This month we look at a case with some interesting facts. If you are a regular reader of this column, you’ll know that good notetaking is often mentioned as a way to protect yourself against lawsuits. In this case, however, a note written in a chart led to a charge of false imprisonment by a patient against a hospital. 

It all started with an off-hand remark. The patient, Mrs A, was leaving an appointment with Ms N, the nurse practitioner who worked with Dr P, Mrs A’s primary care physician. Mrs A’s medical history included high blood pressure, back pain, and pain and swelling in her right leg. The issue with her right leg began 7 years ago, when Mrs A fell while skating. The fall resulted in a sore that did not heal properly and chronic pain and swelling in the leg, for which she often came into the office. As Mrs A was leaving the office, she turned to the nurse practitioner.

“I’m so tired of dealing with this pain in my leg,” she said, as she walked out of the office. “I just feel like slitting my wrists.”

Alarmed, Ms N made a note about the comment in the patient’s chart and mentioned it to Dr P the next morning. Years earlier, the practice had lost a patient to suicide, so Dr P was proactive when he heard what he considered “trigger words.” He called Mrs A and suggested that she get counseling or go to the emergency department, but she angrily refused. Dr P also spoke to Mrs A’s husband when he came to the office to pick up paperwork for her. Mr A told the physician that his wife was irritable because of the pain but did not intend to harm herself.

Two days later, the patient’s husband called Dr P, saying that his wife wanted to order a device she had seen online that could “suck the fluid out of her leg.” The physician strongly advised against it and warned of the danger of infection and failure rate. He suggested that the patient go to the emergency department, and she grudgingly agreed.

In the emergency department, Mrs A was taken to an examination room and had her blood drawn and vital signs taken. She was seen by Dr H, who told her that there was nothing that could be done for her leg in the emergency department and that she should follow up with her family physician. Mrs A was extremely frustrated and said she would do whatever she had to in order to stop the chronic pain, including cutting and draining her own leg.

At some point during this encounter, Dr H noticed the notes from her last office visit in which she expressed suicidal ideation. After sitting in an exam room for several hours, Mrs A, who had not been told that she could leave yet, had had enough. She got dressed, walked out, and was walking to her car when a nurse ran out and told her that she could not leave the hospital.

“You’re not doing anything for my leg, and I’m tired of sitting here,” said Mrs A. “I have to get home to take care of my sick cat. I’m not staying here any longer.” She continued walking toward her car. At this point, the nurse called hospital security, who in turn called the police. Mrs A was then escorted back to the hospital by a nurse, 2 security guards, and 3 police officers. The nurse told Mrs A that she would have to change back into a hospital gown, relinquish her purse to a security guard, and speak to a mental health counselor.

After this, the situation began to spiral even more out of control: as the nurse was insisting that Mrs A put on a paper gown and hand over her purse, a struggle ensued between Mrs A, who was trying to hold on to her purse, and a police officer who was trying to take it. The police officer was bitten on the finger during the struggle, and Mrs A was arrested for battery.

Months after the incident, Mrs A sued the hospital for false imprisonment. The hospital made a motion for summary judgment, arguing that there was no issue of material fact in dispute, and according to the law they were entitled to judgment. The court agreed and dismissed the case. The patient appealed.