Published Feb 20, 2004
Can someone tell me - if a patient is brought into the ed with SI and then is later discharged home by the nurse (per the order) with follow up psych evulation - what happens if she commits suicide before her eval? Who is responsible?
I have never discharged a patient with SI. They get a PET eval, and then 5150'd. If they were discharged and commited suicide, it would probably be whoever wrote the order is liable (either the MD or psych team evaluator).
I have a friend whose huband was released from the ED and suicided about 2 hours later. Big lawsuit...it's been about 6 years now and it's still going on--appeals, etc.
I'm assuming MD as well as D/C nurse is liable. It's against policy to let someone with SI go home, so the
discharge nurse would be just as liable, right? This situation has happened to me once, told to get a "No Harm Contract" signed (as if that really means anything),
and let him go. I didn't feel comfortable, so I refused to d/c him. No one else would either. Pt ended up getting admitted.
it actually depends....if someone is having active suicidal ideations then in all reality they should have an emergency pscyh eval by the ED doc or a Crisis intervention member...and from there either be admitted or discharged,....
there are however cases where the pt was cleared by the ED MD, and the psych MD and still committed suicide......by the law's standards it is a very gray area...in MD there is a 72hr (i believe) window where after that the facility isn't responsible....
when it comes down to it...if someone is serious about suicide then they will attempt and likely succeed. but these people rarely seek help...the ones we see really want help and don't truly want to die....
hope it works out for ya.
This is a point of irritation for me, at what point does an individual cease to be responsible for their actions? Providing that they are not under the influence of something, of course. Why should it be the responsiblity of the heathcare provider to make sure these SI patients are protected from themselves?
In PA we have what is called a "302" (a 5150 in CA) basically an involuntary admission BUT you have to have a petitioner in order to carry out this order.
This is the sticky part, the state police will seldom agree to petition, and then we have to go through the process of finding a petitioner. Our Crisis team usually evaluates this person and then decides if they are indeed suicidal (most arent). we see a lot of "no harm contracts" signed, and, after roughly 6-8 hours the person has eaten, received lots of attention, sobered up and they go on their way.
I don't know what would happen but bet it wouldn't be good. We have a psychiatrist who will not see SI consults if they are self pay. I had one patient with issues and doc would not consult ordered to be d/c'd. I asked them if they had any thoughts of hurting themself or any suicidal thoughts. I then documented this in length. If they would have had any suicidal thoughts I would have called the doctor and went up the chain of command to get this person seen or at least to keep them until they were more stable. It is a cruel world out there for psych patients without insurance.
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