Molchon v. Tyler

• Decision Date: 08 June 2001
• Docket Number: Record No. 002010.
• Citation: 546 S.E.2d 691,262 Va. 175
• Court: Virginia Supreme Court
• Parties: Andrew MOLCHON, M.D. v. Sandra P. TYLER, as Administratrix of the Estate of Michael Tyler (Deceased), et al.

546 S.E.2d 691

262 Va. 175

Andrew MOLCHON, M.D. v. Sandra P. TYLER, as Administratrix of the Estate of Michael Tyler (Deceased), et al.

Record No. 002010.

Supreme Court of Virginia.

June 8, 2001.

Gary A. Godard, Fairfax (Patricia C. Karppi, McLean; Godard, West & Adelman, Faifax, on briefs), for appellant.

Elaine Charlson Bredehoft, Reston (John C. Cook, Arlington; Charlson Bredehoft, on brief), for appellees.

Present: All the Justices.

KOONTZ, Justice.

In this appeal, we consider whether the trial court properly confirmed a jury verdict in favor of the plaintiffs in a wrongful death action alleging medical malpractice in the negligent discharge of a psychiatric patient who subsequently died as a result of gunshot wounds inflicted by police officers in circumstances which the parties agree were the equivalent of suicide.

BACKGROUND

"According to settled principles of appellate review, we will consider the evidence in the light most favorable to the plaintiff, who comes to this Court armed with a jury verdict approved by the trial judge." Salih v. Lane, 244 Va. 436, 438, 423 S.E.2d 192, 194 (1992).

The decedent, Michael Lee Tyler, had a 20 year history of depression and substance abuse. Following the death of his father from cancer in December 1993, Tyler became severely depressed and began to drink heavily. Tyler was admitted to Dominion Hospital on May 5, 1994. Dr. Andrew Molchon, a psychiatrist, was Tyler's admitting and treating physician. Although Molchon determined that, once stabilized through inpatient treatment, Tyler would benefit from placement in a "structured residential situation," Tyler was discharged from Dominion Hospital on May 10, 1994, without directions to enter a structured program. Tyler subsequently failed to keep a psychiatric outpatient appointment scheduled for him on Molchon's orders.

On May 14, 1994, Tyler attempted to commit suicide. Following his suicide attempt, Tyler was treated at Fairfax Hospital and was then transferred to Dominion Hospital on May 16, 1994, where he was again placed under Molchon's care. Molchon's admitting diagnosis reflects that Tyler was suffering from "[d]epression . most likely major depression... [a]lcohol dependence . [p]robable personality disorder of mixed type .. overdose of multiple medications and self-inflicted lacerations of both wrists."

On May 18, 1994, Molchon's progress notes for Tyler state: "I think that it is absolutely necessary for [Tyler] to have a structured living situation after discharge." (Emphasis added). The following day, Molchon noted that Tyler "report[ed] continuing suicidal ideation but [had] no fixed plan at this time." Molchon's progress notes then state: "The problem is that without a structured living situation ... it is unlikely that [Tyler] will be able to maintain sobriety for more than a few days at most. If he drinks, he will be a very high suicidal risk (as demonstrated by recent attempt)." (Emphasis added).

Over the course of the next several days, Tyler failed to respond satisfactorily to treatment and repeatedly indicated to hospital staff that he was "not ready" to be discharged because he was "not [yet] safe." Although various options for discharging Tyler to another psychiatric hospital or structured living situation were considered, no suitable facility had space immediately available. Molchon's progress notes during this period continue to emphasize the need to discharge Tyler to a structured living situation.

On May 23, 1994, Molchon determined that Tyler was "clinically no longer in need" of hospitalization, but acknowledged that the "[p]roblem now is finding an adequately structured living situation since without this he would be at risk for relapse into drinking." The following day, Tyler again expressed his concern that he was "not ready" to leave the hospital and his fear that he would relapse into alcohol abuse and again attempt suicide. Referring to this statement, Molchon's progress notes state: "My assessment of situation is that [Tyler] is using hospital[ization] inappropriately [and] is using the spectre of further suicide attempts [and] relapse" to avoid being discharged. However, noting Tyler's history of suicide attempts, Molchon decided to seek a second opinion as to Tyler's "readiness for [discharge]."

On May 26, 1994, Molchon's progress notes reflect his view that Tyler's "[treatment] plan is at stalemate." Tyler's social worker at Dominion Hospital arranged for Tyler to have a pre-admission interview at the Northern Virginia Mental Health Institute (NVMHI). However, Molchon cancelled Tyler's pass to leave the hospital to attend this interview, apparently out of concern that the two or three day waiting period for admission to NVMHI was incompatible with his plan to discharge Tyler as soon as possible and because Molchon did not "believe ... that [Tyler] is [a] danger to self/or others" so as to meet the requirements for admission to NVMHI.

Molchon further indicated that he had discussed Tyler's case with the doctor from whom he had sought a second opinion, and that "it [was Molchon'sj understanding" that this doctor agreed that Tyler did not need further acute, inpatient hospitalization. Nonetheless, Molchon delayed making a final decision to discharge Tyler "over [Tyler's] protest" out of concern that there was a "risk that [Tyler] may `act out' in order to get back into the system."

On May 27, 1994, Tyler's social worker arranged for him to have a pre-admission interview on June 3, 1994 for residential treatment at one of two facilities operated by Loudoun County Mental Health Services. The social worker advised Tyler that, in the interim between his discharge and this interview, he could seek assistance through an emergency services telephone line and that he should attend Alcoholics Anonymous meetings. Tyler indicated to the social worker that he might "sleep in his van" following discharge. Molchon's progress notes for that day indicate that Tyler had "reached MHB," meaning that he had reached the "maximum hospital benefit" provided by his insurance coverage and directed that he should be "discharg[ed] tomorrow — follow up plan as described above," apparently referring to the social worker's notes.

Molchon had no further contact with Tyler after May 27, 1994. On May 29, 1994, Tyler was discharged from Dominion Hospital on the order of Molchon's partner, who was on call for Molchon during the Memorial Day holiday weekend.

Late in the evening of May 30, 1994, after having attended an Alcoholic Anonymous meeting, Tyler went to the apartment of Sandra Tyler, his estranged wife. Tyler was distraught and indicated to his wife that he wanted to be readmitted to Dominion Hospital, saying that he did not "feel safe." Tyler's wife contacted the hospital and CMG, Tyler's medical insurance carrier, but was advised that Tyler was not eligible for further inpatient treatment. Tyler became agitated and attempted to cut his wrists with a knife. He then barricaded himself in the bathroom.

Lieutenant John B. Patton, another police lieutenant, and two deputies of the Loudoun County Sheriff's Office arrived at the apartment in response to a telephone call from Tyler's wife. After two or three hours, Tyler emerged from the bathroom brandishing the knife and began to "scream and yell" at the deputies. Tyler's behavior was erratic; one moment calm and the next highly agitated. Tyler repeatedly asked the deputies to shoot him. Still brandishing the knife, Tyler rushed Lt. Patton, who fired his service weapon six times, killing Tyler. Although Tyler's wife testified that her husband did not appear to be intoxicated, an autopsy revealed that Tyler's blood alcohol level was .18 at the time of his death.

On April 7, 1999, the plaintiffs filed a wrongful death suit alleging that Molchon's discharge of Tyler from Dominion Hospital violated the applicable standard of care and was a proximate cause of Tyler's death.¹ Following a jury trial in which the trial court received evidence in accord with the above-recited facts, the jury returned its verdict in favor of the plaintiffs and awarded $1,304,456 in damages. The verdict included jury...