Psychiatric Patient Commits Crime After Being Discharged from Hospital

Case Overview

This case involves a patient who was admitted to hospital after displaying erratic and violent behavior at his parent’s home. Upon admission, it was observed that the patient was suffering from critical physical and psychological conditions and required professional psychiatric treatment. According to the medical records, the treating psychiatrist knew that the patient had a recent medical history of both suicidal ideation and homicidal ideation. Additionally, it was noted that the patient was exhibiting signs and symptoms of paranoia, psychosis, and depression. Nevertheless, the psychiatrist still discharged the patient shortly after he was admitted. A few hours after the patient was discharged into the care of his parents, he was able to get away from their house. At this point, the patient began wandering the streets of his neighborhood, until he eventually broke into a stranger’s home. Once inside the home, the patient began to cut himself, and eventually jumped off the roof, suffering significant injuries. It was alleged that the hospital was negligent in discharging the patient as early as it did.

Questions to the Forensic Psychiatry expert and their responses

Are you familiar with the proper policies, procedures, and protocols for psychiatric treatment, including discharge?

I have trained in and worked in a general inpatient unit in a community psychiatric hospital with a large proportion of involuntary admissions with chronically ill patients such as the individual described in this case. I am very familiar with the policies and protocols for discharge.

Should a patient exhibiting these symptoms and behavior be discharged?

From the information provided, the patient met criteria for involuntary treatment and should not have been discharged. Unresolved depression with psychosis and paranoia is a risk factor for suicide, and it would be difficult to imagine a scenario where this patient would be safe for discharge. It would have been important for doctors to consider other risk factors for suicide and violence including hopelessness, past attempts, and whether the individual was future-oriented. It would also be important to know if the treatment team contacted the family and friends of the patient, as self-report of suicidal ideation is not adequate to determine suicidality.

About the expert

This highly qualified expert is double board certified in Psychiatry and Forensic Psychiatry. He has been in active practice for over 7 years. He completed his MD at the Bangalore University in India prior to moving to the United States. He completed an Internship in Psychiatry at the University of Kansas Medical Center and completed his Residency in Psychiatry at the Unversity of Texas Health Sciences Center. After practicing for 4 years, this expert went on to complete a Fellowship in Forensic Psychiatry at the Oregon Health Sciences University. He is highly respected and awarded in this field. He is a member of the highly reputable Physicians for Human Rights - Asylum Network. He is currently serving as an Assistant Professor of Psychiatry and Forensic Psychiatrist in the Competency Restoration Unit at a Major University affiliated Psychiatric Center in the Southwest. Along with his clinical responsibilities, this expert is actively involved in research and publishing his work.

E-057103

Specialties:

Forensic Psychiatry