Tales from the Couch

Seeing the patient from psychiatry’s perspective

When the Patient is More Sane Than the Psychiatrist

When common sense is lacking

As a forensic psychiatrist, I’m often called upon to examine plaintiffs in civil cases where someone is suing because of injuries sustained in an incident. In addition to physical injuries, the plaintiff often claims psychiatric damages.

Some years ago, I examined a man who told an exceptionally strange story. Gregory was suing the State of New York for medical malpractice, claiming there was a significant departure from accepted medical practice resulting in physical and psychiatric injuries.

Gregory was a schizophrenic patient who had been hospitalized many times at Bronx State Psychiatric Hospital, a facility operated by New York State. One winter night, he presented at the emergency room, complaining of voices telling him to kill himself. He grew increasingly alarmed when the voices became more insistent than ever. These are called command hallucinations in which the patient is told what to do; they’re very dangerous because the person often obeys them.

The emergency room resident, who in deposition testimony admitted having read Gregory’s psychiatric records, chose not to admit him for stabilization. Rather, he wrote a prescription and handed it to Gregory, saying, “Just fill the prescription and take two pills immediately. Then take two every day. The voices will go away in a day or so.”

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“But Doc, the voices are so strong.”

“They’ll go away soon.”

“Hey, Doc, I don’t have any carfare.”

“Where do you live?”

“One Hundred Sixty Eighth Street, here in the Bronx.”

The doctor reached into his pocket and handed Gregory a subway token. “Take this. The train will drop you off near your apartment.”

“But, Doc…”

“Don’t worry. Just take the medication.”

Gregory left the emergency room, walked to a nearby train station, and when the train roared into sight, jumped onto the tracks. He was lucky he didn’t lose his life, but his leg was severed by the train.

One of the foremost personal injury lawyers in the country represented Gregory in his lawsuit against New York State. He claimed the hospital doctor departed from standard psychiatric and medical practice by allowing a blatantly psychotic man, who was under the influence of demonic-like voices, to leave the emergency room and do egregious harm to himself. The State’s defense claimed the patient was psychotic and would have thrown himself in front of the train, whether or not he had visited the hospital that night.

Rather than a jury trial, the case was presented before the New York Court of Claims which decided Gregory was not treated appropriately. It determined the opportunity to interrupt this man’s psychotic thinking presented itself, but the hospital failed in its duty to provide adequate care. Had Gregory been admitted to the hospital, he would still have his leg.

The hospital clearly departed from accepted psychiatric practice, for which Gregory was awarded two million dollars for the loss of his leg and the mental anguish, pain and suffering he experienced as a result of the hospital’s malpractice.

Clearly, the resident, on that fateful night, demonstrated less common sense than the psychotic, schizophrenic patient in his care.

 

 

Mark Rubinstein, M.D., is a former professor of psychiatry at Cornell. His most recent book is the novel Mad Dog House.

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