T.L. v. City Ambulance of Eureka, Inc.
| Docket Number | A162508 |
| Decision Date | 29 September 2022 |
| Citation | 83 Cal.App.5th 864,299 Cal.Rptr.3d 797 |
| Parties | T.L., a Minor, Plaintiff and Appellant, v. CITY AMBULANCE OF EUREKA, INC., et al., Defendants and Respondents. |
| Court | California Court of Appeals Court of Appeals |
Esner, Chang & Boyer, Andrew Nathan Chang ; Adamson Ahdoot and Christopher Adamson for Plaintiff and Appellant.
Foley & Lardner, Eileen Regina Ridley, Alan R. Ouellette, San Francisco, Sara Alexis Abarbanel, San Diego; Porter Scott, Stephen E. Horan and David Robert Norton for Defendants and Respondents.
While plaintiff was being transported by ambulance from a crisis stabilization unit to an inpatient psychiatric facility, she suddenly unbuckled the two belts strapping her to the semi-reclined gurney and stepped out of the back of the moving ambulance, sustaining serious injuries. She sued the ambulance company and the paramedic and EMT staffing the ambulance.
At the stabilization unit, plaintiff had been placed on a "section 5585" 72-hour mental health hold. ( Welf. & Inst. Code, § 5585.1 ) However, she was calm and cooperative while at the unit, was never diagnosed as being a danger to herself, and was transported by ambulance to and from a local hospital for a medical clearance, without incident. Her attending psychiatrist determined she was also stable for transport to the in-patient facility, where she could receive a higher level of care than was available locally.
Defendants moved for summary judgment on the sole ground they owed no duty "to prevent plaintiff from engaging in impulsive, reckless, irrational and self-harming conduct," relying on Hernandez v. KWPH Enterprises (2004) 116 Cal.App.4th 170, 10 Cal.Rptr.3d 137 ( Hernandez ). Concluding Hernandez was dispositive, the trial court granted the motion.
Plaintiff appeals, claiming Hernandez is distinguishable and defendants owed her a general duty to act with due care. We agree with plaintiff and reverse.
In the fall of 2017, plaintiff's guardians brought her to the county Same-Day Services Department, where she was evaluated by a "Crisis Stabilization Unit" clinician. She was subsequently admitted, on a voluntary basis, to the stabilization unit.
Later that afternoon, the crisis clinician completed [REDACTED TEXT] (some capitalization omitted) placing plaintiff on a mental health hold under section 5585.2
[REDACTED TEXT.]
In the stabilization unit, plaintiff was evaluated by the attending physician, Dr. Qyana Griffith, a board-certified psychiatrist and neurologist. Dr. Griffith noted plaintiff had a history of cannabis disorder, meaning she was devoting "a lot of time trying to obtain" the substance, to the extent it interfered with day-to-day activities. Plaintiff stated she was not attending school because she was being bullied, [REDACTED TEXT]. Plaintiff did not report any suicide "ideations" (meaning "thoughts of hurting herself") or other "self-injurious behavior."
Based on what the clinician reported [REDACTED TEXT].
Dr. Griffith also concluded [REDACTED TEXT]. Dr. Griffith explained that her conclusion in this regard was based, in part, on the fact plaintiff [REDACTED TEXT]. Plaintiff was "fidgety" during the assessment but did not "display any aggressive" or "self-injurious behaviors."
Later that day, after Dr. Griffith and the medical staff determined she was safe for transport, plaintiff was taken by ambulance to and from a local hospital for a "medical clearance" as to her physical health. Dr. Griffith would not have approved the transport had plaintiff been "in an agitated state" or "uncooperative." The transport to and from the hospital was uneventful. The lab work indicated she was "basically a healthy young lady medically."
The following day, when plaintiff was discharged and prepared for transport to the inpatient [REDACTED TEXT]. Dr. Griffith distinguished, however, between [REDACTED TEXT].
