New York Law Review

Tag: Suicide Prevention

  • Huntley v. State of New York, 62 N.Y.2d 134 (1984): Hospital’s Negligence for Failure to Communicate Suicide Plan

    Huntley v. State of New York, 62 N.Y.2d 134 (1984)

    A psychiatric hospital is liable for negligence when a staff member fails to inform the treating psychiatrist about a patient’s communicated suicide plan, leading to the patient’s unsupervised departure and subsequent injury.

    Summary

    Helen Huntley, a psychiatric patient with a history of instability, communicated her specific suicide plan involving jumping from a nearby parking garage to a staff member at Hutchings Psychiatric Center. This information was not relayed to her staff psychiatrist, who had the authority to grant her unsupervised leave. Huntley subsequently left the hospital unsupervised and attempted suicide by jumping from the garage. The New York Court of Appeals held the hospital liable for negligence, finding that the failure to communicate the suicide plan constituted a breach of the hospital’s duty of care. The court also clarified that CPLR 4010, concerning collateral sources, doesn’t apply to common-law negligence claims.

    Facts

    Helen Huntley was a patient at Hutchings Psychiatric Center with a documented history of mental instability and depression.
    Prior to the incident, Huntley exhibited signs of deterioration and unusual behavior.
    One day before her suicide attempt, Huntley told a hospital staff member about her specific plan to jump from a nearby parking garage.
    This critical information was not communicated to Huntley’s staff psychiatrist.

    Procedural History

    Huntley sued the State of New York in the Court of Claims, alleging negligence.
    The Court of Claims found in favor of Huntley, determining that the State was negligent.
    The Appellate Division unanimously affirmed the Court of Claims’ decision.

    Issue(s)

    1. Whether the failure of a hospital staff member to communicate a patient’s specific suicide plan to the treating psychiatrist constitutes a breach of the hospital’s duty of care, leading to liability for negligence when the patient attempts suicide.
    2. Whether CPLR 4010, regarding the collateral source rule, applies to common-law negligence actions against a hospital.

    Holding

    1. Yes, because the failure to transmit the patient’s specific suicide plan to the staff psychiatrist, who controlled the patient’s privileges to leave hospital premises, constituted a breach of duty. The hospital was negligent in failing to take measures to secure the patient’s physical safety.
    2. No, because CPLR 4010 is limited to actions for medical malpractice and is thus inapplicable to reduce this common-law negligence award.

    Court’s Reasoning

    The court emphasized that its review was limited to addressing legal errors, given the affirmed findings of fact supported by evidence.
    The court found that the hospital failed in its duty to adequately supervise Huntley, especially considering her history and behavior leading up to the incident.
    Crucially, the court highlighted the failure to communicate Huntley’s specific suicide plan to the psychiatrist, which foreclosed any opportunity to make a medical judgment about modifying her privileges. The court stated, “here, any opportunity to form a medical judgment was foreclosed by a failure to transmit the information, and no measures were taken to secure respondent’s physical safety.”
    While a medical judgment to continue Huntley’s privileges, even if erroneous, might not have led to liability for malpractice, the failure to even consider the information due to lack of communication constituted negligence.
    The court distinguished this case from medical malpractice, where liability arises from errors in medical judgment. Here, the negligence stemmed from a breakdown in communication, preventing any judgment from being made.
    The court also affirmed the Appellate Division’s decision to not apply CPLR 4010, clarifying its limited application to medical malpractice actions only and not common-law negligence claims.

  • 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.