Littleton v. Good Samaritan Hosp. & Health Center
| Decision Date | 12 October 1988 |
| Docket Number | No. 87-1308,87-1308 |
| Citation | 529 N.E.2d 449,39 Ohio St.3d 86 |
| Parties | LITTLETON, Admx. of the Estate of Pearson, Appellant and Cross-Appellee, v. GOOD SAMARITAN HOSPITAL & HEALTH CENTER et al., Appellees and Cross-Appellants. |
| Court | Ohio Supreme Court |
Syllabus by the Court
A psychiatrist will not be held liable for the violent acts of a voluntarily hospitalized mental patient subsequent to the patient's discharge if (1) the patient did not manifest violent propensities while being hospitalized and there was no reason to suspect the patient would become violent after discharge, or (2) a thorough evaluation of the patient's propensity for violence was conducted, taking into account all relevant factors, and a good faith decision was made by the psychiatrist that the patient had no violent propensity, or (3) the patient was diagnosed as having violent propensities and, after a thorough evaluation of the severity of the propensities and a balancing of the patient's interests and the interests of potential victims, a treatment plan was formulated in good faith which included discharge of the patient.
On June 19, 1981, two-and-one-half-month-old Carly Ann Pearson died from an overdose of aspirin administered by her mother, Theresa Pearson. Two weeks prior to Carly's death, Theresa was released from the mental health unit of Good Samaritan Hospital and Health Center where she had been receiving treatment from staff psychiatrist Richard W. Murray, M.D., and psychologist Elizabeth Wales, Ph.D. This case involves the liability of Dr. Murray for the death of Carly. 1
Shortly after Carly was born, Theresa began to feel depressed, anxious, and distracted from her usual duties. She was afraid the baby would come between her and her husband, Gregory, and her little boy, Christopher. She experienced feelings of rejection toward Carly, had impulses to harm Carly, and was fearful for Carly's safety.
Theresa's obstetrician referred her to Dr. Wales and she met with Dr. Wales several times in April. Dr. Wales initially diagnosed Theresa as suffering from post-partum depression. Dr. Wales attributed Theresa's concerns about Carly to Theresa's belief that she had caused the divorce of her parents when she was a little girl. Theresa believed men did not like little girls and feared that since she had caused her father to leave her mother, Carly might cause Greg to leave her.
When Theresa did not progress as Dr. Wales had hoped, Dr. Wales recommended a thorough physical and psychiatric evaluation. Following the recommendation of Dr. Wales, Theresa voluntarily checked into Good Samaritan Hospital on April 30, 1981. Greg's mother, Janet Ferguson, took over the care of Carly and Christopher.
Theresa was placed in the open ward of Good Samaritan's Mental Health Unit. Good Samaritan uses a team approach in treatment where various professionals in the mental health field participate in and implement treatment decisions. The team involved in Theresa's care included therapist Donna Susan Perry, nurse Selma Garber, and Dr. Murray. Dr. Murray was primarily responsible for Theresa's care. Dr. Wales was not a formal part of the team but she continued to see Theresa and had contact with the team members throughout Theresa's difficulties.
While at the hospital, Theresa participated in daily therapy sessions and took relaxant and antidepressant medication prescribed by Dr. Murray. Carly was brought in for an overnight stay in order to observe the interaction between her and Theresa. According to nurse Garber, Theresa took care of Carly but did not exhibit "motherly affection" toward her.
Theresa was released on May 8, 1981, in part because the goal of the original treatment plan was to avoid lengthy interruption of Theresa's relationship with her family and in part because Theresa pressed for discharge. She resumed care of Carly.
Dr. Wales was in charge of Theresa's care following her release and had numerous contacts with Theresa throughout the month of May. During this time, Theresa was often upset and would frequently talk with Greg about giving the baby up for adoption or placing her in a foster family. On one occasion, Theresa, while being observed by Greg, pulled covers over Carly's head while Carly was sleeping and said she wished the baby was gone.
