Turner v. Jordan
| Decision Date | 29 December 1997 |
| Citation | 957 S.W.2d 815 |
| Parties | Emma D. TURNER and Rufus L. Turner, Appellants/Cross-Appellees, v. Harold W. JORDAN, M.D., Appellee/Cross-Appellant. |
| Court | Tennessee Supreme Court |
William D. Leader, Jr., Eugene N. Bulso, Jr., Boult, Cummings, Conners & Berry PLC, Nashville, for Appellants/Cross-Appellees.
W. Warner McNeilly, Jr., Watkins, McGugin, McNeilly, & Rowan, Nashville, for Appellee/Cross-Appellant.
We granted this appeal to determine whether a psychiatrist owed a duty of care to protect a hospital nurse from the violent and intentional acts of a hospitalized mentally ill patient. If such a duty is owed, the next issue to be decided is whether the patient's intentional conduct should be considered in determining comparative fault under McIntyre v. Balentine, 833 S.W.2d 52 (Tenn.1992). The final issue is whether, after finding that the jury verdict as to fault is contrary to the weight of the evidence, the trial court may reallocate comparative fault in lieu of ordering a new trial. 1
The trial court determined that the psychiatrist in this case owed a duty of care to the nurse, and instructed the jury to consider the intentional conduct of the patient, a non-party, in determining the psychiatrist's comparative fault. The jury returned a verdict for the nurse in the amount of $1,186,000. It allocated the fault as 100 percent to the psychiatrist and zero percent to the patient. The trial court approved the jury's verdict except as to the allocation of fault, and granted a new trial. The Court of Appeals affirmed, finding that a duty was owed, that the patient's intentional conduct should be compared with the psychiatrist's negligence, and that a new trial should have been granted.
We agree that the psychiatrist owed a duty of care because he knew or should have known that his patient posed an unreasonable risk of harm to a foreseeable, readily identifiable third party. We have also determined that the trial court erred in instructing the jury to compare the patient's intentional conduct with the defendant's negligence in allocating fault. We, however, consider the error harmless because the jury allocated 100 percent of the fault to the negligent defendant psychiatrist. Finally, although not applicable here, in view of our result we have decided that the trial court may not reallocate comparative fault after weighing the evidence as the thirteenth juror, but must instead grant a new trial. Accordingly, we reverse the Court of Appeals in part and affirm in part, and remand this case to the trial court for entry of a judgment on the jury's verdict.
In March of 1993, the plaintiff, Emma Turner, a nurse at Hubbard Hospital in Nashville, was attacked and severely beaten by Tarry Williams, a psychiatric in-patient at the hospital. The defendant, Harold Jordan, M.D., was the attending psychiatrist.
Williams, who had been diagnosed as bipolar and manic, had been a patient at Hubbard on five prior occasions; three of these times he was found to be a danger to himself or others and was committed to the Middle Tennessee Mental Health Institute. On one occasion, in April of 1990, Williams tried to attack Dr. Jordan with a table leg, but hospital staff intervened.
On March 4, 1993, Williams was again admitted to Hubbard's psychiatric ward and examined by a resident physician. Williams's history indicated that he had not taken his prescribed lithium, which was used to control his bipolar disorder, for over a week. Williams also reported that he had met with "Gorbachev and Saddam Hussein" and that he had "classified information" about space flights and nuclear science. The resident physician determined that Williams had illogical and disorganized thinking, flight of ideas, grandiosity, and delusional thinking. Lithium was prescribed, which takes five to seven days to reach a therapeutic level.
The next day, on March 5, 1993, Dr. Jordan reviewed and approved the resident physician's orders. He and members of a treatment team then attempted to interview Williams, who refused to cooperate and left the interview. The treatment team then discussed the case for thirty to forty-five minutes, after which Dr. Jordan wrote:
This patient presents no behavior or clinical evidence suggesting that he is suicidal. He is aggressive, grandiose, intimidating, combative, and dangerous. We will discharge him soon by allowing him to sign out AMA [Against Medical Advice].
(Emphasis added). That evening, according to notes, Williams, although quiet and non-disruptive, had an "angry and hostile" affect. Around 11:30 p.m., after requesting a cigarette and asking the nurse, Emma Turner, about being discharged, Williams attacked Turner, inflicting severe head injuries.
