Opinion ID: 3172059
Heading Depth: 3
Heading Rank: 1

Heading: The Hospital Assumed a Duty to Prevent K.W. From Harming Himself

Text: Â¶19Â Â Â Â Â Â Â Â The Hospital agreed to provide mental healthcare services to K.W. upon his admission to the Hospital. As such, it owed him a general duty of care consistent with Coloradoâs professional standards for physicians. 5 The Hospital does not dispute that it was bound by this general duty. Â¶20Â Â Â Â Â Â Â Â In addition, the Hospital undertook to prevent K.W. from suffering harm as a result of his suicidal impulses when the Hospital admitted him to the inpatientÂ psychiatric unit. As such, the precise issue presented in this case is whether, by doing so, the Hospital assumed an additional affirmative duty of care to K.W., and, if so, whether the Hospitalâs assumed duty subsumed K.W.âs own duty of self-care. We answer both questions in the affirmative. Â¶21Â Â Â Â Â Â Â Â In general, a party assumes anotherâs duty of care and may be subject to liability for breaching that duty when the party voluntarily undertakes to render a service. See Jefferson Cty. Sch. Dist. R-1 v. Justus, 725 P.2d 767, 770â71 (Colo. 1986) (adopting Restatement (Second) of Torts Â§ 323 (Am. Law. Inst. 1965) (âNegligent Performance of Undertaking to Render Servicesâ)); cf. DeCaire v. Pub. Serv. Co., 479 P.2d 964, 966â67 (Colo. 1971) (applying a related section of the Restatement (Second) of Torts (Am. Law Inst. 1965)ânamely, section 324A (âLiability to Third Person for Negligent Performance of Undertakingâ)). Under the assumed duty doctrine, as adopted by this court in Justus, the question of whether the Hospital assumed a duty rests on two factual findings: (1) whether the Hospital, âthrough its affirmative acts or through a promise to act, undertook to render a service that was reasonably calculated to prevent the type of harm that befell the plaintiffâ and (2) whether the plaintiff ârelied on the [Hospital] to perform the service.â 725 P.2d at 771. Here, the undisputed facts show clearly that the Hospital undertook not only to render mental healthcare services to K.W. but also to prevent him from suffering harm by acting on his suicidal impulses. It is also clear and not subject to any genuine dispute that K.W. and his parents relied on the Hospital to provide those services. Therefore, the Justus test has been satisfied and we hold that the Hospital assumed an affirmative duty to prevent K.W. from harming himself. Â¶22Â Â Â Â Â Â Â Â Nevertheless, the fact that the Hospital assumed this duty does not conclusively determine whether, under these facts, K.W.âs duty of self-care was eliminated for comparative fault purposes. In order to decide whether the Hospitalâs assumed duty subsumed K.W.âs own duty not to harm himself, we must carefully evaluate the scope of the duty assumed by the Hospital. â[T]he scope of any assumed duty . . . must be limited to the performance with due care of that service undertaken, because the [defendantâs] liability under a voluntarily assumed duty can obviously be no broader than the undertaking actually assumed.â Id. at 772 n.5. In other words, when a defendant assumes a duty to a plaintiff, âwhat counts as contributory negligence is determined largely by the scope of the defendantâs duty.â Dan B. Dobbs, The Law of Torts Â§ 200, at 500 (2000). If the defendantâs duty to protect the plaintiff contemplates, encompasses, and thereby subsumes the plaintiffâs duty not to act in a certain way, then the plaintiff cannot be faulted for acting in that way. Cf. Justus, 725 P.2d at 772 n.5 (noting that âthe scope of [a defendantâs] undertakingâ is âlimited to the question of whether or not it encompassed the task of preventing respondent from [taking the actions that led to harm]â). If the duty undertaken by the defendant and the harm to the plaintiff precisely matchâin that the purpose of the undertaking was to prevent the harmâthen it would be improper to allow the defendant to use the occurrence of that type of harm as a defense, âsince that was the very thing he was obliged to prevent.â Dobbs, supra, at 500. 6 Â¶23Â Â Â Â Â Â Â Â With no Colorado case directly on point, we look to the decisions of other jurisdictions for persuasive guidance. People v. Weiss, 133 P.3d 1180, 1187 (Colo. 2006). In Tomfohr v. Mayo Foundation, 450 N.W.2d 121, 122 (Minn. 1990), the Supreme Court of Minnesota held that a comparative negligence defense was not appropriate in an inpatient suicide case. There, a patient voluntarily admitted himself to a psychiatric hospital, where he was diagnosed with severe depression. Id. He told hospital authorities that he had suicidal ideation, though he âdenied any current thoughts of suicide.â Id. He was âlocked in a psychiatric ward and placed on suicidal precautionâ but âwhile alone in his room[,] committed suicide by hanging.â Id. The court rejected the comparative negligence defense, reasoning that âin this specific type of case, the mental condition of the patient exists prior to the hospitalâs negligent act, and it is that condition which gives rise to the hospitalâs duty of care and which defines the scope of that duty.