• FreeAdvice has a new Terms of Service and Privacy Policy, effective May 25, 2018.
    By continuing to use this site, you are consenting to our Terms of Service and use of cookies.

Is this a case of malpractice?

Accident - Bankruptcy - Criminal Law / DUI - Business - Consumer - Employment - Family - Immigration - Real Estate - Tax - Traffic - Wills   Please click a topic or scroll down for more.

D

dogchopper

Guest
I live in Georgia (if that matters)
A few weeks ago my husband committed suicide. It was unexpected. But, here is the story of why I think the hospital is at fault. (sorry if its a bit long)

He attempted suicide (i didnt know at the time) on a thursday morning by taking an overdose of his medication (paxil) and some other meds that he wasnt supposed to be taking. I thought he had just taken too many sleeping pills and I couldnt wake him up. So, by 10:00am I called 911 and they took him to the hospital. When there I told the ER doctor (and I had told the paramedics) that I thought maybe he took too many sleeping pills or that he may have accidently taken my daughters medication. He was totally confused and unresponsive for a while. Then he was babbling about how he lost his job and things like that, you could tell he was upset about that. While there in the ER The doctor asked how long he had been on Paxil because sometimes it will give you a reaction similar to his where you are totally confused, cant walk straight, and have a fever. Exactly his symptoms. Well, again I mentioned the meds.. But, for some reason because he had a fever they assumed he had a virus, that he may have gotten bitten by some bug? So they treated him with antibiotics .. admitted him into the hospital and ran ALL kinds of tests. All this time my husband kept talking about loosing his job, and he wasnt make much sense but you could tell he was upset. On the medical records it even says to have a psyc evual. BUT they didnt. They also didnt seem to check his blood for perscription meds, only for illegal drugs. SO, they let him go from the hospital Saturday afternoon at about 4:30..
That day he finally admited to me he had tried to kill himself. (after he was home) and we talked a bit, but our kids were running around so we wanted to wait till they went to bed. Well, he went downstairs to watch tv with the kids, snuck out of the house and shot himself. He had been home from the hospital for about 4 1/2 hours and he was dead.

Should the hospital have tested him for these meds? should they have gotten that psyc evual.. I know they should have, but are they liable for this? If they had known they would have surely admited him into the psyc ward??

So, is this a case >??


Nancy
 


rmet4nzkx

Senior Member
Nancy,
I'm sorry for your loss. Did they do an autopsy and if so did they check blood levels of Rx in his blood at the time of his death? They should be able to find some of them depending upon the half lives of the Rx, this may already be included in the autopsy, if not, if they kept samples it could be done even though it has been a few weeks. Do you know what medications he took and did you provid the bottles to the hospital or the corneror? Depending on the tests the hospital ran, they may still have blood samples to test, all depends on when this all happened. These things would be important evidence.

If they released him without a psych evaluation, when one was ordered and he was despondent or even confused, I would certanily consider the hospital responsible unless there was something else that happened. Please contact an attorney ASAP. Has the hospital contacted you at all?
 

ellencee

Senior Member
The hospital is not negligent in any way, shape, or fashion. If the wife felt the husband should not have been discharged, she should have asked for assitance in getting her husband involuntarily committed to a mental health facility. He was lucid when he went home and lucid when he talked to his wife who obviously didn't feel it was inappropriate to leave him alone.

It is a tragic loss, but it is no one is responsible for his death but him.

EC
 
D

dogchopper

Guest
Thanks rmet4nzkx
They did not do an autopsy. I didn't even think of that at the time, and he was cremated so its out of the question now. The hospital hasn't contacted me, I don't even know if they know he's dead? The corner took him to a different hospital. I did get a copy of all the medical records and I did speak to an attorney who is going to refer me to a malpractice attorney. I was just wanting to make sure before I went further.
They did TONS of blood work on him in the hospital. I was shocked they didn't find anything. Yes I did have some of the bottles of what he took, and I gave them a list of things I thought he may have taken accidentally?
Anyways, I'll see what the malpractice attorney says.

