Emergency Medicine Physician Neglects to Call Psychiatry Consult

This case involves a thirty-four-year-old male patient, with a significant medical history of mental issues, including paranoid schizophrenia. He was brought to the ER by the police after a delusional episode and was treated with a number of psychotropic medications. A psychiatry consult was not called and the ER staff decided to manage the patient’s mental instability without assistance. The patient was in the ER for approximately five hours and suffered cardiac arrest due to an apparent reaction to the sedatives prescribed to him. The patient was successfully resuscitated and transferred to an ICU unit, and he spent three weeks recovering from congestive heart failure. Additionally, the patient contracted pneumonia and sepsis during his hospital stay which complicated his recovery. As a result of the cardiac arrest and severe complications of the respiratory infection, the man is not able to walk under his own power.

Question(s) For Expert Witness

1. Should a psychiatric consult have been called in this case, and would it have altered the outcome for this patient?

Expert Witness Response E-000320

I believe that a psychiatric consult may have benefited this patient greatly. The role of the consultation-liaison psychiatrist is to see patients with comorbid medical conditions at the request of the treating medical or surgical consultant or team. Psychiatrists are highly trained in the side effect profile of psychotropic medications and are better suited to evaluate an individual's medical issues to prevent serious complications such as the cardiac manifestations seen here. If this patient was a known schizophrenic, and was displaying psychotic features at the time of his arrival, it would also be wise to perform a drug screen to see if he was on any other illicit drugs that could have contributed to the heart attack.