Suicide in psychiatry and medical liability: A case series

The suicide of a patient is a serious event that may constitute a therapeutic failure. To prevent these situations, national and international guidelines exist. When a suicide occurs in a psychiatric hospital or immediately after release, legal action may follow, most frequently for malpractice claims related to the failure to provide reasonable management of the suicide risk. In an attempt to respond to the increased anxiety in the health care system and among practitioners, we used case reports to determine the minimum medico-legal standards that the physician must follow in the context of suicide. From February 1st to May 30th, 2019, we gathered all available expert psychiatric reports following criminal prosecutions from the University Center of Legal Medicine of Geneva. We restricted the extraction of cases to those from January 1st, 2007, to May 30th, 2019. We identified 7 cases. The psychiatrist expert provided a care setting assessment, clinical/survey assessment, and suicidal risk assessment. Improper care setting assessment was the most commonly found conclusion, but the two other categories were as detrimental concerning suicidal risk. Only one psychiatrist was condemned, but the decision was revoked on appeal. The combination of our cases and a scoping review on the subject leads to the recommendation of minimum medico-legal standards to complete individualized suicide risk reduction plans. Minimal medico-legal standards should be applied and documented to optimize care practice for the reduction of suicidal risk at three different levels: the initial evaluation, the treatment, and the surveillance.