Opinion ID: 1822581
Heading Depth: 3
Heading Rank: 4

Heading: Particular Risk of Harm

Text: ¶ 50. A mentally disabled plaintiff who seeks to rely on a defendant's heightened duty of care must establish, among other things, that (2) the defendant caregiver knew or should have foreseen the particular risk of harm that led to the plaintiff's injury. See ¶ 35 above (emphasis added). The former test in Jankee required proof that (2) the defendant caregiver could have foreseen the particular injury that is the source of the claim. Jankee, 235 Wis. 2d 700, ¶ 93 (emphasis added). ¶ 51. The foreseeability prong of the former test proved to be confusing. For example, use of the term particular injury led to debate whether the hospital should have foreseen Hofflander's attempt to escape from a third-floor window in another patient's room by tearing a loose air conditioner from its mounting. Did all of these elements constitute the particular injury that St. Catherine's and Horizon should have foreseen? Was the particular injury that the defendant should have foreseen even more particular namely, a back injury or a leg injury as opposed to any injury? ¶ 52. The Jankee opinion borrowed heavily from the analysis by Charles Williams in the Nebraska Law Review. The wording of the foreseeability prong in the Williams article stated the proposition as follows: For a plaintiff to prove a nonfeasance tort, the plaintiff must show that . . . (2) the harm that befell the plaintiff was of the type the defendant should have foreseen. Charles J. Williams, Fault and the Suicide Victim: When Third Parties Assume a Suicide Victim's Duty of Self-Care, 76 Neb. L. Rev. 301, 304 (1997). Our new phrase, particular risk of harm, is more consistent with the Williams formulation than the Jankee language. ¶ 53. To illustrate, when a mental health institution assumes the custody and control of a mentally disabled person as a suicide precaution, the risk of suicide is clearly foreseeable. The foreseeability of suicide requires the institution to act with a heightened duty of care to prevent this particular risk of harmat least until the risk is no longer foreseeable. Whether a particular risk of harm remains foreseeable for the entire duration of an institution's special relationship with a patient is a question of fact. However, the mere passage of time will seldom be enough for an institution to substantially relax its heightened duty of care. ¶ 54. There are other risks of harm in a mental health institution, including the risk of elopement, the risk of self-injury other than suicide, and the risk of injury to other people such as staff members, visitors, and fellow patients. [15] The custody and control rule does not signify that a caregiver is liable for any and all injuries sustained by a patient simply because one risk of harm was foreseeable. Rather, our formulation is based on the proposition that the particular harm to which the mentally disabled person's claim relates should have been foreseeable. [18, 19] ¶ 55. In Jankee, we explained that modern hospitals treating persons with mental disabilities focus on therapy and rehabilitation, not maximum security. Jankee, 235 Wis. 2d 700, ¶ 96 (citing Payne v. Milwaukee Sanitarium Found., Inc., 81 Wis. 2d 264, 270, 260 N.W.2d 386 (1977)). A duty to restrain or guard a specific patient emerges only when a hospital has `knowledge of the propensity or inclination of the patient to injure (himself) (herself) or escape.' Wis JICivil 1385.5; see also Wis JICivil 1385. Id. No cause of action arises unless the hospital has notice of an individual patient's disposition to inflict self-injury. Thus, a hospital is under no duty to take special precautions when there is no reason to anticipate one patient's escape or suicide. If a caregiver is unaware of a patient's propensity for self-injury, the caregiver cannot assume the patient's duty of self-care. Jankee, 235 Wis. 2d 700, ¶ 97 (citations omitted). These passages explain our adherence to the adjective particular in front of the phrase risk of harm. ¶ 56. In this case, the dispute is whether the defendants should have foreseen Hofflander's attempt to escape. Did the defendants have notice from Hofflander's statements and actions and from other available evidence of the risk that Hofflander would try to elope? [16] The fact that Hofflander was initially placed as a suicide risk does not mean that she could not later manifest such a risk of elopement, thereby triggering a duty to take focused preventive action. Conversely, Hofflander's placement as a suicide risk did not automatically make every other possible risk of harm to her foreseeable as a particular risk. ¶ 57. It should be noted that the Behavioral Services Unit was a locked unit and that Hofflander did not attempt to elope from a window in her own room. These facts show the Unit's consciousness of possible patient elopement and some of the steps taken to address this risk of harm. It is a question of fact whether the defendants took sufficient steps to address this general concern. Beyond that, the question is whether the defendants should have foreseen a particular risk of elopement for Hofflander that required them to undertake additional precautions to prevent her escape.