Adding insult to injury? Doctor who suffered jaw, eye and brain injury from attack by MMA fighter patient ordered to pay court costs

A B.C. doctor who suffered a brutal assault by a hospital patient who used to be a world-class jiu jitsu fighter has been ordered to pay court costs for a 36-day civil court trial that he pursued after rejecting a $625,000-settlement offered by the province’s Interior Health Authority. Dr. Rajeev Sheoran, a psychiatrist who works in the Okanagan region, failed to prove in court that the health authority was liable for the attack because it was negligent in ensuring there were proper policies and procedures that would have prevented the assault from happening, nor did it implement whatever policies and procedures it already had. The assault “could have and should have been predicted and prevented,” Dr. Sheoran claimed in his civil suit. But the claim was dismissed in March, with the judge finding that Dr. Sheoran had not proven that the health authority’s actions “fell below the requisite standard of care.” The Interior Health Authority asked the court to order Dr. Sheoran to pay double its court costs because it had made a settlement offer in September 2021, but the judge rejected that request. Gregory Stanley Nield, the patient who assaulted Dr. Sheoran, was sentenced in April 2017 to 30-months probation but his conviction and sentence were appealed. In February 2020 the charges against Nield were dropped because of errors made by the judge in the original trial. Read: Pain management: Tulsa shooting exposes threats doctors face Although Dr. Sheoran did not succeed in his civil claim, “his decision to proceed to trial instead of accepting the offer was not an unreasonable one,” the judge noted in his decision. “The amount of the offer was a small fraction of (Dr. Sheoran’s) claim for damages, and indeed was a relatively small fraction” of the health authority’s position on damages, the judge wrote. Indeed, experts retained by both parties agreed that Dr. Sheoran had suffered multiple physical injuries, including jaw fractures involving both mandibles, fractures of the orbial walls, a periorbital hematoma, nasal bone fractures, dental injuries, cranial nerve injuries and a traumatic brain injury. He needed an eye implant and reconstructive dentistry. In addition to his physical injuries, Dr. Sheoran has been diagnosed with major depressive disorder and post-traumatic stress disorder. However, the health authority’s experts disagreed with Dr. Sheoran’s experts about his prognosis for recovery and return to work, arguing that Dr. Sheoran would, with assistance and accommodation, be able to go back to his career in medicine. Read: How to stop patient hostility The attack on Dr. Sheoran happened in December 2014, when he was interviewing Nield, a world-ranked jiu jitsu competitor and registered massage therapist who was committed to the Penticton Regional Hospital under the Mental Health Act. According to court documents, Nield had gone to the emergency department with his wife, who had reported that for the past few weeks her husband had not been sleeping and was exhibiting mood swings and erratic behaviour. Nield, who had been self-medicating with magic mushrooms for headaches, had become more confrontational and was having problems at work and with the neighbours. On the day of the attack, Dr. Sheoran was alone with Nield in an interview room at the hospital. Nield had been asking for passes that would allow him to leave the hospital temporarily and Dr. Sheoran took him to the interview room for an assessment. While he could not remember what triggered the attack, Dr. Sheoran recalled seeing Nield leaning down “as if he had dropped something” and then punching him in the face. He tried to get to the panic button inside the room but was hit again and lost consciousness. Read: Turkish medical workers strike for better pay, safer work A nurse who was at the nursing station at the time described hearing “a number of very loud thuds that sounded like someone banging on furniture.” She went to the room as Nield was leaving and found Dr. Sheoran “slumped onto the desk in the corner of the room and seated on the chair, and there was a lot of blood. The nurse followed Nield around the ward at a distance to ensure he didn’t come into contact with other people, according to court documents. At one point Nield complained that his hand was sore and asked for some ice. In his civil suit, Dr. Sheoran asserted that the health authority was either “ignorant of its obligations to assess and mitigate the risk of violence” in the inpatient psychiatry unit at Penticton Regional Hospital. He cited the health authority’s failure to conduct a violence risk assessment—which is legally required—and an aggressive behaviour assessment scale. However the health authority argued that the standard of care is not defined by an assessment scale or a form. Rather its duty of care is to take “reasonable steps to provide a safe work environment, including with regard to violence prevention, and that it met those obligations.” In his decision, the judge noted that there was no dispute about Dr. Sheoran suffering a loss because of the assault or about the health authority owing him a duty of care. “The primary area of controversy in this case is the standard of care and whether the (Interior Health Authority’s) conduct fell below that standard,” he wrote. A key basis for Dr. Sheoran’s suit was his argument that, had the health authority complied with its obligations, no one would have gone with a high-risk patient into any of the interview or treatment rooms as they were designed at the hospital at the time of his assault, and that there would have been at least two people with the patient. He also said there would have been a better system in place to communicate the risk of violence, as well as a mechanism to move someone such as Nield to a more suitable facility. However, Dr. Sheoran was not able to prove in court that he had asked any of the nurses to be present for his assessment of Nield. None of the nurses could recall him making such a request and he could not recall which of the nurses he had asked. Read: Neurologist facing court proceedings in cases alleging sexual assaults against multiple patients The judge also noted that Dr. Sheoran, having interviewed Nield on previous occasions, knew as well as—if not better than—anyone about Nield’s risk for violent behaviour. “Although (Dr. Sheoran) argues that if a violence risk assessment had been conducted earlier, there would have been policies and procedures in place that would have identified Mr. Nield as a high risk patient, the fact is that the risk posed by Mr. Nield was well-known on the ward,” the judge wrote. “Nothing that would have flowed from a violence risk assessment, even if one had been conducted earlier, would have changed anything.” The judge pointed out that, by the time of the assault, Dr. Sheoran had met with Nield alone in the interview room on more than one occasion, and that he had done so even though he had more information than another did about Nield’s history of violence. Dr. Sheoran’s claim that the health authority should have had a policy that would have prevented anyone from meeting with Nield alone is, in effect, “suggesting that the assault would not have occurred if the (Interior Health Authority) had a policy that would have overridden his own clinical judgment. “However, he presented no expert evidence on the standard of care that provided a single example of a hospital or health authority with such a policy,” wrote the judge. “As such, the evidence falls far short of establishing that the (Interior Health Authority) was required to have such a policy.” Since the attack, the health authority rolled out a number of safety improvements to protect staff in the psychiatric ward. These include additional security cameras, improved sight lines in the interview room, and weighted furniture in place of common area furniture. Staff and physicians were also required to use a personal alarm system. Read: Discrimination not a factor in hospital's refusal to treat black man who died hours later: SHA

Adding insult to injury? Doctor who suffered jaw, eye and brain injury from attack by MMA fighter patient ordered to pay court costs

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