What happens if a patient is under psychiatric care and the patient commits suicide. Can the psychiatrist be held liable? Under what circumstances can the psychiatrist be held liable? A case issued by the First Department today sheds some light on these questions - Durney v Terk, 2007 NY Slip Op 06060. In that case Arthur Hudson was being treated by two doctors and a medical student at Lenox Hill Hospital as an inpatient for major depression and suicidal ideas between March 2 and March 8 2001. When he was discharged from Lenox Hill, he was scheduled to start an intensive outpatient program at St. Vincent's Hospital on March 15, 2001, the first available date. Before leaving Lenox Hill and starting the program at St. Vincent's, Hudson promised to take prescribed medications, and to "contract for safety" meaning that he agreed to advise another person if his suicidal ideas returned or if he began to feel unsafe. Apparently when he did so, however, he hesitated when asked if he would contract for safety with his wife. On March 14th 2001, the day before he was to begin outpatient treatment, Hudson committed suicide.
His wife then commenced an action for wrongful death action against Lenox Hill Hospital, the doctors and medical student. A jury found that the defendants had departed from accepted standards of psychiatric care by failing carefully and competently to evaluate Hudson following the discussion of the contract for safety at the March 8, 2001 discharge meeting. They concluded that such departure deprived Hudson of a substantial possibility of avoiding suicide on March 14, 2001. In its verdict, the jury found that the failure to re-evaluate the discharge plan following Hudson's "hesitation" constituted a deviation from accepted medical practice.
The First Department reversed the jury's verdict and found no malpractice. The Court stated that a medical provider cannot be held liable for a mere error in professional judgment. In order words, it is not enough to show that another professional would have chosen a different course of action. Rather, what is required is that a provider's treatment decision must be "something less than a professional medical determination." The Court almost seemed to be saying that there must be some absence of exercising professional judgment.
In the case before it, the Court noted that the plaintiff's expert testified that Hudson had been properly diagnosed, that the accepted psychiatric history had been taken, and that Hudson's in-patient treatment was proper. Further, the Court noted that the expert said that the intensive treatment program selected for Hudson was the type of program he would have chosen, and that the medications prescribed were appropriate.
With respect to Hudson's "hesitation" at the discharge meeting, the Court noted that while the plaintiff's expert stated that the "hesitation" required "exploration" he failed to offer any testimony that the "hesitation" should have led to a different course of treatment. Moreover, Hudson's wife testified that she never communicated to any hospital personnel that she had observed her husband hesitate. Nor was there any evidence in the record that anyone else independently observed it.
Thus, in short the mere fact that the patient may have hesitated in answering a question about a safety pledge was not enough to prove that there was any psychiatric malpractice. If Hudson, instead of merely hesitating, had indicated he would not take the safety pledge and he was released, would the Court have reached a different conclusion?
Psychiatric patients and their families so rarely win malpractice cases that I doubt that even if he had refused to make a safety contract that they would have been held liable. If anyone knows, what is the current percentage of people with psychiatric disabilities winning malpractice cases excluding cases where the treatment provider actually had sex with the patient?
Posted by: Alison Hymes | July 13, 2007 at 09:25 AM
No one intent on suicide can be stopped. Holding a doctor responsible for the intentional act of mental patient is scapegoating. No evaluation, nor treatment, nor restriction has proven to reduce suicide significantly. Furthermore, multiple factors enter into a suicide. The emotional abuse by the family and love interest are far more powerful determinants than psychiatric treatment.
These and other factors imply no suicide malpractice has any validity in the law, in science, nor in public policy.
Posted by: Suicide Malpractice | January 25, 2009 at 05:16 PM
If anyone can provide the name of the plaintiff expert, I would appreciate it. He should be held accountable for the garbage science claims he made in this case. Where is the scientific evidence that restricting patients for hesitation prevents suicide? Furthermore, he needs to provide 20 cases or more where he restricted a hesitant patient and showed a reduction in the risk of suicide.
Posted by: Suicide Malpractice | January 25, 2009 at 05:21 PM