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Legal Review and Commentary
Hospital's failure to prevent suicide leads to $300,000 settlement
By Blake J. Delaney, Esq., Buchanan Ingersoll & Rooney, Tampa, FL
News: A man was taken to a hospital after nearly committing suicide from an overdose. Although the hospital placed the man on its suicide prevention ward, the patient hung himself in his room two weeks after his admission. The man's estate sued the hospital for negligence, and the parties settled for $300,000.
Background: A 31-year-old father was transported by ambulance to a hospital after attempting to kill himself by ingesting 19 tablets of paroxetine, an antidepressant designed to increase the level of chemical serotonin in the brain. The hospital assigned the patient to its suicide prevention ward, where he was monitored and counseled. The hospital learned that the man's medical history included drug addiction, bipolar disorder, and depression.
Two weeks after his admission, and while still in the hospital's suicide prevention ward, the man committed suicide by hanging himself from a noose that he had formed from a bedsheet. The man's estate sued the hospital and claimed it was negligent in failing to properly monitor the decedent.
The hospital responded that it acted reasonably in not expecting the man to commit suicide because he had been taking his medication as instructed and had not exhibited any further suicidal ideations. The hospital also disputed damages by arguing that the man did not endure any conscious pain and suffering and that the man was unemployed at the time of his death, thereby precluding any reasonable establishment of economic damages. The hospital and the plaintiff settled the case for $300,000.
What this means to you: "Clearly, this is a tragic case. But predicting suicide is not a science," says Ellen L. Barton, JD, CPCU, a risk management consultant in Phoenix, MD. Barton notes that even the most skilled health care providers have only rudimentary tools available for treating suicidal patients. If the judgment regarding treatment turns out to be wrong, even the most exemplary assessment will not necessarily carry the day for the defense.
And as equally nonscientific is a risk manager's decision as to whether to settle a case like this one. Several considerations require fair balancing, including the patient's personal situation. In this case, the fact that the patient left a minor child and the fact that he had an underlying mental illness would make him extremely sympathetic to any jury. Some juries might even find that the very fact that this individual harmed himself constitutes proof of negligence. "Sadly, such cases exist, and they seem to be among the most difficult to defend," concludes Barton.
Other plaintiffs, however, are not as sympathetic and therefore do not present as significant of a risk of exposure to the hospital. In a reported case out of Mecklenburg, NC (Case No. 01-CVS-9520), a jury awarded only $54,250 to a husband after his wife committed suicide by hanging herself with a pair of shoelaces while she was a patient at a psychiatric hospital. And in a case arising in Kings County, NY (Case No. 47886/98), a jury awarded a man's estate only $71,989 after the man hung himself with a belt in his hospital room. It is possible that the jury awards were so low in both of those cases because neither decedent left any surviving children. Of course Barton notes that it is quite possible that another reason the damages were not higher is that, as in the case above, it was difficult to establish economic damages.
A second factor that can affect the amount of a jury award in cases such as this one is the hospital's conduct leading up to the patient's suicide. In a case out of Jefferson County, AL, Case No. 04-7574, for example, a jury awarded a 53-year-old man's estate $12 million in damages after he killed himself while a patient at a hospital. In that case, he was referred to the hospital because of depression and suicidal tendencies. Because the psychiatric unit was full, the hospital placed the patient first in a dual diagnosis unit, and 38 hours later transferred him to another ward, where he was permitted to walk on to an outside patio high above the ground. The man ended up scaling a wrought iron fence and jumping down several floors to a parking deck, and then jumping a second time from the parking deck to the ground 80 feet below, which resulted in fatal injuries.
Finally, Barton notes that even if a facility was appropriately staffed with trained mental health professionals and even if that staff members were using appropriate risk assessment tools and suicide prevention strategies, some experts still would opine that the patient's suicide could not have been prevented. "That, unfortunately, is the dilemma that all suicide cases present to risk managers who are deciding whether to settle or proceed to trial," she says.
Because the patient in this case was on the hospital's "suicide prevention" ward, the facility apparently was a psychiatric hospital or a facility that dealt with a large number of such patients. That, in turn, according to Barton, would indicate that the facility should have had a fairly sophisticated system in place to evaluate suicidal patients. Such a system would include: a full psychiatric evaluation of "suicidal" or "self-destructive" patients; suicide risk assessment tools; trained staff capable of using screening mechanisms; and suicide prevention strategies.
Many facilities classify patients based on the risk of self-injury that they present. A patient designated as "Q15," for example, requires visual inspection every 15 minutes, cannot have access to sharp objects or any other material or object that can inflict bodily harm, and must request permission for use of restrooms. And a patient designated as "Q30" requires visual inspection every 30 minutes, is allowed unrestricted access to the rest room, and is permitted to wear a bathrobe with a belt.
The patient in this case had a history of drug addiction, bipolar disorder, and depression, and he presented to the hospital having already attempted to commit suicide. Barton therefore suggests that the level of supervision and scrutiny should have been raised. After the patient had been on the ward for two weeks, he was taking his medication and being regularly assessed, at which point Barton questions whether the staff was lulled into a false sense of complacency. By indicating in the fact pattern that the patient no longer was suffering from suicidal ideation, the staff might have put the patient on a lower level of scrutiny, such as by determining one-on-one supervision to be no longer necessary. If true, the hospital may have acted prudently in settling with the plaintiff before trial.