Whether the universal standard of care for treatment of mental illness should include suicide prevention is the subject of a case now before the Florida Supreme Court.
The husband of a woman who committed suicide in 2008 while under the outpatient care of a family physician sued, alleging medical negligence. Initially, a circuit judge granted summary judgment in favor of the physician, but the Florida Second District Court of Appeal reversed the decision and allowed the case to proceed. The appeal was heard earlier this month in Tallahassee.
In this case, the woman in question had depression. According to court records, the patient began taking the antidepressant venlafaxine in 2005, but stopped taking it sometime in 2008. On the day in question, she phoned the physician, who was in family practice, and reported that she was, according to the appeals court, under mental strain and crying easily. An assistant fielded the outpatient call and reported it to the physician. The doctor changed the woman’s medication to escitalopram, a different antidepressant, offered a sample of escitalopram for pickup at the office, and made an appointment for the woman with a gastroenterologist.
According to news reports, justices asked under what circumstances a physician could predict a patient’s risk for suicide. The defendant’s attorney told the court that the patient in question had no history of suicide attempts and had presented only with distress and stomach discomfort. The attorney argued that when the patient was found to have hung herself the day after phoning the family physician, it was a “unique, deliberate, and intentional act” that the physician could not have anticipated under the standard of care.
The defendant also argued that Florida state law treats suicide differently from other types of health care.
The attorney for the plaintiff argued that this conclusion was not warranted, and that this was a case of medical negligence resulting in death of a patient. The plaintiff argued that “doctors treating patients for depression can foresee that failing to treat them in a timely and competent manner may result in suicide.” The plaintiff argued that the physician should have spoken with the patient directly and conducted an evaluation before prescribing escitalopram.
The standard of care was also called into question by at least one of the appeals court justices. Justice R. Fred Lewis questioned why suicide is “such a reserved area,” considering recent scientific advances in understanding of the human mind and psychiatry more generally.
A decision is expected later this year.
Ann Latner, JD, a former criminal defense attorney, is a freelance medical writer in Port Washington, N.Y.