Control of the Suicidal Patient

Beginning in early August 2005, Monisa Reeves experienced a number of psychiatric symptoms. She was seen at a mental health facility on August 5 or 6, 2005, for psychotic symptoms, but she was not hospitalized. The next day she attempted to jump off a balcony into an empty swimming pool. The police were called and took her to a hospital emergency department. On that occasion, Reeves was involuntarily admitted to a mental health facility. However, three days later her status was changed from involuntary to voluntary and she was discharged.

When Reeves was discharged from the psychiatric facility, she was transferred to Horizons Crisis Group Home, a voluntary mental health facility. She stayed at Horizons from August 15 until August 17, when she was discharged at her request.

On August 23, she was taken to a hospital emergency department and was again admitted to Horizons. She was seen at Horizons by a psychiatrist, Mark Peterson, who diagnosed her with severe major depressive disorder with psychosis and bipolar disorder with psychosis. He prescribed medication for her. Reeves was again discharged from Horizons on August 29. Expert testimony later indicated that she had not been subjected to either a suicide risk or a self-harm assessment.

On August 31, Reeves poured gasoline on herself and set herself on fire. She did not die in the attempt.

Reeves brought suit for medical negligence against a number of defendants, including Peterson. Peterson moved for summary judgment, which was denied. He moved for reconsideration, which was also denied. This appeal to the Court of Appeals of Georgia ensued.

Voluntary Treatment Status

The issue was whether Peterson could be held liable for Reeves's injuries when she was on a voluntary therapy regimen and Peterson had no control over her actions.

The Georgia Court of Appeals reviewed the evidence to date and affirmed the denial of the motion for summary judgment. The court acknowledged that Peterson did not have control over Reeves's actions, but noted that the subject of control is not present in the statute on a physician's duty to his/her patient. (See Off. Code Ga. Annot. §37-3-4.) Rather, the court noted that the statute would hold a physician liable “for failing to meet the applicable standard of care in the provision of treatment to a patient.” Reeves presented the affidavit of an expert that indicated that Peterson's care was not within the standard of care for a treating psychiatrist under the same or similar circumstances. The court noted that the standard of care can encompass the duty to involuntarily commit a patient if she is a danger to herself or others.

These cases often turn on whether the practitioner was duly diligent in assessing the patient.

Accordingly, the Court of Appeals held that there was a genuine issue of material fact regarding the appropriateness of Peterson's care for Reeves and affirmed the denial of the motion.

The management of the potentially suicidal patient is a perennial issue in mental health. In this case the issue is not whether Peterson had control over Reeves's actions, but whether he should have had control over her actions by involuntarily admitting her to a psychiatric facility. That is often the crux of the issue and it is not a decision to be made lightly.

A patient who is felt to be at risk of suicide (and someone with severe depression probably qualifies as an at-risk person) should be reassessed periodically for suicide risk, and should have a suicide risk assessment done at every juncture in care. The suicide risk assessments should be continued until the person is no longer considered to be at risk of self-harm. These cases often turn on whether the practitioner was duly diligent in assessing the patient. Was the initial assessment appropriate? Were ongoing assessments made at junctures in care appropriate? Were appropriate interventions put into place? Was the discharge assessment appropriate? Were potential threats identified and addressed? Was the patient and/or family appropriately instructed in afterdischarge care? Was care taken at every turn to ensure, to the extent possible, that the patient would be kept safe?

The practitioner's control over the patient is always going to be limited, to some extent. The question will always be: Were all appropriate steps taken to provide care for the patient in a safe and effective manner? If the answer is no, liability may ensue.

Peterson v. Reeves, No. A11A1870

(Ct. App. Ga. March 30, 2012).