What we know and what we don’t know about the fatal fall from the hospital window

Maine Medical Center in Portland. (BDN photo by Seth Koenig)

Maine Medical Center in Portland. (BDN photo by Seth Koenig)

On Tuesday evening at around 5:10 p.m., Paul Cady, 43, of Hollis, fell to his death from a sixth floor window of the Richards Building at Maine Medical Center in Portland, the state’s largest hospital.

The tragic incident has shaken both the hospital community and Cady’s family, and has captured the attention of the entire state.

But many of the details surrounding the case remain unclear, with state, hospital and local police officials saying they’re unavailable or unable to release specifics until they’ve finished their investigations into what happened — which is common in the immediate aftermath of such an incident.

Sometimes in situations like this, it’s helpful to step back and take inventory of what we know and what we don’t know. It helps set the stage for what questions we’ll be asking in the coming days and provides some context for what investigators are likely working to determine.

What we know…

… about Paul Cady

In addition to the name, age and hometown of the victim, as released Wednesday by Portland police, Paul Cady’s daughter, 20-year-old Miranda Cady, has told us a bit more about him.

He was a father of three, raising the youngest of them — a three-year-old — as a single dad.

According to what Miranda Cady has written on an online fundraising page set up to help offset some of the costs of his funeral, Paul Cady was in a serious motorcycle accident on March 9 in which he wasn’t wearing a helmet and suffered a traumatic head injury.

He was put in a medically-induced coma in the immediate aftermath of the crash, but over the course of a few weeks reached a point where his daughter said he was “up, walking and talking.”

… about what happened the night of the fall

Miranda Cady wrote her father was fixated on getting out of the hospital and going back home to his family, and couldn’t seem to accept that he needed more medical treatment and rehab.

Here’s how she described the incident:

“All he could focus on was getting home and due to his state of mind he was willing to try anything to get out of that hospital. He was able to open his hospital window enough to get out. … I would just like to put that this was not an act of suicide but a desperate attempt to be home with the family.”

Paul Cady, seated, with Miranda Cady and others at Maine Medical Center in Portland, in what Miranda Cady described as the last photo taken of him alive. (Photo courtesy of Miranda Cady)

Paul Cady, seated, with Miranda Cady and others at Maine Medical Center in Portland, in what Miranda Cady described as the last photo taken of him alive. (Photo courtesy of Miranda Cady)

… about hospital safety

In addition to Portland police, the state Department of Health and Human Services’ Division of Licensing and Regulatory Services is investigating the incident.

According to DHHS spokeswoman Samantha Edwards, the state of Maine does have licensing rules regarding windows in hospitals. As of 2009, any new or thereafter significantly renovated hospital facility must comply with, among other things, the American Institute of Architects’ “2006 Guidelines for Design and Construction of Health Care Facilities.”

That organization broadly states that if windows in patient rooms are operable, “operation of such windows shall be restricted to inhibit possible escape or suicide.”

More on that in a bit.

Maine Medical Center’s safety record in particular, by at least one watchdog group’s criteria, has been a mixed bag in recent years.

The Leapfrog Group’s semiannual hospital safety ratings, which the group says track “performance in keeping patients safe from preventable harm and medical errors,” are widely cited in media reports and by industry organizations.

Maine Medical Center earned an A grade in the spring of 2012, B grades in the fall of 2012 and in both periods in 2013, and C grades in every ranking released since.

While those grades suggest an overall downward trajectory since 2012, those rankings factor in 28 diverse criteria. Most of the black marks the organization gives Maine Med are for things like surgical site infections and accidental cuts and tears during medical procedures.

Under the criterion arguably most applicable to Paul Cady’s case — a category the Leapfrog Group titles “Track and reduce risks to patients” — Maine Medical has shined.

In the hospital’s most recent evaluation in the fall of 2015, the organization scored Maine Medical Center a 120 out of a possible 120 points under this category, which broadly rates a hospital’s awareness of “safety risks” and whether it’s proactive dealing with them.

… about the stakes

Obviously, this is a tragedy that has affected the Cady family, as well as hospital staff and fellow patients. Maine Medical Center spokesman John Porter has said the hospital offered counseling to staff and patients who were “shocked and saddened” by the incident, and has repeatedly said the institution wants first and foremost to extend its deepest sympathies to the Cady family.

And before the man’s death, Miranda Cady was laudatory of the hospital, writing that her father was being cared for by “some pretty amazing people” in the intensive care unit.

Attorney Daniel Lilley speaks to reporters in this 2013 file photo. (BDN photo by Troy R. Bennett)

Attorney Daniel Lilley speaks to reporters in this 2013 file photo. (BDN photo by Troy R. Bennett)

But we learned Thursday that Portland attorney Daniel Lilley is now representing the estate of Paul Cady. Lilley is well-known for taking on some of the highest profile cases in Maine, and has a reputation as being a fierce advocate for his clients.

In an interview with Portland NBC television affiliate WCSH 6 Thursday, Lilley stopped short of promising any legal action. But it’s fair to say that his presence is a sign the family is at least considering a lawsuit, depending on what the state and police investigations turn up.

What we don’t know

… about what happened to Paul Cady

We still don’t really know how he got out that sixth story window.

Miranda Cady wrote that, disoriented and trying to go home, he was able to open the window enough to get out.

But neither the police nor hospital officials have corroborated that explanation publicly. Maine Medical Center spokesman Porter has declined to release any more details about the incident, citing the ongoing investigations.

Could the sixth floor window be opened enough for a patient disoriented by a brain injury to climb out? Or was the window reasonably restricted with some kind of safety mechanism to prevent that — and Cady, disillusioned, took extraordinary measures, like breaking the window, to escape?

I asked, but that’s one of the many questions hospital officials say they can’t address right now, and one which will likely be answered through the state investigation.

“We’re not making any claims that there are any problems at the moment, except to say we are interested in what [investigators] find,” Lilley told WCSH. “The window, as I understand it, is a very narrow kind of a window. So it does present some challenges and we have no ideas except to speculate and we don’t want to do that.”

UPDATE: The chief medical examiner ruled that Cady’s death was an accident, our media partners at WGME reported on Wednesday, April 6.

… about how state licensing rules apply here

Remember the American Institute of Architects guidelines cited above? Where it said that if windows in patient rooms are operable, “operation of such windows shall be restricted to inhibit possible escape or suicide?”

If Cady just opened his window enough to climb out, as his daughter believed, that would mean the operation of his window was not restricted enough to inhibit his escape.

What’s less clear, however, is whether that section of the hospital is new enough to be subject to that requirement. As DHHS’ Samantha Edwards said, that AIA guideline only applies to hospital facilities built or significantly renovated — by “significantly,” here, I mean renovations costing at least $50,000 — since 2009.

The Portland Press Herald’s Matt Byrne, who has done some excellent reporting on this case, reported that the Richards Building was constructed in 1969.

So in order for the AIA requirement to kick in, there would need to have been at least $50,000 worth of renovations since 2009. Has there been?

That’s another detail the hospital isn’t releasing right now.

Even if there has been at least $50,000 in renovations at the Richards Building, there still may be gray area with regard to whether the AIA rules apply.

For instance: Does that $50,000 in work need to have been done in the unit in question, or does renovation work anywhere in the building require the entire facility to be in compliance? (So, for instance, if the hospital did $50,000 worth of repairs to a unit on the second floor in 2010, would that mean a window on the sixth floor, even if it wasn’t included in that work, now needs to meet AIA guidelines?)

There are going to be many questions to be answered in the coming days.

Seth Koenig

About Seth Koenig

Seth has nearly a decade of professional journalism experience and writes about the greater Portland region.