Pediatric Psychiatrist Discharges Child; Results in Suicide

This case involves a fifteen-year-old male patient who presented to the emergency room after being arrested by the police for displaying strange behavior in public. The patient was admitted to the inpatient psychiatric ward for observation and was started on a mood stabilizer for a diagnosis of Mania. The patient stayed in the hospital for two weeks and was discharged after his mood and affect appeared to be stable. The patient left the hospital with a lithium prescription and was told to follow-up with his primary care physician to set up psychiatric evaluations. The patient was found dead two days later in a hotel room next to an empty bottle of his psychotropic medication.

Question(s) For Expert Witness

1. Should this patient have been admitted longer and directly handed off to a psychiatrist for further mental status evaluation?

Expert Witness Response E-006302

Caregivers should be vigilant about suicidal potential and should document their assessments in the medical record at each visit. Poor impulse control in patients with a personality disorder, particularly those with a cluster B disorder, places some degree of legal responsibility on the physician. If a patient threatens someone else with injury, the physician may have a duty to warn the intended victim, either directly or through legal authorities, under the Tarasoff ruling. Medications are in no way curative for any personality disorder. They should be viewed as an adjunct to psychotherapy so that the patient may productively engage in psychotherapy.