Wednesday, April 8, 2009

Why Judges Matter, Part 2

As a lawyer, I read new court decisions every day, some of which relate to my practice and others that just make me cringe. Another cringe-worthy decision was just published, courtesy of the U.S. Court of Appeals for the Sixth Circuit, covering Michigan, Ohio, Kentucky, and Tennessee. The case is Moses v Providence Hospital, and the author is the same judge who gave us the tortured opinion in Gass v Marriott Hotels, about which I posted previously.

In this latest mess, the court reinstated a lawsuit against Providence Hospital, filed by the personal representative of a woman murdered by her husband. The wife took her husband to the emergency room at Providence as he was experiencing headaches, high blood pressure, and vomiting, as well as slurred speech, disorientation, hallucinations, and delusions. The hospital admitted him. Initially, he was going to be placed in the psychiatric unit, but he never was. A week after his admission, the hospital released him, with one doctor noting that he "wants to go home. His affect is brighter. No physical symptoms now." Ten days later, the husband murdered his wife. He was subsequently convicted of first degree murder and is spending the rest of his miserable life in prison.

Two years later, the wife's personal representative sued, alleging that the hospital was negligent and also violated the Emergency Medical Treatment and Active Labor Act (EMTALA). The trial court dismissed the case, but the Sixth Circuit reinstated it.

The entire gist of the Sixth Circuit's opinion can be summarized thusly: the hospital thought the husband was psychotic and a danger when it admitted him; the hospital released him mistakenly or prematurely; and he then murdered his wife. Therefore, the hospital is liable.

Here's the problem with the court's reasoning -- the husband was convicted of first degree murder. Under Michigan law, first degree murder is defined as "murder perpetrated by means of poison, lying in wait, or any other willful, deliberate, and premeditated killing." The court's ruling assumes that the husband's alleged psychosis had something to do with the fact that he murdered his wife, but the conviction is for a willful, deliberate, premeditated killing, not for a killing resulting from a psychosis or psychological disorder.

To analogize, this case is like finding a hospital liable because someone commits a fraud after being discharged following misdiagnosis of a cracked rib. The diagnosis and the crime have nothing to do with one another and, in the Moses case, are mutually exclusive. The fact that the husband had hallucinations or delusions is irrelevant to a conviction for a willful, deliberate, and premeditated killing.

What is the effect of this ruling? Hospitals will now be less inclined to release patients, even if they believe the patients pose no threat or have improved sufficiently. This will, of course, drive up health care costs and insurance rates, squeeze hospital bed availability, and ultimately promote to some extent the conditions that energize advocates for nationalized health care.

Through the EMTALA and decisions like this, Congress and the courts are telling hospitals whom they must treat and, now, whom they must keep and for how long. It is a small step to specify the treatment to be given, at which point government control will be complete.

I don't know about you, but I prefer to make decisions about my treatment with my doctor, rather than having to obey the pronouncements of a judge from Cincinnati.

No comments:

Post a Comment