Floridas suicide ruling puts physicians at risk

Case details

The day before the patient died, she called her physician’s office because she had not been feeling well for a few months and had a variety of symptoms, some of which were consistent with depression. This was something her primary care physician, Joseph Chirillo Jr., had been treating her for, using medication that she advised his office she had stopped taking. Chirillo’s office advised her to come to the office to pick up a sample of a different anti-depressant and made an appointment for her with a gastroenterologist to investigate other symptoms she was experiencing.

The patient’s husband sued Chirillo and his practice after the suicide, alleging that the doctor was negligent for failing to recognize her depression, not talking to her directly and failure to conduct an evaluation before providing the new anti-depressant, according to media reports.

In August 2016, the Florida court ruled that the case against Chirillo could go to jury trial to determine his negligence in the case.

Analysis

Chirillo is not a psychiatrist or a psychologist. He is a medical doctor specializing in family medicine. Forty percent of primary care physicians provide mental health care to patients, according to a 2013 article in the Journal of the American Board of Family Medicine. Without their treatment the unmet mental healthcare needs would be even greater.

In this Florida case, the patient stopped taking her anti-depressants and did not inform her doctor for a number of months. How can a physician be held liable for a patient who disregards his instructions and subsequently takes her own life? 

Next: Larger ramifications

A primary-care physician who understands the potential to be held liable for a patient’s suicide if he/she treats the patient for depression might make it a policy to refer all potential mental health issues to psychiatrists or psychologists. On the surface this policy sounds reasonable but that only works in an ideal world. Two-thirds of primary care physicians report that “they could not get outpatient mental health services for patients,” according to research in Health Affairs.

Larger ramifications

The court’s decision in this case will allow grieving parents, widows and widowers the ability to recover financially from attending physicians after their loved one commits suicide. There is also the risk that patients who attempt suicide and incur high medical bills as a result will sue to cover their expenses.

Losing a patient is difficult even when there was nothing the doctor could have done differently. A lawsuit creates significant added stress and it isn’t just losing the lawsuit that creates a nightmare for the physician. The time spent dealing with the lawsuit puts added pressure on the physician. Media coverage may further degrade a doctor’s practice and reputation.

The potential that a doctor will be held responsible for something they have no control over will add to the stress burden and increase burnout. It will also contribute to dissuading our youth from becoming physicians.