Gary Mottau voluntarily checked into the McPike Alcohol Treatment Center ("McPike"), which was operated by the state. Mottau was told that if he violated center rules, including the drinking of alcohol, he would be dismissed from the center. One day, Mottau left McPike, bought a bottle of vodka, consumed most of it, and returned to the Facility. After the staff came to the conclusion that Mottau had been drinking, a Breathalyzer test was administered to him. When the results revealed a blood alcohol reading of 0.22 percent, he was discharged. Staff members made two offers to Mottau to transport him to a place where he could sober up, but he refused and left on foot. Approximately two hours later, he was struck by a car on a dark road.
Mottau filed a claim against the State of New York, alleging that the McPike staff negligently allowed him to leave the center in an intoxicated condition.
Holding: The claim was dismissed. The court of claims first looked to see if the staff at McPike owed Mottau a duty of care. They found that their relationship fell between the psychiatric facility-patient relationship, where a duty is owed, and the tavern owner-intoxicated patron relationship, where no duty is owed. The court decided Mottau's situation was closer to that of the intoxicated tavern patient, since Mottau could have no reasonable expectation that he would be protected from the consequences of his impaired state. To support this conclusion, the court pointed to the facts that Mottau was voluntarily at McPike, and that he was told he would be dismissed if caught drinking.
The court went on to conclude that even if a duty had existed, McPike did all that it could to help Mottau. McPike did not have adequate facilities to provide supervision for intoxicated individuals. Their policy was to offer to transport the intoxicated person to a rescue mission, an alcohol crisis center, or the person's home. McPike followed this policy, but Mottau refused to accept the center's help. Mottau contended that given his high blood alcohol level, McPike should have known that he was incapable of making a reasoned decision, and thus his refusal of help did not relieve the center of its duty. The court rejected this argument, pointing out that under Mottau's interpretation, the center would have had to transport him against his will, and that McPike did not have authority under state law to take such an action.
| Samuel Klagsbrun, M.D. Chief Executive Officer Four Winds Hospital |
Dr. Klagsbrun comments: The court's decision to absolve the alcohol treatment center which discharged the claimant, Mr. Mottau, for violating the Center's rule against intoxication may possibly have legal validity as narrowly defined by existing law. As a practicing psychiatrist however, I find that decision unacceptable from the point of view of best practice standards.
I have great difficulty accepting the assertion offered by the treatment center that they were unable to handle and monitor a drunken patient. I find it very hard to believe that the facility could not put the claimant in bed, let him sleep it off, and discharge him once he awoke from his drunken sleep. Having consumed a bottle of vodka, the claimant was unlikely to get into medical difficulties or go into DTs, as the facility apparently feared. Furthermore, the claimant was familiar to the staff at the facility and they could easily, in my opinion, have negotiated his cooperation to go to bed or stay confined in a room until he sobered up. That would have taken a minimal effort.
The concern I have has more to do with the underlying principle that every healthcare facility should live up to the full responsibility of doing its best on behalf of patient care, even in the face of difficult patients. Allowing a delusional patient, a psychotic patient, or a drunken patient whose judgment is highly questionable, or a patient whose judgment is so poor as to be unable him to step out of harm's way, to leave the grounds of a healthcare facility is simply wrong by standards of responsible and appropriate care. Many, if not most, patients who are in a facility for purposes of treating their addictions, will periodically, if not commonly, break the rules. If they do so in a fully conscious and competent state of mind, they are of course to be asked to leave. If they do so in a highly questionable state of mind, there is a responsibility by the facility or health practitioners to protect a patient against himself, especially when he is basically incompetent to make sensible decisions.
If the facility, for reasons that are hard for me to understand, would have found this approach unacceptable, offering an alternative to an intoxicated man is not the answer. Placing such a patient in the car and driving him either to another facility, an emergency room, a safe house, a relative, or even jail, would have been preferable as a way to keep him safe until he recovered from the intoxication. The opinion in Mottau states: 'The statute authorizes" an appropriate person to 'take the person to an alcoholism facility for immediate observation care and treatment." The claimant already was in such a facility and the appropriate behavior for that facility was to keep an eye out on the claimant until he was safe to be discharged.
Let him sleep it off then discharge him once be awakens.
As a medical director of a psychiatric facility which has a substance abuse division, had any of my staff allowed such a patient to leave while intoxicated, that staff member would have been fired on the spot. There isn't a facility in the country which does not face the situation described in this case with a large number of patients. It is a difficult part of running a facility, but it is a routine aspect of the responsibility, which goes hand in hand with being a caretaking professional.
 | Lawrence Levine, J.D. Professor of Law University of the Pacific |
Professor Levine comments: At least to the extent that the court determines that the McPike Alcohol Treatment Center owes no duty to the injured plaintiff, this decision seems wrong. Duty focuses on whether the law imposes an obligation on the defendant to act other than arbitrarily toward the plaintiff. Here the plaintiff sought out the defendant for alcohol treatment, no doubt paying the defendant for its services. While it is true that under traditional duty principles a person is not obligated to intervene for another's benefit, here there is a special relationship under which the plaintiff is to some measure entrusting himself to the care of the defendant based on the defendant's asserted expertise. Surely this should constitute a special relationship creating obligations of care on the defendant's part.
Further, a key component of finding duty is foreseeability. Nothing that transpired here appears unforeseeable. It is hardly surprising that a person seeking aid with alcoholism would relapse and become intoxicated (notwithstanding internal policies to the contrary). Nor is it unexpected that a person who was expelled from the treatment program and permitted to leave the defendant's facility alone after the defendant determined that he was highly intoxicated (almost three times the legal limit) would be injured as a result of his inebriated state.
A stronger basis for the court's decision is that, assuming a duty was owed by McPike Alcohol Treatment Center, there was not enough evidence from which a jury could reasonably find breach of duty—that is, negligent conduct on the part of the defendant. The court finds that, in light of New York law, the steps taken by the defendant were reasonable. If in fact relevant state law placed the defendant in the predicament claimed by the court (potential liability for keeping the plaintiff and a risk of liability for setting him free), the answer lies in changing the law, not in allowing this defendant to escape responsibility for foreseeable harm caused by its actions.
