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I work in an obstetrics (OB) unit in a small rural hospital. A male patient with a history of substance abuse was treated in the ED for a drug overdose, then admitted to the hospital for observation and further treatment. The only available bed was in the OB unit.

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Because this patient was agitated and possibly hallucinating, we nurses thought placing him on the OB unit was unsafe for the newborns and mothers. He was ambulatory and we were afraid he'd walk in on another patient and her baby. We discussed this with our manager, but she said the hospital was full and her hands were tied.


Fortunately this patient was discharged without incident. But now we're wondering-if someone had gotten hurt, would the hospital or nurses have been liable?-M.S., MAINE


The hospital has a duty to provide a safe environment for all patients. If one patient is potentially dangerous to others, the hospital should take steps to ensure safety-for example, by providing a sitter or making other security arrangements. If the hospital fails to meet this obligation, it could be held liable if someone gets hurt.


Your facility should have admission and discharge criteria for the OB unit, which this patient wouldn't have met. It should also have a policy for holding patients in the ED. Failure to have appropriate policies and procedures in place (or failure to follow them) could expose the facility to significant liability.


What about your personal liability? Sounds like you properly alerted management to your concerns, which would probably protect you from legal exposure in court. But don't hesitate to go the extra mile if you believe your patients are in danger. Work through channels to institute appropriate policies and procedures and rectify this unsafe situation before someone gets hurt. Document your efforts at every step.