Medicolegal Issues

What is your liability for involuntary commitment based on faulty information?

Current Psychiatry. 2017 March;16(3):21-25,33

References

1. Pinals DA, Mossman D. Evaluation for civil commitment: best practices for forensic mental health assessments. New York, NY: Oxford University Press; 2011.
2. Testa M, West SG. Civil commitment in the United States. Psychiatry (Edgemont). 2010;7(10):30-40.
3. Hedman LC, Petrila J, Fisher WH, et al. State laws on emergency holds for mental health stabilization. Psychiatr Serv. 2016;67(5):529-535.
4. Groendyk Z. “It takes a lot to get into Bellevue”: a pro-rights critique of New York’s involuntary commitment law. Fordham Urban Law J. 2013;40(1):548-585.
5. Brooks RA. U.S. psychiatrists’ beliefs and wants about involuntary civil commitment grounds. Int J Law Psychiatry. 2006;29(1):13-21.
6. Giacco D, Priebe S. Suicidality and hostility following involuntary hospital treatment. PLoS One. 2016;11(5):e0154458. doi: 10.1371/journal.pone.0154458.
7. Wyder M, Bland R, Herriot A, et al. The experiences of the legal processes of involuntary treatment orders: tension between the legal and medical frameworks. Int J Law Psychiatry. 2015;38:44-50.
8. Valenti E, Giacco D, Katasakou C, et al. Which values are important for patients during involuntary treatment? A qualitative study with psychiatric inpatients. J Med Ethics. 2014;40(12):832-836.
9. Katsakou C, Rose D, Amos T, et al. Psychiatric patients’ views on why their involuntary hospitalisation was right or wrong: a qualitative study. Soc Psychiatry Psychiatr Epidemiol. 2012;42(7):1169-1179.
10. Kaltiala-Heino R, Laippala P, Salokangas RK. Impact of coercion on treatment outcome. Int J Law Psychiatry. 1997;20(3):311-322.
11. Hoge SK, Lidz CW, Eisenberg M, et al. Perceptions of coercion in the admission of voluntary and involuntary psychiatric patients. Int J Law Psychiatry. 1997;20(2):167-181.
12. Lehrer DS, Lorenz J. Anosognosia in schizophrenia: hidden in plain sight. Innov Clin Neurosci. 2014;11(5-6):10-17. 13. Gordon S. The danger zone: how the dangerousness standard in civil commitment proceedings harms people with serious mental illness. Case Western Reserve Law Review. 2016;66(3):657-700.
14. Kallert TW, Katsakou C, Adamowski T, et al. Coerced hospital admission and symptom change—a prospective observational multi-centre study. PLoS One. 2011;6(11):e28191. doi: 10.1371/journal.pone.0028191.
15. Danzer G, Wilkus-Stone A. The give and take of freedom: the role of involuntary hospitalization and treatment in recovery from mental illness. Bull Menninger Clin. 2015;79(3):255-280.
16. Roe D, Weishut DJ, Jaglom M, et al. Patients’ and staff members’ attitudes about the rights of hospitalized psychiatric patients. Psychiatr Serv. 2002;53(1):87-91.
17. Amidov T. Involuntary commitment is unnecessary and discriminatory. In: Berlatsky N, ed. Mental illness. Farmington Hills, MI: Greenhaven Press; 2016;140-145.
18. Monahan J, Hoge SK, Lidz C, et al. Coercion and commitment: understanding involuntary mental hospital admission. Int J Law Psychiatry. 1995;18(3):249-263.
19. Guest Pryal KR. Heller’s scapegoats. North Carolina Law Review. 2015;93(5):1439-1473.
20. Stone AA. Mental health and law: a system in transition. Washington, DC: U.S. Government Printing Office; 1975:75-176.
21. Katsakou C, Bowers L, Amos T, et al. Coercion and treatment satisfaction among involuntary patients. Psychiatr Serv. 2010;61(3):286-292.
22. Setkowski K, van der Post LF, Peen J, et al. Changing patient perspectives after compulsory admission and the risk of re-admission during 5 years of follow-up: the Amsterdam study of acute psychiatry IX. Int J Soc Psychiatry. 2016;62(6):578-588.
23. Stelfox HT, Gandhi TK, Orav EJ, et al. The relation of patient satisfaction with complaints against physicians and malpractice lawsuits. Am J Med. 2005;118(10):1126-1133.
24. Goldman A. Continued overreliance on involuntary commitment: the need for a less restrictive alternative. J Leg Med. 2015;36(2):233-251.
25. Fisher WH, Grisso T. Commentary: civil commitment statutes—40 years of circumvention. J Am Acad Psychiatry Law. 2010;38(3):365-368.
26. Curley A, Agada E, Emechebe A, et al. Exploring and explaining involuntary care: the relationship between psychiatric admission status, gender and other demographic and clinical variables. Int J Law Psychiatry. 2016;47:53-59.
27. Muroff JR, Jackson JS, Mowbray CT, et al. The influence of gender, patient volume and time on clinical diagnostic decision making in psychiatric emergency services. Gen Hosp Psychiatry. 2007;29(6):481-488.
28. Muroff JR, Edelsohn GA, Joe S, et al. The role of race in diagnostic and disposition decision making in a pediatric psychiatric emergency service. Gen Hosp Psychiatry. 2008;30(3):269-276.
29. Unick GJ, Kessell E, Woodard EK, et al. Factors affecting psychiatric inpatient hospitalization from a psychiatric emergency service. Gen Hosp Psychiatry. 2011;33(6):618-625.
30. Ng XT, Kelly BD. Voluntary and involuntary care: three-year study of demographic and diagnostic admission statistics at an inner-city adult psychiatry unit. Int J Law Psychiatry. 2012;35(4):317-326.
31. Lo TT, Woo BK. The impact of unemployment on utilization of psychiatric emergency services. Gen Hosp Psychiatry. 2011;33(3):e7-e8. doi: 10.1016/j.genhosppsych.2010.10.010.
32. van der Post LFM, Peen J, Dekker JJ. A prediction model for the incidence of civil detention for crisis patients with psychiatric illnesses; the Amsterdam study of acute psychiatry VII. Soc Psychiatry Psychiatr Epidemiol. 2014;49(2):283-290.
33. Heilbrun K, NeMoyer A, King C, et al. Using third-party information in forensic mental health assessment: a critical review. Court Review. 2015;51(1):16-35.
34. Mass shootings at Virginia Tech, April 16, 2007 report of the Virginia Tech Review Panel presented to Timothy M. Kaine, Governor, Commonwealth of Virginia. http://cdm16064.contentdm.oclc.org/cdm/ref/collection/p266901coll4/id/904. Accessed February 2, 2017.
35. Segal SP, Laurie TA, Segal MJ. Factors in the use of coercive retention in civil commitment evaluations in psychiatric emergency services. Psychiatr Serv. 2001;52(4):514-520.
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37. Anderson JC. How I decided to sue you: misadventures in psychiatry. Reprinted in part from: Moody CE, Smith MT, Maedgen BJ. Litigation of psychiatric malpractice claims. Presented at: Medical Malpractice Conference; April 15, 1993; San Antonio, TX. http://www.texaslawfirm.com/Articles/How_I_Decided_to_Sue_You__Misadventrues_in_Psychiatry.pdf. Accessed December 27, 2016.
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40. Ohio Revised Code §5122.34.
41. California Welfare & Institutions Code §5150(E).
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Dear Dr. Mossman,
Last week, I hospitalized a patient against her will, based in part on what her family members told me she had threatened to do. The patient threatened to sue me and said I should have known that her relatives were lying. What if my patient is right? Could I face liability if I involuntarily hospitalized her based on bad collateral information?

