The New Jersey Supreme Court heard arguments Monday on whether hospitals and doctors have a special duty of care to ensure that mentally ill patients do not harm or kill themselves — even those who have exhibited no prior signs.
In an appeal from a no-cause verdict in a wrongful death suit, the court is asked to review whether the trial judge gave an improper charge on the extent to which jurors could take into account the conduct of a depressed patient who leapt to his death at Rahway Hospital.
An Appellate Division panel upheld the verdict, saying Middlesex County Superior Court Judge Nicholas Stroumtsos made it clear that the jury could not consider the patient’s conduct in considering causation and liability.
Frederick Hetmanski went to Rahway Hospital on three successive days in September 2007, complaining of depression that was worsening despite his being prescribed drugs. The last day he went to the hospital was Sept. 7. Dr. Martin Mayer decided that Hetmanski needed to be transferred to a psychiatric facility and the hospital began making arrangements for the move.
Before he could be moved to the other facility, Hetmanski had to be medically cleared, and that required that he undergo an X-ray. During his prior visits to the hospital, Hetmanski had been placed in a room with a glass wall so he could be observed. However, he was left unattended when taken to the X-ray room. He left the room, wandered through the hospital and made his way to the fifth floor. From there he got out on the roof and jumped to his death.
The suit named as defendants the hospital; Mayer, the director of its psychiatry department; the hospital’s security service, Motivated Security Services; and several other doctors and nurses.
The defendants said that prior to his suicide Hetmanski had expressed vague thoughts of suicide, but had stopped well short of saying that he was thinking of killing himself.
The jury found that while the hospital was negligent, its actions were not the proximate cause of Hetmanski’s death.
On Monday, the lawyer representing the estate asked the court to order a new trial in Hetmanski v. Rahway Hospital, A-65-11.
“Mr. Hetmanski was under the care, custody and control of Rahway Hospital,” said John Spoganetz, who runs a firm in Iselin.
“He was entitled not to have his conduct considered against him. He was of a special class of patients who cannot take care of themselves.”
Justice Jaynee LaVecchia asked whether Hetmanski’s conduct was in any way relevant.
No, Spoganetz said. “His conduct was not of his own volition,” he said.
Justice Anne Patterson said Hetmanski took a “pretty substantial series of steps” to make it from the X-ray room to the hospital roof.
“He took those steps because of his depression,” Spoganetz said. “He was owed a special duty of care by his doctors.”
Justice Barry Albin suggested that Hetmanski had shown a potential for self-harm, and asked Spoganetz whether there was a duty to protect the patient from himself.
“That is correct,” Spoganetz said.
Albin pointed out that Stroumtsos told the jury that there was no negligence on Hetmanski’s part and that he was “not part of the equation.”
“Are you happy with that?” he asked.
Spoganetz said that wasn’t enough. “There should have been a recharge on proximate cause,” he said.
Richard Amdur, representing the hospital and the employees other than Mayer, said the trial was conducted properly.
“During this four-week trial, not once did any defendant mention comparative negligence or fault on the part of Mr. Hetmanski,” said Amdur, of Eatontown’s Amdur, Maggs & Shor. The jury, he said, was told “unequivocally” that Hetmanski’s conduct was not at issue.
Albin asked whether it was proper that Hetmanski was “left to wander around.”
“What standard [of care] should there have been? One on one?” Amdur replied, adding that it would not have been the nurses’ job to determine what security measures should have been taken to ensure Hetmanski did nothing to harm himself.
“Dr. Mayer said he made the decision” as to how Hetmanski should be handled, he said.
Motivated Security Services’ attorney, Wendy Smith, said her client could not be held liable in any way for Hetmanski’s death.
“Motivated was not told Mr. Hetmanski was there. They were not told of the degree of his depression. They were not asked to monitor Mr. Hetmanski,” said Smith, of the Roseland office of Marshall, Dennehey, Warner, Coleman & Goggin.
Motivated’s security guards, she said, were not even aware of a problem until they were told that a person had been seen on the roof.
“A duty of care should not apply to nonhealth-care professionals,” Smith said.
Mayer’s attorney, Jeffrey Krompier, said this case did not rise to the level where the jury had to be instructed that there was a special duty of care.
“This case is not so unique,” said Krompier, who runs a firm in Parsippany. “He was not substantially mentally ill.”
Patterson suggested Hetmanski may have shied away from telling anyone at the hospital that he was considering suicide, adding that men sometimes shield their emotions.
“We can only deal with the facts as presented,” said Krompier.
“Are you giving all reasonable inferences to the plaintiff?” asked LaVecchia.
“I think it is appropriate to do so,” Krompier said. “But even under these circumstances … there was no basis on which to give a charge of a special duty of care.” •