Nancy
 

lkc15507

Member
I too am extremely sorry for your loss. Suicide of a loved one is one of the most difficult things anyone could bear. Please do not question that you could have been responsible. You are not. I seriously question the decision to dismiss your husband without the psych eval that was ordered. From your post, I understand that much of what you learned was in retrospect. You were not professionally equipped or even lay equipped to know how to deal with the situation once you learned of your husband's attempts to take his own life. Unfortunately, most psychiatric treatment is based upon the information delivered by the patient. If your husband denied suicidal ideation, there was probably little the hospital could do. However, I would recommend a thorough review by medical and legal professionals if you wish to pursue this. Just know that no courtroom decision will assuage your grief. Please seek the help of a qualified grief counsellor, preferably one with experience in surviving the suicide of a loved one.

My heart goes out to you. lkc15507
 

ellencee

Senior Member
This question has been posted and answered numerous times. It is tragic that posts regarding the suicide of loved ones can be accurately described as "numerous".

In several of the previous posts, attorneys and medical professionals have stated there is no liability of the hospital.

Some of the posters to this thread are applying standards of care from the former TV show Chicago Hope and applying some standards of care for nonvoluntary admissions or admissions brought in by the police or patients whose mental status prevents releasing them into the general public (I am talking bizarre mental behavior with correlating physical problems). Maybe some of the standards of care being applied are from the '70's when MDs and hospitals exerted a kind of 'policing' of patients.

A consult is a request for an opinion from a different discipline or a different provider (MD or other professional). The only professionals responsible for carrying out a consult order are the nurses or other healthcare staff that enter the consult request into the computer and ascertain that the request gets to the office of the requested consultant. No MD can order another MD to see a patient or provide a consultation. No MD can refuse to dismiss a medically stable/safe, voluntarily admitted patient because the requested consultation was declined or not completed. In this situation, the acute care facility had no right to hold a voluntarily admitted patient who was medically competent.

It is not fair to the original poster for healthcare professionals to support the poster in seeking to hold someone other than the her husband responsible for his behavior.

Certainly, the original poster should speak with a medmal attorney in her area so that she can receive objective legal advice and gain the freedom to move forward in the grief process.

EC
 

lkc15507

Member
Your post makes no sense to me. No one has advocated anything other than a prudent review of this person's situation. "Numerous"? I don't even find the word in these posts. If there are previous posts, she was probably intimidated or put off by unfriendly folks. Who the heck advocated holding a voluntarily admitted patient against his will? Medically competent or otherwise? Fair? Have you a concept of the word? The leaps and bounds and assumptions astound me. The attempts to cover the leaps and bounds are even more astounding.
 
Last edited:

rmet4nzkx

Senior Member
Ellen,
I based my advice on My professional experience, knowledge and training in Mental health issues, psychopharmacology etc and Standard of Care for such situations, NOT on "Chicago Hope". I know the episode to which you refer and that is a classical presentation of the risk of treatment for depression which must be closely monitored, but this case did not come close to that portrail. Paxil was a new drug at that time. I asked questions about the autopsy because if one had ben done, the resuts would be critical, in their absence more difficult to prove but still provable.

The patient was non responsive, that was why 911 was called and there was suspition of overdose. This is different than volluntary admission and release. OP was expecting the ER doc to know what was needed in this situation and to order appropriate tests and evaluations, that didn't happen. OP is not qualified to determin if the SOC was followed. There is an increased risk for suicide to Paxil one of the Rx mentioned, in one study there was incresed risk of suicide, 1/60 Paxil as opposed to 1/550 placebo and in the UK is no longer being perscribed to some populations.

Assessment and release by an ER doc, unless they were competent in psychiatry, without a psych eval which was ordered but not done or doing tox screen for Rx drugs, does not meet the standard of care anywhere. The fact that the corner took the body to another hospital did not lead to a M&M at the original hospital for that reason and the original hospital at this point has no knowledge of what transpired subsequent to release.

The ER doc was assuming the man had serotonin syndrome which includes:confusion, diarrhea, fever, poor coordination, restlessness, shivering, sweating, talking and acting with excitement you cannot control, trembling or shaking, twitching; because of the confussion and fever, however OP also described other signs of overdose while others signs of serotonin syndrome which may seem like an manic episode were not present.

