Overdose Admission [Allegedly Discharged by Psych Too Soon]
Case #125
A 48-year-old man was having marital problems.
He had chronic issues with alcohol abuse and was periodically physically abusive to his wife.
She asked for a divorce, and he was very upset.
Several days later, he drank a large amount of alcohol and took an indeterminate amount of Percocet, Fioricet and tizanidine.
His children (ages 13 and 8) found him unresponsive on the couch.
They called 911 and he was taken to the ED.
In the ED he was noted to be breathing spontaneously.
He did not require intubation but was admitted to the ICU.
The next morning he was medically cleared, but was extremely agitated.
He was given chemical sedation with Ativan.
Unfortunately he continued to escalate, threatening staff members verbally and holding his fists up in an aggressive manner.
He was placed in 4 point restraints for several hours.
He told the nurses that he had a $600,000 life insurance policy which would provide for his children’s care after he died.
The following day, he was much more calm.
He was reassessed by another psychiatrist.
The psychiatrist’s consult note is shown here:
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After being discharged, the patient went to a liquor store.
He drove his car to the edge of a cliff at a local quarry.
He started drinking heavily.
His wife and extended family were looking for him the entire day, and spoke with him several times by phone.
He refused to tell them where he was.
The police were contacted and began searching for him based on his cellphone location.
Unfortunately it was too late.
He drove off the cliff and died by suicide while on the phone with his wife.
His wife hired an attorney and filed a lawsuit against the discharging psychiatrist and the hospital.
The expert witness opinion for the plaintiff is shown here:
The plaintiff requested $4,500,000 to settle the case.
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The defense hired their own experts.
An excerpt from their counter-arguments is shown here:
The defense also laid out an argument that the patient’s own negligence led to his death, not the psychiatrist’s alleged negligence.
The 2 sides ultimately reached a confidential settlement before trial.
MedMalReviewer Analysis:
I am disappointed that the defense settled this lawsuit. It seems clear that the patient deliberately lied and was intent on taking his own life. Psychiatrists do not possess a magical ability to predict patient’s actions and know when they are lying.
The physician seems to have done a thorough review of the situation and obtained collateral from the appropriate sources. The patient’s own wife did not feel he was suicidal at discharge. He also arranged for him to be seen the next day, which shows his careful and attentive approach.
The plaintiff’s criticism primarily centers around the fact that defendant did not address the life insurance policy. This is not a modifiable factor. Holding the patient for another few days or weeks would not change the fact that he has a life insurance policy.
The plaintiff’s expert also notes that the impending divorce and restraining order should have prompted longer hospitalization. This would set a dangerous precedent in which the healthcare system forcibly hospitalizes people with these issues against their will without a clear endpoint, despite patient and family insistence that they are no longer suicidal.
I have a final update from Case #3 [Paid Subscribers].
A 49-year-old woman with breast cancer sued several radiologists for missing a thoracic lesion that turned out to be metastatic disease.
The case reached its final conclusion and the court released new documents:
CT scan reports
PET scan reports
Defense expert counter-arguments
An excerpt from the plaintiff’s billing records