Suicide Malpractice Case [Naturopathic Provider and Allopathic Psychiatrist]

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Sad case here: Suicide [Naturopathic "Doctor"]

Young woman with suicidal thoughts.
Takes her husband's gun, holds it to her head.
Tells family, they try to help her but she is resistant to hospitalization.

Sees a naturopathic doctor, apparently there was no screening for suicidality.

Dies by suicide several weeks later.

Husband sues multiple providers (psychiatrist who had seen her months before, social worker, naturopathic doctor).

Everyone eventually ends up settling.

 

[deleted1100659]

Sad case here: Suicide [Naturopathic "Doctor"]

Young woman with suicidal thoughts.
Takes her husband's gun, holds it to her head.
Tells family, they try to help her but she is resistant to hospitalization.

Sees a naturopathic doctor, apparently there was no screening for suicidality.

Dies by suicide several weeks later.

Husband sues multiple providers (psychiatrist who had seen her months before, social worker, naturopathic doctor).

Everyone eventually ends up settling.

Seems ridiculous that the psychiatrist would have any liability if he had seen her months before and not recently. We know risk factors for suicidality but no one is a fortune teller. If she had seen him recently and she had expressed SI, and he didn't have her go inpatient, then I would understand that scenario.

 

[wolfvgang22]

The psychiatrist likely had no say in whether to settle or not. My understanding is that unless you pay for an extra rider on your malpractice insurance, the insurance company decides whether to defend against litigation or settle.

It does really suck that this psychiatrist now has to defend themselves every time they renew a license or apply for hospital privileges. This is a major reason I want out of medicine as soon as possible. I've never been sued but colleagues tell me it is a nightmare.

 

[deleted1100659]

The psychiatrist likely had no say in whether to settle or not. My understanding is that unless you pay for an extra rider on your malpractice insurance, the insurance company decides whether to defend against litigation or settle.

It does really suck that this psychiatrist now has to defend themselves every time they renew a license or apply for hospital privileges. This is a major reason I want out of medicine as soon as possible. I've never been sued but colleagues tell me it is a nightmare.

The second part is what I feel every day. Especially as someone who has 4 midlevels under him. I am quite meticulous with my chart reviewing and they do listen so that helps but I absolutely hate what you described. Does it matter if you're at fault? Nope. Does it matter that you were probably the one helping the patient or that you had zero liability? Nope. But now that scenario is just stuck with you indefinitely. There should be some kind of provision where if you werent found at fault, then it isnt brought up in the future on applications and doesnt stay with you for the next 4342343 years.

I interviewed at a facility where a midlevel started lamictal, and the patient got SJS (turns out the fault was really the patient, they used the medication inappropriately despite being given careful instructions). Of course the supervising doctor was dragged into the mess and from that scenario i am always extremely hesitant to allow lamictal at my place of work unless the patient has shown they're reliable and they have failed other medications.

 

[calvnandhobbs68]

"It is evident that the attorney wrote these opinions and simply changed out the introductory text for each expert who was willing to endorse the opinion. This significantly detracts from the weight of the opinion for any medically-informed reader, but serves the legal purpose perfectly well."

YUP

F'ing scammer expert witness. Should be ashamed of he/herself. The statements contain bizarre things like saying admitting this patient to the hospital months before the suicide would have somehow prevented the suicide in October. Bullsh*t.

Insurance company probably settled for some low amount and figured it wasn't worth the time to take this to court.

 

[comp1]

This is so weird. There isn't any evidence that a psychiatric hospitalization reduces suicide risk months later... Psychiatric hospitalizations are about the immediate threat. I can't quite pin down the timeline here...which seems very crucial. When did the MD last see the patient and when did the ND?

 

[shotgunlagoon]

This is so weird. There isn't any evidence that a psychiatric hospitalization reduces suicide risk months later... Psychiatric hospitalizations are about the immediate threat. I can't quite pin down the timeline here...which seems very crucial. When did the MD last see the patient and when did the ND?

"" The patient continued to see her medical providers over the next few months. Phone visit with the naturopathic doctor in late September 2016. She died by suicide in October 2016."
They seem to have left out the majority of the timeline...