OP was correct in asking if the blood levels of Rx should have been done in addition to illegal drugs and the ordered psych eval. In this case a patient, who was despondent, with a possible OD was released without appropriate care or assessment, while on the surface, suicide is an autonomous act, the attempted intervention failed to meet the SOC, misDx of Serotonin Syndrome certainally suggests malpractice, so referal to an attorney was more than appropriate.
 
D

dogchopper

Guest
Thanks for the 'kind' replies

Well, I sure did not intend to start any type of argument here. And I was shocked at the unkind post on the first day, which is why I just ignored it. I have enough stress with out dealing with that too.

As far as 'Chicago hope' goes, I rarely ever watched the show so I have no clue why it was mentioned.

I will defiantly contact an attorney and have the case reviewed. If the attorney feels it is something that needs to be looked into, we will do that. I am very angry that they did not run the proper blood tests. I cant imagine why they did not find this overdose. From what I have seen in the medical reports they only ran tests for illegal drugs. For that reason alone I am very upset with this hospital. I am just praying they can learn something from this and not let this happen to someone else. Life's can be saved or lost thru the intervention of the ER personnel.

As the others stated, I am not a professional, and have never in my life dealt with suicide or suicide attempts. In fact this suicide was a total shock, something I never EVER thought he would even consider.

There were no previous posts, this was my first time here. I came here in search of some advice.

I thank you all for the kinds words and advice. Life right now is difficult and I know it will be a while before it gets any easier.

Thanks
Nancy
 

rmet4nzkx

Senior Member
Nancy,
I'm so sorry that a difference of opinion arose here amidst your sensitive issue and suring your time of loss. Even amongst experts there is a variance of opinion and also the intrusion of personal vs professional opinions. Please forgive our differences, how something looks to one expert may be different than another because their scope of practice or experience is different.

You are correct in questioning the standard of care, nor are you responsible for second guessing the doctor, although that is a common defense to make the victim responsible. In the field of emergency medicine, ER doctors have a broad scope of practice yet not the concentrated experience of the specialist so it is a trade off between the referal for followup and the acute treatment. In your case, in the absense of the psych eval ordered, was there an outpatient mental health visit scheduled prior to release? Was the Paxil prescribed by a psychiatrist or a PCP? These will be issues raised when you consult with your attorney. But the fact remains that the ER doctor recognized the need for a psych eval and released without one and suicide resulted.

Here are several references to the sandard of care for psychiatrists on the issue of suicide, please note there is a difference between standard of care and prediciton of suicide:

Psychiatric Times ... The evaluation of suicide risk is a challenging clinical task. ... Clinical standards for the prediction of suicide do not exist; however, the standard of care ... www.psychiatrictimes.com/p031241.html

The following is from Psychiatric News re the SOC for psychiatrist which did not happen here:
Psychiatric News -- 38 (24): 20
pn.psychiatryonline.org/cgi/content/full/38/24/20
Q. A colleague was successfully sued by the family of a patient who committed suicide. I am now concerned about my own liability for the acts of my patients who are or may become suicidal. I can’t predict the future, yet that’s what I feel is the expectation. What risk management advice can you give me?

A. An impression shared by many psychiatrists is that to avoid liability related to treating patients with suicidal behaviors, psychiatrists are expected to be able to predict whether a particular patient will attempt suicide and thus prevent all suicide attempts, however unforeseeable. Thankfully, however, courts recognize that psychiatrists are only human; they do not expect impossible powers of prediction.

What is expected, as in any psychiatrist-patient interaction, is that the psychiatrist will meet the standard of care—that is, will exercise that degree of skill, care, and diligence exercised by members of the same profession/specialty practicing in light of the present state of medical science. In a lawsuit involving suicide, the psychiatrist’s actions will be assessed by reviewing certain factors, including, but not limited to, these:

• Whether there was adequate identification and evaluation of suicide-risk indicators and protective factors for the patient with suicidal behaviors

• Whether a reasonable treatment plan was developed based on the assessment of the patient’s clinical needs

• Whether the treatment plan was appropriately (that is, not negligently) implemented and modified based on an ongoing assessment of the patient’s clinical status

