St. Paul's Hospital to pay $390,000 to former patient who attempted suicide

A B.C. Supreme Court judge has found Providence Healthcare, the operator of St. Paul’s Hospital in downtown Vancouver, liable for a former patient’s brain damage as the result of an attempted suicide under the hospital’s watch.

According to a written ruling by Justice Susan Griffin, a 36-year-old male patient was admitted into hospital just before midnight on May 23, 2011 after being arrested by Vancouver Police under the Mental Health Act. His wife had called police after he consumed a quantity of alcohol and displayed suicidal behaviour.

The ER doctor gave the order for the patient to remain in hospital care overnight so that he can “sober up and sleep it off” before a reassessment is made in the morning. The patient was sent to the Comox Unit, a special secure ward behind a set of locked doors for mental health patients.

As all of the ward’s single-patient ‘exclusion rooms’ were occupied, the patient was left in the ward’s stretcher area, where there is a bathroom with a lockable door not visible from the nursing station.

At some point overnight, the nurses lost track of the patient, who was later found hanging above the toilet with a blue hospital gown wrapped around his neck. He was not breathing and did not have a pulse.

CPR treatment could not be provided immediately as the door was locked. As well, the code team with the ‘crash cart’ could not enter the bathroom until an engineer was able to remove the door off the hinges.

The patient eventually resumed breathing on his own, but required support with breathing in the intensive care unit.

It was later determined that the patient had suffered severe, permanent brain damage from the self-inflicted trauma. Serious brain damage occurs during the first five minutes while death can occur after 10 minutes.

Justice Griffin concluded the hospital is liable given that its facilities, specifically the bathroom, were not designed in a way that would be safe for such patients. The hospital also lacked policies or protocols for nursing staff to ensure patients were not permitted to be unmonitored in unsafe environments, such as inside an unsafe locked bathroom over a lengthy period of time.

As well, the ward is usually manned by three nurses, including at least one psychiatric nurse. However, on the night of the incident all three nurses were ER nurses – there were no psychiatric nurses on duty.

Apparently, the nurses witnessed the patient walking to use the bathroom a number of times, but they were “not particularly concerned” given that he had consumed a large quantity of cider.

“I find that the two nurses on duty at the time of the hanging incident failed to meet nursing standards of care for observing [the patient],” reads the ruling. “Their primary task in looking after him that evening was to keep watch over him to ensure he stayed safe. They lost track of him and did not know how long he was in the bathroom before checking.”

“They thus allowed a situation where [the patient] was unsafe because he had sufficient amount of time alone and unmonitored to seriously harm himself. The nurse who finally checked on him also did not know how to immediately unlock the door, which should have been basic knowledge.”

The patient was awarded $361,000 in damages to help cover his costs for the remainder of his life. His mother was awarded another $30,000 in trust to care for her son.

The ER doctor was also named as a defendant, but her involvement was settled before the trial began.