Court Opinion

ID: 9682091
Source: CourtListenerOpinion
Date Created: 2023-08-24 08:05:16.339537+00
Date Added: 2024-06-11T18:17:37.431069
License: Public Domain

TATUM, Special Judge,
dissenting:
I agree with the majority in the dismissal of the outrageous conduct action, but must respectfully dissent from the majority opinion affirming the action of the Trial Court in directing a verdict for the defendant in the negligence action. In my view, a jury question was presented.
I agree with the majority that there was evidence of negligence on the part of the defendant. I disagree that such negligence could not be found by a jury to be the proximate cause of the death of the decedent. I would distinguish this case from Lancaster v. Montesi and Jones v. Stewart, cited by the majority.
The history of the previous attempts of the decedent to commit suicide is strong evidence that he was afflicted with a mental illness that caused suicidal compulsions. It was for this reason that the decedent was placed in the care of the defendant, a health provider. It was the duty of the defendant to attempt to prevent the decedent from committing suicide.
In Adams v. Carter County Memorial Hospital, 548 S.W.2d 307 (Tenn.1977), our Supreme Court cited, with apparent approval, a treatise in 24 Vanderbilt Law Review, 217 (1971) entitled “Civil Liability for Causing Suicide: A Synthesis of Law and Psychiatry.” I quote from this treatise:
“Hospitals and psychiatrists may be charged with an affirmative duty to prevent their patients from committing suicide. ...
First, it seems clear that liability could be imposed upon a psychiatrist for a gross error in judgment with respect to whether a patient should be confined. Giving full ambit to psychological justifications for not confining patients unless absolutely necessary, suicidal symptoms may be so apparent that confinement would be ordered by a psychiatrist of ordinary skill. For example, if an individual has made serious suicidal attempts, has been deeply depressed, has suffered loss of sleep, appetite, and in effect is almost unable to function in society, but his psychiatrist has declined to have him placed in a hospital, the psychiatrist might be held liable for the individual’s subsequent suicide.
*80In Bell v. New York City Health and Hospitals Corp., 90 A.D.2d 270, 456 N.Y.S.2d 787 (1982), the Supreme Court of New York was confronted with the identical question with which we are faced. The New York Court rejected the physicians’ argument that a suicide was an independent, intervening cause unrelated to his pre-existing negligence, stating:
“In our view, the proof on the question of causation was sufficient to submit the issue to the jury. Plaintiffs expert testified that the premature discharge of the patient was a contributing factor in the attempted suicide, which was viewed as being part of a continuing psychotic process. In other words, the attempted suicide was a product of the illness for which John Bell was negligently treated, and his premature release from the hospital. Furthermore, the defendants were clearly in a position to prevent the ‘avoidable’ mistake had proper care been exercised. Bell only had the burden to establish that the premature discharge was a substantial contributing factor of his injuries. He was not obligated to exclude other potential causes. The jury could either reject or accept the physician’s opinion that the negligent release of plaintiff John Bell was a proximate cause of the suicide attempt.”
I also agree with the New Jersey Superior Court in Cowan v. Doering, 215 N.J.Super. 484, 522 A.2d 444 (1987). In that case, a physician admitted a depressed patient to intensive care, who had taken an overdose of sleeping pills. The physician failed to take suicidal precautions. The patient subsequently attempted suicide by jumping from the hospital window. At trial, the physician took the position that the patient understood and appreciated the consequences of her acts and therefore her suicidal attempt was an independent intervening cause. In rejecting this defense and upholding a jury verdict, the New Jersey court stated:
“Observation has particular efficacy where, as here, the duty of the physician and the hospital encompasses the responsibility to safeguard the patient from the reasonably foreseeable risk of self-inflicted harm.
We find no sound reason to adopt the sterile and unrealistic approach that if a disabled plaintiff is not totally incompetent, he is fully legally accountable for his own negligence. In view of the present state of medical knowledge, it is possible and practical to evaluate the degrees of mental acuity and correlate them with legal responsibility. In our view, a patient known to harbor suicidal tendencies whose judgment has been blunted by a mental disability should not have his conduct measured by external standards applicable to a normal adult. Where it is reasonably foreseeable that a patient by reason of his mental or emotional illness may attempt to injure himself, those in charge of his care owe a duty to safeguard him from his self-damaging potential. This duty contemplates the reasonably forseeable occurrence of self-inflicted injury regardless of whether it is the product of the patient’s volitional or negligent act.”
