Legal Review & Commentary-Woman denied admission to psychiatric unit, commits suicide the next morning: $6.5 million verdict awarded

By Mark K. Delegal, Esq., and Jan Gorrie, Esq.

Pennington, Moore, Wilkinson, Bell and Dunbar, PA

Tallahassee, FL

News: A 43-year-old woman presented herself at a hospital emergency department asking to be admitted to the psychiatric unit. The admission was denied, and she committed suicide the next morning. An Illinois jury returned a $6.5 million net verdict against the hospital.

Background: The woman arrived at the defendant hospital's emergency department one evening. She wanted to be admitted to the psychiatric unit. After waiting 2½ hours, she was first seen by a medical resident. The medical history taken by the resident revealed that she had been admitted to a mental health center two months prior and that she was depressed. She was not, however, taking Lithium as had been prescribed.

The attending physician consulted the on-call psychiatrist by phone, and together they determined that she did not fit the criteria for admission. The woman refused to sign the discharge papers and was taken home by a taxi in the early morning hours. Later in the morning, she called her two brothers and allegedly told them her situation was hopeless because she had no health insurance. Then she hanged herself in the garage.

The plaintiff's estate argued that the history taken on her was incomplete, and had it been more thorough, it would have revealed an extensive, two-decade history of mental illness that included many hospitalizations and suicidal tendencies. The plaintiff also maintained that the on-call psychiatrist should have come to the hospital to examine her rather than rely upon the emergency room physician's telephone account of the situation.

In addition, the plaintiff claimed the medical resident discussed the issue of health insurance with the woman. Finally, the plaintiff said the encounter with the hospital, from questions to insurance coverage to refusal to admit, further exacerbated her fragile state and led to suicide.

Conversely, the defendants maintained that the standard of care was appropriate and that she had not manifested signs of suicide at the hospital. The $13 million verdict was reduced 50% because the cause of death was suicide.

What this means to you: Because of the imminent and fatal outcome, in hindsight it seems obvious the woman needed immediate medical atten- tion. As for improvements and precautionary notes for risk managers, much of this case rested with how the physicians handled the situation.

"Most disturbing in this case is the implication that she was not admitted because of her lack of insurance. On the other hand, it may be that she did not manifest any of the signs or symptoms acute enough to merit admission under the hospital's protocols," notes Phyllis Maxey, RN, director of risk management at Carolinas Health Care System in Charlotte, NC.

"The initial history does seem to have failed to include several key findings. First is the issue of her extensive mental health history. And second, noncompliance with medication in an alleged psychiatric patient with no insurance can mean one of two things — either she was bipolar [and] therefore clinically predisposed to be noncompliant, or [she was] simply unable to afford her medication. Either way, the medical history or record does not seem to have addressed this issue," Maxey says.

"Further, if indeed her lack of insurance was in any way used in the decision not to admit, rather than based on the clinical, medical diagnoses, there are serious implications for COBRA [Consolidated Omnibus Budget Reconciliation Act] and EMTALA [Emergency Medical Treatment and Active Labor Act] violations. In addition, the fact that the on-call psychiatrist did not come in to examine the patient also gives rise to a potential COBRA violation," she explains.

The case probably should be referred for medical peer review along with the suggestion to the medical school that medical residents be advised of federal law and, more practically, all of the potential causes of medication noncompliance.


Estate of Maryann Martino, deceased v. Illinois Masonic Hospital, Cook County (IL) Circuit Court, Case No. 97L874.