Monday, August 4, 2014

A medical malpractice action based on a psychiatric consultation.

Practice point:  The plaintiff had gone by ambulance to the hospital complaining of feeling overwhelmed by stress. An emergency room physician concluded that plaintiff's symptoms were consistent with depression, and ordered several tests and a psychiatric consultation. After some of the test results came back, the emergency room physician telephoned defendant-psychiatrist for the consultation. The emergency room physician advised him that she anticipated that plaintiff would be medically cleared, and asked defendant to confirm her initial assessment that plaintiff was not suicidal or a risk to others and, thus, would not require involuntary admission. Defendant reviewed the plaintiff's chart, looking for any indication that he had suicidal or homicidal ideation. Then, after performing his evaluation, defendant concluded that plaintiff was not a danger to himself or others and would not require involuntary admission. Defendant offered plaintiff a referral for outpatient psychiatric treatment for depression. As defendant was gathering information regarding the outpatient referral, plaintiff and his partner left the hospital before being formally discharged by the emergency room physician, who was still waiting for medical test results and overseeing treatment. Plaintiff became unresponsive in the cab ride home and returned to the emergency room about 45 minutes later. He was reexamined and, after a neurological consultation, it was determined that he had suffered a stroke.

Plaintiff sued, among others, defendant-psychiatrist, against whom he alleged a departure from acceptable medical practices by not performing a neurological examination and thereby ruling out a neurological etiology for his symptoms; by not developing a list of differential diagnoses; and by not referring plaintiff for further diagnostic studies to work up neurological problems. The Supreme Court denied defendant's motion for summary judgment dismissing the complaint insofar as asserted against him.

The Appellate Division reversed, finding that defendant established his prima facie entitlement to judgment as a matter of law by demonstrating that his duty of care as a consulting psychiatrist did not extend to the departures alleged by the plaintiff.  Where, as here, plaintiff was being actively treated by an emergency room physician for any medical causes of his symptoms, and exhibited no clear signs of neurological problems at the time, defendant had no duty beyond properly performing an evaluation to determine whether plaintiff was a danger to himself or others and would require involuntary admission for depression. The Appellate Division found that, in opposition, the plaintiff failed to raise a triable issue of fact.

Student note:  A physician's general duty of care to the patient may be limited to those medical functions undertaken by the physician and relied on by the patient.

Case:  Chin v. Long Is. Coll. Hosp., NY Slip Op 05406 (2d Dept. 2014)

Here is the decision.

Tomorrow's issue:  Motion to amend the complaint is granted.