Thereafter, Emma Turner sued Dr. Jordan for medical negligence, alleging he violated his duty to use reasonable care in the treatment of his patient, which proximately caused her injuries and damages. At trial, Dr. David Sternberg, a psychiatric expert witness, testified that Jordan's failure to medicate, restrain, seclude or transfer Williams fell below the standard of care for psychiatrists. He explained:
The standard of care in a case like this requires, first, an evaluation of whether the patient is a danger to himself or others. And, indeed, Dr. Jordan determined, it seems to me from the record, both his deposition and from the records from the hospital, that the patient was, indeed, dangerous. Then the standard of care requires, if a patient is found, in fact, to be dangerous, that the patient be prevented from acting on that dangerousness; that staff be informed, of course, about the patient's dangerousness; that the patient be medicated, if necessary, to prevent acting on the dangerousness, or be restrained or secluded; or that the patient be transferred to another treatment setting which could handle a patient who is of that severe dangerousness.
In his own defense, Dr. Jordan testified that he did not remember Williams or any information about his dangerousness prior to the attack on Emma Turner. He agreed that had he known about Williams's prior dangerousness, he would have discharged him. However, Dr. Jordan's discharge summary written after the incident said:
Realizing that this patient had been hospitalized on this issue before and exhibited some hostile and violent behavior and questioning the veracity of his statement that he was suicidal, we wrote an order indicating that [Williams] could be encouraged to sign out and be allowed to sign out on request. We considered discharging him outright because of his history of violent behavior.
In addition, Linda Lawrence, nursing coordinator at Hubbard Hospital, testified that Williams's past violent behavior, including the attempted attack on Jordan in 1990, had been discussed during the treatment team meeting on March 5, 1993.
After the completion of the proof, the trial court instructed the jury on the law of comparative fault, and it provided the jury with a verdict form indicating it could allocate the fault, if any, between the alleged negligence of Dr. Jordan and the alleged intentional conduct of patient Williams. 2 The jury returned a verdict for the plaintiffs, Emma and Rufus Turner, allocating 100 percent of the fault to defendant Jordan. The trial court approved all of the jury's verdict except the allocation of fault. As a result, it granted the defendant's motion for new trial, but thereafter granted an interlocutory appeal. The Court of Appeals affirmed.
We granted the appeal to consider the important questions of duty, comparison of fault between a negligent actor and an intentional actor, and the trial court's authority to reallocate fault in lieu of granting a new trial.
First, the defendant psychiatrist asserts that the lower courts erred in determining that he owed a duty of care to protect the plaintiff nurse the unforeseeable and uncontrollable acts of his patient. The nurse, however, argues that the psychiatrist had a duty of care to protect her from foreseeable risks of harm posed by his hospitalized mentally ill patient.
To determine whether a duty exists, we turn first to familiar principles of negligence enunciated by our earlier cases. A claim for negligence requires the following elements: (1) a duty of care owed by the defendant to the plaintiff; (2) conduct by the defendant falling below the standard of care amounting to a breach of that duty; (3) an injury or loss; (4) causation in fact; and (5) proximate or legal cause. Bradshaw v. Daniel, 854 S.W.2d 865, 869 (Tenn.1993).
The existence of a duty is a question of law for the court which requires consideration of whether "such a relation exists between the parties that the community will impose a legal obligation upon one for the benefit of others--or, more simply, whether the interest of the plaintiff which has suffered invasion was entitled to legal protection at the hands of the defendant." Id. at 870, quoting, W. Keeton, Prosser & Keeton on the Law of Torts, § 37 at 236 (5th ed.1984). The imposition of a legal duty "reflects society's contemporary policies and social requirements concerning the rights of individuals and the general public to be protected from another's act or conduct." Id. at 870.
In determining whether a duty is owed in a particular case, we have generally used a balancing approach consistent with principles of fairness. See McClung v. Delta Square Ltd. Partnership, 937 S.W.2d 891, 901 (Tenn.1996) (). In McCall v. Wilder, 913 S.W.2d 150, 153 (Tenn.1995), we explained that "[a] risk is unreasonable and gives rise to a duty to act with due care if the foreseeable probability and gravity of harm posed by defendant's conduct outweigh the burden upon defendant to engage in alternative conduct that would have prevented the harm." Among the several factors which must be considered are
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