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Court Discusses Application of Mental Hygiene Law

 

In 1971, a mildly retarded individual was admitted to the Wassaic Developmental Center, a State institution for the mentally retarded. At the time of her admission, she was 16 years of age, and had a known history of epileptic seizures which rendered her immobile for minutes at a time. Her medication, Dilantin, kept her epileptic condition under control although she did continue to experience some seizures following her admission. In 1974, the child was placed in a family-care home. At the time of the placement, 6the foster mother was informed by social workers that the child was an epileptic, but was never given any records regarding her condition. The foster mother was told that the child was to take her medication three times a day. Between the years 1974 and 1978, the child suffered periodic seizures while under the foster parents’ supervision.

The foster’s residence had been certified by the State as a family-care home following an inspection in or about 1975. A recertification was made in 1977. During the certification inspections, as well as intermittent other inspections, no hazardous conditions were found to exist in the home. The second-floor bathroom, where the underlying incident occurred, was outfitted with a bathtub, commode, sink and closet. The bathtub, which was enclosed by sliding glass doors, was equipped with a showerhead and faucet with one control for the hot and cold water. The door to the bathroom was a solid, standard, wood type with a butterfly lock below the handle on the inside of the bathroom. There was no turning device for the lock on the outside of the door. The foster’s were never directed to remove or change the lock on the bathroom door.

On April 7, 1978, at approximately 7:00 P.M., the child went to take a bath in the upstairs bathroom. Although she had not been told to do so, she locked the bathroom door. She stepped into the bathtub, turned on the hot water, and then suffered an epileptic seizure which rendered her immobile. At approximately 7:15 P.M., the foster mother became aware of the problem when another mentally retarded client residing in the home summoned her. Upon arriving at the bathroom, she discovered the door locked. By looking underneath the door, she was able to observe the child standing in the corner of the tub, with her back against the wall, and away from the shower spout. The bathroom door was eventually forced open and the claimant was transported to the hospital. The child was diagnosed as having suffered first, second and third degree burns on her lower legs and ankles.

The instant claim against the State was commenced in 1980, seeking to recover $5,000,000 for personal injuries, $750,000 on a derivative claim and $10,000,000 in punitive damages. Following a trial, the Court of Claims found, in the first instance, that the State had the primary responsibility for the child’s care and safety and as such was required to insure that any potentially unsafe condition which might exist in the subject family-care home be remedied. The court also determined that the foster parents were agents of the State and, therefore, negligence on their part was imputable to it. Based on the facts as adduced at the trial, particularly the child’s known history of epileptic seizures, the court concluded that the State was negligent in permitting them to have a bathroom door in their family-care home equipped with a lock which could not be opened from the outside. Such negligence was further found to have been a proximate cause of the injuries suffered since, as a result thereof, the child was exposed for several minutes to water of such a temperature that it resulted in severe burns. She was awarded $125,000 as full compensation for her injuries. The derivative claim and the demand for punitive damages were dismissed.

The issue presented by these appeals is whether the State may be held directly liable for injuries sustained by a mentally disabled individual, while a resident of a State-certified family-care-home in which she had been placed by the State pursuant to Mental Hygiene Law article 31.

Before discussing the issue of the State’s direct negligence in this case, we note that a question arises as to whether the Court of Claims’ determination that the foster parents negligence could be imputed to the State was proper. Mental Hygiene Law article 31 and the regulations promulgated thereunder provide for the placement of mentally disabled persons in State certified family-care homes. Such facilities are defined as “the combination of a private residence and a family certified by the commissioner according to regulations stated elsewhere in this part to provide care for no more than 10 mentally disabled persons”. A family-care provider is “a person or persons to whom an operating certificate has been issued by the commissioner to operate a family care home”. Placement in a family-care home acts as a conditional release which terminates the State patient’s inpatient status and sets up an arrangement of outpatient care and treatment.

In considering the issue of whether the State could be vicariously liable for the negligence of a family home-care provider. That case involved a mentally disabled individual who had been committed to a State institutional school. During the claimant’s confinement, the school entered into a custodial contract with a nearby farmer, allowing the claimant to work on the farm on “convalescent status”. While working on the farm, the claimant sustained physical injuries when he fell 40 feet from the top of a scaffold erected on the outside of a silo. The trial court in Hawley found the State vicariously liable for the claimant’s injuries.

This holding, however, does not mandate that the Court of Claims’ modified judgment be reversed and the claim dismissed. If the record supports a finding that the State was independently and directly negligent vis-a-vis the claimant, the additional holding in the Court of Claims’ decision imputing the fosters’ negligence to the State is mere surplusage which would not nullify the ultimate judgment in favor of the claimant. Having eliminated the State’s alleged derivative responsibility for possible negligence of the contract-service providers, it must, therefore, be determined whether the State can be found to be an independent tort-feasor based upon direct negligence on its part under the specific facts of this case.The State is not an insurer against any and all injuries suffered by mentally disabled patients in its care.

