For Daniel Ryan of Mashpee, a short trip in October to visit his wife in Cape Cod Hospital would be the last journey of his life. For reasons that remain unclear, Ryan was subdued by hospital staff, placed in a headlock, and fell into a coma.
Ryan never regained consciousness and died at the hospital three weeks later. He was 35.
Now, after six months, an inquest will be conducted to determine whether Ryan's death resulted from a crime. The state medical examiner has ruled the death a homicide.
"I think this case lends itself to that particular procedure," said Michael O'Keefe, the Cape and Islands district attorney, who requested the inquest. "The community has a great deal of interest in knowing exactly what happened."
The inquest, to be conducted by Presiding Justice Kevan Cunningham of Taunton District Court, is expected to take place in June. The findings will be considered by O'Keefe as he decides whether to bring charges.
The state's ruling of homicide does not necessarily mean Ryan died from criminal conduct, only that human actions caused his death.
What occurred on Oct. 9 at the Hyannis hospital has been a subject of dispute between the staff there and the state Department of Public Health, which cited the hospital for violating Ryan's rights by using inappropriate restraints that resulted in his death.
What is known is that Ryan's behavior concerned hospital staff to the extent that he was taken to an emergency room to be evaluated. Hospital officials would not elaborate on those initial worries, but Ryan later began walking through the hospital without authorization and was apprehended by a security worker.
Ryan then became violent, the hospital contends, and presented a danger to himself and others.
However, a state review of a video surveillance tape did not buttress that account. Instead of attempting "to break loose and run through the public corridor," as the hospital's report stated, Ryan tripped on a sheet that had been placed over his head and fell forward, according to the video review.
At this point, the state reported, a security officer who had been escorting Ryan also fell forward. He then placed the victim in a headlock, flipped him over, and appeared to restrain Ryan by sitting on him.
At least two other hospital employees helped immobilize Ryan, the report said. According to state investigators, hospital workers do not appear to have evaluated Ryan's condition or eased the restraints until emergency care was required.
Ryan's family could not be reached.
Kerry Choi, a Boston lawyer who represents Ryan's wife and two daughters, rebutted the hospital's assertions that Ryan had become dangerously unruly. "I clearly dispute that he was a threat to himself or others," Choi said. Choi declined to comment on the inquest announcement or the family.
In addition to its findings that the hospital had violated Ryan's rights, the state also found that the security staff apparently had not been trained to restrain patients without harming them.
Three members of the security staff, a security supervisor, a nursing supervisor, nursing assistant, and emergency care technician refused to be interviewed, the state reported. In addition, the director of security failed to file an incident report, the investigation found.
Hospital officials disagreed in the state report that Ryan was inappropriately restrained. David Reilly, a spokesman for the hospital, declined to react today to the announcement of an inquest. Since Ryan's death, Cape Cod Hospital has upgraded its security training among other improvements.
The inquest is expected to follow a preliminary hearing in May, said Louise Illanich, chief administrative assistant at Barnstable District Court, where the closed proceeding will be held.
Justice Cunningham will be able to summon witnesses under oath; and Ryan's family as well as other individuals approved by the judge will be allowed to attend.
"This will afford an opportunity for the family to be there as the evidence is presented," said O'Keefe, who indicated that he intends to ask that the findings be made public.
O'Keefe said he could not request an inquest until after the state medical examiner ruled in March on Ryan's cause of death
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