â Id. at 125. The court thus concluded that, unlike a case where a patient is injured in some unrelated way while at the hospital (such as falling out of bed when the patient is there for psychiatric therapy), comparative negligence may not be asserted where the injuries suffered were âthe result of the very thing the patient was attempting to prevent by hospitalization.â Id. This case provides a straightforward rule: If a hospital assumes a duty to protect and treat a patient for a specific condition, and if theÂ patient is injured by a foreseeable event directly related to that condition, then the hospital cannot assert that occurrence as part of a comparative negligence defense. Â¶24Â Â Â Â Â Â Â Â In this case, as in Tomfohr, the scope of the Hospitalâs duty was straightforward: it agreed to use reasonable care to prevent a known suicidal patient, K.W., from attempting to commit or committing suicide when he was in the Hospitalâs exclusive care for treatment of that condition. Here, the Hospitalâs assumed dutyâto protect K.W. from his own suicidalityâwas aimed at preventing precisely the type of harm that ultimately befell K.W. Moreover, the action K.W. actually tookâhanging himself with material found in his roomâwas foreseeable. 7 K.W. was admitted to the mental health unit for inpatient care following a serious suicide attempt. The Hospital knowingly placed him under âsuicide precautionsâ because he was âunable to contractâ for his own safety and was, in his doctorâs words, âclearly a danger to himself.â Accordingly, under these facts, K.W.âs âobligation of [self-care] was transferredâ to and assumed by the Hospital and he could not have been at fault as a matter of law. Tomfohr, 450 N.W.2d at 125. Â¶25Â Â Â Â Â Â Â Â When a hospital admits a person into its custody who the hospital knows is actively suicidal, and when the admission is for the purpose of preventing that personâs self-destructive behavior, the hospital assumes a duty to use reasonable care in preventing the patient from engaging in such behavior. We hold that this duty subsumes any fault attributable to the plaintiff for harm suffered as a result of those self-destructive acts. To hold otherwise would be to ignore the effect of a hospitalâs willful undertaking and would ârender meaninglessâ the hospitalâs assumption of an affirmative duty to use reasonable care in protecting the patient from his known desire to harm himself. McNamara v. Honeyman, 546 N.E.2d 139, 143, 146â47 (Mass. 1989) (holding that where a âsuicidally activeâ patient was admitted to the hospital and committed suicide by hanging, âthere can be no comparative negligence where the defendantâs duty of care includes preventing the self-abusive or self-destructive acts that caused the plaintiffâs injuryâ); see also Cowan v. Doering, 545 A.2d 159, 167 (N.J. 1988) (refusing to allow a comparative negligence defense where the patient was admitted to the hospital after a suicide attempt and jumped from her hospital window); Restatement (Second) of Torts Â§ 449, cmt. b (Am. Law Inst. 1965) (âTo deny recovery because the otherâs exposure to the very risk from which it was the purpose of the duty to protect him resulted in harm to him, would be to . . . make the duty a nullity.â). Â¶26Â Â Â Â Â Â Â Â The rule we create today does not, as the Hospital asserts, âessentially impose[] strict liability on hospitals caring for suicidal patientsâ nor does it require a hospital to be the âinsurer of its patientsâ safetyâ by preventing all suicide attempts. A plaintiff will still be required to prove that the defendant had a duty to prevent foreseeable harm, that it breached that duty, and that defendantâs breach proximately caused the harm. See, e.g., Cowan, 545 A.2d at 166 (noting that âeven though plaintiffâs conduct had no relevance in terms of her fault or contributory negligence, the evidence submitted concerning her conduct was considered by the jury as it related toÂ defendantâs ultimate responsibility, through the concept of proximate causeâ). Our holding today simply means that when the patientâs suicidal acts âare the very acts which the medical provider had a duty to prevent, the providerâs own failure to prevent the suicide should not create its own defense.â Tomfohr, 450 N.W.2d at 125. Â¶27Â Â Â Â Â Â Â Â We also caution that our holding is limited by the factual situation presented here. 8 It is undisputed that the Hospital had knowledge of K.W.âs suicidality and his recent suicide attempts. With this knowledge, the Hospital admitted K.W. to its secure mental health unit and placed him under âhigh suicide precautionsâ for the purpose of preventing him from attempting to commit suicide. The same day he was admitted, while in the Hospitalâs exclusive custody, K.W. hung himself with material that was in his room and suffered a devastating brain injury. Under these circumstances, the Hospital assumed the duty to prevent just such an injury, and it cannot assert K.Wâs fault as a defense.Â