Submitted by “Dr. R”

In all U.S. states, laws permit psychiatrists to involuntarily hospitalize persons who pose a danger to themselves or others because of mental illness.¹ But taking this step can be tough. Deciding to hospitalize a patient against her will involves weighing her wants and freedom against your duty to look out for her long-term welfare and the community’s safety.^2,3 Often, psychiatrists make these decisions under pressure because the family wants something done immediately, other patients also need attention, the clinical picture is incomplete, or potential dispositions (eg, crisis care and inpatient beds) are limited.³ Given such constraints, you can’t always make perfect decisions.

Dr. R’s question has 2 parts:

What liabilities can a clinician face if a patient is wrongfully committed?
What liabilities could arise from relying on inaccurate information or making a false petition in order to hospitalize a patient?

We hope that as you and Dr. R read our answers, you’ll have a clearer understanding of:

the rationale for civil commitment
how patients, doctors, and courts view civil commitment
the role of collateral information in decision-making
relevant legal concepts and case law.

Rationale for civil commitment

For centuries, society has used civil commitment as one of its legal methods for intervening when persons pose a danger to themselves or others because of their mental illness.⁴ Because incapacitation or death could result from a “false-negative” decision to release a dangerous patient, psychiatrists err on the side of caution and tolerate many “false-positive” hospitalizations of persons who wouldn’t have hurt anyone.⁵

We can never know if a patient would have done harm had she not been hospitalized. Measures of suicidality and hostility tend to subside during involuntary hospital treatment.⁶ After hospitalization, many patients cite protection from harm as a reason they are thankful for their treatment.^7-9 Some involuntary inpatients want to be hospitalized but hide this for conscious or unconscious reasons,^10,11 and involuntary treatment sometimes is the only way to help persons whose illness-induced anosognosia¹² prevents them from understanding why they need treatment.¹³ Involuntary inpatient care leads to modest symptom reduction^14,15 and produces treatment outcomes no worse than those of non-coerced patients.¹⁰

What is your liability for involuntary commitment based on faulty information?

References

Rationale for civil commitment

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