Lead Opinion
delivered the opinion of the court:
May a psychiatrist and hospital be held liable under the Wrongful Death Act (740 ILCS 180/0.01 et seq. (West 1996)) for the death of a patient when the patient committed suicide while in their care and custody but was not bereft of reason or insane at the time he took his own life? We believe the answer is yes, so long as the act of suicide is reasonably foreseeable and the defendants have breached the applicable standard of care.
I. FACTS
Plaintiffs Herbert Winger and Joyce Winger filed a wrongful death action against the defendants, Franciscan Medical Center (hospital) and Dr. Danilo Domingo, a psychiatrist, after their son Nathan committed suicide while in the defendants’ care for severe depression. Nathan was admitted to the hospital’s psychiatric ward on January 27, 1990, under the care of Dr. Domingo. He voluntarily admitted himself after taking extra Elavil, which had been prescribed by Dr. Domingo to treat his depression.
Nathan had a history of suicide attempts. Prior to his death he had been admitted to the defendants’ facility five times for suicide attempts in the five previous months. At the time he entered the hospital on the 27th, Nathan informed a nurse that he took extra Elavil to help with his depression and that he was going to let himself “sink so low again that [he would] get suicidal.” The nurse’s notes stated “Plan, monitor patient, prevent from self-harm.” Nathan was placed on “close supervision,” which allowed a psychiatric patient unmonitored access to bathroom facilities, as well as belts, shoelaces, telephone cords and other objects that might assist an individual to inflict self-harm. Patients on “suicide precautions,” however, did not have access to such objects. The hospital’s policy defined potentially suicidal patients as patients who discuss death and the uselessness of life. If the admission was due to a suicide attempt, that fact was to be reported to the patient’s physician immediately.
After Nathan’s admission, Dr. Domingo recommended an aggressive treatment of electroconvulsive therapy (EOT) for him. Later, Nathan expressed doubt to a nurse regarding EOT therapy and stated that he “felt like a loser” and a “fool.” He said he was scared of death and that he was scared that he would feel as he did the rest of his life, but that he could not live that way. He felt “bad all the time.” At 10 p.m. on January 29 a nurse quoted Nathan as saying “It’s hopeless. I feel hopeless. I keep trying, but I can’t do anything with my life. I worry about the EOT. I worry about whether it will help or not. I wish I was manic depressive instead of this. My life is hopeless.” Close supervision was maintained. Shortly after midnight, Nathan stuffed clothing under his bed sheets to make it appear as if he were in bed. He entered his bathroom and locked the door behind him. He then committed suicide by hanging himself with his shoelaces from a showerhead.
II. PROCEDURAL HISTORY
Plaintiffs filed a wrongful death action on June 3, 1991, alleging that the hospital was negligent because it failed to provide a nonlocking door and a breakaway showerhead. The complaint also alleged that Dr. Domingo was negligent for failing to order “one-to-one” supervision, failing to properly treat Nathan, and failing to properly use psychiatric therapy. Plaintiffs voluntarily dismissed the action on April 27, 1994. They refiled on December 6, 1994, alleging that the hospital’s staff failed to place Nathan under proper supervision, failed to prohibit him from having access to the bathroom, and failed to restrict his access to shoelaces. The new complaint alleged that Dr. Domingo was negligent because he failed to place Nathan under closer supervision and allowed him access to bathrooms, belts, shoelaces and other instruments that were potentially harmful. Plaintiffs filed an amended complaint on July 23, 1996, which included the previous allegations that the hospital was negligent for failing to provide breakaway showerheads.
The hospital and Dr. Domingo subsequently moved for summary judgment. Both relied on the statements of plaintiffs’ expert, Dr. Richard Goldberg. In his deposition, Dr. Goldberg opined that Nathan understood and appreciated his acts and that he intended to kill himself. The defendants consequently argued that since Nathan’s actions were intentional and not comparable to the defendants’ negligence, and he was not bereft of reason at the time he committed suicide, no recovery was possible. The hospital also moved to dismiss the complaint pursuant to section 2 — 619 of the Code of Civil Procedure (Code) (735 ILCS 5/2 — 619 (West 1996)), claiming that the complaint was barred by the statute of limitations.
The trial court granted the motions for summary judgment. Relying on Stasiof v. Chicago Hoist & Body Co.,
Plaintiffs’ counsel subsequently deposed defense expert Dr. Morton Silverman, who testified regarding the foreseeability of Nathan’s suicide. Dr. Silverman agreed that the mental health care professional should take precautions to prevent a patient from committing acts that are self-destructive, even if the patient is not insane or bereft of reason. With the new deposition in hand, the plaintiffs moved for reconsideration. Although the court considered the new evidence, it denied the motion and this appeal followed.
