In a long-awaited decision, Chirillo v. Granicz, the Supreme Court of Florida provided much-needed clarity on the thorny question of the liability that may extend to a psychotherapist for his or her patient’s suicide. The decision resolves conflicting rulings from two of Florida’s Courts of Appeal and provides coherent guidance to litigants wondering whether the conduct of a treating psychotherapist is actionable.
Granicz was brought by the widower of a patient who had received mental health care treatment from a primary care physician for about three years prior to her suicide. The physician began providing treatment to the patient in 2005, and in September of that year, he switched the patient’s antidepressant medication from Prozac to Effexor. In October 2008, the patient contacted the physician’s office and told a medical assistant she had ceased taking the Effexor because she believed it was causing various deleterious side effects, including difficulty sleeping and digestive problems. After reading notes on this conversation taken by the medical assistant, the physician called the patient, told her that he was changing her prescription to Lexapro, and referred her to a gastroenterologist. The physician told the plaintiff that she could obtain samples of Lexapro from the office, but he did not schedule an appointment to meet directly with the plaintiff. Some days thereafter, the patient went to the office to obtain the samples.
On the following day, the widower found the patient’s body hanging in their garage. The patient did not leave a note, and both the widower as well as one of the couple’s adult daughters testified that the patient did not give any indication of having suicidal thoughts. The widower brought a medical negligence claim against the physician and several other defendants on behalf of the deceased person. Following discovery, the trial court granted the defendants’ motion for summary judgment, finding that the defendants did not have a legal duty to prevent the patient’s suicide. The widower appealed, arguing that the trial court improperly characterized the duty the physician owed to the plaintiff. The Second District Court of Appeal concurred with the widower and reversed the trial court’s grant of summary judgment. However, the Second District noted that its decision was in conflict with precedent from the First District Court of Appeal, and the case was appealed to the Supreme Court of Florida.
The key issue to be resolved was which legal duties, if any, are owed by a physician treating a patient with a mental health condition to prevent that patient’s suicide. In reversing the trial court, the Second District held that the applicable standard to be applied in such cases is whether the physician exercised “[the] level of care, skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar health care providers.” Granicz v. Chirillo, 147 So. 3d 544, 548 (Fla. 2d DCA 2014). However, this holding was in conflict with the First District Court of Appeal’s decision in Lawlor v. Orlando, 795 So. 2d 147 (Fla. 1st DCA 2001). In Lawlor, the First District first held that the particularized duty of care that a physician has to prevent a patient from harming himself in a custodial setting does not apply when the care is provided on an outpatient basis. Id. at 148. Second, the First District held that a general duty of care did not apply because the facts in that case did not demonstrate that the physician’s conduct created a foreseeable risk of the patient’s suicide, noting that evidence of depression or other risk factors did not necessarily make the suicide foreseeable. Id. Accordingly, unlike the Second District’s decision, premised on the statutorily defined duty of care physicians generally owe to patients in medical negligence cases, the First District ruling rested on a duty either specifically arising in a custodial setting or otherwise needing to meet the general duty of care standard, based on the conduct foreseeably causing a risk of suicide. The Supreme Court of Florida concurred with the reasoning of the Second District and abrogated the First District’s ruling in Lawlor.
First, the Supreme Court noted that a physician does not have a specific duty to prevent a patient’s suicide in a noncustodial setting. However, simply because there is no specific duty to prevent a patient from injuring herself in an outpatient setting does not mean that negligence liability could not arise from the physician’s distinct duty to provide care in the manner of a reasonable, prudent health care provider. Accordingly, if a physician fails to provide care in a reasonable fashion, and a plaintiff can establish that the failure to provide such care “caused” the patient to harm herself, liability can be found. See Perez v. United States, 883 F. Supp. 2d 1257, 1286 & n.90 (S.D. Fla. 2012) (“The outpatient status of a person being treated for severe mental illness clearly does not, as a matter of law, completely absolve a psychiatrist or mental health provider from the duty to render . . . an appropriate diagnosis, treatment, and care”).
The Supreme Court noted that in Lawlor, the First District erroneously considered the foreseeability of the patient’s suicide in determining whether a duty of care existed. Instead, when determining whether a duty of care exists, a court’s inquiry should be limited to whether there was evidence demonstrating that the physician did not exercise reasonable care. In this case, the Supreme Court found that the plaintiff had propounded evidence that the physician did not exercise reasonable care, based on the expert testimony of several other medical professionals. Furthermore, although the foreseeability of the suicide is pertinent to whether there is sufficient evidence of proximate cause, an issue distinct from duty, the Supreme Court noted that the evidence showed that the physician knew that the patient had ceased taking her medication abruptly, which increased the risk of suicide, and conceded at his deposition that the abrupt cessation was a contributing factor in the patient’s suicide. Accordingly, there was evidence from which a reasonable jury could determine that the physician’s failure to provide prudent care “caused” the patient’s suicide.
Although the Supreme Court’s decision provides much-needed clarity, medical negligence liability remains a complicated area of the law. Indeed, if you’ve recently been harmed as a result of possible medical negligence, you should consider finding experienced counsel to both determine the viability of the claim and lead you through the litigation process. The South Florida medical malpractice attorneys at Frankl & Kominsky have provided assistance to many Florida patients and are prepared to provide you guidance with a possible claim. Indeed, if you believe you may have a viable medical malpractice claim and would like to hear more about your legal options, feel free to contact us to arrange a free case consultation.