Suicidal pt. committed suicide: judgment for defendants.

PEGGY SUE ELLIS SUFFERED FROM A SERIOUS PSYCHIATRIC ILLNESS FOR APPROXIMATELY 30 YEARS WHEN SHE WAS ADMITTED TO BAPTIST MEDICAL CENTER.

She had previously been hospitalized for management of her psychiatric illness, and she had a history of suicide attempts. Her November 11, 1999, admission, came after an attempted suicide, she had been admitted to Baptist three times in 1999, for management of her psychiatric illness. Dr. Rita Patton was her physician during all of her admissions.. Dr. Patton prescribed Seroquel, a psychotropic agent used to treat schizophrenia. The patient was placed on a suicide watch in the hospital; the watch continued during her hospital stay. Her condition waxed and waned during her stay. Her condition regressed from November 18 to November 19, and the dosage of her medication was increased. On November 22, 1999, when she was asked whether she would hurt herself, she replied "I hope not." That same day, she stated that she was scared and worried, and she showed signs of paranoia and unreasonable fears regarding her family. She also stated that she was anxious about being discharged the next day. She was discharged on November 23, 1999, with a discharge plan formulated by Dr. Patton. The plan included; (1) a follow-up appointment with her therapist at the Eastside Mental Health Center the next morning; (2) arrangements for daily visits by a home-health psychiatric nurse to monitor her mental health state and to monitor her compliance with the prescribed medication and; (3) help from her cousin in monitoring compliance with the prescribed medications. On November 24, 1999, the patient went to the Eastside Mental Health Center where she was evaluated by her therapist. The therapist noted that the patient had been unable to fill her prescription for Seroquel and that she was confused about her medications, obsessed with psychotic thought, and frightened that she had an "inappropriate and blunted affect". Dr. Patton was unaware that the patient had not been able to fill her prescription. On November 26, 1999, the patient was found dead of a drug overdose in her apartment. The coroner determined that the manner of death was suicide. The administrator of her estate filed suit against the Psychiatric Clinic and Dr. Patton. After a trial, judgment was entered for the defendants on the grounds that the plaintiff failed to introduce necessary expert medical evidence as to causation. The plaintiff appealed.

THE SUPREME COURT OF ALABAMA AFFIRMED THE JUDGMENT ENTERED FOR THE DEFENDANTS. The court held, inter alia, that the plaintiff failed to introduce necessary expert medical testimony that the allegedly negligent action of the defendants was the proximate cause of the decedent's suicide. The court required more than the coroner's report that the patient's death was the result of suicide. Accordingly, since the plaintiff failed to introduce expert medical evidence and testimony that the alleged negligence of the defendants was the proximate cause of the patient's suicide, the plaintiff could not prevail. The court affirmed the judgment for the defendants.

THE ISSUE OF CAUSATION IN THIS CASE COULD NOT BE DECIDED WITHOUT THE BENEFIT OF EXPERT TESTIMONY. The decision to discharge the patient in accordance with the terms and conditions of the discharge plan was accompanied by a number of additional medical determinations. Deciding whether Dr. Patron's decision to discharge the patient probably caused the patient to commit suicide included evaluation of the reasonableness of that decision in light of other medical determinations accompanying it. Evaluating the reasonableness of medical decisions is not a matter for which "[a] jury could use 'common knowledge and experience.'" The court noted that other jurisdictions have also found that in medical-malpractice cases involving suicide, expert testimony is required to establish that the alleged breach of the standard of care proximately caused the suicide. A concurring judge, while agreeing with the majority in its ultimate determination, felt it necessary to observe that the majority opinion focused in particular on the statement of one of the expert medical witnesses who stated that given the patient's condition at the time of her release "[it] was highly probable that she might do something to herself, yes." The judge noted that the word 'might' was construed to mean, in a strict and literal sense, 'possible.' The concurring judge agreed that 'possible' was not enough to decide the case for the plaintiff. He left no doubt that nothing less than expert medical testimony that the negligence of the defendant was, in fact, the direct and proximate cause of the patient's suicide was required. The plaintiff failed to present the required testimony as to causation. Thompson v. Patton, 2008-AL-1013.001 (10/10/2008) So.2d -AL

Meet the Editor & Publisher: A. David Tammelleo, JD, is a nationally recognized authority on health care law. Practicing law for over 40 years, he concentrates in health care law with the Rhode Island firm of A. David Tammelleo & Associates. He has presented seminars on medical, nursing and hospital law throughout the United States. In addition to his writings as Editor of Medical Law's, Nursing Law's & Hospital Law's Regan Reports. his legal articles have been published in the most prestigious health law journals. A prolific writer, his thousands of articles, as well as his achievements as an attorney and lecturer, have won him recognition in Martindale-Hubbell's Bar Register of Preeminent Lawyers, Marquis Who's Who in American Law. Who's Who in America and Who's Who in the World.

Print Get the Mag Weekly Updates