A Case of Matricide

Victor Bruscato suffered from severe mental illness when he came under the care of Dr. Derek O'Brien. He had been diagnosed, over the course of his life, with mental retardation, pervasive developmental disorder, schizophrenia, an unspecified psychotic disorder, organic mood disorder, intermittent explosive disorder, and pedophilia. Bruscato had expressed homicidal thoughts toward his parents, with whom he resided, and had physically assaulted them, as well as others. He also experienced auditory hallucinations that commanded him to kill people or to molest girls. He was prescribed Zyprexa and Luvox to help control his behavior.

In May 2002, O'Brien discontinued the Zyprexa and Luvox because he was concerned that Bruscato might develop neuroleptic malignancy syndrome (NMS), a relatively rare disorder. O'Brien's expert witness later testified that discontinuing these medications was the wrong course of treatment and not medically justified.

Indicted but Incompetent to Stand Trial

Without medication, Bruscato's behavior became more erratic and difficult to control. He began having nightmares, panic attacks, and bouts of heavy sweating. Bruscato also started hearing voices telling him to kill, and he became increasingly hostile toward his parents. On August 15, 2002, Bruscato killed his mother by striking her head with a battery charger and then stabbing her 72 times. He was indicted for his mother's death, but was found not competent to stand trial and was never convicted of a crime. Shortly after the time of the homicide he was committed to Central State Hospital, where he currently resides.

Bruscato, through his guardian, brought suit for medical malpractice against O'Brien. The trial court dismissed the suit on public policy grounds. It reasoned that Bruscato should not be entitled to profit from the murder of his mother. The Georgia Court of Appeals reversed the judgment of the trial court. Bruscato v. O'Brien, 307 Ga. App. 452, 705 S.E. 2d 275 (Ct. App. Ga. 2010). An appeal to the Supreme Court of Georgia ensued.

The Supreme Court of Georgia held that, when one knowingly commits a wrongful act, he cannot benefit from his wrongdoing. The court reviewed all the evidence of Bruscato's mental illness and ruled that his psychiatric condition prevented him from exercising a reasonable degree of care to prevent him from taking improper and illegal actions. It further noted that Bruscato had never been convicted of a crime with respect to his mother's death.

Criminally Insane can Sue Despite Slayer Statute

The Supreme Court of Georgia had recently ruled on the Georgia “slayer statute.” In Levenson v. Word, 286 Ga. 114, 686 SE2d 236 (Ga. 2010), the court held that one who feloniously and intentionally killed the deceased will be precluded from inheriting from the estate of the deceased. This holding was in line with the Levenson case.

Accordingly, in a unanimous decision, the Georgia Supreme Court affirmed the judgment of the court of appeals (finding Bruscato was entitled to sue) and sent the matter back to the trial court for trial. A key factor in this case was that Bruscato was never found guilty of a crime and probably never will be. This leads to the conclusion that Bruscato's action was not intentional for the purposes of forming the requisite legal intent to commit a crime. Since Bruscato was incapable of forming the legal intent to commit the crime, his action could not be felonious.

Treatment planning for patients with mental health needs can raise complex and difficult issues requiring careful management in the psychiatric practice. Changes in treatment plans should be approached cautiously with due regard for the safety of the patient and those around him. O'Brien's own expert testified that Bruscato should have been hospitalized to determine whether he had NMS, and, with the benefit of hindsight, that would probably have been a more appropriate course. Changes in treatment plans need to be objectively justifiable and be made in the best interest of the patient and, where appropriate, the public at large.

In order to defend a case like this, the mental health professional needs to show that s/he was duly diligent: (1) the patient was assessed appropriately, (2) the interventions contemplated were objectively justifiable, (3) due care was taken to ensure the safety of the patient and others around him/her, (4) all steps in the process were carefully documented, and (5) the standard of care was met. To do less is to invite liability.

O'Brien v. Bruscato, 289 Ga. 739;

715 S.E.2d 120 (Ga. 2011)