Psychiatric Institute of Washington, v. Allen

• Decision Date: 20 May 1986
• Docket Number: No. 84-114.,84-114.
• Citation: 509 A.2d 619
• Parties: PSYCHIATRIC INSTITUTE OF WASHINGTON, Appellant, v. James T. ALLEN and Bonita K. Allen, Appellees.
• Court: D.C. Court of Appeals

509 A.2d 619

PSYCHIATRIC INSTITUTE OF WASHINGTON, Appellant, v. James T. ALLEN and Bonita K. Allen, Appellees.

No. 84-114.

District of Columbia Court of Appeals.

Argued November 28, 1984.

Decided May 20, 1986.

David P. Durbin, with whom Edward J. Lopata, Washington, D.C., was on brief, for appellant.

W. David Allen, with whom Allen T. Eaton and Richard L. Swick, Washington, D.C., were on brief, for appellees.

Before MACK, BELSON and TERRY, Associate Judges.

TERRY, Associate Judge:

On August 12, 1981, thirteen-year-old Daniel Allen was admitted to the Psychiatric Institute of Washington ("the Institute"), a private psychiatric hospital. One month later, on September 12, an Institute employee walked into Daniel's room and found him lying on the floor unconscious, with a belt around his neck. Efforts to revive him were unavailing. He was taken to Georgetown University Hospital, where he died without regaining consciousness.

Daniel's parents, James and Bonita Allen, brought this action against the Institute and Dr. Judith Forgotson, the psychiatrist in charge of Daniel's treatment there, alleging that his death was a direct and proximate result of their negligence. The jury returned a verdict in favor of Dr. Forgotson, but it found the Institute liable to the Aliens and to Daniel's estate in the amount of $270,000. On appeal from the judgment entered on that verdict, the Institute contends that there was insufficient evidence to permit the case to go to the jury, that the court erred in refusing to give certain jury instructions, and that counsel for the Aliens made improper comments during his closing argument which deprived the Institute of a fair trial. We find no reversible error and accordingly affirm the judgment.

I

The evidence at trial established that Daniel Allen had a history of serious psychiatric problems. When, at the age of twelve, he was involved in several fire-setting episodes, his parents sought professional assistance from Dr. Myron Hafetz, a clinical psychologist. After treating Daniel for approximately three months, Dr. Hafetz concluded that he might "hurt himself or be a danger to the community."¹ Dr. Hafetz therefore referred him to Children's Hospital, where he was treated on an emergency basis for approximately six weeks. At the time of his admission, the following entry was made in Daniel's file:

Child requires emergency hospitalization for escalating firesetting, potentially life-threatening. . . .

* * * * * * *

Diagnostic impression — severe neurotic character, narcissistic personality; no evidence on initial exam of borderline pathology.

His admission note stated:

Daniel is a 12 [year] old [white] male referred by private [doctor because of a history] of firesetting. . . . [History] of setting fire to his bed and then climbing into bed to sleep — seemingly unaware of suicidal gesture.

Within a few days after his admission to Children's Hospital, a staff psychiatrist, Dr. Taiw Okusami, and several of his colleagues devised a comprehensive treatment plan for Daniel. This treatment plan, which became a part of Daniel's file, was in the form of a table. Under the heading "Problem Description" appeared the entry "Suicidal Ideation." In the next column, under the heading "Plan," was written the following:

Observe on ward. Limit to ward. Review next Wednesday. Explore ideation in extended psychiatric and psychological evaluation.

In the next column immediately to the right, under the heading "Goals," was written "Prevent Suicide." The fourth column listed the names of the hospital staff members responsible for Daniel's care. Finally, in the fifth column, headed "Current Status of Problem," appeared this entry:

Passive suicidal ideations and frequent talk about death; sometimes wishing [he] were dead.

About three weeks later, a nurse found Daniel in a compromising sexual situation with another patient. While the nurse and Daniel were discussing the incident, Daniel "expressed wishes that he were dead"; he was then placed on a twenty-four-hour suicide watch. Some time thereafter Dr. Okusami concluded that Daniel needed extended treatment in a residential program and referred him to the Institute.

