Suicide litigation and risk management: a review of 32 cases.

Thirty-two cases of suicide or self-injury in which I served as a medicolegal consultant are reviewed. Suits involving suicide have increased to 18 to 25 percent of psychiatric practice litigation. The demography of suicide is discussed and contrasted with the population studied; this study stresses the problem of the young, unstable, and poorly predictable patient. Considerations in risk management include adequate and timely records, documentation for decisions (particularly involving privileges), clear hospital policies and procedures, and adherence to those policies. In this study, at least 10 percent of the cases did reflect defects in care by the psychiatrist or hospital staff. Lawsuits against psychiatrists have increased rapidly. In 1975, an AMA study indicated that the claims rate against psychiatrists was 2.27 percent per year, the second lowest of physician groups. 1 A claim means that an action against a physician has been reported to an insurance company, and the percentage refers to the ratio of claims as related to numbers in that specialty in a one-year period. Slawson reported that claims against psychiatrists have increased from 2 percent in 1978 to 4 percent in 1983 (the rate for non-psychiatrists is now about 25 percent). Psychiatric malpractice costs in five years have increased four-fold; in that series, negligence leading to suicide was invoked in 18 percent of threatened suits against psychiatrists. Bellamy3 reported earlier that 14 percent of claims against psychiatrists involved suicide. Slawson, in another article,4 stated that claims in Southern California against psychiatrists for all causes from 1958 to 1967 were only 1.5 percent (1.5 per hundred psychiatrists per year), increasing by 1979 to 4 percent per year in California, with 25% involving suicide.s I have previously discussed the law regarding suicide liability and how it should reasonably be applied.6-9 Litman 10 noted that 1 percent of suicides occurred in hospitals, general and psychiatric; with one-third resulting in lawsuits, of which one-half were against psychiatric hospitals. He analyzed seven lawsuits as a suicidologist expert witness. I will report on 32 cases where I was a consultant to attorneys in litigation involving suicide (including cases of self-injury involving similar principles).