Opinion ID: 462582
Heading Depth: 3
Heading Rank: 1

Heading: The Duty and Standard of Care

Text: 21 The initial question before us is whether St. Elizabeths owed a duty to appellant. On this point, our inquiry is made easy by well-established principles of tort law and by specific provisions of the D.C.Code. It is well-recognized that institutions, such as prisons and mental hospitals, that have custody over dangerous persons have a duty to members of the public to exercise reasonable care to control their inmates or patients. In this regard, section 319 of RESTATEMENT (SECOND) OF TORTS (1965) provides: 22 One who takes charge of a third person whom he knows or should know to be likely to cause bodily harm to others if not controlled is under a duty to exercise reasonable care to control the third person to prevent him from doing such harm. 13 23 Thus, as the custodial ward of criminally insane patients, St. Elizabeths assumes a duty to take a reasonable care to prevent harm to others. 14 As we have previously noted, 24 [b]y reason of its nature as a public institution St. Elizabeths Hospital owes a duty to the public in carrying out its difficult responsibilities. 15 25 .... 26 Unless persons injured by the hospital's failure to properly perform its functions can recover for their injury, society's ability to insure that the hospital conscientiously performs its duties is rendered haphazard at best. 16 27 In the instant case, as part of this duty to protect the public, St. Elizabeths was obligated to take steps to prevent the escape of its dangerous patients; 17 and appellant, who was injured by virtue of White's unauthorized leave, could properly seek recovery for a breach of this duty by the Hospital. 28 The District Court was of the view that St. Elizabeths was not negligent because the Hospital could not have reasonably foreseen that Dwayne White would harm his wife. This line of reasoning, however, is precluded in this case by the D.C.Code, which creates a presumption of dangerousness that remains for the duration of White's mandated confinement at St. Elizabeths. Dwayne White was committed to St. Elizabeths after his acquittal by reason of insanity and, therefore, under D.C.Code Sec. 24-301(e), White could not leave Hospital grounds until the Superintendent of St. Elizabeths certified that he ha[d] recovered his sanity and will not in the reasonable future be dangerous to himself or others, and the District Court agreed with the Hospital's assessment. 18 Even conditional releases of patients such as Dwayne White must be approved by the court. 19 Indeed, in February 1979, the District Court had refused to grant Dwayne White even a conditional release for only one day to visit his sister's house. 29 Ultimately, therefore, the decision as to the dangerousness of those patients committed to St. Elizabeths after acquittal by reason of insanity is not one for the Hospital; rather, St. Elizabeths is obligated to treat these patients as dangerous until a court determines otherwise. 20 The purpose of section 24-301 is to protect the patient and the public by insuring that statutory standards for release are not subverted by allowing the ultimate determination [of dangerousness] to be made according to the individual, subjective standards of the hospital staff. 21 Hence, regardless of its own view of Dwayne White's dangerousness, St. Elizabeths had an obligation to confine Dwayne White to the Hospital grounds. In a case involving circumstances very similar to those here, the Fourth Circuit held: 30 The Restatement [of Torts] measures a custodian's duty by the standard of reasonable care. Here, that standard has been delineated by the precise language of the court order. The appellants were to retain custody over [the patient] until he was released from the Institute by order of the court. No lesser measure of care would suffice.... [T]hey could not substitute their judgment for the court's with respect to the propriety of releasing him from confinement. 22 31 Given this presumption of dangerousness, we must focus solely on whether the Hospital breached its duty to confine White to the Hospital grounds. The evidence supporting the Hospital's argument that White was not dangerous is simply not relevant to the ultimate determination of negligence in this case. 32 As to the question of whether the Hospital breached its duty, we conclude that officials at St. Elizabeths were negligent in permitting White to escape. It is uncontested that the Hospital was aware of at least two instances during 1979 in which Dwayne White left the grounds--once in March 1979, to marry Genoa White and once in September 1979, to assist appellant when she required hospitalization in connection with a possible miscarriage. Yet, Dwayne White's voluminous Hospital Records fail to reflect a single measure subsequently taken by Hospital staff to ensure that Dwayne White would remain on Hospital grounds or even a modicum of concern about these known absences. Although by June of 1979 the Hospital knew that Dwayne White had left the grounds to marry appellant, there is not even a reference to the marriage in his medical records until a September 25, 1979 note on White's progress. The Hospital was aware that Dwayne White had left the grounds on September 19, 1979--only ten days after his grounds privileges were increased to 9-to-9 privileges--but his medical records again evidence no measures taken to ensure that he would remain on Hospital grounds. 23 In addition to these two known unauthorized absences, members of the Hospital staff admitted that White was probably visiting his wife on a routine basis. In our view, the ease with which White was able to leave Hospital grounds and the failure of the Hospital to respond in any way to the known instances of White's unauthorized absences are more than sufficient to constitute a breach of the Hospital's duty to take reasonable steps to keep Dwayne White confined to the Hospital grounds. On the record before us, the District Court's conclusion to the contrary was clearly erroneous. 33 This negligence, moreover, is compounded by the fact that the Hospital had every reason to know that Dwayne White was in fact leaving the Hospital grounds on a routine basis. By September 25, 1979, the Hospital staff was well aware of Dwayne White's desire to leave Hospital grounds to help his wife. In a progress report, the Hospital noted: 34 It seems that the most anxiety provoking element for Mr. White at this time is his wife. That is, he is not able to be with her off of the grounds, she is now pregnant with some possible medical complications and she is not, by history, a very mentally stable individual. Because of these things Mr. White feels a great deal of pressure to help his wife and to be with her, but is unable to do these things because of his hospital confinement. 24 35 It is somewhat remarkable that even after this acknowledgment of White's desire to leave the grounds to be with wife--made only six days after the Hospital learned of Dwayne White's second known unauthorized absence with his wife--the Hospital took no steps to increase their supervision of White's grounds privileges. Furthermore, at least one Hospital staff member who had contact with Dwayne White during this period admits to having had suspicions that Dwayne White was leaving the Hospital with regularity to visit his wife. Although Dr. Madsen testified that he did not know for sure that White was leaving the grounds, 25 he had suspected that White was doing so because it had been his experience that individuals who go off the hospital grounds once will go off the grounds at other times. 26 Indeed, Dr. Madsen testified that before the assault on Genoa White, he personally believed that [White] had probably been going off the Hospital grounds with some regularity. 27 36 In short, we find that the Hospital was clearly negligent in failing to police and confine White to Hospital grounds. Until a court determined that White no longer presented a danger to the public, the Hospital was obligated to take steps reasonably necessary to keep him on its grounds. The record in this case is simply devoid of evidence that the Hospital even attempted to meet this obligation. 28