The Florida Supreme Court’s decision to make a physician liable for the suicide of an outpatient who had stopped using her prescribed medication for depression exposes physicians to added risk, even if they aren’t Florida residents. In this article I will detail some of the reasons this decision is misguided and why it is a risk for all physicians, not just Florida physicians.
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—a malady her physician, Dr. Chirillo, had been treating her for with medication that she advised his office she had stopped taking during the call. Dr. Joseph S. Chirillo Jr.’s office advised her she could come to the office to pick up a different anti-depressant and made an appointment for her with a gastroenterologist to investigate other symptoms she was experiencing.
Dr. Chirillo is not a psychiatrist or a psychologist. He is a medical doctor specializing in family medicine. If you’re a layperson who has not navigated mental health care in America you are probably not aware that about 30% of all mental health care is provided by primary physicians or that primary physicians seldom have adequate training to effect cures—they can only prescribe medications that help with the symptoms of depression and other mental illnesses.
The truth is that mental health care does not receive the attention or resources needed to provide needed care to Americans. There are 3,000 counties in the United States that are classified as “having inadequate mental health care resources.” I believe that number underestimates the problem because many people who would benefit greatly from care never seek care due to stigma and beliefs that the way they feel is just the way it is and that there is nothing they can do to enjoy life more. Estimates indicate only about one-third of Americans with mental health problems actually receive treatment for their condition.[i]
One reason mental health is so poor, not just in the United States, but around the world is linked back to unvalidated science about the purpose and use of emotions. The hypothesis that has been widely accepted and taught about emotions wasn’t overturned until 2007 and few people are aware of or use the new, healthy method of interacting with their emotions. There are at least five peer-reviewed studies published and five books about the new method, but billions of people still live according to the erroneous hypothesis and it leads them to lives that are far less enjoyable than they could be.
Can a physician be held responsible for a patient’s lack of knowledge of the healthy way to use her emotions to develop resilience and healthy mental states and thought patterns? I don’t think he can or should, especially when it is highly unlikely he doesn’t know or use the new definition of emotions.
Patient compliance or adherence is the degree to which a patient correctly follows their physicians directions. Believe it or not, many patients do not follow physician prescribed treatment plans. For example, a tremendous amount of the high cost of diabetes treatment is hospitalizations that result when patients do not follow a prescribed treatment plan. In this Florida case, the patient stopped taking her anti-depressants and did not inform the prescribing physician for a number of months. Anti-depressants all have warnings not to stop taking the medication without consulting with one’s doctor but this patient did not do that. Suicidal ideation is one of the potential side effects of stopping anti-depressant medication.
How can a physician be held liable for a patient who disregards his instructions and subsequently takes her own life? Is the patient not an adult with full decision-making capabilities? If she isn’t, wouldn’t her widower (who sued the physician) be in a better position to judge her lack of capacity to make decisions from his day-to-day observations than a family physician that probably didn’t spend an hour with the patient?
In an ideal world the physician would have spent more time with the patient, but our medical model is reactive and based on insurance dictates that severely limit reimbursements for time spent with patients beyond 8 – 15 minutes or so depending on the situation. Additionally, Dr. Chirillo is not trained to treat mental health issues so spending more time with the patient would not necessarily have been productive for her and could have been counterproductive.
Suicide is the #2 cause of death for age ranges 10 – 35 and the #4 cause of death for ages 35 – 54.
The Misguided Court Decision