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In July, our monthly topic was a typical scenario that a patient will go through when they call 911. This month, we are going to see what happens when a severely intoxicated patient comes into the hospital and what the responsibility of the healthcare providers is in terms of patient safety. We will investigate the legal aspects of discharging or restraining an intoxicated patient, and what doctor’s, nurses, and hospitals should be doing to protect themselves.

A 35 year-old male gets admitted to the Emergency Department after falling onto the sidewalk outside of a bar. There is no trauma. His blood alcohol level in the ED is 0.40%, and he is very lethargic. He is admitted to the ICU for airway monitoring. When he wakes up the next morning, he demands to go home. His blood alcohol level at that time is 0.20%. He is alert and oriented, has normal vital signs, is conversational and in no distress. The attending psychiatrist finds no reason to hold him involuntarily, he does not seem to be a threat to himself or others. He has no history of violence. He tells the medical staff that he will voluntarily seek outpatient treatment and knows the location of the clinic. What does the medical staff do in this situation? Let him leave? Hold him involuntarily?

In June 2013, the New York State Court of Appeals upheld a lower court’s decision to dismiss a 2007 lawsuit against a hospital for failing to prevent a patient from leaving the hospital while he was still intoxicated.  He subsequently stumbled out into traffic, was hit by a car and became paralyzed from the neck down as a result. The Appeals Court based their decision on the state’s Mental Hygiene Law which says that providers are neither permitted nor required to forcibly hold patients admitted voluntarily for treatment unless they are a clear threat to themselves or others, or they are unable to make medical decisions for themselves. Read more here.

This month’s civil topic is “Patient Safety: Intoxication”  Areas of discussion:

  • Case Scenario (9/1/14)
  • Risk Management/Documentation (9/8/14)
  • TBD (9/15/14)
  • TBD (9/22/14)

Note: To see all posts in this topic, click here.

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