 

[AD04]

Too bad there wasn't more details about this case from the psychiatrist's POV. Dissecting psychiatric malpractices cases would make for some good learning. I'm very surprised that an assistant professor at a "world renowned medical school" would put his / her name on a template. I wonder if the lawyer had the psychiatrist write the letter and then the lawyer tweaked it for the ND to sign.

 

[hallowmann]

So the lesson here is what? Include suicide risk assessments with anyone with SI? That's already how we're taught, so I wonder if the psychiatrist really had quite minimal documentation.

 

[calvnandhobbs68]

So the lesson here is what? Include suicide risk assessments with anyone with SI? That's already how we're taught, so I wonder if the psychiatrist really had quite minimal documentation.

I'm sure. We've all seen people with terrible documentation. I've even seen people with decent documentation that forget to put at least a suicide risk assessment template at the end of notes (I just basically have a template I put at the end with risk factors/protective factors/overall risk impression thats probably good enough).

This just reiterates the fact that anyone could be sued for anything at any time though. The family was just looking for a payday and got whatever lowball settlement the insurance company tossed out there to not have to deal with this. Whatever. The "expert witness" crap is again just bizarre and extremely lacking in details about WHY certain actions should have been taken which would have been picked apart in court. "Failing to admit to the hospital for further evaluation"? I mean, sure if a patient told me they'd put a gun to their head recently, I'd be sending them packing to the ED but it's not at all clear that the psychiatrist knew that from the limited info here. Can't admit everyone with intermittent SI to the hospital (or even IOP for god sake in most places). "Failing to properly monitor medication" what does that even mean? "Failing to properly evaluate symptoms in order to formulate a proper treatment plan" what?

So yes, either the documentation and care here was truly terrible so they had a leg to stand on or they were just throwing words out there to see what would stick.

 

[Candidate2017]

The claim that the psychiatrist did not recommend removal of the gun, if true, is not great. It’s easy enough to have a dot phrase that covers firearm screening, automatic recommendation of firearm removal for depression or suicidal/homicidal gestures, and their family’s agreement/refusal.

Suicide is the biggest malpractice risk in our field, and firearms are the biggest and most controllable factor in successful suicides. Ergo, any effort spent on firearms and suicide risk assessment has more impact than worrying about whether Lexapro increases cardiac risk in a pt with MI

No one is going to fault us for failing to warn family to keep a patient away from ropes, heights, traffic, or heroin. But guns literally trigger a special response. We can debate whether there's evidence that inpatient hospitalization prevents suicide, but anyone who touches a gun with SI needs a trip inpatient to appease a jury.

But for all we know this is probably a small payout that costs less than paying two defense lawyers and a paralegal for a week of work. As an aside, the only thing worse than a gun suicide, for all parties involved (except plaintiff's lawyers), is a failed gun suicide.

 

[Bartelby]

I think claiming the psychiatrist should have involuntarily hospitalized her and that would have prevented the suicide months later is ridiculous. That said, was the psychiatrist's plan to see this patient every six months or so even though she was exhibiting some very concerning parasuicidal behavior (with no other referrals)? That doesn't seem great. Of course we don't have all the information, maybe the psychiatrist offered early follow-up or referrals, but if not the lack of follow-up seems to be the most concerning piece.

 

[FN9]

The claim that the psychiatrist did not recommend removal of the gun, if true, is not great.

Any good expert witness can find multiple things that they feel deviated from the standard of care. So take that with a grain of salt.

The sister did recommend removal of the gun a few months prior, a good defense attorney would have used that all day long to plant doubt, the problem is that insurance companies want to settle, doctor would be risking his career if he wanted to fight given the small damages so they settle.

Commenting on the gun would be helpful though would not prevent suicide, if she had poisoned herself (almost as common in females as guns), and the husband decided to sue, I dont think the outcome would have been different, the insurance company again would settle to limit monetary damage and the doctor would be foolish not to accept and walk away.

