New York Law Review

Tag: Professional Judgment

  • Schrempf v. State, 66 N.Y.2d 289 (1985): Liability for Release of Mental Patient Based on Professional Judgment

    Schrempf v. State, 66 N.Y.2d 289 (1985)

    The State is not liable for injuries inflicted by a released mental patient where the decision to release or maintain the patient on outpatient status was based on a reasoned professional judgment, even if that judgment ultimately proves to be incorrect.

    Summary

    The husband of the claimant was fatally stabbed by Joseph Evans, a mental patient on outpatient status. The claimant sued the State, alleging negligence in failing to commit Evans prior to the assault. The Court of Claims found the State liable, and the Appellate Division affirmed. The New York Court of Appeals reversed, holding that the psychiatrist’s decision to maintain Evans on outpatient status was a matter of professional judgment and, therefore, not a basis for liability. The court emphasized that psychiatric decisions involve calculated risks and that disagreement among experts does not automatically establish negligence. The treating psychiatrist considered that Evans was calm and cooperative and that aggressive intervention could be counterproductive.

    Facts

    Joseph Evans, a 27-year-old with a history of mental illness, was an outpatient at Hutchings Psychiatric Institute. He had been admitted six times, often following violent incidents. His diagnoses included manic depression and paranoid schizophrenia. Evans’ condition generally improved with medication and therapy, but he was an unreliable outpatient, often missing appointments and neglecting his medication. In September 1981, Evans voluntarily returned to Hutchings, where a psychiatrist determined he did not pose an immediate risk and placed him on outpatient status. In November, he began a vocational rehabilitation program. He did not regularly take his prescribed medication, which the psychiatrist addressed by reducing the dosage and rescheduling when he complained that the drugs made him drowsy at work.

    Procedural History

    The claimant sued the State in the Court of Claims for wrongful death, alleging negligent care and treatment of Evans. The Court of Claims found the State negligent for admitting Evans to outpatient care in September 1981. The Appellate Division affirmed. The State appealed to the New York Court of Appeals.

    Issue(s)

    Whether the State can be held liable for negligence in the care and treatment of a mental patient who, while on outpatient status, injures a third party when the decisions regarding the patient’s care were based on the exercise of professional medical judgment.

    Holding

    No, because the decision to place Evans on outpatient status and to continue that status despite his non-compliance with medication was based on a reasoned professional judgment, and the State is not liable for mere errors in such judgment.

    Court’s Reasoning

    The Court of Appeals acknowledged the State’s duty to provide reasonable care to mental patients and to protect the public from potentially dangerous individuals. The court differentiated between governmental functions (e.g., police protection, for which a special relationship is required for liability) and proprietary functions (e.g., medical care, for which the State is held to the same standard of care as private actors). The court emphasized that psychiatric care involves a balancing of interests: the patient’s rehabilitation and the public’s safety. Because psychiatry is not an exact science, decisions regarding treatment involve calculated risks and often generate disagreement among experts. The court stated that “the modern and more humane policy of the medical profession and the law contemplates returning the mental patient to society, if he does not pose an immediate risk of harm to himself or others.”

    The court found that the psychiatrist’s decision to maintain Evans on outpatient status, despite his erratic medication compliance, was a matter of professional judgment. The psychiatrist had considered Evans’ history, his cooperative behavior, and the potential disruption that involuntary commitment could cause. The court noted that even the claimant’s experts did not agree on the appropriate course of action. The court concluded that, while the psychiatrist’s judgment proved mistaken in hindsight, it was not negligent because it was based on a reasoned assessment of the available information and the patient’s individual circumstances. As such, “it must be recognized as an exercise of professional judgment for which the State cannot be held responsible.”

  • Topel v. Long Island Jewish Medical Center, 55 N.Y.2d 682 (1981): Medical Malpractice and Professional Judgment in Psychiatric Care

    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.