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Malpractice Rx

Suicidal patient jumps from building after protesting hospital discharge

Cases were selected by CURRENT PSYCHIATRY’s editors from Medical Malpractice Verdicts, Settlements & Experts, with permission of its editor, Lewis Laska of Nashville, TN ( Information may be incomplete in some instances, but these cases represent clinical situations that typically result in litigation.

Vol. 3, No. 9 / September 2004

Hudson County (NJ) superior court

A 44-year-old man with bipolar disorder and a history of suicidal behavior was hospitalized after telling the treating psychiatrist he had suicidal thoughts. Approximately 3 weeks later, the psychiatrist informed the patient he would be discharged.

Despite his objections, the patient was discharged 4 days later with the psychiatrist’s approval. This occurred even though the patient was found to be suicidal when he was evaluated that day by an in-hospital social services agency.

Two days later, the patient jumped from a 4-story building and sustained permanent partial paralysis. Subsequent treatments included spinal rod insertion, laminectomy, skin grafts, and 3 months’ rehabilitation.

The patient sued the psychiatrist for negligence for both the discharge and for inadequate medication management. The suit claimed that the prescribed mood stabilizer was dosed below therapeutic serum levels and that the psychiatrist switched the patient’s adjunctive antidepressant too close to his discharge date to determine its efficacy.

  • The case was settled for $1 million.

Inappropriate drug therapy blamed for inducing fatal heart failure

Kings County (CA) superior court

A patient with severe mental illness died of congestive heart failure (CHF), and his three minor children argued that their father’s medications caused his death.

The patient’s surgeon and family practitioner observed that he had a history of acute psychosis and was taking haloperidol. He was also being treated for schizophrenia and bipolar disorder and was living in a group home. The patient was diagnosed with diabetes in 1998.

In 2000, a group home staff member observed ankle swelling and foam around the patient’s mouth. The consulting psychiatrist reduced the mood stabilizer dosage. The family physician subsequently saw the patient for complaints of cough, wheeze, dizziness, and foam on the mouth. Neither physician acknowledged the foam.

The patient was found dead the next day. Autopsy showed that he died of drug intoxication; toxicology studies showed that serum levels of two psychotropic medications were elevated.

The plaintiffs argued that the psychiatrist’s mismanagement of the psychotropics led to the patient’s death, and that the family practitioner failed to test for CHF. The psychiatrist argued that the drug levels were necessary to control the patient’s mental illness. The family practitioner questioned the autopsy conclusion and stated that relevant diagnostic studies were not ordered because the patient’s presentation was atypical for CHF.

  • The jury settled in the defense’s favor.

Unattended patient sustains brain injury in attempted suicide

Unnamed county (MN) district court

A patient was hospitalized in the psychiatric unit with a diagnosis of major depressive disorder, suicidal ideation, and a defined suicide plan. The hospital psychiatrist ordered a suicide watch.

Three days after admission, hospital staff allowed the patient to use the psychiatric unit’s exercise equipment. When left unsupervised in the exercise room, the patient attempted suicide by hanging. Staff discovered and resuscitated the patient, but the hanging attempt resulted in severe anoxic brain injury, which caused permanent and total disability.

  • The case was settled out of court for $2.75 million.

Bipolar teen attacks mother with knife; family blames misdiagnosis

Tarrant County (TX) district court

A 14-year-old boy was being treated in early 2000 by a psychiatric group for depression and hyperactivity, for which he was prescribed methylphenidate and paroxetine. Later that year, he became agitated and attacked his mother with a knife. He was arrested and charged with assault with a deadly weapon.

The plaintiff sued the psychiatrists for failure to diagnose his bipolar condition and showed that prescribing paroxetine without a mood stabilizer is contraindicated in bipolar patients. The defendants argued that the patient did not have bipolar disorder when the medications were prescribed.

  • The jury found no negligence. Claims by the plaintiff’s mother were dismissed.

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