A $10,000 fine levied against a skilled nursing facility that allowed a suicidal resident to leave the building and then kill himself will stand, a federal appeals court has ruled.

The unidentified resident was admitted to Del Rosa Villa in San Bernardino, CA, after breaking his leg during a suicide attempt. A nurse there recommended the resident be placed on 24-hour suicide watch. Four days after a trip to the emergency room and back for unruly behavior, he was allowed to go outside unsupervised to smoke. Twenty minutes later, he was found, hanged by his own belt.

The U.S. Court of Appeals for the Ninth Circuit said earlier decisions by three government entities to levy the fine were backed up by sufficient evidence. 

The appeals court ruled the outcome was “reasonably foreseeable” and that allowing the agitated and injured patient to leave the facility unattended was justification for the fine.