Lessons Learned From Our Suicide Cases

As Martin pointed out in his blog last week, suicide is one of the two most common events leading to litigation against psychiatrists, the other being related to psychopharmacology.  PRMS has since 1986, handled thousands of events, claims, and lawsuits involving a patient suicide or suicide attempt.  From all of those cases, there are many lessons learned, including the following:

1. 1. There are effective ways to increase patient safety and minimize liability risk.  Here is a chart.
2. 2. The risk assessment is crucial.
3. 1. a. Inquire about firearms
   2. b. Document your assessment
   3. c. Use a standardized format consistently for suicide assessment.  Many such tools are available, such as the SAFE-T card

    

4. 3. You need to know – ahead of time – the criteria and process for involuntary hospitalization.
5. 4. You need to know the exact definitions of observation statuses at all the hospitals where you practice.  For example, is “close observation” 1:1 observation?  Does an observation order have to have been renewed after a specific number of hours to avoid reverting automatically to a lower level of observation?
6. 5. Patient safety is an exception to confidentiality.  Accordingly, if a patient at risk for outpatient suicide refuses to permit you to speak to family members, consider doing so anyway when:
7. 1. a. The risk is significant
   2. b. The family seems unaware of the risk
   3. c. The family is in the position to assist in keeping the patient safe

    

8. 6. Documentation allows your hard work and good clinical care to be understood.
9. 7. In the event of a suicide, remember:
10. 1. a. Confidentiality survives the patient’s death
    2. b. Call your professional liability insurer to report the death and obtain guidance

     

Here are more practical pointers.

Donna Vanderpool, MBA, JD – Vice President As Vice President of Risk Management, Ms. Vanderpool is responsible for the development and implementation of PRMS’s risk management services for both The Psychiatrists’ Program and The Neurologists’ Program. Ms. Vanderpool has developed expertise in the areas of HIPAA and forensic practice, and has consulted, written and spoken nationally on these and other healthcare law and risk management topics. She most recently wrote a chapter concerning the risks of harm to forensic experts for Robert L. Sadoff, MD’s book Ethical Issues in Forensic Psychiatry: Minimizing Harm, (Feb. 2011/Wiley). Ms. Vanderpool received her undergraduate degree from James Madison University, and her MBA and JD from George Mason University. Prior to joining PRMS in 2000, Ms. Vanderpool practiced criminal defense law, taught business and legal courses as an adjunct faculty member at a community college and spent eight years managing a general surgical practice in Virginia.