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A physician being sued for malpractice by the family of a depressed patient who committed suicide cannot turn the tables by claiming that the patient's own negligence contributed to her death, an Illinois appeals court has ruled.
Donald Shin, M.D., was Kathryn Hobart's family physician. During an office visit she complained of symptoms of severe depression. She also suffered from panic attacks. Shin referred her to a psychiatrist, who, because of the severity of Hobart's depressive symptoms, suggested she sign herself into a hospital, which the patient did voluntarily. The psychiatrist put her on a regimen of Doxepin, to which Hobart responded positively. After several days, she was released, and arrangements were made for treatment to continue on an outpatient basis.
She returned to Shin's office two weeks after the hospitalization complaining of running out of Doxepin and of the cost of frequent refills. The physician responded by prescribing 90 pills and supplying her with a refill prescription for 90 more. That amounted to a one-month supply, according to an account of the case in the March issue of Forensic Echo.
A relatively minor incident several weeks after the hospitalization, the theft of her backpack, sent her into a new and severe depressive episode. The day following the theft, she filled the Doxepin prescriptions, checked into a motel, and took all of them, as well as 20 additional pills she had hoarded. She died from the overdose.
Hobart's mother filed a malpractice suit against Shin charging that the amount of pills he prescribed her daughter was excessive and deviated from standards of care in such a case.
It took more than five years for the case to come to trial, and one month before it did so, Shin asked the court to allow him to amend his response to the malpractice charge by asserting an affirmative defense known as contributory negligence. That is, that Kathryn Hobart's actions in hoarding medication that she knew she was supposed to take several times a day contributed directly to her suicide.
Shin failed in this strategy, however, when the appeals court overturned a lower court's decision and ruled that contributory negligence is not a relevant defense in a suicide-based malpractice litigation.
It is the nature of the illness for which she sought treatment that her rationality and decision-making ability are impaired, the court said. Thus, unfortunate though the outcome was, Hobart was acting in accord with behaviors that are characteristic of and consistent with her disorder and did not meet the legal standard for contributory negligence on her part.
Psychiatrist Michael Welner, M.D., commenting on this case in the Forensic Echo, of which he is editor in chief, regretted that in rejecting Shin's argument, the Illinois court followed an all-too-frequent pattern of "deciding that if there is a history of an illness, a patient need not be expected to take personal responsibility." He stated that in choosing this response, the court was taking a "countertherapeutic" stance.
Psychiatrists and other therapists who treat suicidal patients and fulfill all the demands that doing so entails, Welner emphasized, can only experience an effective outcome "with a patient who can engage in a treatment plan." The circumstances of this case are "no different from the nephrologist who can only manage a kidney failure with dialysis, but requires the patient's involvement and regular attendance, when failure to do so may hasten death."
Rejecting the court's paternalistic argument about patients' decision-making autonomy, Welner supported Shin's contention that his patient's negligence did, in fact, contribute to her death, since the patient "made a choice not to advise the doctor that she had essentially stopped taking the medicine. . . . The decision may horrify us," he wrote, but some people do actually choose suicide as the best alternative after evaluating the circumstances of their lives.
The very serious risk facing patients if psychiatrists and others can be convicted of malpractice and patients' decisions marginalized, Welner believes, is that therapists will decide that treating them "isn't worth the risk." These seriously ill patients will then end up being treated by professionals with less skill and training.
[Hobart v. Shin, N.E.2nd 617, Ill. App. 1997]