Suicide is the third-leading cause of death among those between 10 and 54 years of age. Patricia Chance filed a negligence claim in Baltimore Circuit Court against Dr. Leroy Bell and Bon Secours Hospital alleging they prematurely discharged her son from inpatient psychiatric care prior to his suicide. A jury awarded $6,000 in economic and $2.3 million in noneconomic damages following the death of Brandon Mackey. The Maryland Code imposes limitations (caps) on awards for noneconomic damages, thus the award was $695,000 after adjustment. The defendants motioned to challenge the verdict, which was successful and Chance filed an appeal.
Brandon Mackey struggled with mental illness for several years. He was first admitted to Bon Secours after attempting suicide and treated by Bell who diagnosed him as having major depressive disorder and possibly bipolar disorder. After being discharged, Mackey was admitted involuntarily two weeks later following a suicide attempt. Dr. Bell again saw Mackey and revised his diagnosis to be “schizoaffective disorder, bipolar type” and prescribed him Risperdal. Bell discharged him shortly after, one day before his suicide by jumping in front of a train.
Chance's suit alleged that Dr. Bell demonstrated negligence in his medical care causing Mackey's death. The claim stated Bell's employer, Bon Secours Hospital, was vicariously liable in the matter. Dr. Nicola Cascella, a psychiatrist, provided expert testimony for the plaintiff. Cascella felt Bell failed to adhere to the standards of care when he discharged Mackey prior to determining if the Risperdal was stabilizing him.
The claim described examples of Dr. Bell's substandard medical care including:
- Failing to communicate (consult) with the Mackey family to obtain further information
- A failure to acquire Mackey's medical records describing his psychiatric conditions
- A failure to accurately diagnose
- Failing to properly adhere to treatment (procedural) standards for the Risperdal medication
- Discharging the patient too early without verifying improvement
Was Bell negligent in discharging Mackey only three days after starting the treatment with Risperdal? Dr. Cascella stated that based on the circumstances of an involuntary hospital admittance after a suicide attempt, Bell breached the acceptable standards for medical treatment. He said that prior to discharge, it should have been confirmed that Mackey was exhibiting a substantial decrease in symptoms. Evidence was also presented indicating Risperdal may take two-weeks (or longer) to begin to effectively deliver results.
A Maryland health statute 10–618 provides immunity from civil liability for physicians who involuntarily admit people to a hospital. The appeals court closely considered aspects of patient rights and the challenges of involuntary hospital admittance. They found that applying the immunity provision solely when a party is actually admitted would be an error. They explained that in “one breath” the statute would discourage orders to admit prior to a detailed evaluation, while in the “next breath” offer immunity only when the physician chose to admit. Fearing liability, mental health practitioners would be inclined to admit the individual, thus taking someone's freedom, instead of applying the proper standards of care through discretionary decisions.