If she denied suicidal thoughts at her visit, then there was no grounds to admit her to inpatient, if she is refusing to take medication then there is not much to do or monitor regarding medication, its unclear what the psychiatrist did or did not do from the article, timeline is not clear,

expert witness mentions failure to timely assess risk of suicide, it mentions symptoms worsened in mid August and suicide occurred in October, so about 8 weeks, again not sure what psychiatrist discussed in those visits.

unknown are who were the other mental health provider and if they had any relevant information.

One can argue if she was severely depressed and non compliant with treatment, recommendation for IOP could be made.

One thing that needs to be stressed is DOCUMENTATION, if notes were very short, expert witness could drive a truck through those notes, we dont have to write a book during each visit but at least cover the relevant points.

 

[deleted1100659]

I just want to add that I hate the whole "removal of firearm" thing. Sure its taught to us, and yes firearms are most common way. But there are other lethal means out there, someone could easily just buy a bunch of OTC meds. And we cant necessarily force them to get rid of their firearms.

Again, public misconception of mental health. Reminds me of the good days in consult psychiatry. There was a patient on the medicine floor where her dog died, and the primary team consulted me to explain death to the patient and give her the bad news because they "didnt want her to decompensate".

 

[clausewitz2]

I just want to add that I hate the whole "removal of firearm" thing. Sure its taught to us, and yes firearms are most common way. But there are other lethal means out there, someone could easily just buy a bunch of OTC meds. And we cant necessarily force them to get rid of their firearms.

It's true we can't force them to give up firearms. But going to the store, buying a bunch of OTC meds, and then deliberately taking them (or even just stockpiling them in the first place) involves a degree of planning and sustained effort. It also takes some time and leaves room for having second thoughts much of the time. Picking up a loaded gun and firing only requires a few seconds of being convinced of the necessity of what you are doing.

We know introducing even trivial barriers to access to means has measurable impacts on suicide attempts (like packaging acetaminophen/paracetamol in blister packs instead of loose in bottles), so I think not suggesting to someone who is struggling with suicidal thoughts that maybe a friend should hold their gun for them for a while is definitely remiss.

 

[Bartelby]

Also attempts by firearm are more than 80% lethal compared to about one and a half percent lethal by overdose. If one of my patients were going to attempt suicide, I would much rather it happen via the one and a half percent lethality route! Lethality of Suicide Methods

 

[calvnandhobbs68]

It's true we can't force them to give up firearms. But going to the store, buying a bunch of OTC meds, and then deliberately taking them (or even just stockpiling them in the first place) involves a degree of planning and sustained effort. It also takes some time and leaves room for having second thoughts much of the time. Picking up a loaded gun and firing only requires a few seconds of being convinced of the necessity of what you are doing.

We know introducing even trivial barriers to access to means has measurable impacts on suicide attempts (like packaging acetaminophen/paracetamol in blister packs instead of loose in bottles), so I think not suggesting to someone who is struggling with suicidal thoughts that maybe a friend should hold their gun for them for a while is definitely remiss.

Also attempts by firearm are more than 80% lethal compared to about one and a half percent lethal by overdose. If one of my patients were going to attempt suicide, I would much rather it happen via the one and a half percent lethality route! Lethality of Suicide Methods

Both absolutely true. Especially in the context of substance use. Depressed-> Bad day-> Go have a few drinks-> Intoxicated-> Worsening suicidality-> There's my loaded gun i should just do it....

Much more lethal and much less opportunity for "second chance" interventions with firearms. Absolutely the highest yield thing to talk to patients about securing and removing from the house if possible. Even doing something like putting a trigger/slide lock on a gun is very helpful for increasing "resistance" to using it. Again, we can't force anyone to do anything, but we can at least document that we talked about it. Many of my patients are surprisingly grateful that we even talked about it and acknowledge the lethality of the method. Quite a few of my parents don't even realize that the kids KNOW there is a gun in the house....until they're like "oh yeah mom I knew dad had that in the back of the closet".

Also, I will add, you will absolutely get burned in a lawsuit if there's no documentation you discussed firearm safety and evidence comes up that the patient died via firearm which was present during your appointment. You can put that the patient denied having a firearm (you can't help if they lie to you) but absolutely no documentation about this will be the first thing they come after.