Daniel was admitted to the Institute on June 23, 1980. Records prepared at that time said that he was being admitted because:

1. Suicidal or destructive behavior [was] an immediate threat.

2. Magnitude of deviant behavior [was] no longer tolerable to patient or society.

3. Treatment [could not] be initiated or continued unless in a supervised setting.

4. Previous hospitalization [had] not used approach available here.

5. Ambulatory treatment [had] been unsuccessful in halting or reversing the course of mental illness.

The Institute gave Daniel a series of tests which revealed that he had a "serious emotional disturbance characterized both by an unsocialized aggressive reaction with fire-setting behavior as well as a depressive reaction with poor self-esteem and self-destructive impulses." The tests also established that "[s]uicidal ideation [was] indicated yet intellectually defended against."

Daniel attended special education classes and participated in individual, group, and family therapy sessions on a regular basis. Despite the therapy, Daniel continued to place himself in dangerous situations and suffered a series of injuries. In August the following notations were made in his file:

Family Problems: There [is] some difficulty with the family's understanding of Daniel's accident-proneness. There is a tendency for them to underestimate the constant danger and self-destructive trends that Daniel engages in. . . .

* * * * * *

Somatic Complaints: Daniel continues to use his real medical problems in addition to other complaints about his body in an effort to gain attention. Since he has been on the program to avoid self-destructive activity, he has put himself in a number of dangerous positions.

* * * * * *

Accident Prone Behavior: This problem was added today with the recognition of the fact that he has not had any day while on the program in which he was able to take care of himself without putting himself in a dangerous position. This whole area needs to be further explored with the parents to see how they set limits on his potentially dangerous activities.

* * * * * *

In regard to Daniel's need for hospitalization, it is apparent that his self-destructive activity, which prior to admission was manifest in fire-setting and other more acting out behavior, has now been turned more upon his own body. He has had a series of injuries often sustained when he has put himself into dangerous positions.

Daniel remained at the Institute until October 1980, when he was discharged for eye surgery at Walter Reed Army Hospital.² At the time of his discharge, his doctor, Dr. Judith Forgotson, noted in Daniel's file that he had shown some improvement in certain areas but nevertheless "required further extended psychiatric treatment."

After the surgery, Daniel went home to recuperate. When he returned to the Institute on August 12, 1981, he was diagnosed as suffering from a "socialized aggressive conduct disorder," and Dr. Forgotson was again assigned to treat him. On the day of his admission, a preliminary treatment plan was devised which included "monitoring of sexual, anti-social, aggressive, [and] self-destructive behavior."³

During the weeks that followed, Daniel was hostile and uncommunicative and had difficulty adjusting to the hospital regimen. On September 10 he became involved in an argument with one of his peers in a group therapy session. He burst into tears and on his way out of the room hit a wall with his right hand. The next evening, September 11, staff members heard Daniel "thumping his right hand on the wall several times." When they walked into his room, they discovered that he had removed the putty from the safety windows. He was promptly moved to a three-bed room across the hall.

On the morning of September 12 Daniel was acting in an "angry and defiant manner." He maintained a "blank expression on his face" at a community meeting, refused to interact with his peers, and announced that he was going to try to get as many "infractions" as he could. Later in the day, on being reprimanded for failing to wait in line for his lunch, he left the cafeteria without eating. Shortly thereafter he approached the nurses' station and asked two of the nurses, Barbara Pickett and Laura Maze, if "it hurt to starve yourself." One of the nurses thought the question was asked in a "joking manner," and replied "Yes, it does; it wouldn't be a good idea." Daniel lingered at the nurses' station for a few minutes, then walked down the hall toward his room. Approximately five minutes later, a psychiatric technician walked into his room and found him unconscious on the floor with a belt around his neck. He was immediately transported to Georgetown University Hospital, but he never regained consciousness and died a short time later.

II

At trial the Allens introduced evidence that the Institute had failed to obtain Daniel's records from Children's Hospital — records which revealed (1) that Daniel had been hospitalized because of "escalating firesetting [which was] potentially lifethreatening," (2) that Daniel had climbed into his bed after setting fire to it, (3) that Daniel had "passive suicidal ideations" and frequently spoke about death, and (4) that one of the goals of the hospital's treatment program was to "prevent suicide." The Allens also established that the nurses on duty at the time of Daniel's death had not read the records from Children's Hospital, that they had not considered Daniel to be suicidal, and that they had not read the Institute's records relating to his previous admission and treatment at the Institute — records which revealed (1) that suicidal or destructive behavior was "an immediate threat," (2) that Daniel was accident-prone and "self-destructive," and...