Cases dealing with brain and head injury involve a complex and highly specialized aspect of the law. In cases of medical malpractice, the depth of experience required, as well as knowledge and awareness of the clinical, and legal aspects involved, is substantial. Trial and context specific experience, as well as a knowledge of past cases can make or break these cases.
In the case of Michael Jason Paur, who hanged himself in a bathroom of St Paul’s Hospital, British Columbia, the hospital was found negligent under the Occupiers Liability Act, R.S.B.C. 1996, c. 337. The two nurses responsible for Paur’s care at the time of the incident, were found liable under negligence. These rulings held through an appeals process.
The initial medical malpractice claim was brought against the admitting physician, Dr Pickett, as well as against the hospital and the nurses who were responsible for the patient’s care at the time of the incident. In cases such as these, it can be difficult to assess negligence of medical professionals, particularly where the judgement of negligence requires some clinical knowledge, but in this case, although the incident was not fatal; the patient suffered severe brain damage as a result of the suicide attempt; and it was clear that the incident could have been avoided with better supervision, and the consideration of the institution to render the ceiling ligature proof. Ultimately the facts were around required standards of care, and the existence of foreseeable risk.
Much of the main court case was taken up with deliberations around the expert opinions provided by Mr. Paur’s legal counsel. When the court explored the facts surrounding this case, it was found that there was substantial evidence, at the time of the involuntary admission of the patient that he should have been better supervised. In the conclusions of the original case, the hospital was found to be negligent because they should have been aware of the real risk associated with this patient, and the fact that there were no policies or protocol in place to ensure patients were not unmonitored [6,7,8,10]. The nurses were found to be negligent for having ‘lost track’  of the patient for long enough for the incident to occur. Dr Pickett, the ER Physician, was not found to be liable.
These defendants questioned the validity of the so called expert reports, brought as evidence against them, mainly on the basis that they deemed these experts insufficiently qualified to make judgements on the matter, and stated that their opinions were not properly explained. When the reports of each of these three experts were examined in court however, none were found to be inadmissible, having adhered to the rules for admissibility drawn from legal precedent of a range of cases referenced. Two doctors; one psychiatrist, and one anaesthetist; and an architect, found a number of key background facts, which point to the reality of negligence. Mr Paur had clear indications of being a suicide risk, and had been certified under the Metal Health Act, for having suicidal thoughts, on admission to the hospital. When found, he had been hanging for some five to ten minutes, in a locked bathroom in a ward, and indicating a pathology, which required strict supervision and observation.
These decisions were taken to Appeal. The Supreme Court of Appeal found that the liability issue which rested on the onus of proof on standard of care required, would remain unchanged, but that the weighting given to consideration of privacy required some further deliberation. This was duly considered in the appeal, but the conclusion reached, was the presiding judge sufficiently considered the therapeutic aspects of privacy and dignity for mentally ill patients, but was right in her weighting and prioritization of safety over privacy .