April Raymond called 911 and asked for a well-being check on her two children, who were with her ex-husband, Cameron.
She told 911 operators that Cameron was telling her about "the end of the world," that she would never hear her children's voices again and sent her "bizarre texts about blood and cutting." Cameron's parents had shared their concerns with April about his strange behavior in the past.
Two police officers went to the home where the ex-husband and children were. Cameron was cooperative. Even so, they decided to take Cameron to the nearby hospital's ED for an involuntary psychological evaluation. He was placed in handcuffs.
En route to the hospital, Cameron made comments such as, "Me and my two sons are kings of the Book of Mormon" and made reference to a "magic sword." Upon arrival at the ED, Cameron signed a Terms and Conditions of Service Form, which included a section on Consent to Treatment. He was then taken to a room and placed on a bed. The triage nurse found him to be "alert, cooperative, calm and oriented to person, time, place and situation." An ED physician then saw Cameron. The physician asked about his alleged bizarre behavior and comments. Cameron denied them and refused to speak to the physician any further.
A psychiatric social worker then interviewed Cameron. She found his thought processes to be linear and goal directed with "strongly paranoid and moderately grandiose content." She also noted he had strong delusions about his family.
In short, her opinion was that he was experiencing symptoms of a psychotic disorder of unknown origin with paranoid features.
Social worker arranges for admission
The social worker completed the required paperwork for Cameron to be transported and admitted to a psychiatric facility. In addition, a state judge was contacted -- pursuant to state law -- who ordered Cameron "be held for emergency examination and treatment" because of his mental illness, his imminent and substantial danger to others and his need for care and/or treatment. Upon his arrival at the psychiatric facility, a psychiatrist ordered an injection of Haldol (to treat the psychosis) and Geodon (to sedate him).
Nurse John entered Cameron's room and told him he was going to administer medication. Cameron told the nurse he did not want the medication administration and that he had a magic sword and would use it against the nurse if he tried to administer the medication.
The nurse consulted with the physician who ordered the medications and said it was essential the patient receive the medication administration because of his condition. The nurse returned to the room and told Cameron he had no choice but to complete the medication administration, that it was for his condition and that a judge had ordered the same. Cameron nodded and did not resist receiving the injection. Cameron was then taken to another psychiatric facility where a psychiatrist examined him and discharged him because he was not a danger to himself or others. The psychiatrist did prescribe additional medications, and Cameron was told to return to the facility for outpatient therapy. However, Cameron did not feel good on the medications, stopped taking them and stopped seeing the psychiatrist he was seeing at the facility.
Ex-husband files suit
Cameron filed a 10-count complaint, and through a series of legal rulings, the hospital that initially evaluated him in the ED remained the only defendant because of the nurse's and physician's conduct who treated him there. His allegations included assault, battery and intentional infliction of emotional distress.
The jury returned a verdict in favor of Cameron, awarding him $722,600. This sum was comprised of $297,600 in compensatory damages and $425,000 in punitive damages.
The hospital countered by filing a Motion for Judgement as a Matter of Law.
Court's decision on the motion
The District Court denied the hospital's motion. An essential point in that decision is important as it pertains to the nurse's conduct and whether an assault and/or a battery took place. The court discussed the requisite intent for an assault or battery to occur. In an assault, the intent is to cause another harmful or offensive contact. With a battery, the intent is to cause bodily contact.
In this case, the court continued, the nurse was aware Cameron did not want the medication administration. Yet, it was administered anyway.
The evidence at trial clearly indicated "the injection of the unwanted medication would offend a reasonable sense of personal dignity and is thus considered an offensive bodily contact." In addition, the nurse's conduct and testimony also supported the fact he possessed the requisite intent for an assault.
Respondeat superior implications for your practice
This case illustrates several principles of tort law and their application to the practice of nursing and healthcare generally. Initially, the liability of the physician and the nurse were vicariously imputed to the facility under the doctrine of respondeat superior, or "let the master speak," according to TheLawDictionary.org. Because the nurse was an employee of the facility acting within the scope of his employment, and the physician an agent of the hospital, their conduct allowed a judgment against the facility.
Moreover, the physician's conduct when mandating the medication administration and the nurse carrying out the order resulted in Cameron's intentional infliction of emotional distress because the amount of the medications and its forced administration was wanton, reckless, grossly negligent and outrageous.
As a result, punitive damages were found to be necessary. As an employee, remember you carry the potential liability of your employer on your shoulders, in addition to your own individual liability. You may not be named as a defendant in a case like this one, but your employer will be if the facts are sufficient to warrant liability under respondeat superior. Forcing medication administration (or treatment) when a patient does not consent to you doing so is generally a no-no. Even though this patient was considered to have a psychiatric diagnosis and was potentially dangerous to himself or others, that consideration did not justify the physician or nurse's treatment decisions to force the medication administration under the circumstances in this case.
Remember that under your state nurse practice act, you, like this nurse, could face disciplinary action for a breach of obligations under the act or its rules when your conduct so warrants.
You can read more about this case at Raymond v. Wilcox Memorial Hospital (D., Hawaii, 2019), online.
Take these courses to learn more about medication administration:
Administration of Moderate Sedation/Analgesia (1 contact hr) To effectively and safely participate in the administration of IV moderate sedation, RNs must be able to differentiate between the levels of sedation/analgesia; demonstrate competence with preprocedural, procedural and postprocedural nursing care; anticipate and respond to patient emergencies during sedation; and understand the medical-legal aspects of sedation/analgesia. This module will address and define the various levels of sedation, the care of patients through the continuum of care associated with moderate sedation and the appropriate medications to achieve moderate sedation. Medication Non-adherence: America's Other Drug Problem (1 contact hr) Poor medication adherence has been called "America's other drug problem." It leads to unnecessary disease progression and complications, reduced functional abilities, lower quality of life and even death. Behavioral, social, economic, medical and public policy factors contribute to the problem of medication nonadherence and affect virtually every aspect of the healthcare system. This urgent issue has attracted significant attention over the past few years, resulting in major reports and action plans, such as the World Health Organization's Adherence to Long-Term Therapies, the National Council on Patient Information and Education's Educate Before You Medicate and the U.S. National Medication Adherence Campaign's Script Your Future. Nurses can favorably impact medication adherence across the healthcare continuum during hospitalization, following discharge, in clinics, in provider offices and in the community. Medication Reconciliation: Avoiding Dangerous Errors (1 contact hr) Medication reconciliation is a comprehensive review of a patient's active medications during care transitions. It is a strategy that enables healthcare providers to make better prescribing decisions for patients. "Reconciling Medication Information" was added as a Joint Commission National Patient Safety Goal in 2005 with the intent to "accurately and completely reconcile medications across the continuum of care." The addition of medication reconciliation as an NPSG created an awareness of the benefits of the service and formalized the process in order to bridge the gap between a patient's medication history and acute treatments. This CE module provides information about the medication reconciliation process and requirements, as well as the importance of medication reconciliation in improving patient safety.
