Opinion
Rehearing Denied April 21, 1967.
For Opinion on Hearing, see 62 Cal.Rptr. 577, 432 P.2d 193. Clausen & Clausen, San Francisco, for appellants.
Clark, Heafey & Martin, Chris G. Gasparich, Oakland, for respondent Presbyterian Hospital and Medical Center of San Francisco.
SALSMAN, Associate Justice.
The action that gives rise to this appeal is one for the alleged wrongful death of Lorraine Vistica. The plaintiffs-appellants are Lorraine's husband, Jerrold Vistica, individually, and her minor children Victoria and Mary, by their guardians ad litem Jerrold Vistica and Aida Ducato Miller, Lorraine's mother. The defendants in the superior court were Presbyterian Hospital and Medical Center of San Francisco and Douglas S. Cartwright, Lorraine's physician. The jury returned a verdict in favor of both defendants. The appeal has been dismissed as to Dr. Cartwright and is pressed only against the Presbyterian Hospital and Medical Center of San Francisco.
We have reviewed the record and considered all points raised in appellants' briefs. Our conclusion is that no prejudicial error warranting reversal is shown and we therefore affirm the judgment.
We abstract the facts from a melancholy record: The decedent Lorraine was a mentally ill person. The testimony of witnesses describes her as one who possessed a schizophrenic personality, was paranoid and strongly motivated toward suicide.
On August 5, 1961, while at home, Lorraine stabbed herself in the chest. She was admitted to the psychiatric ward of respond Lorraine remained at the hospital until September 8th, when she was permitted to go home to spend the daytime hours with her family. She did not make satisfactory progress at home, however, and while on this schedule engaged in at least one alarming but ambiguous course of conduct which suggested her continued motivation to suicide.
On October 19th Lorraine was readmitted to the hospital for full time care. Upon Lorraine's readmission Dr. Cartwright again ordered that hospital personnel take precautions against her suicide. Lorraine's tendencies toward elopement were also described in her doctor's notes and conveyed to and noted by the nurses on the psychiatric ward.
At trial both sides offered testimony as to the meaning of the terms 'suicide precautions' and 'elopement precautions'. Although different witnesses described their understanding of these terms in varying ways, a fair term simply means that increased vigilance must be used in the care of a patient such as Lorraine, while the latter term means that the patient is to be carefully observed and the door of the ward watched to see that the patient does not flee the hospital.
The psychiatric ward where Lorraine was a patient is operated on the 'open ward' pattern, presently considered best for psychiatric patients, and in which patients are relatively free from restraint. Lorraine's doctor considered it particularly important that she not feel imprisoned. Because of her relative freedom, the need for suicide and elopement precautions was particularly evident to her doctor.
The psychiatric ward had a kitchen, a nurses' station and a solarium, as well as sleeping rooms for the patients. The furniture in the solarium included a radio console, light wooden chairs and a metal wastebasket. The windows in the solarium were divided into two sections, a lower one which was fixed shut, and an upper one, transomlike, which could be opened. The upper portion of each window was fitted with chains and a metal strap which prevented the window from opening wide. On one window, however, the chains had not been knotted up short, so that the window could be opened considerably further than the others. The solarium was three floors above street level.
On October 29th appellant Aida Miller visited her daughter Lorraine. She found her in the solarium. There was dust on her dress. Mrs. Miller saw the radio console below the window that could be opened widest, and the window was open. A chair was on top of the console and the metal wastebasket had been placed on top of the chair. Lorraine indicated that she had arranged the furniture as it was found. Mrs. Miller reported these facts to the nurse on duty and also to Dr. Cartwright, who said he would order 24-hour surveillance for Lorraine. Other nurses on the ward, and a hospital orderly, were also made aware of this occurrence.
On October 30th Dr. Cartwright saw Lorraine at the hospital. He questioned her about the furniture pile-up in the solarium. She denied any participation in the incident, but at the same time the doctor found her angry, tense, and full of desire to return home. Later, Lorraine's mother arrived. She too found her daughter angry and demanding to be permitted to go home. Dr. Cartwright refused permission for his patient to leave the hospital.
