Patient harmed self after being in your care?
How you can protect yourself legally
Executive Summary
Physicians are likely to be named in malpractice lawsuits involving a patient's self-harm, even if the care had nothing to do with behavioral health. To reduce risks:
- Inquire about the patient's psychiatric history and symptoms.
- Follow-up on any affirmative responses.
- Request a consult or make a referral to a psychiatrist or other mental health professional.
If one of your patients commits suicide shortly after being in your care, you are likely to be named in any subsequent malpractice claim, even if your care had nothing to do with behavioral health.
It is frequently the case that any physician who had a recent encounter with a patient will be drawn into a malpractice claim, says Mary Jean Geroulo, JD, an attorney at Wilson Elser in Dallas. "But if a patient does not disclose a history of mental illness or suicidal thoughts when asked , and does not have any outward manifestation of such symptoms, then it is not likely that a physician treating the patient for an unrelated issue will be held responsible," she says.
In allegations against behavioral health physicians involving a patient's self-harm, plaintiffs usually claim that psychiatrists failed to recognize that patients were at risk for self-injury and/or failed to manage the risk appropriately, says Paul S. Appelbaum, MD, Dollard Professor of Psychiatry, Medicine, & Law and director of the Division of Law, Ethics, and Psychiatry at Columbia University College of Physicians & Surgeons in New York City.
"However, there may be many subcomponents to those claims," says Appelbaum. These include failure to do the following:
- ask the patient about suicidal history and current ideation, including plans of self-harm;
- inquire about the availability of means of self-harm;
- speak with family members or others to obtain additional information;
- obtain past treatment records or review such records if they were obtained;
- speak with previous mental health treaters;
- monitor the patient's suicidal ideation over time;
- implement appropriate treatment for the underlying disorder, including medication and psychotherapy;
- warn family members so that they can take preventive measures;
- hospitalize the patient.
- Appelbaum says non-psychiatric physicians are at risk for these allegations:
- that the physician should have known the patient had a mental disorder and/or was likely to injure himself or herself;
- that the physician should have instituted appropriate treatment or referred the patients to a psychiatrist or other mental health professional.
"If patients were already in mental health treatment, plaintiffs may claim that treating physicians failed to communicate information about the risk of self-harm, such as suicide threats, to the treating mental health professionals, thereby precluding preventive action from having been taken," says Appelbaum. (See related story, below, on the legal standard of care for non-behavioral health physicians caring for psychiatric patients.)
