The Tennessee Court of Appeals has ruled that a medical center can be held liable for one patient attacking another, raising questions about hospitals' responsibility to protect patients from third parties, American Medical News reports.

A 2010 Joint Commission report found that assaults, rapes, and killings of patients, visitors, and staff at health care facilities have increased in recent years. For example, there have been 256 violent crime reports filed to the group's Sentinel Event Database since 1995. 

The lawsuit was filed against two Tennessee medical facilities in 2010 by a woman claiming that a male patient assaulted her while staying at one of the hospitals. The patient alleged that hospital staff did not adequately monitor her or properly supervise the patient who assaulted her. She also alleged that the hospital accepted patients even though the facility lacked the resources to care for them.

The provider denied any wrongdoing and said the case should be dismissed because the claims do not constitute medical negligence. The hospital also argued that the patient failed to comply with the Tennessee Medical Malpractice Act, which requires plaintiffs to file a pre-suit notice and certificate of merit in medical liability cases.

A trial court initially ruled in favor of the hospital, saying that the case included medical liability claims, such as "monitoring of patients, the admission of patients, and the placement of patients with regard to room assignments and staffing levels." 

However, the appeals court earlier this summer reversed the decision, saying the patient still can sue the hospital for the alleged attack. The lawsuit must move forward on the grounds of "ordinary negligence" or "premise liability," rather than medical negligence, according to the decision.

Is an attack medical negligence?
Experts say a plaintiff can only sue on grounds of medical negligence if it is apparent that the injury occurred as a result of medical treatment or a lack of adequate medical services. However, other court decisions—including a 2007 decision by the Tennessee appeals court—have considered a patient attack as medical negligence. The appeals court in that case—which examined a nursing home patient attack—ruled that the facility's decision to admit and retain a violent patient "was a medical decision."

Hospital executives outline ways to keep patients safe
An emergency physician at the University of Kentucky's Good Samaritan Hospital said facility administrators should be proactive in evaluating a facility's violence risk. He recommended that staff take extra precautions with patients who have a history of alcohol misuse, drug problems, or domestic violence, noting that health workers should be trained in self-defense.

Meanwhile, the network director for protective services at Philadelphia-based Albert Einstein Healthcare Network notes that using technology, such as cameras, panic alarms, and other staff communication tools, can help identify violent situations sooner and lead to faster solutions (Gallegos, American Medical News, 8/29).