Mental illness
The basics of negligence
Negligence claims involve four basic ingredients. The same ingredients hold for healthcare professionals specializing in mental illness.
They are:
Duty to treat. If a health care professional does not have a duty to treat them, of course, failure to treat is not negligence. This means that negligence requires a health care professional/patient relationship.
Breach of duty. Care given must be shown to be inadequate, below the operative standards of care. Pop-up information. Legally speaking one is only required to perform up to the minimum standards of the profession. A person is not required, legally, to perform to the full extent of their capability. Morally speaking, a person who is entrusted with the care of another may be obliged not only to perform to a higher level than is required by law, but also may be required to increase her or his level of skill by, for example, continuing education beyond the minimum required by law. Think about whether you agree with this.
Causation. In order to constitute negligence, health care treatment must be shown to be the cause of the injury suffered. This is often a difficult point in health care. A health care professional may perform in an acceptable manner and yet a patient may become worse. It may appear that the condition became worse due to the care received. This is, unfortunately, often the case. But, equally unfortunate, often people become ill due to unavoidable side effects of care. A health care professional is not responsible for such side effects, unless, under certain circumstances, a patient was not informed about the possibility of such side effects.
Damage. If a patient is not injured, does not suffer a loss, due to treatment, then there is no cause for a medical negligence lawsuit.
Negligence and mental illness
In some ways mental illness involves issues not typically faced in other forms of illness. For example, patients typically are not threats to themselves, at least in any direct and immediate sense. Pop-up information. It is easy to come up with circumstances in which patients, other than those mentally ill, are threats to themselves. For example a patient might not pursue proper care. A physician could be sued for failure to protect a patient from his or her own behavior. For example, a physician may fail to make clear the importance of certain tests. If this is the case, and a patient fails to get the test and suffers harm accordingly, the physician may be liable for that patient's injury. Mentally ill patients are sometimes threats to themselves and to others.
Do mental healthcare professionals have legal obligations to protect their patients against suicide?
The answer is affirmative. Mental healthcare professionals do have an obligation to protect their patients from themselves. Of course, this involves following the standards of the profession. Sometimes efforts may be made to protect patients from themselves that are unsuccessful. This does not automatically mean that the health care professional is liable for the patient's injury.
Meier v. Ross General Hospital
Here is a case in which the court affirmed the obligation of a health care professional to protect her or his patient: Meier v. Ross General Hospital (445 P. 2d 519) 1968.
In this case a patient attempted suicide. The patient jumped from an unbarred window after being left alone in the room. The higher court sent the case back to the law court for retrial, stating: "The judge should instruct the jury … that if it finds that defendants allowed the decedent to remain in the room with an openable window for a good faith medical reason that is inextricably bound up in a course of treatment involving the exercise of medical judgment beyond the knowledge of common laymen, they must assess this medical reason in the light of the standard of medical learning and skill prevalent in the community." Pop-up information. You may recall that we noted that higher courts do not attempt to retry the facts of the case. In this case, the higher court notes that a health care professional may be liable, and that the jury should be instructed about this. This is a matter of law. However, the higher court did not attempt to judge whether or not the facts of the case actually involved liability. The original verdict in this case supported the health care professional.
North General Hospital v. Krakower
Simply because a patient commits suicide does not mean that the health care professional is responsible. If the professional follows the appropriate standard of care, the professional is not liable.
North General Hospital v. Krakower (393 So.2d 57), 1981 makes this clear.
In this case the court determined that the psychiatrist followed ordinary procedure in ordering a 24-hour attendant for a suicidal patient. However, the attendant left the patient alone. The patient died after jumping from a fire escape, the court concluded: "The record is devoid of evidence that the doctor departed from the standard of reasonable medical standards."
This case squarely indicates that injury is not enough by itself for negligence.
Paddock v. Chacko
What about a patient who fails to follow the advice of a health care professional and as a result suffers harm? That of course depends upon how the advice was given and understood. It is not automatically the case that failure to follow advice resulting negligence. What is required is that the health care professional follows standard procedure. Pop-up information. Of course what counts as standard procedure is often in dispute.
Here is a tragic case. Paddock v. Chacko (522 So.2d 410) , 1988. It involves a child who killed herself by setting herself on fire. Her father did not follow medical advice about committing his daughter to a mental institution. The psychiatrist was held not liable.
The court concluded:
"Dr. Chacko recommended hospitalization to the plaintiff's father but his suggestion was rebuffed due to a concern about insurance and because the father did not really believe that his daughter was in need of hospitalization. Although plaintiff was an adult, she had placed her care in her father's hands, and Chacko then offered the alternative of an increase in the dosage of medication and waiting before making further decisions concerning hospitalization. He made his telephone number available to the parents so they could contact him if the plaintiff's situation grew worse. Once Chacko offered this advice, there was nothing more he could have done, other than to forcibly take the plaintiff into custodial supervision….."