At 4 p. m. on the 30th, Dr. Cartwright warned nurses on the ward of Lorraine's emotional state. He requested that they observe her carefully, and that she not be left alone.
At 5 p. m. Lorraine had dinner in her room, and afterwards lay down upon her bed.
At about 5:50 p. m. an orderly came to her room and asked her to play cards. She At 5:58 p. m. the ward nurse received a telephone call from an unidentified person who said that a girl's body was lying on the ground, beneath a window of the psychiatric ward, on the Webster Street side of the hospital. A quick search of the ward disclosed the absence of a patient.
In the solarium, the radio console stood beneath the window that opened widest. On top of the console was a wooden chair, and above that, the metal wastebasket.
The girl in the street was Lorraine. She was dead.
Appellants first argue that respondent was guilty of negligence as a matter of law. They say that it was negligence for the hospital to permit Lorraine to be alone for any period of time, regardless of how brief. They also urge that it was negligence to permit the window in the solarium to open as wide as it did, and to allow the furniture to remain there after it had been so ominously piled up at the window the day before Lorraine's death.
There can be no doubt at all that, on our record, a verdict in favor of appellants would have been fully supported by the evidence. But this is not to say that the evidence shows the hospital negligent as a matter of law. Here, as in almost every case where negligence is claimed, the question is one of fact. The existence of negligence becomes a question of law '* * * only if reasonable men following the law can draw but one conclusion from the evidence presented.' (Gray v. Brinkerhoff, 41 Cal.2d 180, 183, 258 P.2d 834, 836.)
A hospital, in caring for the mentally ill, is not an insurer of the safety of its patients. It is required to exercise reasonable care, and of course, the quantum of care required may vary according to the facts of the particular case. (DeMartini v. Alexander Sanitarium, Inc., 192 Cal.App.2d 442, 448, 13 Cal.Rptr. 564, 91 A.L.R.2d 383.) The facts of our case show that Dr. Cartwright ordered respondent's personnel to give Lorraine close observation, and to watch her carefully to protect her from herself. But he did not order that someone be at her elbow at all times, day and night. Special nurses were not ordered. She was not put under restraint, or in seclusion. There was also the question, implicit in some of the medical testimony, whether closer observation of Lorraine than that prescribed would have been beneficial or harmful. While all recognized Lorraine's condition as grave, the nurses and attendant also knew that from time to time she was permitted to leave the hospital in the company of her mother, and that she sometimes joined in group social activity on the ward. Lorraine was alone for a very brief time, a matter of eight minutes or less, before she met her death. On the facts, it was for the jury to decide if respondent had breached its duty to exercise reasonable care toward her. Finally, the trial judge, in ruling upon the motion for a new trial, considered the same question. He, too, concluded that respondent had not breached its duty toward its patient and accordingly denied a new trial. His denial carries weight, and we do not ignore it.
We have examined both Lange v. United States, D.C., 179 F.Supp. 777 and United States v. Gray, D.C., 199 F.2d 239, cited to us by appellants. We do not find either case persuasive on the issue here presented. In each of the cited cases negligence was found on the facts presented. In neither is there any suggestion that negligence was present as a matter of law.
The court instructed the jury on the doctrine of res ipsa loquitur in its conditional form. The instruction in effect required the jury to find that (1) Lorraine's death was one which ordinarily would not have occurred in the absence of negligence; (2) that at the time of her death she was under the exclusive control of the hospital, and (3) that her death was not due to any voluntary action or contribution on her part, before applying an inference of negligence against respondent. Appellants do not It has been said that a party may rely upon the doctrine of res ipsa loquitur even though he has participated in the events leading up to the accident, if the evidence excludes his conduct as the responsible cause. (Zentz v. Coca Cola Bottling Co., 39 Cal.2d 436, 444-445, 247 P.2d 344; Gow v. Multnomah Hotel, 191 Or. 45, 224 P.2d 552, 228 P.2d 791.) If Lorraine was so mentally ill as to be devoid of all reason, she could not be guilty of contributory negligence, nor could she have assumed the risk of her own death, or have been its responsible cause. Thus we return again to the factual question of Lorraine's mental state immediately before her death. Some of the facts bearing upon that issue have already been recited in the statement of facts. There must be added here, however, the further evidence, coming from Dr. Cartwright, that Lorraine was oriented as to time, place and person, and that she knew what she was doing. Her mother testified that Lorraine was angry, not emotionally upset. We have previously described her intense desire to leave the hospital and return to her home and family. These facts clearly require that the question whether Lorraine's own actions were, in part at least, the 'responsible cause' of her death be left to the jury to decide. (DeMartini v. Alexander Sanitarium, Inc., supra, 192 Cal.App.2d 442, 445-448, 13 Cal.Rptr. 564, 91 A.L.R.2d 383.)
