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Healthcare Update: Identifying Suicidal Risk – What the Courts Say

07 December 2018

Background

On the night of 17 April 2011, JC was admitted to the emergency department at University College Hospital, Galway following a drug overdose. She was discharged the following afternoon and tragically on 19 April 2011 took her own life. Her husband, to whom she had been married for 25 years, brought proceedings alleging negligence against the HSE and Dr B, a non- consultant doctor working in psychiatry, for failing to identify the imminent risk of JC committing suicide and wrongly discharging her. All claims were denied by the HSE and Dr B.

The Interviews

JC was first seen by Dr B in the emergency department on the morning after being admitted. The duration and nature of this encounter was disputed. Dr. B interviewed her and spoke with her husband for approximately five to seven minutes in a corridor of the emergency department.

The High Court reasoned that a more substantial conversation with JC’s husband would have influenced Dr B’s decision about what course of treatment was appropriate for JC. The Court found that Dr B’s decision to limit his discussion with JC’s husband because of medical confidentiality was based on an “erroneous” view of the limits of patient/doctor confidentiality. This view was deemed contrary to generally accepted practice.

“Red Flag”

The Court heard that JC had suffered from depression and anxiety arising from sexual abuse during her childhood which was the subject of a police investigation. Her marriage suffered and JC had made a prior attempt at suicide, which she had concealed from her husband.

Dr B did not enquire about this previous suicide attempt with JC or anyone else. The Court found that a medical practitioner acting appropriately would have treated this prior incident as significant and made further enquiries. Had Dr B investigated this incident further, it was probable he would have discovered that JC’s husband was unaware of any previous suicide attempt. This would have raised a red flag warranting further enquiry.  

Collateral information

The Court decided that Dr B should have contacted JC’s General Practitioner (GP) before her discharge. The GP had diagnosed JC with depression four weeks before the overdose. The Court believed the GP’s opinion would have had some bearing on Dr B’s care plan. Given the complexities of the case, the Court also decided that Dr B should have contacted the consultant psychiatrist on call before JC was discharged.

“Not an appropriate standard of medical care”

The Court ultimately found that JC had not been afforded an appropriate standard of medical care. JC should have been admitted as an in-patient where she would have been in a secure environment and under the “watchful eye” of hospital staff. Had this course been followed, it was probable that she would have survived.

In light of Dr B’s unjustified reliance on his brief interview with JC, his “over-optimistic” view of the risk of her further self-harming and the inadequacy of his collateral enquiries, the Court concluded that a claim for negligence against the Dr B and the HSE had been successfully made out. Damages in the amount of €263,220 were awarded to JC’s husband in respect of mental distress, loss of consortium and financial loss incurred due to the loss of his wife

Conclusion

This judgment should serve as a caution to psychiatric doctors treating patients who attend the emergency department with possible suicidal intent. The key takeaways are:

  • Have a detailed interview with the patient
  • Make enquiries about any prior suicide attempt
  • Take a collateral history from a spouse/family member if possible
  • Where appropriate make contact with the patient’s GP
  • If appropriate consult with a senior psychiatry colleague before discharging the patient
  • Ensure the patient interview is fully documented in the medical records recording the date and time of the interview

For more information on treating patients who display possible suicidal intent, contact a member of our Healthcare & Medical Law team.


The content of this article is provided for information purposes only and does not constitute legal or other advice.

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