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Klein v. Sanford USD Medical Center

Supreme Court of South Dakota

December 9, 2015

NICHOLAS SHAWN KLEIN, Plaintiff and Appellant,
SANFORD USD MEDICAL CENTER, Defendant and Appellee.



PETER J. BENDORF Sioux Falls, South Dakota and ANDREW BIRKELAND of Hovland & Rasmus, PLLC Edina, Minnesota Attorneys for plaintiff and appellant.

MELISSA C. HINTON REECE M. ALMOND of Davenport, Evans, Hurwitz & Smith, LLP Sioux Falls, South Dakota Attorneys for defendant and appellee.

ZINTER, Justice

[¶1.] Nicholas Klein sued Sanford USD Medical Center for damages allegedly caused by his claimed premature discharge from the hospital. The circuit court granted Sanford summary judgment. The court concluded that Sanford was entitled to good faith immunity under SDCL 34-12C-7 because Klein demanded to be discharged against medical advice. Klein appeals, asserting that SDCL 34-12C-7 does not apply, and that if it does apply, there was a genuine dispute of material fact whether Sanford acted in good faith. We affirm.

Facts and Procedural History

[¶2.] On January 16, 2011, at approximately 1:00 a.m., thirty-eight-year-old Nicholas Klein drove to the Sanford USD Medical Center emergency department after being struck in the throat and head during an altercation at a bar. The nurse's notes recorded Klein "has a normal mood and effect. . . . His mood appears not anxious. He does not exhibit a depressed mood. He expresses no homicidal and no suicidal ideation." At approximately 2:00 a.m., Klein complained of increasing pain in his neck and throat. Sanford performed a CT scan and recommended that Klein be intubated to protect his airway. Klein was intubated and admitted to the intensive care unit. The nurse's notes indicated that Klein "tolerated the procedure well. There were no complications."

[¶3.] While intubated, Sanford staff administered sedation medication-Propofol, Versed, and Fentanyl. The record is not clear, but it suggests that Klein began to receive sedation medication at 2:30 a.m. To assess the condition of his airway and determine whether Klein should remain intubated, Dr. Ashraf Elshami obtained consent from Klein to perform a bronchoscopy. The bronchoscopy revealed no compromise to Klein's airway. At approximately 11:00 a.m., after Klein had been intubated for approximately eight hours, Sanford staff extubated Klein and discontinued administration of sedation medication.

[¶4.] At 11:55 a.m., Klein asked Sanford Nurse Kelli Kolander when he would be allowed to leave the hospital. She informed Klein that a physician would have to discharge him sometime during the week. Klein became agitated and started to pull at his heart rate monitor, IV, and tubing. Klein insisted on leaving the hospital. Kolander informed Klein that he would be leaving against medical advice. She asked that Klein allow her to consult with his physicians, and Klein agreed. Kolander contacted Dr. Curtis Peery (the on-call trauma surgeon) and Dr. Elshami. Dr. Peery did not object to Klein leaving against medical advice. Dr. Elshami informed Kolander that he wanted Klein to drink fluids before leaving. Klein refused. Kolander related Klein's refusal to Dr. Elshami, and Dr. Elshami informed Kolander that Klein could not be forced to drink fluids. Dr. Elshami approved Klein leaving against medical advice. Kolander also contacted Klein's regular physician, Dr. Schaefer, and spoke with Dr. Schaefer's resident. Dr. Schaefer's resident approved Klein leaving against medical advice. According to the nurse's notes, Klein informed Kolander that he had an appointment scheduled with Dr. Schaefer for the next week.

[¶5.] After consulting with Klein's physicians, Kolander obtained Klein's signature on a release form reflecting his desire to leave against medical advice. Kolander also obtained Klein's signature on additional paperwork related to his discharge. Klein refused to take any discharge paperwork with him. He also refused any assistance with his dressings after the IV was removed. Kolander offered to contact Klein's family. Klein refused, although he gave Kolander permission to inform his family that he had left if his family were to contact the hospital. Klein told Kolander that he would drive himself home. She informed Klein that his judgment and ability to drive could be impaired because he had received sedation medication within the last four hours. The nurse's notes indicated that Klein said he did not care and would drive anyway. The nurse's notes further indicated that Klein "was agitated through this time."

[¶6.] After leaving Sanford at 12:30 p.m., Klein drove to his mother's home, retrieved a bottle of alcohol, and drove to his home in Hills, Minnesota. At some point between 12:30 p.m. and 2:30 p.m., Klein drank the alcohol and overdosed on his HIV medication (Ritonavir and Darunavir) and acetaminophen. Klein then walked out of his house and brutally assaulted his neighbors. Klein later explained that he had no clear memory of his actions after leaving Sanford. Klein had a history of depression, anxiety, and prior suicide attempts.

[¶7.] Klein pleaded guilty to multiple charges related to the assault. As part of his criminal prosecution, a Minnesota court ordered a psychiatric evaluation. Dr. Michael Harlow examined Klein and issued a mental health hold. Dr. Harlow opined that at the time of the assault, Klein was "mentally ill secondary to delirium from medication administration." He concluded that Klein "was laboring under such a defect of reason at the time of the offenses that he did not know the nature of the acts or that they were wrong." The Minnesota court found Klein "not guilty by reason of mental illness[.]"

[ΒΆ8.] In January 2013, Klein brought this suit against Sanford. He alleged that at the time of his discharge, he was suffering from a state of substance-induced delirium and Sanford should have been aware of his changed mental condition. Klein claimed that Sanford negligently failed to assess his mental condition after he insisted on leaving against medical advice, which failure made him a danger to himself and ...

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