Hospital Found Liable For Brain Injury Following Patient Suicide Attempt

Reasons for judgement were released today by the BC Supreme Court, Vancouver Registry, finding a hospital liable for a profound and permanent brain injury a patient suffered during a suicide attempt by hanging while in the care of the Defendant.
In today’s case (Paur v. Providence Health Care) the Plaintiff “suffered a brain injury when he attempted suicide by hanging in a bathroom at St. Paul’s Hospital“. He was there certified under the mental health act following having suicidal thoughts.  In finding the hospital was negligent in their care of the Plaintiff and finding them liable for his damages Madam Justice Griffin provided the following reasons:

[6]             I have conclude that SPH was negligent because, in summary:

a)    as part of its patient mix, SPH had a large number of suicidal, intoxicated patients treated in the ER who were certified and held involuntarily, many of them held in the Comox Unit;

b)    SPH knew or ought to have known of the real risk that a suicidal, intoxicated certified patient might attempt suicide by hanging in the hospital;

c)     SPH knew or ought to have known that the bathroom in the Comox Unit was unsafe for such a patient as the bathroom had not been made ligature-proof;

d)    SPH knew or ought to have known that the risk to a patient who attempts hanging is a very grave risk, as serious irreversible brain damage can be done to the patient quickly, within the range of five minutes, and the hanging can be fatal beyond ten minutes; and

e)    SPH had no policies or protocols for nursing staff in place to ensure that such patients were not permitted to be unmonitored in an unsafe locked bathroom for a period of time approaching five minutes or more.

[7]             This is not a case where, in the exercise of clinical judgment as to the degree of suicide risk Mr. Paur presented, medical professionals made a decision to allow Mr. Paur the freedom to be unmonitored for a period of time in an environment in which he might attempt hanging. Because he was intoxicated, Mr. Paur’s level of suicide risk had yet to be assessed beyond the fact that he was a suicide risk.

[8]             Nor is it a case where, after weighing the known risks, costs and benefits, SPH made a decision as to how to deal with the risk of suicidal patients attempting suicide by hanging in the bathroom in the Comox Unit, either by designing the bathroom a certain way or by instituting nursing policies to deal with the risk. Rather, this is a case where SPH ought to have known there was a significant risk to suicidal patients posed by the bathroom in the Comox Unit and by the lack of protective policies concerning bathroom use, but did nothing about this risk.

[9]             Mr. Paur was left unmonitored in the bathroom for a long enough period to be able to wrap a hospital gown around his neck, open up the ceiling tiles, tie the gown around fixtures in the ceiling, and hang himself to the point of unconsciousness, causing brain damage.

[10]         It would have been relatively simple and not too costly for SPH to design the bathroom facilities safely to prevent the risk of suicide by hanging; or, alternatively, to establish policies to mitigate the risk of a suicidal patient being left alone in the bathroom unmonitored for a sufficiently long period of time as to cause serious harm from hanging.