46-1 through 23 (Rev.2002), the Lauderdale County Circuit Court entered a judgment against East Mississippi in the amount of $250,000. We affirm the circuit court's judgment in all respects.

FACTS

¶ 2. Julia Renee Hall, who was 25 years old at the time of the accident, has been institutionalized at different mental health facilities since she was 13 years old. Her latest admitting diagnosis was schizophrenia, disorganized type, borderline; and borderline personality disorder. Her discharge diagnosis from her last stay at East Mississippi² was Axis One: schizoaffective disorder, bipolar type; alcohol dependency, in remission; amphetamine abuse, in remission; cannabis abuse, in remission; Axis Two: borderline personality disorder. She has been civilly committed to East Mississippi on four different occasions.

¶ 3. On June 4, 2001, Hall became convinced that she would be transferred to the "back building," a facility for chronically ill patients. Hall and other patients believed that the back building was an area where violence and abuse run rampant among the patients and where there was little to no hope for recovery. Angela Eason, a staff member, filed the following report about what occurred the afternoon of June 4:

Pam Johnson and I took the patients out for a smoke break at 5:00 o'clock, 1700. . . .

When these patients finished smoking, we returned to the unit on the elevator where the patients started talking about the back building and asking why would a patient get sent to those buildings. I explained it's usually they can't be stabilized on medications or patients that just keep on cycling through the system time and time again.

Julia Hall then laughed and said, You mean like me? I then said, I haven't heard your name come up about going to the back building, but you do keep moving up and down between second (a less restrictive ward) and third and you need to get it together. You are too young to be institutionalized all your life.

¶ 4. When they returned to the third-floor ward, Hall was "hysterical" and "crying" because she thought that the staff was going to transfer her to the back building. Patients Amanda Neal and Regina O'Bryant told Hall that they had a plan in place to escape and coaxed Hall to join them. Neal and O'Bryant's plan was to escape through a third-story window in the all-purpose conference room which adjoined the nurses' station. The door to the room was not locked, and there was no security screen on the window. The window was inoperable, but the women somehow removed a window pane. The group took sheets from a linen closet on the floor which was also unlocked. They entered and exited the conference room several times before Hall actually went out the window and began climbing down a "rope" created by tying the sheets together. Hall lost her footing and fell to the ground. She suffered multiple fractures of the right leg, necessitating eight surgeries so far. Her right foot and heel have become infected several times due to soft tissue damage. She has undergone bone and skin grafts. At the time of the hearing, her right foot and lower leg were swollen and appeared to be deformed, and she noticeably limped. The circuit judge found that Hall would "never be able to hold gainful employment of any consequence for the rest of her life," and that "she has a future of probable repeated and long-term mental health treatment in institutions."³

¶ 5. The circuit judge found that $1,000,000 for actual and compensatory damages⁴ was appropriate. He allocated fault as follows: East Mississippi, 50%; Hall, 25%; Neal, 12-1/2%; and O'Bryant, 12-1/2%. Then, applying the cap on compensatory damages as set out in Miss.Code Ann. § 11-46-15 (Rev.2002),⁵ the circuit judge entered a judgment against East Mississippi in the amount of $250,000. East Mississippi appealed.

DISCUSSION

¶ 6. "A circuit court judge sitting without a jury is accorded the same deference with regard to his findings as a chancellor, and his findings are safe on appeal where they are supported by substantial, credible, and reasonable evidence." City of Jackson v. Internal Engine Parts Group, Inc., 903 So.2d 60, 63 (Miss.2005) (citing City of Jackson v. Perry, 764 So.2d 373, 376 (Miss.2000)). Questions of law are reviewed de novo. Internal Engine, 903 So.2d at 63 (citing Maldonado v. Kelly, 768 So.2d 906, 908 (Miss.2000)).

I. WHETHER EAST MISSISSIPPI HAD A DUTY TO PREVENT HALL FROM HARMING HERSELF BY ATTEMPTING TO ESCAPE THROUGH THE THIRD STORY WINDOW.

