Doe vs. Roe Hospital and Individual Care Providers
Attorney for plaintiffs:
Harvey D. Peyton, Esq.
Peyton Law Firm, PLLC
2801 First Ave.
PO Box 216
Nitro, WV 25143
Tel. (304) 755-5556; (800) 681-9555
Expert retained by plaintiffs’ counsel:
Harold J. Bursztajn, M.D.
Associate Professor of Psychiatry (part-time)
Co-founder, Program in Psychiatry and the Law
Department of Psychiatry
Beth Israel Deaconess Medical Center
Harvard Medical School
96 Larchwood Drive
Cambridge, MA 02138
Dr. Bursztajn’s forensic neuropsychiatric evaluation of a psychiatric malpractice claim following a suicide after discharge from inpatient hospitalization leads to a settlement favorable to plaintiffs.
Mary Doe committed suicide two days after her discharge from the psychiatric unit of Roe Hospital, to which she had been admitted involuntarily five days earlier after an apparent overdose attempt. Her family sued the hospital, treating psychiatrist, and members of the clinical staff for malpractice. Plaintiffs’ counsel retained Dr. Bursztajn to conduct a forensic neuropsychiatric evaluation of potential deviations from the standard of care as well as causation.
In his Certificate of Merit, Dr. Bursztajn found that that the mental-health care provided to Ms. Doe during her hospitalization, including the discharge planning and follow-up, deviated from the standard of inpatient psychiatric care for suicidal patients in her condition. Furthermore, it was his opinion that had the standard of care been met, her suicide more likely than not would have been prevented. Consistent with a failure to perform an adequate clinical assessment, the treatment team disregarded indications of high suicide risk level, including a report that she had burned a suicide note after its discovery by her family. Moreover, they failed to adequately assess Ms. Doe for the likelihood that she was suffering from an underlying psychotic disorder, which, if untreated, can seriously undermine a patient's ability to ensure her own safety. In particular, they gave insufficient consideration to her having maintained apparently delusional beliefs about her personal and medical history.
Dr. Bursztajn also found that Ms. Doe was discharged prematurely, without adequate risk assessment or an adequate plan to ensure her safety. Ms. Doe, who was on an involuntary admission status for up to 30 days, was discharged a day after she had been observed to be quite affectively labile, irritable, angry, and easily agitated. On that day her dosage of the antidepressant medication Cymbalta had been doubled, and one day was insufficient time to observe the effects of the increased dosage. In addition, Ms. Doe was discharged to a volatile family situation (foreseeably exacerbated by her husband’s having petitioned for involuntary commitment) in the home where she had attempted suicide several days earlier. Hospital staff also failed to adequately assess and address Ms. Doe's access to lethal means of committing suicide. Finally, the unmonitored interval prior to her first outpatient appointment was excessive, given her mental status during her admission and the circumstances that had necessitated hospitalization. Although some form of intensive outpatient treatment might have met minimal standards of care, the applicable standard of care called for much closer monitoring and a more gradual transition than immediate discharge to an unstable living situation. The care provided in this case stands in contrast to other cases in which Dr. Bursztajn has testified as a defense-retained expert and in which suicide was neither foreseeable nor preventable.
After the Certificate of Merit was submitted for mediation, plaintiffs’ counsel informed Dr. Bursztajn that a favorable settlement was obtained “with your excellent help.”