55 N.Y.2d 682 (1981)
In psychiatric malpractice cases, a doctor’s decision concerning a patient’s treatment plan, including the level of observation, is considered a matter of professional judgment and will not result in liability absent evidence of a deviation from accepted medical practice negating factors considered by the physician.
Summary
This case concerns the extent to which a psychiatrist can be held liable for the suicide of a patient. The Court of Appeals held that the decision to reduce constant observation of a suicidal patient to 15-minute intervals was a matter of professional judgment, considering factors like the patient’s reaction to surveillance and the potential for rehabilitation. The court affirmed the dismissal of the case, finding that the plaintiff’s expert testimony failed to negate the factors the doctor considered, and thus did not establish a prima facie case of malpractice. A strong dissent argued the decision undermined established medical malpractice principles.
Facts
Harold Topel, a New York City detective, was admitted to Long Island Jewish Medical Center after two suicide attempts by strangulation. He was diagnosed with severe psychotic depression and placed under the care of Dr. Harold Levinson. Initially, Topel was under constant observation due to his high suicide risk. However, after a few days, Dr. Levinson reduced the observation to 15-minute intervals, citing the patient’s agitation and the potential benefits of an open ward environment for electroshock therapy. Topel then committed suicide by hanging himself with his police belt while alone in his room.
Procedural History
Topel’s widow sued Dr. Levinson and the hospital for medical malpractice and wrongful death. The trial court dismissed the complaint after a jury verdict for the plaintiff, finding the plaintiff had not made out a case on the law. The Appellate Division affirmed, citing Centeno v. City of New York. The case then went to the New York Court of Appeals.
Issue(s)
Whether the psychiatrist’s decision to reduce constant observation of a suicidal patient to 15-minute intervals constituted a deviation from accepted medical practice, thereby establishing a prima facie case of malpractice.
Holding
No, because the decision to reduce the observation was a matter of professional judgment, considering multiple factors, and the plaintiff’s expert testimony failed to adequately negate those factors, preventing the establishment of a prima facie case of malpractice.
Court’s Reasoning
The Court of Appeals reasoned that a hospital cannot be held liable for implementing a treatment plan prescribed by the attending physician. With regard to the physician, the court acknowledged the difficulty in distinguishing between medical judgment and deviation from accepted medical practice. It emphasized that Dr. Levinson considered several factors in his decision, including Topel’s reaction to constant surveillance, the potential for his heart condition to be aggravated, the gesture-like nature of his prior suicide attempts, the rehabilitative aspects of an open ward, and the increased likelihood of obtaining consent for electroshock therapy. The court stated that the plaintiff’s expert testimony failed to adequately negate these factors, thus not establishing that the doctor’s judgment deviated from good medical practice. The court warned against subjecting every medical judgment to the “second guess of a jury,” emphasizing the need to respect a physician’s professional judgment when it is based on a reasoned consideration of relevant factors. Judge Fuchsberg’s dissent strongly criticized the majority’s reliance on Centeno v. City of New York, arguing that it undermines established medical malpractice principles. The dissent argued that the plaintiff presented a strong prima facie case of malpractice by showing that the doctor’s treatment deviated from the accepted medical standard of care, and this deviation caused the patient’s death. He pointed to the testimony of the plaintiff’s expert who stated that the proper treatment of this patient included constant observation. The dissent argued that disagreement between professional experts in itself creates a factual issue for the jury’s determination. The dissent further criticized the majority for substituting its own judgment for that of the treating physician, noting its lack of medical expertise. He concludes that it is not the court’s role to determine what constituted accepted medical practice.