A federal appeals court has upheld a $10,000 fine against a skilled nursing facility for leaving a suicidal patient unattended, who then walked out of the facility and killed himself.

A federal appeals court has upheld a $10,000 fine against a skilled nursing facility for leaving a suicidal patient unattended, who then walked out of the facility and killed himself.

The U.S. Court of Appeals for the Ninth Circuit said the Department of Health and Human Services’ ruled that the decision (Del Rosa Villa v. Sebelius, 2013 BL 330965, 9th Cir., No. 12-71685, 11/26/13) to fine petitioner Del Rosa Villa was supported by substantial evidence. The court denied a petition to overrule decisions that led to the fine.

The unidentified patient first received care at Del Rosa Villa in May 2009 after he broke his leg in a suicide attempt. Hospital employees who treated the man noted psychiatric issues and a risk of self-harm.

After admission to Del Rosa Villa, a nurse noted that the patient should be put on 24-hour suicide watch. The patient was sent to the emergency room after Del Rosa Villa staff couldn’t calm him June 5. The patient returned two days later and resumed the unusual behavior. On June 9, the nursing staff allowed him to go outside the facility to smoke, according to court records. He was found 20 minutes later hanging from his belt.

The incident was self-reported and CMS subsequently cited and fined Del Rosa Villa for failure to adequately supervise a resident to prevent an accident.

Before resorting to federal court, the facility appealed the citation to an administrative law judge and the HHS Departmental Appeals Board, both of which upheld the ruling.

The appeals court announced Nov. 26 that it was “reasonably foreseeable” that allowing the agitated and injured patient to leave the facility unattended was justification for the fine. The original CMS citation found that facility personnel were either unaware of the need or failed to implement heightened supervision; failed to increase the patient’s supervision due to his deteriorating condition; and ignored the foreseeable risk of letting the patient outside unattended.