On the list of common law school study techniques is to read and re-read cases multiple times. For students in their first year of law school, this behavior quickly becomes a habit through necessity. That’s because — as most experienced law students quickly learn — a story that initially appears clear and straightforward can reveal greater complexity on each subsequent telling. As an example, let’s look at the doctor/patient relationship and how it can be viewed from a variety of perspectives when liability must be determined.
Suicide is a major problem around the country today. It is the third most common cause of death in people aged 10 to 54, according to the Centers for Disease Control and Prevention (CDC). When people start experiencing suicidal thoughts, they often see a doctor. Doctors, after all, are supposed to help with these feelings and prescribe medication that can help. This creates a very interesting relationship and one that often comes under scrutiny when a patient still commits suicide, even after seeing a doctor. Is the physician or psychiatrist liable? That is a tricky question with a complicated answer.
It essentially comes down to a doctor’s duty. All doctors have a duty to their patients to treat them according to the reasonable standards of care. If a doctor breaches that duty, they are liable. If they do not, they are not liable. Determining what a proper breach is though, is challenging.
A Recent Case
The question of a doctor’s liability when a patient commits suicide arose in a recent case. A doctor was dedicated to his very busy practice. He saw patients all day and then when the doors closed for the day, he spent his spare time calling around to patients, pharmacies, and insurance companies.
After a long day at the office, his receptionist told him that a patient had called. She had been the doctor’s patient for five years and had a history of depression. Under the doctor’s advice, she had been taking venlafaxine for approximately three years. The patient had called that day to say she had stopped taking her medication. It was causing side effects that she could no longer handle, such as inability to sleep, spontaneous crying, and gastrointestinal issues.
The doctor, after reading the note, wrote a prescription for escitalopram. He also wrote a referral to a gastroenterologist. He never saw the patient, but the receptionist called to tell her she could pick up the new prescription and some samples from the office. She was never told to make an appointment with the doctor.
The patient picked the prescription up from the office and immediately filled it. She then went home, took the entire bottle, and hanged herself. Now, her husband has filed a lawsuit against the doctor. While the lower courts found the doctor could not be held liable for the suicide, the appeal courts found otherwise. It will now be left to a jury to decide.
When is a Doctor Liable for a Patient’s Suicide?
A patient committing suicide is not reason enough to hold a doctor liable. It is similar to when a doctor recommends a certain cancer treatment, but the treatment does not work and the patient passes away. This unsuccessful treatment does not make the doctor responsible for the death, as long as they made every effort to provide a reasonable standard of care. Alternatively, a delayed cancer diagnosis may find the doctor liable.
In the most recent case, there is an argument that the doctor did not provide a reasonable standard of care. He understood that patients that suddenly stop taking venlafaxine were more at risk for suicidal thoughts. As such, he should have asked the patient to come into his office and speak with her. At that time, he could have counseled the patient on the dangers of suddenly stopping the medication. He could have also observed her, looking for signs of depression and suicidal thoughts. Unfortunately, he did neither of these things.
The appeals court remanded the case back to the lower courts based on that failure to speak to the patient or even observe her before prescribing another antidepressant. Doctors have a duty to assess patients and prescribe them the best course of treatment based on that assessment. Failure to do so indicates liability on the part of the physician.
The “special relationship” between a doctor and their patient must also be considered when determining liability. This relationship gives rise to a doctor’s duty, even if none would have existed otherwise. When a doctor knows they are dealing with a suicidal patient, they must do something to try and prevent suicide from occurring. That could be prescribing medication, or referring the patient to a psychiatrist. The patient does not necessarily have to follow the advice of the physician, but the doctor must at least attempt treatment.
When is a Doctor Not Liable for a Patient’s Suicide?
There is an argument to be made in this recent case, and so many others, that doctors should not be held liable when their patients commit suicide. Supreme courts throughout the country have exonerated many doctors facing malpractice lawsuits in cases that involve suicide. The arguments for doing so typically include the fact that doctors do not have actual control over their patients, or that there is no special relationship.
In order for a special relationship to exist, the doctor must have physical control over a patient. For example, if a patient was being treated in a mental health facility and committed suicide while there, it could be argued that the doctor had a special relationship with the patient. The patient was in the doctor’s physical care and under their control.
In the case of the doctor that did not see the patient before prescribing antidepressants, the patient was not under the physical control of the doctor. She was at home when she hanged herself. Therefore, there was no special relationship, which indicates the doctor was not liable.
During his trial, medical experts are likely to argue that the doctor should have known that when the patient abruptly stopped taking her former medication, she would be prone to thoughts of suicide. This was an issue the attorney for the plaintiff had already brought up when the case was going through the lower courts. However, the patient did not tell the doctor she was going to stop taking the drug. The doctor did not find out until she had already taken those actions. Therefore, there was no way to stop the suicidal thoughts from occurring.
Lastly, it can also be argued that suicide is a surprise to everyone it affects. In this case, the woman’s husband was also greatly surprised that the woman had committed suicide. Although medical professionals are expected to understand the signs of suicidal thoughts, it is sometimes extremely difficult to recognize them. When those closest to the woman could not determine she was in trouble, it is going to be just as difficult for someone not as close to the situation to recognize the same symptoms.
The complexities of this case are the same challenges in every malpractice suit that involves suicide. It is why sometimes the courts find doctors liable, and sometimes they do not. It all depends on the facts of a certain case, and how those facts are presented to a jury. It must be determined if a doctor breached their duty of care and if they had a special relationship with the patient.
About the Author
John Fisher of John H. Fisher, P.C. has spent the last 20 years focusing on helping victims that have suffered a catastrophic injury. Highly respected in his field, Mr. Fisher has appeared in TRIAL magazine as a legal expert on many occasions. He is also a regular speaker for the New York State Bar Association, The National Trial Lawyers, PILMMA, and Great Legal Marketing.