III. STANDARD OF REVIEW
A motion for summary judgment may only be granted when the right of the moving party is clear and free from doubt. Pedersen v. Joliet Park District,
IV STATUTE OF LIMITATIONS
We will first address the hospital’s argument that the plaintiffs’ claims are barred by the statute of limitations. The hospital claims that the refiled action is barred because it was not preserved by the savings provision in section 13 — 217 of the Code (735 ILCS 5/13 — 217 (West 1994)). It asserts that the second suit contains entirely different allegations of medical negligence which cannot be filed more than two years after the claimant knew or should have known of the negligence, and in no event more than four years after the alleged negligence. 735 ILCS 5/13 — 212(a) (West 1996). It argues that all of the new claims in the second action are clearly barred since they were filed more than four years after the event.
A wrongful death action must be filed within two years after the death of the plaintiffs’ decedent. 740 ILCS 180/2 (West 1996). The action may be dismissed after the limitations period and be refiled pursuant to the one-year savings provision in section 13 — 217. Kristan v. Belmont Community Hospital,
Seizing upon the language of identical claim and cause of action, the hospital maintains that the second complaint involves a different claim which could not be saved under section 13 — 217. We disagree.
In Gonzalez v. Thorek Hospital & Medical Center,
The court then sought to determine whether the plaintiff could avail herself of section 13 — 217 by analyzing whether the defendants had sufficient notice of the litigation arising from the same set of facts and circumstances. Gonzalez,
Similarly, in the instant case, although the plaintiffs did not refile precisely identical allegations in their second complaint, we believe the refiled claims are sufficiently identical to satisfy the requirements of section 13 — 217. Just like the first complaint, the second complaint is a wrongful death action related to the hospital’s failure to anticipate Nathan’s conduct and act reasonably to prevent the injury suffered at its facility. The second arises out of the same facts and circumstances and is a wrongful death action against the hospital for its failure to properly provide for its patient. We thus hold that the action was properly refiled.
V. DUTY OF CARE: KNOWLEDGE OF SUICIDAL TENDENCIES
Turning to the merits of the action, and the bases upon which summary judgment was awarded, the defendants argue that this court should affirm because the plaintiffs are improperly attempting to compare the decedent’s intentional conduct to their alleged negligence. They insist that Nathan’s intentional conduct was an intervening act and that Nathan is solely responsible for his injuries. Relying on Ziarko v. Soo Line R.R. Co.,
In Ziarko, an employee brought suit against his employer and a railroad for injuries he suffered in an accident involving a train after he stepped from his truck. He sued the railroad for negligence and wilful and wanton conduct and his employer for negligence. The railroad brought a contribution claim against the employer. The employer argued that the railroad was barred from asserting such a claim because it could not seek to compare its wilful and wanton conduct to that of the employer since its conduct was only negligent. The court held that the railroad could seek contribution so long as its conduct was not intentional. Ziarko,
The defendants point out that this position is consistent with the Restatement (Second) of Torts, section 482(2) and section 503, which in relevant part state:
“A plaintiff whose conduct is in reckless disregard of his own safety is barred from recovery against a defendant whose reckless disregard of the plaintiffs safety is a legal cause of the plaintiffs harm.” Restatement (Second) of Torts §§ 482(2), 503(3) (1965). “[Wlhere the plaintiffs conduct is itself in reckless disregard of his own safety, it bars his recovery not only from a defendant who has merely been negligent, but also from one who has acted in reckless disregard of the plaintiffs safety. The greater fault in the one case is balanced against the greater fault in the other.” Restatement (Second) of Torts § 503, Comment c (1965).
Defendants assert that these principles provide a solid basis for concluding that the law does not recognize any comparison of one’s own intentional conduct with the alleged tortfeasor’s actions. They assert that the only exception is when the decedent or injured party was bereft of reason at the time he injured himself and his mental condition was the result of the tortfeasor’s conduct.
There is support for this proposition in our state. In Stasiof v. Chicago Hoist & Body Co.,
More recently, the court in Moss v. Meyer,
We do not disagree that these cases remain viable today. However, all the cases cited are distinguishable from the present action. This is an action asserting psychiatric malpractice and the failure to properly supervise; it is.different from general medical malpractice actions because the negligence is not in the diagnosis or treatment but, rather, it is in the failure to carefully protect a patient from inflicting self-harm. Kent v. Whitaker,
This is a reasonable approach given that in Damera, as in the instant case, the decedent sought the services of the psychiatrist to treat and cure his condition. The crucial problem in the previous cases we have cited and ones like them is that the act of suicide was not reasonably foreseeable and thus liability reasonably could not be placed on the tortfeasor. That is not the case here. Here there is a genuine issue of fact regarding the foreseeability of the suicide. Therefore, we do not find Stasiof, Little or Moss controlling.
