Hospital liability for suicide: a regional survey

When a hospital is sued following a patient suicide, the usual claim is wrongful death. An earlier study) and more recent claims data2•3 show it to be a frequent basis for negligence actions against psychiatrists and psychiatric hospitals. The notion that patient suicide in a hospital setting is, of itself, evidence of poor or inadequate professional care has an obvious common-sense appeal. However, it has been well argued4 that not all suicides can be prevented and that effective treatment usually involves taking calculated risks. The clinical alternative, a more traditional and conservative approach, which in some cases may amount to little more than custodial care, may not be in the patient's best interest. Such an approach can promote and maintain an extravagant dependency and thwart treatment efforts which encourage maturation and individuation. The psychiatric hospital is probably the most common setting in which severely depressed patients are treated. Suicidal behavior forms the basis for a substantial number of hospital admissions, with the expectation that the psychiatric ward is a relatively safe setting in which to commence evaluation or treatment. In most cases this is probably so. However, hospitalized patients do kill themselves, and the effect on other patients and the ward staff can be shattering. We have discussed this aspect of patient suicide in another papers and wish now to extend our assessment in a direction to include the hospital itself as a public service and business entity. At a time when medical malpractice has become a national issue, there is no doubt that psychiatric hospitals will be held more strictly accountable for the quality of care they provide. Our recent review of court actions subsequent to hospital suicide6 showed a distinct trend toward greater liability for both hospitals and doctors. While such a judicial posture may sometimes seem unwarranted, and can run counter to enlightened efforts at treatment, it has in fact become a reality.