by Donna Vanderpool, MBA, JD

Ms. Vanderpool is Vice President at PRMS, Inc. in Arlington, Virginia.

Funding: No funding was provided for the preparation of this article.

Disclosures: The author is an employee of PRMS Inc., a risk management consulting company for healthcare providers.

Innov Clin Neurosci. 2018;15(9–10):30–31

This ongoing column is dedicated to providing information to our readers on managing legal risks associated with medical practice. We invite questions from our readers. The answers are provided by PRMS, Inc. (www.prms.com), a manager of medical professional liability insurance programs with services that include risk management consultation, education and onsite risk management audits, and other resources to healthcare providers to help improve patient outcomes and reduce professional liability risk. The answers published in this column represent those of only one risk management consulting company. Other risk management consulting companies or insurance carriers may provide different advice, and readers should take this into consideration. The information in this column does not constitute legal advice. For legal advice, contact your personal attorney. Note: The information and recommendations in this article are applicable to physicians and other healthcare professionals so “clinician” is used to indicate all treatment team members.

Question

My patient’s husband just called the office to let us know that my patient was found deceased last night. She had hanged herself. I can’t believe it—the patient was doing well and at the patient’s last visit, just two weeks prior, there were no signs of suicidal ideation. This is my first patient suicide—what do I do?

Answer

We know a patient intent on suiciding might suicide, even with the best care possible. As Dr. Robert Simon said, “There are three kinds of psychiatrists: those who have had a patient commit suicide, those who will have one commit suicide, and those with both. If you practice long enough, someone will commit suicide. It’s inevitable.”1 Here are some things to keep in mind:

Contact your professional liability insurer to report an event as soon as possible. Such notification is likely required under your policy and will enable your insurance company to provide prompt assistance with questions as they arise.

Protect the security and integrity of the patient’s record. If maintained on paper, the patient’s record should be kept separately under lock and key. Any correspondence with your professional liability insurance company and your attorney should be maintained separately from the medical record.

Do not alter the record. The record is your defense in a lawsuit or licensing board complaint. After an event, do not attempt to correct errors in the record without the approval of your insurance company or your defense attorney. Imperfect records can support a defense; altered records cannot. Furthermore, record alteration could be a criminal act under state law and will likely trigger a coverage exclusion in your insurance policy.

Determine the status of the patent’s bill. If a balance is owed, carefully consider whether to bill the deceased patient’s family. In a few cases, families have reported that receiving a bill after their loved one’s death triggered their decision to sue the psychiatrist.

Be prepared to deal with your own reactions. Clinicians whose patients suicide can experience severe distress from a range of emotions encompassing grief, self-doubt about treatment choices, and fear of a lawsuit. It is important to keep in mind that not all adverse outcomes are the result of medical errors, and that not all medical errors result in lawsuits

Do not discuss the case with anyone until you have discussed this issue with your claims examiner or defense attorney. Any discussions about the case with a spouse, colleague, or friend could violate patient confidentiality, and statements you make could be exploited by plaintiffs’ lawyers in subsequent litigation. Clinicians can benefit from establishing a treatment relationship with another practitioner to deal with their personal crisis, keeping in mind that patient information must not be disclosed.

Carefully consider whether to attend the patient’s funeral. We recommend that treating clinicians consider attending only if specifically invited by the patient’s family. If you decide to go, we suggest a brief appearance, with a prepared response to the inevitable question of how you knew the patient. Because this can be fact specific, depending on the involvement of the patient’s family in the deceased patient’s treatment, you can discuss this and other issues, such as sending a condolence card, with your liability insurance company.

Understand that patient confidentiality survives a patient’s death. The American Medical Association Code of Medical Ethics Opinion 3.2.2 states, “In general, patients are entitled to the same respect for the confidentiality of their personal information after death as they were in life.”

Expect requests for release of the patient’s record. You should obtain guidance from your liability insurance company in processing requests for information by entities, such as the following:

  • The medical examiner
  • Insurance companies
  • Other treating providers
  • Attorneys—Note that a request for the record from an attorney does not necessarily mean that the attorney will be suing you. Plaintiff attorneys typically want to review medical records before agreeing to take the case.
  • Family members

• Seek guidance from your liability insurance company prior to participating in any type of review of the patient’s care. This includes peer review, incident review, and quality assurance review from the patient’s health plan.

References

  1. Levin A. Patient Suicide Can Exact Huge Toll on Clinicians. Psychiatric News site. 21 Jan 2005. https://psychnews.psychiatryonline.org/doi/full/10.1176/pn.40.2.00400010.