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Woman involuntarily committed suffers mental anguish $65,000 verdict awarded
By Radha V. Bachman, Esq.
Buchanan, Ingersoll & Rooney, PC
Tampa, FL, and
Suzanne Gruszka, RN, MAS, CLNC, LHRM
Administrator, Clinical Support Services
News: A woman suffering from personal problems and the subsequent unexpected death of her son was involuntarily committed to a behavioral health center by a psychologist allegedly following a telephone conference in which the woman expressed suicidal ideation. The physician failed to document the specifics of the conversation on the records required for an involuntary commitment. The woman sued the physician and the center. A Louisiana jury found that the applicable standard of care had been breached and awarded the woman $65,000 in damages.
Background: A 28-year-old single woman went to visit a clinical psychologist complaining of stress reaction and some bouts of marital discord. Shortly after the visit, the woman's son passed away unexpectedly in an accident. After the son's funeral, the psychologist engaged in a telephone conference with the woman and allegedly determined that the woman expressed suicidal ideation. Following the telephone conference, the woman was involuntarily committed to a behavioral health center in the area. The woman remained in the center for nine days.
The woman asserted that she was not suicidal and filed suit against the psychologist and the behavioral health center claiming that she was improperly committed based on a telephone conference between the psychologist and the woman's estranged husband who had informed the psychologist that the woman was suicidal. The woman further alleged that the psychologist had not performed the required evaluations and examinations prior to an involuntary commitment. The woman's claim against the behavioral health center relied on the center's failure to release the woman after determining that she did not pose a danger to herself or others and was not gravely disabled. Furthermore, the woman was forced by the center to take medication which was not appropriate for her condition. Had the psychologist performed an in-person evaluation, the woman argued, he would have determined that she was not suicidal. The claim was for personal injury, disability, physical pain and suffering, mental anguish, and loss of life enjoyment due to the defendants' alleged actions.
The physician responded that he had acted within the appropriate standard of care by conducting a thorough telephone consultation with the woman. The call between the physician and the woman had led the physician to believe that the woman was suffering from suicidal ideation and that she was indeed a threat to herself. In response, the woman stated that she had not spoken to the physician on this day and that the physician had failed to document the conversation on the Physicians Emergency Certificate which was required to be filed to effectuate the commitment.
The center also denied the woman's claim that it had breached the standard of care and alleged that the woman did not have sufficient evidence to support such a claim. Summary judgment ultimately was awarded to the center, but the case was pursued against the psychologist. A jury verdict was returned in favor of the woman in the amount of $65,000: $15,000 for loss of enjoyment of life and $50,000 for mental anguish.
What this means to you: In this case the woman states that she had been involuntarily confined in to a behavioral health center for alleged suicide ideation. Involuntary treatment or confinement is treatment that is undertaken without the person's consent. In most cases, involuntary confinement refers to psychiatric treatment that is administered regardless of the patient's objection. Typically these are individuals who are deemed to be a danger to themselves or others. Most states allow some form of involuntary treatment for short periods of time under emergency conditions, but the criteria for confinement vary from state to state.
The justification for involuntary treatment is usually the potential for severe consequences if the patient is not treated. According to the background information, the woman had suffered a great loss during a time of increased stress. It appears that the initial contact with the psychologist was by the patient; however the subsequent contact was by the psychologist. It is unclear what prompted that conference call with the patient, but the information leads you to believe that the estranged husband recommended the conference call. Thereafter, the woman was involuntarily confined for nine days for suicide ideation.
The woman states that the psychologist did not perform the required evaluation and examination prior to the confinement. According to the State of Louisiana, Human Services Law, a mentally ill person may be admitted to a treatment facility for observation, diagnosis, and treatment not to exceed 15 days under an emergency certificate.
Any psychologist can execute an emergency certificate; however it requires an examination of the individual and documentation of such. Failure to conduct an examination prior to executing the certificate is considered negligence. The examination date cannot be more than 72 hours prior to the date on the certificate.
The examination should state objective findings relative to the mental condition of the individual that lead to the conclusion that the individual is a danger to herself. The certificate is valid for 72 hours and is delivered to the director of the treatment facility where the individual will be treated.
Upon admission to the treatment facility, the director notifies the coroner of the parish in which the treatment facility is located and advises him/her of the admission. The coroner or his/her deputy must independently examine the individual and execute the emergency certificate that is a necessary precondition to the individual's continued confinement.
In this case, the background information suggests that this process was not followed. In any treatment situation be it physical or mental illness, a face-to-face assessment and examination is necessary to appropriately diagnose and treat the individual. A telephone consultation can certainly provide some basic information, but a healthcare provider has a duty to examine the individual before coming to a conclusive diagnosis. At that point, the practitioner documents the findings and develops the treatment plan.
The Center for Medicare and Medicaid Services (CMS) and The Joint Commission (TJC) have specific standards or conditions for participation regarding patient assessments and reassessments. For psychiatric hospitals that use TJC for deemed status, each patient must receive a psychiatric evaluation within 60 hours of admission.
CMS states that psychiatric hospitals must protect and promote each patient's rights. Upon admission the patient should receive a thorough history and physical examination with all indicated laboratory examinations. This assessment is used to develop a treatment plan specific to the patient's needs.
It appears that this patient's rights were ignored by several individuals. According to the state laws for involuntary confinement, there was a requirement for an examination and signed certificate. Furthermore, the system is designed to have another practitioner examine the individual and sign a certificate, but it appears that the documentation of these examinations were not available.
There has been much controversy regarding involuntary confinements and possible misuse/abuse of such confinements. Critics have said that patients who have been confined and given psychiatric medications have suffered with disabilities following confinement. It appears that the patient's rights were not at the forefront in this case and that the standards of care for involuntary confinement in this state were not followed. The key is to ensure proper procedures are followed and that the documentation supports the finding.
District Court of Louisiana, Fifteenth Judicial Circuit, Parish of Lafayette, Case No. 99-4357.