Psychiatrists Are Responsible

By Lawrence Landskroner

Author's note: This article has great importance to law enforcement officers and members of the public who are injured by or are involved with emotionally disturbed people. It illustrates the rights, responsibilities, and remedies for those so afflicted.

Psychiatrists are responsible for negligence in treating patients who inflict themselves with injuries or harm third persons when they make errors in treatment or cause their patients to commit injurious acts by improper prescription of drugs.

This is a new area of the law, but there have been a string of cases where the foregoing occurrences, as well as occurrences where the psychiatrist engages in sexual adventures with his patients in the guise of treatment, have made them responsible for the events that have occurred because of their practice. A psychiatrist may be held responsible when a psychiatric patient reveals a threat or intent to harm someone and the psychiatrist fails to take appropriate steps to warn the intended victim or prevent the harm. A classic case was Tarasoff v. Regents of University of California; a patient told a psychotherapist that he was going to kill an unnamed, but readily identifiable girl. The patient told the psychotherapist and physicians that when the girl came home from where she was vacationing in Brazil, he was going to kill her. The psychiatrist sent a letter to the local chief of police requesting assistance in securing the confinement of the patient and suggested that the patient be confined to a mental hospital. The patient was taken into custody, but was released after officers were satisfied that he was rational and promised to stay away from the young woman. The psychiatrist told the police to return his letter and asked that all copies of it be destroyed along with the notes he had taken, and ordered no action to be taken to place the patient in a treatment and evaluation facility. Neither the girl nor her parents were notified that she was in grave danger from the man who was going to be released from custody. Shortly, she returned from Brazil. Two months later, that patient again told the psychiatrist he was going to kill the girl. The patient went to the girl's residence and made good his previous threats. The court held that the psychiatrist in that case must disclose a patient's confidential disclosure of intent to harm a readily identifiable person, and the failure to do so was enough to impose responsibility for wrongful death or injuries to the person. The court attacked the question of recognizing the importance of retaining the confidentiality of the disclosures during therapy, but held that in order to avert harm to others, the information should have been disclosed. The rule is a reasonable price to pay for the lives of possible victims.

In another case, a psychiatric team was sued for injuries suffered by a man who was shot by a mental patient who discovered the man naked in bed with the patient's wife. The court rejected the claim that the team was liable on the basis that one of the team members knew that the man carried a gun. The patient had never revealed threat of harm to kill anyone nor had he confided any hatred toward the plaintiff. The court held that the danger must be to a specific person, not to the public.

In the decisions that have been handed down, the duty to warn has been imposed only where the harm is threatened to third persons. If the psychiatric patient threatens only self-inflicted harm, generally the courts have held that the psychiatrist is not obligated to warn the patient's family of such tendencies. But, the psychiatrist must take affirmative steps to prevent suicide and self-inflicted injury.

In one case, a Jury awarded $3.6 million dollars to a woman who suffered brain damage when she wedged her neck between the side rails of a steel hospital bed. She had been in the hospital for about ten days and on the night before the occurrence, the nurses stayed with her throughout the night. In the morning the woman attempted to leave the hospital and told the psychiatric technician that the voices were telling her to hurt herself. She was then placed in a seclusion room. The evidence admitted in the trial indicated that a steel hospital bed should not have been placed in the seclusion room, unless the patient was under constant observation. In a similar decision the hospital and the treating psychiatrist were found negligent in the death of a patient who killed himself by jumping head-first through a second story window. The liability was based upon the fact that the patient, known to be suicidal, should have been placed on the first floor or at least in a more secure room.

Liability for self-inflicted injuries can arise also for a hospital's failing to search a person adequately upon admission. In this case a 19-year-old woman attempted suicide with a gun she carried with her when she was admitted to the hospital. Had she been searched thoroughly the suit alleged, the gun would have been discovered and the suicide attempt foiled. The case involved a settlement in excess of $1.5 million dollars.

Sometimes liability can he imposed if a patient is left alone only for a few minutes. An example of this type of occurrence is in a case where a nurse was appointed to stay with a patient at all times and went out of the room for eight minutes. The treating psychiatrist informed the hospital staff that the patient required constant observation because of her suicidal inclinations. Despite these warnings, the woman was left alone long enough to kill herself.

There are other cases where the failure to place the patient in a locked or secured ward is basis for liability. A widow and the children of a 28 year-old man were awarded $1.6 million for the man's wrongful death. The patient escaped from an unlocked ward in which he had been placed, went home, and shot himself in the head.

A duty of the psychiatrist to make a proper diagnosis of the patient's condition is part of the area of responsibility. There must be a thorough history taken from the patient. Failure to do so resulted in liability for a psychiatrist who failed to take a complete history and inaccurately diagnosed barbiturate addiction as epilepsy. The fact that a diagnosis is impose liability. A psychiatrist is not liable for honest errors in judgment.

In one case a suicidal patient was given Tofrinal, an anti-depressant, even though medical records indicated that the drug worsened his suicidal state of mind. He was later discovered dead, having hung himself with a belt, which the hospital had omitted to take from him. The judge awarded $100,000 for this 34-year old unemployed man's wrongful death.

The psychiatrist, as well as the hospital, may be responsible for injuries caused by the patient while under the influence of an erroneously prescribed drug. In one such case a serviceman on leave was admitted to a psychiatric hospital. He was described as having a reaction of hysteria, anxiety and depression. One month after his release he went to the out-patient clinic where Valium was given. Several days after he began taking the Valium, the patient injured the plaintiffs in a head-on collision. At the trial, it was unanimously agreed that Valium should not have been prescribed as it intensifies the depression. The plaintiff brought suit and was awarded $285,000 which was upheld on the appeal.

Copyright (c) 1996 Lawrence Landskroner. All rights reserved. Reproduction in whole or in part in any form or medium without express written permission of Lawrence Landskroner is prohibited.

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