The suicide of a patient is a tragedy for any physician.
Patients with suicidal thoughts or ideation appear occasionally in physician encounters. The Joint Commission recently noted that the rate of suicide is increasing, and suicide is now the 10th leading cause of death in the United States.1 Most people who commit suicide received healthcare services in the year prior to death, usually for reasons other than mental health issues or suicidal thoughts. It’s a strong reminder that any patient—no matter what issue is being treated and in any setting—could be at risk for suicide.
The patient’s well-being should be the primary concern, but physicians also must consider the potential legal liability that can come from failing to adequately screen patients for suicide risk and taking the proper steps when needed. The remorse a physician may face over missing signs can be compounded by legal action claiming the physician is accountable for the patient’s demise. A consistent and formal screening process, plus a response plan, will protect both the patient and the physician.
A recent case illustrates how even if the patient denies suicidal ideation when asked, the physician could be held liable for the suicide if there were other risk factors to consider. The case involved a 60-year-old woman with chronic back pain from an auto accident 10 years earlier, treated by her family practitioner over several years for pain, depression, and hypertension. Prior to her death, the woman had three appointments with the doctor over nine months for insomnia, pain medication adjustment, antidepressant medication monitoring, and blood pressure checks.
The notes from the last encounter state: “No energy; insomnia; denied suicidal thoughts and denied feeling depressed.” Six days later, the patient overdosed on a combination of sleeping medication and anti-anxiolytics. Notes in the medical record from the next-to-last appointment said the patient “complained of insomnia; increased depression and increased anxiety; referral to psychologist.” However, she did not see the psychologist and the family practitioner’s office did not follow up. The defense experts said that the doctor should have considered the entire history instead of just the last visit and concluded the patient was at risk of suicide.
These are some key strategies for ensuring that a physician practice or hospital is sufficiently addressing suicide risk in patients:
Note: In addition to her legal experience, Robin Diamond has a master’s degree in psychiatric nursing from Vanderbilt University.
By Robin Diamond, MSN, JD, RN, Senior Vice President of Patient Safety and Risk Management, The Doctors Company
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.