We agree with Damera that the circumstances are special in nature. However, the defendants would argue that, nonetheless, no liability may attach in this case because this is not a case comparing the defendants’ negligence to the decedent’s contributory negligence, but rather this is a case comparing negligence to intentional conduct.
It is well settled that a hospital and its staff must exercise reasonable care to protect suicidal patients from self-harm. Dinnerstein v. United States,
For example, in Tomfohr v. Mayo Foundation,
In Bramlette v. Charter-Medical-Columbia,
Similarly in Psychiatric Institute v. Allen,
In Weathers v. Pilkinton,
We disagree with Weathers. Despite the fact that a patient is not bereft of reason and may appreciate the consequences of his actions, we recognize the fact that there are varying degrees of mental affectation. Although a patient may be in full understanding of his actions, an illness may still exist for which treatment has been requested and admission sought. The patient can still, as in this case, work against his physician and cut the Gordian knot before the physician can work to unravel it. See Damera,
“Where it is reasonably foreseeable that a patient by reason of his mental or emotional illness may attempt to injure himself, those in charge of his care owe a duty to safeguard him from his self-damaging potential. This duty contemplates the reasonably foreseeable occurrence of self-inflicted injury regardless of whether it is the product of the patient’s volitional or negligent act.”
As health care professionals, the defendants assumed a duty to exercise the degree of care toward their patients that would be followed by members of their profession under similar circumstances. Britton v. Soltes,
We believe the principles of fault stated in Damera may be applied in cases of intentional conduct when it can be demonstrated, as in this case, that the conduct arose from the plaintiffs mental state (e.g., severe depression), the act of suicide was foreseeable, and the plaintiff was in the custody or control of the physician or hospital at the time he acted. This rule arises from the special duty owed by the psychiatric caregivers to the patient. See C. Williams, Fault & the Suicide Victim: When Third Parties Assume a Suicide Victim’s Duty of Self-Care, 76 Neb. L. Rev. 301 (1997) (arguing that when the caregiver assumes custody or control of a psychiatric patient and has knowledge of his suicidal tendencies, the defendant should be held to assume the victim’s duty of self-care). We accordingly hold that when the mental healthcare professional has assumed the custody or control of an individual, be it for a voluntary or involuntary admission, so that it is treating the individual and has knowledge of his suicidal tendencies, the defendant assumes the patient’s duty of self-care and must act reasonably to prevent self-inflicted harm. Liability will not be absolved for the simple reason that the patient was not bereft of reason and could appreciate the severe consequences of his actions.
VI. CONCLUSION
We note that the defendants are not guarantors of safety. This is not a matter of strict liability. The burden on the hospital and physician is to take reasonable steps to avoid a foreseeable tragedy in their facility. The degree of care and its character will necessarily vary with the circumstances of each case. In this case whether the suicide was foreseeable and whether the conduct of the defendants was reasonable under the circumstances are questions of fact to be determined by a jury. Therefore, we hold that summary judgment was inappropriately granted.
For the foregoing reasons, the judgment of the circuit court of Rock Island County is reversed and remanded for further proceedings consistent with this opinion.
Reversed and remanded.
Dissenting Opinion
dissenting:
I respectfully dissent. Summary judgment is required where the pleadings, depositions, admissions and affidavits on file show that there is no genuine issue of material fact and that the moving party is entitled to judgment as a matter of law. 735 ILCS Ann. 5/2 — 1005(c) (Michie 1996); Machinery Transports v. Morton Community Bank,
The state of the law in Illinois on this issue is clear: where a defendant is alleged to be liable in tort for the suicide or attempted suicide of a plaintiff or a plaintiffs decedent, the act of suicide is an independent intervening act which breaks the chain of causation and shields the alleged tortfeasor from liability, unless the injured party is insane or bereft of reason and attempts suicide while in that state. Stasiof v. Chicago Hoist & Body Co.,
Here, there is no dispute that Nathan was not insane nor bereft of reason. Plaintiffs own expert testified in his deposition that Nathan understood and appreciated his acts and that he intended to kill .himself. Given these undisputed facts, and the state of the law under Stasiof, Little, and Moss, the trial court properly granted the defendants’ motion for summary judgment.
While the majority notes that some of our sister jurisdictions have chosen to adopt a rule of law that creates liability for health care providers based upon a concept of a heightened duty to protect potentially suicidal patients from self-harm, no such duty has, to date, been created in Illinois. In light of our own supreme court’s holding in Little, it would have been error for the trial court to have relied upon precedent from other jurisdictions to deny the summary judgment motion. I believe that it is error for our court to do so.
For the foregoing reasons, I would affirm the trial court’s granting of the defendants’ motion for summary judgment and I dissent on that basis.