On May 27, Dr. Wales received a phone call from Theresa. Theresa was agitated. She felt she had proof that the baby was not Greg's and was afraid Greg would leave her if she told him. Dr. Wales recommended she reenter the hospital, and Theresa was readmitted on May 29, 1981. Greg's father, Carl Pearson, and Carl's girlfriend, Margaret (Sue) Bookwalter, took charge of Carly.
Throughout her second admission, Theresa expressed concern about not loving Carly and a desire to put Carly up for adoption. She was preoccupied with the notion that Greg was not Carly's father, and wondering whether to tell Greg. She was afraid of losing her husband and son. Dr. Murray prescribed an antipsychotic drug, Stelazine, to help reduce Theresa's anxiety, and involved Theresa in various group activities at the hospital.
On a number of occasions Theresa expressed concern that she would hurt Carly. On the evening of June 1, a nurse made a note in the hospital record that Theresa However, three hours later, following a hypnosis session, the same nurse made a notation which stated:
Though aware of these notations, Dr. Murray did not talk with Theresa about her statements and therapist Perry could not remember whether she had done so. There is no charted conversation with Theresa about these statements. Dr. Murray felt the conflicting statements indicated that Theresa did not have a fixed objective to harm Carly.
Dr. Wales was not aware of these specific statements, but claimed there were many such statements by Theresa. Dr. Wales testified that every time Theresa mentioned she would harm Carly or was afraid she would harm Carly, Dr. Wales would ask how she would do that and Theresa never mentioned having a plan.
A few days following these statements, a meeting was held with Theresa and her family for the purpose of formulating a program for Theresa's care. 2
A program was established which called for Theresa to be relieved of her responsibility for taking care of Carly for one year. Greg's father and Sue agreed to share the responsibility for Carly's care with Greg's mother during that time. The goal was to protect Carly and to allow Theresa time to recover from the stress of caring for Carly while strengthening Theresa's relationship with her husband and son. Visitation with Carly was strongly encouraged in the hope that Theresa would bond with Carly and take over her care when she recovered.
The family members present at the meeting were warned, either explicitly or implicitly, that Theresa had the potential for harming Carly, but were not told of Theresa's specific threat of June 1 to kill Carly. Though his testimony contradicts itself, Greg testified that he understood the harm Theresa might cause Carly was neglecting to care for Carly, not actively hurting her.
The family was also instructed that Theresa was never to be left alone with Carly. Greg's understanding of the instructions was that Theresa was not to be left alone with Carly for long periods of time, i.e., two or three hours. He felt that the team left it to his discretion as to when and if Theresa was capable of taking care of Carly for short periods of time.
Theresa was discharged from Good Samaritan on June 5, 1981. Prior to her discharge, Theresa met with Greg and told him that she had been having an affair and that Carly was not his. Greg doubted Theresa's confession but said that in any event, he would not leave her and that he wanted to have Carly as part of his family though Theresa wanted to give Carly up for adoption.
At the time of Theresa's discharge, Dr. Murray diagnosed her as having recurrent depression. His reason for discharging her, as stated in his discharge summary, was that Theresa had been able to maintain a low level of anxiety, agitation and withdrawal for forty-eight hours following a hypnosis session. Dr. Murray testified that, in his best medical judgment, he did not believe Theresa had a fixed purpose or plan to hurt Carly and he felt the care plan adequately protected Carly by separating her from Theresa. Theresa wanted to go home and he saw no grounds for involuntary commitment.
Perry would have preferred that Theresa stay longer, but Theresa was adamant about leaving and there were no grounds, in Perry's opinion, for involuntary commitment. Dr. Wales supported the discharge even though Theresa still feared that Carly would interrupt her life. She felt Theresa's fears of harming Carly were adequately resolved by the plan to delegate responsibility for Carly's care to other family members and the fact that the paternity issue had been discussed with Greg and apparently was resolved. Dr. Wales thought that further hospitalization would have been detrimental to Theresa because it would have increased the time of separation between Theresa and her husband and son, a separation Theresa was intensely worried about.
After her discharge, Theresa continued to meet with Dr. Wales, who was in charge of follow-up. Greg's father and Sue Bookwalter continued to...
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