It is well settled, however, that the State is under a duty to exercise reasonable care in protecting such patients so as to prevent their being injured that: “The cause of injury, however, must be one that the State could reasonably foresee before liability attaches. The degree of reasonable care is measured by the physical and mental infirmites of the patients as the hospital officials and employees know them.
A claimant, in order to establish the negligence of the State, must show that it was reasonably foreseeable that an injury could occur but need not demonstrate that the precise or exact manner in which the accident occurred was foreseeable or could be anticipated. In the instant case, the resolution of this issue requires a study of the State’s policies and programs with respect to mentally disabled persons such as the subject child.

Over the years there has been an acceleration in the community placement programs, such as family-care homes, so that the State’s patients could live in smaller, less regimented, home-like environments in a local community. Such programs came about due to the exposure and subsequent furor surrounding the deplorable conditions existing at Willowbrook Developmental Center in 1977. The overpopulation therein, with the resultant problems, caused a major rethinking of and radical changes in the methods of treatment to be afforded at State’s facilities, including Wassaic Developmental Center.

In addition to reducing the populations of such facilities, a major goal and concern was the creation of safer, more normalized environments and life styles for the patients. Indeed, 14 NYCRR 87.8(d), in setting forth the duties and responsibilities of family-care providers, states, in particular, that they shall “(1) provide a home-like, family living environment. The family-care provider must ensure a resident’s right to reasonable privacy”. The whole thrust of the normalization theory was to embark on programs providing new and stimulating experiences so as to allow the patients to develop beyond a mere simple existence.

As this normalization process was the primary basis of the family-care home program in which claimant was a participant, she was encouraged to be more responsible for herself in daily living in an attempt to normalize her life. To assist her in this endeavor, a clinical staff, under the supervision of a treatment team leader, was assigned to follow her progress as a family-care home patient. Such teams followed up on the clinical aspects of an individual’s treatment plan developed at the time of release. A major part of such treatment, as with the entire normalization program, was the encouragement of feelings of independence and self-sufficiency in the individual clients. The purpose of the team was to insure that the specialized needs of a patient were being met, and that a healthy, ideally normalized environment was being provided.

The State was aware that such environments, with more freedom and privacy, entailed greater risks for its family-care home patients, as opposed to other patients in more restrictive programs. Of particular import is the fact that, while rules applicable to community residences or multiple dwellings require bathroom door locks to be operable from the outside to facilitate opening in the event of an emergency, such a requirement did not apply to the home-care program. The general expressed objective of the State was that such environments were to be normal and homelike rather than danger-free for the general home-care patient. As a general rule, such objectives may be deemed laudable and appropriate. Unfortunately, Adrienne was subject to the unique problem of a seizure disorder, which fact was well known by her team leader, members of the team and the foster parents prior to April 1978.

It is well settled that a finding of negligence does not impose liability unless such negligence is found to have been a proximate cause of the injuries suffered. The claimants’ burden then is to show that the State’s conduct was a substantial causative factor in the sequence of events which led to the injuries. However, such a showing needs not be made with absolute certainty nor exclude every other possible cause of the injury. Whether or not the delay occasioned by the locked bathroom door was a substantial factor in causing the injuries sustained is a question of fact which may be determined by a review of the expert medical testimony.

All of the experts agreed that the amount of time during which the skin is exposed to a source of heat is a significant factor in the development and degree of severity of the resulting burn. The body’s ability to disperse the heat being applied to it is diminished as the temperature of the water increases and as more of the body surface is covered by the water. Here it is apparent that certain critical limits were exceeded with respect to the temperature of the water, the area of skin exposed to the heated water and the amount of exposure time which necessarily resulted in the severe burns sustained by Adrienne. The facts and circumstances were present in sufficient quantity and quality so as to permit a finding that the child’s injuries were caused by prolonged exposure to hot water resulting from an inability to expeditiously rescue her. We find no reason to disturb that finding since the defendant’s negligence with respect to the lock caused the delay and was, therefore, a substantial factor in causing Adrienne’s ultimate injuries and was a proximate cause thereof.

While we agree with the State that Adrienne was entitled to privacy, we find insupportable, with respect to her particular situation, the position of the Commissioner of Mental Health that the interest of such privacy in family-care homes overrides the interest in access to bathrooms from the outside, even where such access would be indicated because of the specific conditions of a resident. These two interests are not mutually exclusive. The State’s duty herein was to provide Adrienne with a reasonably safe environment given its knowledge of her known propensity for seizures. The fulfillment of that duty could very well have been accomplished by a bathroom lock which permitted entry from the outside by a key kept exclusively in the possession of the foster parents. This would have accommodated the patient’s right to privacy while, at the same time, providing immediate access in emergency situations such as that which did, in fact, occur.
This court is in full sympathy with the goals and ideals upon which the normalization process is based and is, therefore, loathe to judicially impose liability which might prompt the State to limit or abandon family-care home programs due to the potential financial burden. Where progress has been achieved in the care, treatment and rehabilitation programs of the mentally ill or disabled, the courts, in exercising their judicial responsibilities, should act with restraint in imposing burdens upon such programs. Despite our reluctance to inhibit the State, in any way, from continuing to structure similar rehabilitative and normalization programs, the particular facts of this case permit the imposition of liability upon the State.

Accordingly, the court held that the modified judgment appealed from should be affirmed.
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