Death by Suicide [Doctor Refuses to Settle]
Case #213
Content warning: This case deals with suicide and an infamous white supremacy organization.
A 52-year-old woman presented to a psychiatrist for anxiety and depression in January 2017.
She was started on an unspecified antidepressant.
She had a single follow-up appointment about 90 days later, at which point clonazepam was also prescribed.
Over the subsequent few months, she allegedly called the office several times to make further appointments.
Apparently the secretary never returned any of her calls.
During this time period, she also had several visits with a licensed professional counselor.
It does not appear that any suicide risk assessments were done.
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The patient saw her primary care nurse practitioner in June 2017.
She told the NP that she could not get a hold of her psychiatrist and was almost out of clonazepam.
The NP prescribed 30 days of clonazepam.
On July 10, the patient called and asked for another refill, which was granted by the NP.
In August 2017, the patient died by suicide with a firearm.
The patient’s husband filed a lawsuit against the psychiatrist, the counselor, the NP, and each of their respective employers.
The plaintiff submitted the following expert witness opinion, which was signed by a board-certified psychiatrist:
The plaintiffs offered to settle for a total of $5,000,000:
$1,000,000 each from the psychiatrist, the licensed professional counselor, and the NP
$1,000,000 from the psychiatrist’s employer and the NP’s employer
An email between the 2 attorneys was included in the court documents indicating that Dr. R refused to settle.
Confidential settlements were reached with the other parties.
Dr. R and his employer were the only remaining defendants.
At deposition, the defendant psychiatrist was asked why he took so long to become board certified after finishing residency.
He disclosed that he had failed oral boards several times.
The defense filed a motion asking the judge to prevent the plaintiff’s attorney from mentioning this in front of the jury:
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As trial neared, the defense suddenly filed a new document asking the patient’s husband to answer a list of questions:
The plaintiff’s attorney filed a motion to seal this document from public view.
They accused the defense of violating the state’s legal rules, claiming that the document should never be filed in a public court database.
The plaintiff ultimately agreed to withdraw the lawsuit against the psychiatrist.
Both sides petitioned the judge to remove the document from public view, and it is no longer accessible on the court website.
MedMalReviewer Analysis:
This is one of the craziest plot twists I’ve ever seen in a medical malpractice lawsuit. It looked like this case was headed for trial until the inflammatory information about the patient’s husband was revealed. It seems suspicious that the defense attorney “accidentally” put this information in the public domain in order to gain a negotiation advantage over the plaintiff.
If the patient truly called the psychiatry office multiple times to set up an appointment and never got a call back, there is validity to a negligence claim against the business. Unfortunately the plaintiff’s expert witness opinion was devoid of details and written so poorly (appears to have been authored by the attorney and rubber-stamped by the expert witness) that we have no information about her alleged attempted to schedule an appointment. Front office staff that give bad medical advice over the phone or refuse to schedule patients can result in lawsuits.
While reviewing the paperwork in this lawsuit, I noticed that the address of the psychiatrist’s office and the address at which the patient was found dead were exactly the same. I previously wrote about a lawsuit in which a patient killed himself in the parking lot of his orthopedic surgeon’s office after a hip surgery left him with chronic pain. Why do patients drive to their doctor’s place of work to kill themselves?
The patient died just over 30 days after her last clonazepam prescription was filled. The timing seems to coincide fairly well with running out of medication and developing significant withdrawal. I’m concerned this may have been an exacerbating factor. It also brings to mind a previous case related to a patient who died by suicide after his PCP retired and the PA he established with refused to continue prescribing the exorbitant amounts of opioids he had previously been prescribed.
There's this statement in the plaintiff's motion: “… husband should not be subjected to having personal and harassing information about himself available to the public.” Well, that's ironic.
Hell of a twist.
It's impossible to say for sure without more info whether the psychiatrist actually was negligent in the strictest of medicolegal senses. If the facts are as reported (started on a med, 90 days before follow up, then started on a controlled med, and no follow up), I would consider that poor care particularly if the patient was medication naive. The timing of the patient's requests for refills is broadly supportive of being given 90 day supplies, and her two requests to the NP would time with a responsible patient requesting refills. So I do suspect this psychiatrist was at minimum a subpar physician. Agree the expert opinion is crap though. The random mention of ECT (bonus points for "additional ECT testing", a phrase that has been uttered by exactly zero psychiatrists ever) particularly gives it away as nonsense.