• Whether the psychiatrist was professionally current regarding the assessment and treatment of patients with suicidal behaviors (that is, knew suicide-risk indicators and protective factors, knew current treatment options/interventions including medications, therapy, hospitalization

• Whether documentation in the patient record was adequate to support that appropriate care was provided in terms of the assessment, treatment, and monitoring of the patient

Failure to meet the legal duty to provide the standard of care to a patient is negligence. In a medical malpractice lawsuit, the plaintiff has the burden of proving that the physician was negligent. It is significant to note, however, that the standard of care is not a static concept. In any particular instance, the standard of care encompasses a range or repertoire of acceptable treatment options and requires the exercise of the psychiatrist’s professional judgment. The exercise of professional judgment alone when choosing among acceptable treatment alternatives will not support an allegation of the breach of the standard of care. The standard of care in a particular case is determined by and based on that specific patient’s clinical needs. Just as there is no such thing as a blanket treatment plan applicable to every patient with a given diagnosis, there is no such thing as a blanket standard of care. Testimony regarding the standard of care is provided in the discovery process or at trial by an expert witness, that is, another psychiatrist who expresses an opinion on whether the care rendered was appropriate given the circumstances.

By doing your professional best to fulfill the expectations listed above, you will be doing all you can to provide quality patient care and thus reduce your potential malpractice liability exposure.

In general:
Evaluation and Treatment of Patients with Suicidal Ideation ...
... 20 The standard of care for patients with suicidality is ... will go on to commit suicide; thus, suicidal ideation warrants thorough evaluation--both when ... www.aafp.org/afp/990315ap/1500.html
___________________________________________________________
There are more but these should help you understand what is required and how what happened failed to meet the standard of care.
I hope this helps
 
D

dogchopper

Guest
Yes that helps very much. Infact I am going to save that information and bring it up to the attorney when I talk to him.

There are so many things that went wrong those few days, and the outcome is one that will haunt us all for ever. No he did not have a psyc appointment scheduled. They did tell him to follow up with his regular doctor with in a week.
The medication was perscribed by an MD. Several, because we have moved since he had started taking the meds many years ago.

I am going to be calling some people today and see if I can go talk to someone to see what can and should be done.

Thanks so very much.

Nancy
 

rmet4nzkx

Senior Member
dogchopper said:
Yes that helps very much. Infact I am going to save that information and bring it up to the attorney when I talk to him.

There are so many things that went wrong those few days, and the outcome is one that will haunt us all for ever. No he did not have a psyc appointment scheduled. They did tell him to follow up with his regular doctor with in a week.
The medication was perscribed by an MD. Several, because we have moved since he had started taking the meds many years ago.

I am going to be calling some people today and see if I can go talk to someone to see what can and should be done.

Thanks so very much.

Nancy
I wish you well with this process, it will bring up a lot of feelings but in the end hopefully will provide some degree of closure. Unfortunately, psychiatric medications are perscribed by non psychiatrists and in this case only stating to follow up with his PCP does not replace the psych eval, so everything you add, simply adds for to your case. When your read the last link to the AAFP it gives the basic expectations for family practice this would apply to ER doctors as well, again, even this was not met, even without the labs for all Rx levels, they failed to provide the SOC, there may be more once all the records are available which may show administrative contributions to what happened, but you attorney should be able to advise you, you might want to print these out as well as the AAFP article. Keep us updated as to your progress or additional questions.
 

ellencee

Senior Member
dogchopper (I assume that means an UGA chopper?!)
After researching numerous sets of standards of care for all levels of hospitals, I can not find one standard of care that supports your allegations. However, I do have a suggestion on how you can get a rapid answer that will be the legal answer to whether or not the hospital is liable for your husband's death due to his suicide.

Go to this site: www.jcaho.org; or simply type, jayco, in your address search bar and click, go.
On the JCAHO site, on the right hand side of the home page is a section "FAQ; submit your own question". Ask if your husband's death is a "sentinel event". You may not have enough space to enter the whole story but you should be able to ask if his suicide after hospital discharge without a psych eval prior to discharge is a sentinel event.

EC
 

Find the Right Lawyer for Your Legal Issue!

Fast, Free, and Confidential
data-ad-format="auto">
Top