McSwane v. Bloomington Hospital & Healthcare System
2009 Ind. LEXIS 1480, 916 NE2d 906 (2009)
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Rule of Law:
A healthcare provider's duty to protect a suspected domestic violence victim is met by taking reasonable measures to address the risk, but this duty does not extend to physically preventing a competent adult patient from leaving with the suspected abuser against her expressed wishes. A patient's insistence on leaving with an abuser despite warnings can constitute contributory negligence, which is a complete bar to recovery in a medical malpractice claim in Indiana.
Facts:
- Malia Vanceneede and her ex-husband, Monty Vanceneede, arrived at Bloomington Hospital seeking treatment for lacerations on Malia's thigh and hand.
- Malia told hospital staff she had been thrown from a horse, but a triage nurse suspected domestic violence because circumstances, such as Malia's untorn jeans, were inconsistent with her story.
- When the nurse discreetly pointed to a domestic violence form, Malia shook her head violently, rejecting the offer of help.
- Malia's mother, Ava McSwane, later arrived at the hospital and informed a nurse that she believed Monty had assaulted Malia with a fireplace poker.
- Hospital security searched Monty for weapons and conducted a sobriety test, both of which were negative.
- Despite pleas from both a nurse and her mother not to depart with Monty, Malia insisted on leaving with him, stating, 'Stay out of our business.'
- Shortly after driving away from the hospital together, Monty shot and killed Malia before killing himself.
Procedural Posture:
- Ava McSwane, on behalf of Malia Vanceneede's estate, filed a medical malpractice complaint against Bloomington Hospital and Dr. Eelma in the Monroe Circuit Court (trial court).
- The defendants moved for a preliminary determination of law, which functions as a motion for summary judgment.
- The plaintiff filed a cross-motion for summary judgment.
- The trial court granted summary judgment in favor of the defendants, the hospital and the doctor.
- The plaintiff (McSwane) appealed to the Indiana Court of Appeals.
- A divided Indiana Court of Appeals reversed the trial court's grant of summary judgment.
- The Indiana Supreme Court granted the defendants' petition to transfer the case.
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Issue:
Does a hospital breach its duty of care, and is a patient contributorily negligent as a matter of law, when the hospital allows a competent adult patient, who is a suspected victim of domestic violence, to leave its premises with her suspected abuser after she explicitly rejects offers of help and insists on leaving with him?
Opinions:
Majority - Shepard, Chief Justice.
No, a hospital does not breach its duty of care as a matter of law under these circumstances, and yes, the patient's actions constituted contributory negligence. The hospital fulfilled its duty by taking reasonable measures to address the risk, including offering help, separating the patient from the suspected abuser, facilitating calls to law enforcement, and having security intervene. To hold that the hospital's duty included physically restraining a competent adult patient would violate fundamental principles of patient autonomy and informed consent. Furthermore, Malia's conduct fell below the standard of care required for her own protection; her insistence on leaving with Monty despite warnings from staff and her own mother constituted contributory negligence, which completely bars recovery in a medical malpractice action under Indiana law. Given the undisputed evidence that she was 'alert and oriented,' her negligence was established as a matter of law.
Dissenting - Rucker, J.
No, summary judgment was improper because genuine issues of material fact exist regarding both breach of duty and contributory negligence. Whether the hospital breached its duty is a question for a jury, not a matter of law. Evidence suggests the hospital failed to follow its own domestic violence policy by not communicating the triage nurse's suspicions to the treating physician, who then missed an opportunity to question Malia alone before she was heavily medicated. Likewise, contributory negligence is a question of fact. Malia had received general anesthesia and multiple narcotic analgesics, making her true decision-making capability at the time of discharge unclear. A jury should determine whether she exercised the degree of care expected of a reasonable person with the same physical and mental infirmities under like circumstances.
Concurring-in-part-and-dissenting-in-part - Sullivan, J.
No, the defendants did not breach their duty of care as a matter of law. Because summary judgment was appropriate on the issue of duty, it is unnecessary to address the issue of contributory negligence.
Analysis:
This decision clarifies the scope of a healthcare provider's duty to a competent adult patient who is a suspected victim of domestic violence, prioritizing patient autonomy over a duty to protect from off-premises harm. It establishes that a hospital's responsibility is discharged by taking reasonable steps to assist, rather than by physically preventing the patient from making what appears to be a dangerous choice. The ruling also highlights the harshness of Indiana's contributory negligence doctrine in medical malpractice cases, which bars any recovery if the plaintiff is found to be even slightly at fault. This decision limits the liability of healthcare providers for the subsequent criminal acts of third parties, especially when a patient explicitly rejects intervention.