Also see Tabor v. Doctor’s Memorial Hospital, 501 So.2d 243 (La.App.1987).
The Tennessee Supreme Court has not directly dealt with the question here involved in a suit against the physician but it has recognized exceptions to the Lancaster and Jones cases in suits against hospitals. I see no distinction in a suit against a hospital and a suit against a physician.
In James v. Turner, 184 Tenn. 563, 201 S.W.2d 691 (1941), the following general rule was enunciated by our Supreme Court:
“Voluntary submission to the authority of the sanitarium raises an implied obligation on its part to give the patient such reasonable care and attention for his safety as his mental and physical condition require. When a patient enters a hospital maintained for private profit, he is entitled to such reasonable attention as his safety may require, and, if he is temporarily bereft of reason and is known by the hospital authorities to be in danger of self-destruction, the authorities are duty bound to use reasonable care to prevent such an act.”
*81In Spivey v. St. Thomas Hospital, 31 Tenn.App. 12, 211 S.W.2d 450 (1947), a wrongful death action was brought against the hospital for its negligence in the care and treatment of a patient who jumped from a hospital window, committing suicide. The hospital argued that the patient’s act of jumping out of the window was altogether unforseeable, that it was an independent intervening cause, and that the hospital could not be charged with negligence for not forseeing and guarding against such an act. In rejecting this argument, this Court said:
“If the actor’s conduct is a substantial factor in bringing about harm to another, the fact that the actor neither foresaw nor should have foreseen the extent of the harm or the manner in which it occurred does not prevent him from being liable.
So the particular harm which actually befell Spivey (the patient) need not have been foreseeable. It is enough that such harm of a like general character was reasonably foreseeable as a likely result of defendant’s failure to use due care to keep him in bed and to protect him against getting out of the window in his delirium.
But quite apart from this view of the case, we think the jury could well have found that his act was not so unusual or extraordinary as to be beyond the range of reasonable expectation; but that it was a thing which might reasonably have been expected to occur in view of his condition. Common experience shows that patients in such condition often jump or fall out of upper story windows of hospitals. Such cases are numerous in the reported decisions.”
For like holdings see Rural Education Association v. Anderson, 37 Tenn.App. 209, 261 S.W.2d 151 (1953); Slaten v. Earl Campbell Clinic Hospital, 565 S.W.2d 483 (Tenn.1978).
In my view, suicide is not an intervening independent cause that will relieve a physician of liability or negligence when the patient had no power of choice. There was evidence in this case that the decedent acted with compulsion and not through a power of choice. Even in criminal cases, a defense of insanity is good even when the accused has substantial capacity to appreciate the wrongfulness of his conduct when, due to mental illness, he does not have the capacity to “conform his conduct to the requirements of law.” Graham v. State, 547 S.W.2d 531 (Tenn.1977). By analogy, I would hold that even if the decedent knew and understood the nature of the suicidal act, the physician would not be relieved of liability if the decedent acted through compulsion and not by an “intelligent power of choice.” As stated, the history of the decedent’s previous attempts to commit suicide is circumstantial evidence sufficient to make a jury question as to whether the suicide was committed by “intelligent power of choice” or by compulsion due to mental illness. I repeat that this suicidal tendency or compulsion was specifically the ailment which the defendant was entrusted to treat.
I also disagree with the majority that the decedent could not have maintained this action had death not ensued. In view of the aforesaid evidence that the decedent ended his life by compulsion due to mental illness, it cannot be said, as a matter of law, that the suicide was “deliberate, calculated, and voluntary” with an “understanding of the physical nature and effect of his act, and a willful and intelligent purpose to accomplish it.” This question was for the jury. See generally, Stokes v. Leung, 651 S.W.2d 704 (Tenn.App.1982). I put little significance to the fact that the decedent went for 17 days after his discharge without committing suicide. It is common knowledge that people suffering with an illness such as the decedent do not generally attempt suicide, hourly, daily, or perhaps even weekly. In any event, this would be a circumstance to be considered by the jury and not this court.
I have a high respect for the opinions of my colleagues. However, I would reverse the judgment of the trial court and remand the case for trial on the negligence issue.