Appellants cite Fowler v. Seaton, 61 Cal.2d 681, 39 Cal.Rptr. 881, 394 P.2d 697. But our case differs from the Fowler case because there the injury was to a child less than four years of age, and therefore legally incapable of contributory negligence. Here, although Lorraine was a grievously mentally ill person, there was some evidence from which the jury could find that she was accountable for her actions, and hence that her conduct was a responsible cause of her death. We see no error in the court's res ipsa instruction.
Appellants also complain of alleged errors of the trial court in its rulings on the admissibility of evidence. Over their objection the court permitted inquiry about a pending action between appellant Jerrold Vistica and appellant Aida Miller concerning custody of the minor children of Lorraine and Jerrold. Appellants argue that this evidence served only to show ill feeling between appellants, and that it was inflammatory and prejudiced their case. Respondent argues that the inquiry was proper because it tended to show that Mrs. Miller had a pecuniary interest in the outcome of the action because, as guardian of the minor children, she would have had control over their estate had they received a favorable judgment.
We agree with appellants that this inquiry had no proper place in the trial. As guardian, Mrs. Miller would have no personal interest in the funds of the minor children who are her wards. But we see no prejudice in the admission of the evidence. We cannot assume that the jury, hearing evidence of a conflict between the father and grandmother over the custody of the minor children of Lorraine, would for this reason deny a recovery to the minors if it otherwise found in their favor. Moreover, we assume that this claim of error was called to the attention of the trial judge at the hearing on appellants' motion for a new trial, since error of law was one of the grounds relied upon in that motion. The trial judge denied the motion and presumably concluded that any error in law that occurred at the trial did not materially affect the verdict of the jury.
The trial court permitted one of the respondent's nurses to testify as to the meaning of the words 'suicide precautions' and 'elopement precautions' used In the first place, appellants themselves made some general inquiry of various witnesses concerning the meaning of the terms in question. This alone would be sufficient to justify respondent's explanation of their meaning through their witness. More important, however, is the fact that the meaning of both phrases is unclear to laymen, and the testimony of witnesses having knowledge superior to that of the jurors is therefore essential to a proper understanding of the terms. It is inferable from the record that appellants wished the jurors to understand the terms meant that Lorraine was to be given 'constant surveillance' at all times. Respondent's showing that the words had a more limited and restricted meaning, and that this meaning was understood by its personnel, was therefore proper.
Finally, appellants argue that the trial court improperly permitted Dr. Kassebaum, then the psychiatric resident, to answer a hypothetical question as to the likelihood that a person such as Lorraine would ultimately commit suicide. They contend that the question itself was improper, and the answer given so prejudicial to their case as to require reversal of the judgment. We do not agree.
If the jury had found in appellants' favor on the issue of liability it would then have been required to assess damages. In fixing damages, the life expectancy of Lorraine would have been an essential factor to be considered. (Dickinson v. Southern Pacific Co., 172 Cal. 727, 158 P. 183. Papini v. Alexander Sanitarium, Inc., 12 Cal.App.2d 249, 55 P.2d 270.) The court took judicial notice of the fact that according to standard mortality tables Lorraine's life expectancy was forty (40) years, and announced this fact, as a part of the evidence, to the jury. Respondent was entitled to show, if it could, that Lorraine's life expectancy was less than that given in the mortality tables. Dr. Kassebaum's answer to the hypothetical question posed was simply expert medical opinion evidence designed to rebut the evidence contained in the mortality tables and was clearly admissible for that purpose.
Judgment affirmed.
DRAPER, P. J., and HAROLD C BROWN, J., concur.