Suicide in hospitals is more common than you think. The Joint Commission reports it is the second most commonly reported sentinel event with 816 events reported as of June 30, 2010. Most of these suicides occur in psychiatric hospitals, followed by general hospitals. Most people commit suicide by hanging. I recall hearing of a man who committed suicide on a medical surgical unit of the hospital where I worked. He hung himself from the pole in the closet. Other people commit suicide though a fatal fall. At Med League, we have worked on several cases involving people who have jumped off the roof of the hospital. Other fatal falls involve falling down a staircase, balcony, laundry chute, or from an upper story window.
Healthcare providers are expected to be attuned to recognize the symptoms of suicidal intent. These include changes in eating or sleeping patterns, withdrawal, feelings of guilt or worthlessness, fatigue, feeling helpless and hopeless. Some individuals identify a plan to kill themselves. And some are at high risk for suicide: the unemployed, unmarried, substance abuser, the person with a history of previous suicide attempt, and having a mood disorder.
The liability issues center around whether the suicide was foreseeable and preventable. Here are some factors that influence that determination:
- Was the environment safe? Did the facility use non-breakaway bars, rods or safety rails? We know of cases of patients who have committed suicide by putting plastic bags over their heads, hanging themselves from light fixtures, or opening windows to climb out.
- Did the staff observe the patient to identify the risk of suicide, reassess the risk, and look for contraband if warranted? In one case, a man became very confused after surgery, kept climbing out of bed and pulling out his intravenous lines, and yet the nursing staff did not intensify monitoring. He threw himself through a glass window and died. The jury found the nursing staff negligent.
- Did the staff make the required observations once the patient was recognized as being suicidal? We know of a case that involved falsified medical records: the checks of the patient were recorded as being made, but were not actually carried out. The case settled.
- Were the staff adequately trained to recognize suicidal behavior and thoughts?
- Was there adequate staffing to provide the needed care? In the case of the falsified records, the staff responsible for making suicide checks were pulled away to perform admission assessments.
- Did staff communicate with each other about the risks of suicide?
- Was the patient placed in a location where he could be observed? In another case, a man waiting to be admitted to a psychiatric hospital was sent to the x-ray department by himself, and climbed a staircase to the roof of the hospital, where he jumped to his death. The defense won this case.
Healthcare providers have the duty to protect the vulnerable. The suicidal patient fits squarely within that definition. In most cases, insurance companies will get their checkbooks. These cases are hard to defend.
Pat Iyer is president of Med League. She has testified in cases involving suicide.