This case involves a patient who was admitted to hospital after displaying erratic and violent behavior at his parent’s home. Upon admission, it was observed that the patient was suffering from critical physical and psychological conditions and required professional psychiatric treatment. According to the medical records, the treating psychiatrist knew that the patient had a recent medical history of both suicidal ideation and homicidal ideation. Additionally, it was noted that the patient was exhibiting signs and symptoms of paranoia, psychosis, and depression. Nevertheless, the psychiatrist still discharged the patient shortly after he was admitted. A few hours after the patient was discharged into the care of his parents, he was able to get away from their house. At this point, the patient began wandering the streets of his neighborhood, until he eventually broke into a stranger’s home. Once inside the home, the patient began to cut himself, and eventually jumped off the roof, suffering significant injuries. It was alleged that the hospital was negligent in discharging the patient as early as it did.
Question(s) For Expert Witness
- 1. Are you familiar with the proper policies, procedures, and protocols for psychiatric treatment, including discharge?
- 2. Should a patient exhibiting these symptoms and behavior be discharged?
Expert Witness Response E-057103
I have trained in and worked in a general inpatient unit in a community psychiatric hospital with a large proportion of involuntary admissions with chronically ill patients such as the individual described in this case. I am very familiar with the policies and protocols for discharge. From the information provided, the patient met criteria for involuntary treatment and should not have been discharged. Unresolved depression with psychosis and paranoia is a risk factor for suicide, and it would be difficult to imagine a scenario where this patient would be safe for discharge. It would have been important for doctors to consider other risk factors for suicide and violence including hopelessness, past attempts, and whether the individual was future-oriented. It would also be important to know if the treatment team contacted the family and friends of the patient, as self-report of suicidal ideation is not adequate to determine suicidality. As a forensic psychiatrist who works in a teaching hospital, I have lectured on involuntary hospitalization and other related topics to the general psychiatry residents. I have also lectured to law students, during my Forensic Psychiatry fellowship.
Expert Witness Response E-057078
I have been a Board certified psychiatrist for over 30 years and am familiar with proper policies and protocols for the treatment including discharge. With the information provided, this patient should not have been discharged.The symptoms mentioned can occur in a broad range of severity and impact suicide risk differentially. I have published on this subject. Last year I entered a whole CME course on suicide risk assessment into our university CME website.