Hospital discharge: psych patient not sent to appropriate care setting, nurse liable for death.

Position:Case overview

The fifty-three year-old schizophrenic patient had spent most of his adult life in psychiatric institutions and group homes.

His last residence before he died was a nursing home. The nursing home had an attendant take him to the outpatient urology clinic on a New York City hospital campus for evaluation of a urinary tract infection. The urologist did an outpatient bladder scan.

The urologist decided rather than go ahead with cystoscopy in the outpatient clinic it was better to admit the patient to the hospital so that cystoscopy could be done in the operating room.

The urologist reportedly told the attendant not to wait around for the patient as he would not be done until very late that evening. In fact, the patient would not be discharged until the next morning.

Nurse's Discharge Instructions Told Patient He Was "Going Home"

After the cystoscopy the patient got a Foley catheter and a urine bag. The discharge nurse's patient teaching apparently focused on how to take care of the catheter and empty the urine bag.

After going through the basics of Foley care the nurse simply allowed the patient to walk out of the facility alone.

The patient was found dead in a New York City park eleven days later. The autopsy revealed he had gone without food or water for several days before he died and he apparently pulled the Foley catheter out by himself.

The family's lawsuit pointed to a breakdown in communication between the urologist, the urologist's physician's assistant and the discharge nurse.

It was not clear if the physician's assistant and the discharge nurse ever spoke directly. The discharge nurse nevertheless was somehow given to understand that the patient was to be discharged "home."

Not having reviewed the chart carefully the discharge nurse failed to realize that "home" for this patient meant the nursing facility he came from, not an independent discharge into the community.

The hospital's policy was that any...

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