¶ 7. To prevail on a negligence claim, a plaintiff must establish by a preponderance of the evidence each of the elements of negligence: duty, breach, causation and injury. Miss. Dep't of Transp. v. Cargile, 847 So.2d 258, 262 (Miss.2003). The cause of Hall's injuries was her fall from the third-story window, and the parties stipulate to Hall's injuries. Therefore, at issue is whether East Mississippi had a duty to prevent Hall from harming herself by attempting to escape through the third-story window and whether that duty was breached.

Standard of Care for Patients with Mental Impairments

¶ 8. A state facility providing mental health care is statutorily mandated to provide "proper care and treatment, best adapted, according to contemporary professional standards." Miss.Code Ann. § 41-21-102 (Rev.2005). Neither the Legislature nor Mississippi courts have defined "contemporary professional standards," but, in dicta, this Court, speaking through the learned Presiding Justice Banks, commented, "[p]ersons deemed incapable of making rational judgments, such that they must be committed, are not to be protected by a lesser standard than reasonable care under the circumstances." Carrington v. Methodist Med. Ctr., Inc., 740 So.2d 827, 829-30 (Miss.1999). In Texas, "[a] hospital is under a duty to exercise reasonable care to safeguard the patient from any known or reasonably apprehensible danger from herself and to exercise such reasonable care for her safety as her mental and physical condition, if known, may require." Mounts v. St. David's Pavilion, 957 S.W.2d 661, 663 (Tex.Ct.App.1997).⁶

¶ 9. The Texas standard of care for the duty a hospital owes to a patient is similar to what we enunciated in Carrington. It is flexible in that the duty owed to patients may increase depending on the physical or mental condition of the patient. It can therefore be applied to different fact situations. We therefore adopt the Texas standard of care.

Duties Owed to Hall

¶ 10. Wood Hiatt, M.D., a board-certified psychiatrist,⁷ testified that East Mississippi had the duty to protect patients from the consequences of their own dangerous behavior, to lock doors to rooms where a patient could be present without supervision, and to put safety screens on windows in rooms where a patient could be present without supervision. Dr. Hiatt also testified that East Mississippi staff was required to know the location of each patient and the actions in which each patient was engaged. Hall had attempted suicide in March of 2001, and she should have been under "special observation." The May 15, 2001, progress notes concerning Hall state that Hall was a "danger to herself and others." Hall became argumentative with a staff member on May 31 and was placed on the third-floor ward, which was a locked unit.

¶ 11. Dr. Hiatt further testified that East Mississippi breached the above-referenced duties by allowing third-floor ward patients to freely enter and leave an unlocked room without supervision, to have access to the linen closet, and to be without supervision long enough to take sheets out of the linen closet, make a rope out of the sheets, pry the window open in the conference room, take off their pajamas and put on regular clothes, attach the rope to a table in the conference room, and climb out the window. What astounds the Court is that the three women were coming in and out of the supposedly off-limits conference room which was right next to the nurse's station. Also, each patient was to be checked every thirty minutes. Whoever staffed the nurse's station or monitored the patients during these events should have become suspicious about the women's activities. Someone should have noticed that the three women had pajamas on and then they changed into regular clothes. Hall testified that most of the nurse's aides were "watching television."

¶ 12. We find, as the circuit court did, based on Dr. Hiatt's testimony, East Mississippi breached the duties of care owed to Hall.

Foreseeability

¶ 13. East Mississippi contends that it committed no negligent acts because Hall's injury was unforeseeable. It states that the door to the conference room was "inadvertently" unlocked and that the window in the conference room was "non-operable" and "non-opening." Therefore, East Mississippi argues, the only foreseeable action on the part of a patient would have been to have been in the room without supervision and not for that patient to pry the glass panes out of the window in an attempt to escape. Several members of the East Mississippi nursing staff testified that they never considered the conference room to be an escape risk and that they never thought a patient would attempt to escape out a third-story window....