The New York State Supreme Court Appellate Division Third Judicial Department (“Appellate Court”) issued a decision on February 23, 2017 in which it held that the trial court had erred in granting summary judgment to the defendant hospital attending physician and the defendant outpatient psychiatric nurse practitioner whose patient committed suicide. The patient’s parents alleged in their New York medical malpractice wrongful death lawsuit that the defendants’ breach of the standard of care led to their daughter’s suicide.
The Underlying Facts
The decedent was admitted as an inpatient to a mental health treatment facility in late July 2011 for anxiety and depression, and was subsequently discharged on August 1, 2011. Upon discharge, the decedent moved in with her sister but was admitted to the defendant hospital on August 16, 2011, due to major depression with suicidal ideation.
The decedent was discharged by the defendant hospital attending physician on August 22, 2011 and was instructed to return to the hospital if her depression worsened and, if it did not, to take two prescription medications and follow up with an outpatient provider. The outpatient provider was the defendant psychiatric nurse practitioner who met with the decedent on August 26, 2011, at which time the decedent promised to send the defendant psychiatric nurse practitioner information regarding an inpatient facility to which she might seek admission but the decedent committed suicide days later.
The defendants moved for summary judgment in their favor, and the trial court entered judgment in their favor. The New York medical malpractice wrongful death plaintiffs appealed.
The Appellate Court Decision
As To The Defendant Hospital Attending Physician:
The defendant hospital attending physician stated in the decedent’s discharge summary that the decedent’s discharge of August 22, 2011 had been deferred from three days earlier because of the lack of available outpatient treatment. The decedent had previously expressed suicidal thoughts and, after learning of the delay, stabbed herself with three separate objects in what she claimed was an effort to sever her femoral artery. There is some question as to whether decedent truly harbored suicidal intent in that incident but, in any case, she demanded discharge three days later, denying that she had any present suicidal ideation and claiming that the hospital setting was contributing to her depression and her irritability.
The defendant hospital attending physician stated at her deposition that she conducted a suicide risk assessment and documented the results of that assessment in the discharge summary. The discharge summary did not state that the assessment had occurred or detail its findings, however, and set forth a care plan that amounted to little beyond directing that the decedent take her medication and present herself to an outpatient care provider over a week later, on September 1, 2011.
The New York medical malpractice plaintiffs submitted the factually specific affidavit of a psychiatrist who, relying upon the foregoing, opined that the defendant hospital attending physician deviated from the minimum standard of care in failing to document a proper suicide risk assessment and then discharging the decedent without ensuring that she obtain psychotherapy and medication management within two days.
The Appellate Court held that the plaintiffs therefore demonstrated material questions of fact as to the liability of the defendant hospital attending physician and, in turn, the defendant hospital and the defendant hospital attending physician were precluded from an award of summary judgment to them.
As To The Defendant Psychiatric Nurse Practitioner:
With regard to the defendant psychiatric nurse practitioner, the decedent successfully had her appointment moved up to August 26, 2011 from September 1, 2011. The defendant psychiatric nurse practitioner conducted a psychiatric assessment of the decedent at that time, finding her to be sad and anxious. The defendant psychiatric nurse practitioner denied during her deposition that the decedent was suicidal, but her written assessment stated that suicidal ideation was “present” and that the decedent had planned to overdose in the past and was still cutting herself.
The defendant psychiatric nurse practitioner diagnosed the decedent with severe major depressive disorder (depression that was untreated inasmuch as the decedent’s prescribed antidepressant had been discontinued at the hospital) and noted that the decedent’s suicidal thoughts increased in tandem with her diagnosed panic disorder. The defendant psychiatric nurse practitioner nevertheless set forth a plan that placed further psychotherapy and medication review on hold until the decedent decided whether to check herself into an inpatient treatment facility and provided more information about the facility to the defendant psychiatric nurse practitioner.
The New York medical malpractice plaintiffs’ expert psychiatrist opined that the defendant psychiatric nurse practitioner fell short of the minimum standard of care by failing to properly conduct and document a suicide risk assessment of the decedent, who was experiencing triggering anxiety and untreated depression. The expert psychiatrist further opined that the defendant psychiatric nurse practitioner departed from the minimum standard of care in placing medication adjustment and psychotherapy on hold in the expectation that a “severely compromised” person would provide more information on an inpatient treatment facility that she was curious about.
The Appellate Court held that in light of the plaintiffs’ expert psychiatrist’s detailed opinion that the defendant psychiatric nurse practitioner set forth a contingent treatment plan that “was itself a deviation from accepted medical standards” so as to deny the decedent “the level of care acceptable within the relevant professional community,” and questions of fact also exist as to the liability of the defendant psychiatric nurse practitioner, such defeat her motion for summary judgment.
Source: Tkacheff v. Roberts, 2017 NY Slip Opinion 01429.
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