Consequences of Bad Choices

[hbscott]

I was recently involved in a multidisciplinary team evaluation of a patient who attempted suicide by placing a shotgun in his mouth. He survived the attempt but was left with only half a face. I was consulted as my department does advanced 3D imaging work to include prosthetic reconstruction of such profound defects.

As I was sitting in this team meeting a question was raised by a social worker on the visitation rights for his wife. The social worker reported that this woman had been married twice before and both previous husbands had successfully committed suicide. This was husband number 3 who had survived his suicide attempt and the wife wanted to visit her husband to "comfort" him.

The question raised to the care team was the wife a danger to her husband knowing the general history as outlined above. We were not privy to all the details but there was some suspicion that the patient's wife may have been a contributing factor to the suicide attempt. I was surprised to see that the care team had differing opinions on this matter that pretty much split down gender lines. I found this interesting.

The men on this particular care team felt that visitation for the wife should be carefully monitored until it could be determined that the wife was not a contributing factor to the patient's suicide attempt. The women on the care team felt that since she had not been arrested by law enforcement that the question was irrelevant. In fact one member stated that perhaps the only thing she is guilty of is making bad choices. It wasn't her fault that the men she chose to marry kept killing themselves.

Since this BB is a wonderful place to sample such diverse, well educated and experienced opinion I thought it would be an interesting case study to present.

Any thoughts?

-HBS

[CCU NRS]

Wow this is interesting It is sort of wierd that she has lost 2 previous husbands and now a third attempted and usually I would think an attempt with a shotgun would be successful. I guess we don't know how the 2 previous men died, so we can't rely on method for any clues, as mentioned the police have not seen fit to arrest but that does not necessarily mean they do not suspect her. I would definately want observed visitation just because this seems to be too large a coincidence. But then your problem becomes who can take time to simply sit and observe this visitor?

Very intrigued let me know what happens

[gypsyatheart]

Personally, I find it very suspicous. I mean, what are the odds that one would marry and have each spouse attempt suicide? IMO there is a definite need for more investigation....are the authorities involved in this at all?

Unless this woman is frequenting mental health facilities looking for her partners, I'm not sure how much of a "choice" may be involved. The other thought is that she, herself, is or has undergone some type of mental health treatment and that is where she seeks out these men. Still needs looking at as far as I'm concerned.

And...I am female.

[hbscott]

are the authorities involved in this at all?

We have been told that the wife is not a suspect at this time. The husband clearly attempted suicide and has admitted doing so at this time. The wife's previous marital history was brought up by social services so we only have limited details on that. Of course we could just ask the wife her opinion on the matter but you have to wonder just how accurate that information would be.

My job is simple. I just have to reconstruct his face. The psychosocial elements of this case are truly challenging and unique in my experience. The behavioral health aspects of this patient care scenario are going to be interesting to say the least.

-HBS

[ShelleyERgirl, LPN]

Sheeewww, something smells fishy to me, like moondancer stated, "what are the odds" that this women would marry not one, not two, but THREE men who either actually committed suicide or attempted it? Come on...... I say carefully watch this women,who knows, she might try to put a pillow over the poor guys face or something!

[prmenrs, RN]

I am concerned about HIPAA re: this discussion.

[hbscott]

I am concerned about HIPAA re: this discussion.

This case study has been carefully presented. No patient demographics, location and/or health care providers have been personally identified. No privacy rules have been violated implicitly or explicitly.

-HBS

[nurseunderwater]

smacks of a hippa violation to me too... :stone

[Sheri257]

Interesting comments. I'm curious about the concerns that this could be a violation. How is this different from other situations that are posted on this board? Is it because the circumstances are so unusual it could lead to identification? I'm just a student and would like to learn more about the concerns posted here ...

[prmenrs, RN]

The specifics are my concern--how many pts out there fit this scenario? The OP is very knowledgeable, and I respect her judgement. We still need to be careful, IMHO.

[hbscott]

I can understand and appreciate the concerns about privacy violations in accordance with the Privacy Act of 1974 and more recent and ever evolving HIPAA legislation. That being said I can assure you there are no HIPAA violations here in this post so far. If you need to do some research on just exactly what constitutes a HIPAA violation may I humbly suggest the following link:

http://www.hipaa.org/

But be warned, it is a very long read....

-HBS

[leslie :-D]

hi hb,

is the husband able to communicate in any way? and if so, what are his reactions when asked if he wants to see his wife? (assuming he's be asked).