Crise v. Maryland General Hospital, Inc.
69 A.3d 536
Md. Ct. Spec. App.2013Background
- On Dec. 31, 2008 Richard Crise (bipolar/schizoaffective history) presented to Maryland General Hospital ER; triaged, examined by ER physician, given Ativan, and awaiting off-site crisis evaluator. He wore a hospital gown, pulled out his IV, paced, and family warned staff he might flee.
- PCT offered to sit one-on-one; ER charge nurse declined due to staffing and kept him in a room across from nurses’ station for visual observation; crisis evaluator was not contacted until ~5:00 p.m.; Crise left through a rear alarmed door and walked several blocks toward home.
- Baltimore police, called by hospital after he left, located him on Howard Street Bridge; when approached by officers he jumped from the bridge and suffered severe fractures.
- Crise sued MGH for medical negligence, alleging breach of the standard of care (e.g., failure to assign a sitter, secure exits, use adequate chemical/physical restraints) that proximately caused his injuries. Both sides produced competing expert opinions.
- At trial, after jury selection and before opening statements, the trial court sua sponte invoked Md. Rule 2-502 and entered judgment for MGH, reasoning that because the hospital lacked legal authority to detain a voluntarily admitted patient it owed no duty to prevent his voluntary departure; court denied reconsideration. Crise appealed.
Issues
| Issue | Crise’s Argument | MGH’s Argument | Held |
|---|---|---|---|
| Existence/nature of duty of care owed by ER to patient | ER-patient relationship created a duty; scope (e.g., monitoring, sitter, restraints) is factual and for the jury to decide based on expert testimony | Because Crise was a voluntary patient and hospital lacked authority to forcibly detain him, no duty extended to preventing his voluntary departure | Reversed: court erred — duty existed as a matter of law; scope/nature of that duty was factual and for jury, not appropriate for Rule 2-502 determination |
| Use of Rule 2-502 sua sponte to decide duty/scope | Rule 2-502 inappropriate because resolution required factfinding intertwined with jury issues; parties lacked notice and opportunity to present evidence | Rule 2-502 is proper for discrete legal questions; court’s factual inferences were supported by record | Reversed: court abused discretion by using Rule 2-502 without notice and by resolving factual disputes reserved for jury |
| Causation (hospital’s alleged failure to monitor → injuries after police arrival) | A sitter would have detected and reported attempts to leave; staff could have intervened before absconding and police involvement; causation is disputed and a jury question | Even if negligence occurred, a sitter could not physically prevent him; hospital complied by calling police; police presence — not hospital — caused jump, breaking causation chain | Causation was factually contested and not resolved as a matter of law; jury must decide |
| Defenses (contributory negligence / assumption of risk) | Plaintiff’s psychiatric state makes objective-reasonable-person defenses inappropriate; allocation of fault is for jury | Objective test applies; voluntary acts (leaving, jumping) bar or reduce recovery as matter of law | Matters present disputed factual/mental-state evidence; for jury to resolve |
Key Cases Cited
- Jones v. State, 425 Md. 1 (2012) (existence of legal duty is prerequisite to negligence)
- Dehn v. Edgecombe, 384 Md. 606 (2005) (medical malpractice duty arises from provider‑patient relationship)
- Shilkret v. Annapolis Emergency Hosp. Assoc., 276 Md. 187 (1975) (standard: degree of care expected of reasonably competent practitioner in same class and circumstances)
- Harris v. Stefanowicz Corp., 26 Md. App. 213 (1975) (historic discussion of Rule 502; limits on court making factual findings that encroach on jury rights)
- Werbowsky v. Collomb, 362 Md. 581 (2001) (Rule 2-502 appropriate for discrete legal issues within sole province of court)