New York’s Highest Court Finds ER Physician and Hospital Have No Duty to Prevent Intoxicated Patient from Leaving Hospital
By: Ryan Perry

Tim Brennan successfully argued before the New York Court of Appeals in Kowalski v. St. Francis Hospital and Health Centers, et al., No. 128, (21 N.Y. 3d 480), to obtain summary judgment in favor of the healthcare defendants, dismissing plaintiff’s case in full.  In a 5-2 decision, the Court of Appeals held that a physician’s duty does not allow, let alone mandate, the involuntary detention of intoxicated patients wishing to leave a hospital.

The matter involved a patient with an extremely high blood alcohol level (.369%), who voluntarily presented to the emergency room while intoxicated and sought entry into the hospital's detoxification program.  About four hours after his arrival, while waiting to be transported to the detoxification program, the patient removed an IV from his arm and eloped from the hospital.  After the man left unescorted, the he wandered onto a highway where he was struck by a car, causing him to become a quadriplegic.

The man sued the hospital, the emergency room doctor, and the emergency room doctor's professional corporation for negligence and medical malpractice for failing to prevent him from leaving the emergency room.  Plaintiff argued, in essence, that intoxication limited his decision-making capacity to the point that, for his own protection, his physicians had a duty to deny him the right to leave.  The question was thus framed for the Court whether a physician’s duty to his patient extends to prohibiting that patient from leaving the hospital.

On behalf of his client, Tim Brennan argued that the hospital and emergency room doctor lacked the authority to involuntarily detain the patient, either under common law or under New York’s Mental Hygiene Law.

Common law permits detention, but only under very narrow circumstances where the patient is in truly imminent harm. Justified forcible restraint is limited to extreme circumstances, such as when a patient was “actually in the process of throwing herself out of a window to escape fancied pursuers.” Warner v. New York, 297 N.Y. 395, 401 (1948), citing Emmerich v. Thorley, 35 A.D. 452 (1st Dep’t 1898).  By contrast, the plaintiff in this case was not delusional, was able to walk by himself and was able to carry on a conversation. While he unquestionably had a high blood alcohol level, he was in control of his faculties. The Court adopted this argument in full and held that the common law exception to a person’s right to be free does not permit denial of that right to someone “who would be safer in a detoxification facility than on the street.”

New York’s Mental Hygiene Law does not allow the involuntary retention of intoxicated people who come voluntarily or are brought without objection to a hospital or other treatment facility. To restrain the man on these facts would have exposed defendants to liability for false imprisonment. A patient cannot be confined simply because he was having suicidal thoughts a month ago. The emergency room doctor had no duty to call the police. The police could not, on the facts known to the emergency room doctor when the man left the hospital, have forced the man to return.

According to the Court: “There can be no duty to do that which the law forbids” and therefore the defendants had no duty to prevent the plaintiff from leaving the hospital. Accordingly, the healthcare provider defendants were awarded summary judgment and the case was dismissed.