Legal Eagle Eye Newsletter for the Nursing Profession (7)1 Jan 99
Quick Summary: Hospital staff must protect suicidal patients from self-harm.
This is the case no matter whether the patient has been voluntarily or involuntarily admitted.
As stated recently by one court, "Where it is reasonably foreseeable that a patient by reason of mental or emotional illness may attempt to injure himself or herself, those in charge of the patient’s care owe the patient a legal duty to safeguard the patient from the patient’s self-damaging potential."
In analyzing the situation after the fact, the main point for the court is whether the patient’s suicidal actions were foreseeable, and whether the conduct of the patient’s caregivers was a reasonable response to the patient’s circumstances.
Healthcare professionals in these circumstances must adhere to the standard of care toward their patients that would be followed by other members of their profession under similar circumstances.
APPELLATE COURT OF ILLINOIS, 1998.The adolescent patient had a history of suicide attempts. Prior to his death he had been admitted to the facility where he died five times in the immediately preceding five months.
When he came in for the last time he was voluntarily admitted to the acute-care medical center’s psychiatric unit.
He told the nurse he had held back taking his Elavil and then had taken an overdose. He stated it was his intention to "sink so low again that he would get suicidal." The nurse’s admitting note indicated a plan of care to monitor the patient and prevent self-harm.
However, according to the Appellate Court of Illinois, the patient was improperly placed on close supervision rather than suicide precautions.
Hospital policy was that potentially suicidal patients be placed on suicide precautions. The hospital’s definition of a potentially suicidal patient included a patient who had discussed death or the uselessness of life or one who had been admitted for an apparent suicide attempt.
A potentially suicidal patient on suicide precautions was not allowed unmonitored access to the restroom or allowed to have objects like belts, shoelaces or phone cords that could be used for self-harm.
Two days into his voluntary hospitalization for aggressive ECT for his depression the patient expressed doubts to a nurse the ECT would help relieve his depression, said he felt bad all the time and hopeless and said he could not go on living the way he was.
Still he was kept on close supervision rather than put on suicide precautions.
In the middle of the night the patient stuffed clothes in his bed to make it look like he was still in bed, then hanged himself in his bathroom.
The court ruled the parents had legal grounds for a wrongful death lawsuit against the hospital and the attending psychiatrist. Winger v. Franciscan Medical Center, 701 N.E. 2d 813 (Ill. App., 1998).