Doctor immune from claim for failure to hold psychiatric patient 

Posted: 1:00 am Mon, July 13, 2009
By Barbara L. Jones

A doctor’s good-faith decision not to place an emergency hold on a psychiatric patient is immune from negligence claims, the Court of Appeals has decided.

The decision to release the patient was made under the Minnesota Commitment and Treatment Act, which contains a provision extending immunity to good-faith decisions to commit or place a 72-hour hold on a patient. The court ruled that the provision was also intended to cover good-faith decisions not to admit a patient.

Doctors had allowed patient Ryan Miller to leave the hospital where he was displaying psychotic symptoms if he agreed to take his medications and followup with his psychiatrist. After being discharged, Miller shot and killed his mother, and shot and injured his father and stepmother.

“We … hold that an examiner’s good-faith determination that a proposed patient does not meet the statutory criteria for an emergency hold qualifies as an act ‘pursuant to any provision of [the Minnesota Commitment and Treatment Act]’ under Minn. Stat. sec. 253B.23, subd. 4,” wrote Judge Jill Flaskamp Halbrooks.

The 16-page opinion, Losen v. Allina Health System, et al., affirms a Ramsey County District Court judge’s ruling granting summary judgment to the defendants on all claims related to the 72-hour hold.

The case simply affirms what the commitment law says, said defense attorney Gregory P. Bulinski of Minneapolis. There has never been a reported case where immunity was sought for a refusal to commit, but it is clear that the Legislature intended to cover those situations, he told Minnesota Lawyer.

Minneapolis attorney William Davidson, who represented amicus curiae Minnesota Medical Association and Fairview Health services, agreed that the case is consistent with legislative intent.

“If the plaintiff’s position had been accepted, it would have encouraged doctors to place patients under 72-hour holds. That’s contrary to good objective medical practice and the commitment act’s requirement that the patient be afforded the least restrictive alternative,” he said.

Minneapolis attorney John Dornik, who represents the plaintiffs, said that the statute was designed to forestall claims for false imprisonment and deprivation of civil rights, and not to prevent classic medical negligence cases, such as this one, from going ahead.

Doctor’s orders

Miller was diagnosed with epilepsy and began to experience hallucinations and other symptoms after a change in his seizure medications. On July 28, 2008, he was seen at United Hospital by two doctors. He was monitored overnight and the next morning removed the monitoring equipment and an intravenous line and attempted to leave the hospital. He was restrained physically by the staff, but the physicians discharged him that day after extensive counseling with family members.

On Aug. 11, Miller’s father contacted the doctor and requested that Miller be taken off his antipsychotic medication because of its side effects. The father was advised that it was not safe for Miller to stop taking the drug until consulting with a psychiatrist. Instead, the father reduced the drug and did not schedule a psychiatric appointment, the court said.

On Aug. 12, Miller’s father dropped Miller off at his mother’s for a visit. When he returned, Miller shot his father and his stepmother, and his mother’s body was found in the home.

Miller was found guilty but mentally ill and was indeterminately committed as mentally ill and dangerous.

The next of kin sued the hospital and the doctors for negligence in prescribing an improper dosage of seizure medication, failing to assess and treat his psychosis, failing to properly and thoroughly assess Miller for dangerousness and failing to place a 72-hour hold on him.

The trial court granted summary judgment to the psychiatrist, the hospital and the other defendants on the claims arising from the 72-hour hold and denied summary judgment on the other negligence claims.

Proposed patient

Minnesota Stat. sec. 253B.23, subd. 4, reads in relevant part, “All persons acting in good faith, upon either actual knowledge or information thought by them to be reliable, who act pursuant to any provision of this chapter or who procedurally or physically assist in the commitment of any individual, pursuant to this chapter, are not subject to any civil or criminal liability under this chapter.”

The Court of Appeals agreed, rejecting the plaintiffs’ argument that the statutory immunity provisions did not apply because Miller was never committed. It also rejected the argument that the affirmative decision not to place a hold on Miller was not covered by the immunity provisions.

The commitment act encompasses the good-faith decision whether to place an emergency hold on a proposed patient, even if the result of the decision is not to place the hold, the court said. (It was undisputed that the defendants acted in good faith.)

“The plain meaning of ‘proposed patient’ is therefore a person who has not yet been admitted or held for emergency care. Once a hold is placed, a proposed patient becomes a ‘patient’ as defined by the [Commitment and Treatment Act]—that is, someone who is receiving treatment. [Miller], whose physicians considered placing a hold on him but did not institute a hold, was a proposed patient,” wrote Halbrooks. (Emphasis by court)

The Court of Appeals also turned back the argument that the plaintiff’s common-law medical-negligence claims deriving from the failure to hold were distinct from the commitment act and therefore could survive the application of statutory immunity.

“In effect, [plaintiffs] ask us to eviscerate the immunity provision by replacing the ‘good faith’ standard of the [commitment act] with one of negligence. But this court is ‘without authority to change the law,’” Halbrooks wrote.