McSwane v. Bloomington Hospital & Healthcare System
2008 WL 650618, 2008 Ind. App. LEXIS 495, 882 N.E.2d 244 (2008)
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Rule of Law:
A hospital's general duty of reasonable care includes safeguarding a patient from harm by third parties, which may extend to the point of discharge when there is reason to suspect the patient is a victim of domestic violence. A factual issue regarding this duty may arise if the patient's capacity is compromised, potentially classifying them as a statutorily protected "endangered adult."
Facts:
- Malia Vandeneede and her former husband, Monty Vandeneede, were divorced but continued to live together.
- On November 25, 2002, Monty brought Malia to Bloomington Hospital for treatment of deep lacerations on her palm and thigh.
- Malia claimed she fell from a horse, but several hospital staff members suspected domestic violence due to Monty's controlling behavior, Malia's guarded demeanor, and inconsistencies in her story.
- During triage, when a nurse pointed to a domestic violence information sheet, Malia shook her head violently.
- Malia's mother, Ava McSwane, arrived and informed a nurse that Monty had beaten Malia with a fireplace poker.
- Despite being offered the opportunity to stay at the hospital and her mother's pleas, Malia insisted on leaving with Monty, telling her mother to "stay out of their business."
- Shortly after Malia was discharged into Monty's care, Monty killed her and then committed suicide.
Procedural Posture:
- Ava McSwane, as personal representative for Malia Vandeneede's estate, filed a medical malpractice complaint against Bloomington Hospital and Dr. Jean Eelma in the trial court.
- All parties moved for a preliminary determination of law.
- The Hospital and Dr. Eelma filed motions for summary judgment.
- The trial court granted summary judgment in favor of both the Hospital and Dr. Eelma, finding they had no duty and that Malia was contributorily negligent.
- McSwane (appellant) appealed the trial court's grant of summary judgment to the Indiana Court of Appeals, where the Hospital and Dr. Eelma were appellees.
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Issue:
Does a hospital have a tort duty to protect a patient from harm by a third party after discharge when hospital staff have reason to suspect the patient is a victim of domestic violence by that third party?
Opinions:
Majority - May, Judge.
Yes, a hospital may have a duty to protect a patient from a suspected abuser upon discharge, and summary judgment for the hospital was improper. A hospital's duty to exercise reasonable care includes safeguarding patients from harm by third parties, and this duty is circumscribed by reasonably foreseeable risks. Citing N.X. v. Cabrini Medical Center, this duty is triggered when observations and information known or readily perceivable by staff indicate a risk of harm. Here, the numerous suspicions of abuse among staff created a genuine issue of fact as to whether the hospital unreasonably disregarded the risk to Malia. Furthermore, a statutory duty may have existed under Indiana's "endangered adult" statute. Given the general anesthetic and multiple doses of opiates Malia received, a jury could find she lacked the mental or physical capacity to provide for her own self-care, making her an endangered adult whom the hospital had a duty to report and protect. For these same reasons, the issue of Malia's contributory negligence is a question of fact for the jury, as her conduct must be evaluated based on a reasonable person with the same physical and mental infirmities.
Dissenting - Baker, Chief Judge
No, a hospital does not have a duty to forcibly detain a competent adult patient against her will. The undisputed evidence shows that Malia was alert, competent, and coherent at the time of discharge, as demonstrated by her ability to engage in a lucid, albeit profane, argument with her mother. Therefore, she was not an "endangered adult" under the statute, and to label her as such is demeaning and paternalistic. The majority's reliance on common law is flawed because the precedent cases involved harm that occurred on hospital grounds by individuals under the hospital's control (an employee or the patient herself), unlike this case where the harm was inflicted by a third party after the patient had left. Imposing such an "astonishingly broad duty" is untenable public policy that would require hospitals to guarantee patient safety off-premises and raises unanswerable questions about how to enforce such a duty without unlawfully detaining a patient.
Analysis:
This decision significantly expands a hospital's potential liability in Indiana by establishing that its duty of care may extend beyond its physical premises to the point of a patient's discharge. It creates a novel, fact-sensitive inquiry into a hospital's responsibility toward suspected victims of domestic violence. The ruling puts pressure on healthcare providers to develop robust protocols for identifying and protecting at-risk patients, balancing the duty to protect against the principles of patient autonomy. Future litigation will likely focus on defining the precise scope of this duty and what actions are considered 'reasonable' for a hospital to take when a seemingly competent adult patient insists on leaving with a suspected abuser.