Prior to transport, Dr. Griffith [REDACTED TEXT]. Dr. Griffith based her opinion plaintiff was "stable for transfer" and "could be safely transferred," in part, on the fact "the staff members and nurses that were with [plaintiff] near the time of the transfer did not report any issues" to Dr. Griffith. Had the nursing staff monitoring plaintiff had any concern she was not ready for transport, they would have alerted Dr. Griffith. Dr. Griffith also independently considered "everything" she and the staff had learned and observed during plaintiff's two-day stay in the stabilization unit, including "the one-on-one reports[3 ] to the nurse and then the nurse reports to me and we get collateral from outside, so we take everything into consideration."
[REDACTED TEXT.]
Dr. Griffith acknowledged that one of her responsibilities as the attending psychiatrist is patient safety during a transport, and she determined plaintiff "could be safely transferred without a doctor's order prescribing a specific position" during the transfer, "including an order pertaining to restraints." Dr. Griffith stated an attending physician would order restraints if, based on his or her personal experience with and observation of the patient, he or she concluded restraints were necessary. She also agreed it would be appropriate for a physician to write such an order "if the patient is exhibiting symptoms or behavior that rises to the level of presenting an imminent risk of self-harm or harm to others." She could not identify any other circumstance where the use of restraints would be appropriate.
Dr. Griffith had never written such an order. Rather, it was her practice not to approve transport unless, in her judgment, the patient was stable and could be safely transported, and if she had any doubt that was the case, she would postpone transfer. As to patients being transported to an inpatient psychiatric facility, Dr. Griffith takes every step to "get them to the point of where they are calm and can be transported" safely, which may include the use of medication. "[W]e try to make sure that they're not in [a] situation where they need restraints." If the patient was combative, she would not authorize transport. She did not give "specific consideration" to the use of soft restraints (light Velcro cuffs) during plaintiff's transfer, and stated the use of even soft restraints on a patient who is calm and cooperative could aggravate the patient.
Dr. Griffith acknowledged she had completed "[h]undreds" of transfer forms and could not recall ever having checked a box in the "position during transfer" section. It was her practice to leave it to the nursing and ambulance staff to determine the "particular mode of transfer." It was her understanding the discharge nurses "would always provide input into the position during transfer" and that the EMTs would determine the position.
Dr. Griffith also acknowledged a psychiatric patient could "potentially" hurt themselves or others, [REDACTED TEXT].
It is not clear from the record before us exactly what Gilbert Fan (the paramedic) and George Schild (the EMT) knew when they placed plaintiff into the ambulance for transport.
In his deposition testimony (only excerpts of which are in the record), Fan stated that while he was receiving a "run-down" from the nurse, he was "looking over the documents."4 It seems apparent Fan read the [REDACTED TEXT.] form and was aware of, and at least glanced at, some of the other medical records. The nurse told him plaintiff "was on a 5150 hold" and "the patient has been calm [and] cooperative with them, no issues," "she was okay for transfer," and was [REDACTED TEXT]. Fan asked the nurse if there was "anything [he] should be worried or concerned about." She repeated plaintiff was "calm, cooperative, and stable for transport." Fan, himself, found plaintiff "calm and cooperative" and "willingly" "following commands." [REDACTED TEXT.]
Schild's testimony was similar (again, only excerpts of his deposition testimony are in the record). Plaintiff was "cool, calm and cooperative." He asked a "few basic questions" to which she did not respond, and she was facially expressionless. She was not "fidgety" and followed all his requests. Schild did not recall talking to the nurse, who spoke with Fan. He glanced at some of the documents in the package of medical records, but did not read everything on every page. He "look[ed] at the 5150 paperwork." He would routinely read "any relevant nurses’ notes," and assumes he did so. But nothing in the record indicates which of these notes he would have read. There "was no indication," "[b]ased on everything [they] gave" him and Fan, as well their own personal observation of plaintiff, that "there was something wrong," that she was having [REDACTED TEXT]. He did not observe any behavior suggesting plaintiff "was potentially violent," and no one at the unit told him she "was potentially violent."
The ambulance company has a specific policy pertaining to the use of restraints. It states, in pertinent part:
Schild understood this policy meant ambulance personnel were authorized to use restraints under certain circumstances. But even if such circumstances existed, they were not required to do so. It was also his understanding there had to be "consensus" between the ambulance personnel before restraints were used. Schild explained that when On a long...
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