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

July 9, 2013

Authors: Marshal S. Endick, Jeffrey B. Araten, Judy C. Selmeci

ERIn a landmark decision, the New York 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.

Kowalski v. St. Francis Hospital and Health Centers, et al., No. 128, (NY Ct. of App., June 26, 2013), involved a patient with a very high blood alcohol level who, on his own accord, left the hospital’s emergency room where he had voluntarily sought detoxification. After eloping from the hospital, the patient wandered onto a highway where he was struck by a car, causing him to become quadriplegic. He sued the emergency room physician, and the hospital vicariously, on the theory that he should not have been permitted to leave. He 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 its client, Wilson Elser defense counsel argued that only two theories of law could possibly permit a physician to detain a patient such as the one in this case and that neither applied in Kowalski.

First, 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.”

The second possible authority permitting a patient to be involuntarily detained is statutory, but clearly inapplicable. Several sections of New York’s Mental Hygiene Laws permit detention of patients under certain conditions. Mental Hygiene Law § 22.09 regulates the detention of persons “whose mental or physical functioning is substantially impaired as a result of … alcohol.” As the defense argued – and the Court acknowledged – the statute distinguishes treatment rendered to voluntary patients (which this plaintiff was) and patients who are brought in by police. Patients who are brought to a hospital by police may be involuntarily detained under certain circumstances. The Mental Hygiene Laws provide no authority for a physician to detain an intoxicated patient at the hospital if that patient came in voluntarily. Therefore, the Court held that the physician and the hospital had no authority, and therefore no duty, to detain the plaintiff.

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.

Wilson Elser substantively participated as defense counsel in this matter.

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