Risk of harm had to be balanced against value of treating mentally ill patient: court
The BC Court of Appeal has upheld the dismissal of a negligence claim filed by a doctor who sustained injuries from an assault by a psychiatric patient.
In Sheoran v. Interior Health Authority, 2023 BCCA 318, Dr. Rajeev Sheoran sustained devastating injuries when he was assaulted in an interview room in the Inpatient Psychiatry Unit (IPU) of the Penticton Regional Hospital while caring for an involuntary patient, Gregory Nield. He alleged the negligence of the Interior Health Authority (IHA), the agency responsible for the management and operation of the hospital, contributed to his injury.
Dr. Sheoran argued that IHA failed to address the risk of violence posed by patients like Nield. He attributed the assault to IHA's failure to discharge its duty to take reasonable care to ensure the workplace was as safe as reasonably possible. He alleged IHA "invited" him to conduct a high-risk assessment of Nield when it knew or ought to have known that its facilities were unsafe and inadequate for such evaluations.
Furthermore, Dr. Sheoran claimed that IHA failed to make adequate inquiries into the threat posed by Nield, including failing to conduct a psychiatric intake and risk assessment. He also said that IHA was unable to take precautions, such as providing staff members with individual panic buttons or personal alarms.
Trial judge's ruling
The trial court ultimately dismissed Dr. Sheoran's claims, so he elevated the matter to the BC Court of Appeal. Dr. Sheoran argued that the trial judge applied an inappropriate standard of care by asking whether IHA acted following medical standards of care in the management of its psychiatric facilities. He contended while that standard is appropriate when determining what care is owed to patients, it is not appropriate when determining whether IHA exercised reasonable care to protect the physicians and staff in the hospital.
Dr. Sheoran emphasized that the case highlights the importance of distinguishing between the duties a health authority owes to its patients from the duties it owes to employees and staff members.
Standard of care
The court noted that the general standard of care was described as an obligation to exercise the care that would be expected of a reasonable and prudent agent in the same circumstances. The court further recognized that the general standard of care does not hinge on expert evidence. However, the definition of the specific obligations owed to the plaintiff is a question for the trial judge to address on the facts of the case.
The court said the trial judge was bound to determine whether IHA discharged its duty to take reasonable care to ensure Dr. Sheoran's workplace was as safe as reasonably possible, recognizing the inherent risks in caring for psychiatric patients. However, the law also required him to engage in a balancing process. In the court's view, the standard of care is a question of law, but its content is always contextual.
The court found that while the jurisprudence to which the trial judge referred when formulating the standard of care was not particularly apt because some of the cases referred to addressed the duty of care a physician owed to a patient, he clearly stated that he was seeking to establish the duty the IHA owed to protect the health and safety of its medical staff.
Furthermore, the court found that the judge accepted that the standard should be "informed by the Worker's Compensation Act and the related Occupation Health and Safety Regulations, IHA's own internal policies, and by the actions taken by other health authorities."
The court also acknowledged that the trial judge regarded evidence concerning the manner in which psychiatric patients should be treated as essential to the translation of the standard of care into a particular set of obligations owed by a defendant when addressing the most significant allegations of fault.
The court also explained that where the work entails some risk of injury, determining what measures should reasonably be taken to reduce that risk requires an appreciation of the costs and benefits. For instance, physicians and nurses who treat patients with infectious diseases run some risk of infection. The court found evidence of psychiatrists to the effect that there is some medical value in meeting with a patient alone and barriers to direct communication can interfere with establishing a physician/patient relationship. Dr. Sheoran described the importance of assessing patients privately because confidentiality is "central to medicine."
The court noted that another psychiatrist testified that he interviews patients alone, where possible because doing so "respects the need to develop a therapeutic relationship."
The court emphasized, "To fail to take account of professional standards of care in this context is to address safety in the workplace while ignoring the nature of the work."
The appeal court considered the entirety of the trial judge's judgment and found that the judge did not simply adopt as applicable the standard of care the IHA owed to patients. The court noted that the in addressing the issue of the safety of patients and others in a hospital, the trial judge referred to the "inherent tension between making a psychiatric ward safe for patients and others on the one hand, and providing therapy to patients with the goal of medical improvement on the other." That tension does not arise in describing the medical standard of care owed to patients. Instead, it occurs where the court addresses the duty to make the premises safe as a workplace while also ensuring effective therapy.
The court noted that setting the standard of care requires a balance between the complete safety of the staff and total freedom and privacy. That balance involves evidence concerning therapeutic care.
Ultimately, the court ruled that the trial judge did not commit an error in refusing to define the standard of care without expert evidence. Furthermore, the court concluded that the risk of harm to Dr. Sheoran had to be balanced against the value of treating a mentally-ill patient.
While the court recognized that Dr. Sheoran suffered life-altering injuries while engaged in a "laudable and important task," the court did not find any legal error in the trial court's judgment. Accordingly, the court dismissed the appeal.