Patton v. Thompson

• Decision Date: 09 November 2006
• Docket Number: No. 1031809.,1031809.
• Citation: 958 So. 2d 303
• Parties: Dr. Rita W. PATTON and Frank Kay Psychiatric Clinic v. Marty THOMPSON, administrator of the estate of Peggy Sue Ellis, deceased.
• Court: Alabama Supreme Court

958 So.2d 303

Dr. Rita W. PATTON and Frank Kay Psychiatric Clinic v.Marty THOMPSON, administrator of the estate of Peggy Sue Ellis, deceased.

No. 1031809.

Supreme Court of Alabama.

November 9, 2006.

Randal H. Sellers and Joseph L. Reese, Jr., of Starnes & Atchison, LLP, Birmingham, for appellants.

Kenneth E. Riley of Farris, Riley & Pitt, L.L.P., Birmingham, for appellee.

BOLIN, Justice.

Dr. Rita W. Patton Psychiatric Clinic, the permission to appeal from Patton and the Clinic's and her employer, the Frank Kaydefendants below, were granted the trial court's order denying Dr. "Rule 50(b)[, Ala. R. Civ. P.,] Renewed Motion for Judgment as a Matter of Law, or, Alternatively Styled, Motion for a Summary Judgment."SeeRule 5, Ala. R.App. P.The trial court certified the following controlling question of law:

"The controlling question of law is the degree of proof necessary to establish the essential element of proximate causation in a medical malpractice/wrongful death action against a psychiatrist for the suicide of that psychiatrist's patient and whether the plaintiff in this case has met that requisite degree of proof."

Factual Background and Procedural History

Peggy Sue Ellis suffered from and had been treated for a serious psychiatric illness for approximately 30 years when she was admitted to Baptist Medical Center Montclair (hereinafter "BMCM") on November 11, 1999.She had previously been hospitalized for management of her psychiatric illness, and she had a history of suicide attempts.Before her November 11, 1999, admission, Ellis had been admitted three times to BMCM in 1999 for management of her psychiatric illness.Dr. Patton was Ellis's physician during all of her admissions in 1999.

Ellis was admitted to BMCM on November 11, 1999, following a suicide attempt.Dr. Patton prescribed Seroquel, a psychotropic agent used to treat schizophrenia.Ellis was placed on a suicide watch in the hospital; the watch continued during her hospital stay.Her condition waxed and waned during her stay.Her condition regressed from November 18 to November 19, and the dosage of her medication was increased.On November 22, 1999, when Ellis was asked whether she would hurt herself, she replied "I hope not."That same day, Ellis stated that she was scared and worried, and she showed signs of paranoia and unreasonable fears regarding her family.She also stated that she was anxious about being discharged the next day.

Ellis was discharged on November 23, 1999, with a discharge plan formulated by Dr. Patton.The plan included: (1) a follow-up appointment with Ellis's therapist at the Eastside Mental Health Center for the next morning; (2) arrangements for daily visits by a home-health psychiatric nurse to monitor Ellis's mental state and to monitor compliance with the prescribed medication; and (3) help from Ellis's cousin in monitoring compliance with the prescribed medication.

On November 24, 1999, Ellis went to the Eastside Mental Health Center, where she was evaluated by her therapist.The therapist noted that Ellis had been unable to fill her prescription for Seroquel and that she was confused about her medications, obsessed with psychotic thoughts, and frightened and that she had an "inappropriate and blunted affect."Dr. Patton was unaware that Ellis had not been able to fill her prescription.On November 26, 1999, Ellis was found dead in her apartment of a drug overdose.The coroner determined that the manner of death was suicide.At the time of her death, Ellis was 53 years old.

On November 19, 2001, Marty Thompson, as administrator of Ellis's estate, sued Dr. Patton and the Clinic, alleging wrongful death under the Alabama Medical Liability Act, § 6-5-480 et seq.and§ 6-5-541 et seq.,Ala.Code 1975("the AMLA").Thompson alleged that Dr. Patton had breached the standard of care by discharging Ellis from the hospital prematurely, failing to formulate an appropriate outpatient-treatment plan, failing to readmit Ellis to a psychiatric unit, and failing to implement proper suicide precautions.

At trial on March 19, 2004, Dr. Nathan Strahl, a psychiatrist, testified as an expert witness for Thompson.Dr. Strahl had reviewed Ellis's medical records, and his testimony regarding causation was as follows:

"Q. ...In your opinion, given your review of the records and your understanding of Ms. Ellis's condition on 11/23/99, was there a probability that she would attempt suicide or self harm if she was released from the hospital?

". . . .

"A.That was a probability.The probability increases the more factors that she would carry leaving the hospital that are risk factors for suicide.

"Q.And did Ms. Ellis possess many of these risk factors?

"A.She did.

"Q.Was it highly probable?

"A.It was highly probable that she might do something to herself, yes.

"Q.Doctor, in your opinion, should a treating psychiatrist, given what we know and what you have reviewed about Ms. Ellis, exercising reasonable care, diligence and skill have recognized this probability that you just testified to?

"A.I would think so, yes, sir.

". . . .

"Q.I think you just answered my next question, but I want to ask it so the record is clear.Strictly concerning this discharge which you have criticized today, given the facts and circumstances that you're aware of in Ms. Ellis's condition on 11/22/99, what would be the standard of care or what would the standard of care have dictated on the date concerning discharge?

"A.In my medical opinion, with the night before, the statements about `I hope so,' reservations about not being suicidal, the continued psychotic features, I would be very concerned about discharge.Usually, the record shows some anxiety typically prior to discharge.I would not count that as a negative factor.Most patients would have some anxiety about leaving.But here we're having clear indication of psychotic symptoms and concerns that she voiced last night about being able to take care of herself in terms of safety.I think based on those two things, hospitalization [sic] is a bit premature.

"Q.Doctor, did Ms. Ellis's discharge fall below the recognized standard of care for a psychiatrist?

"A.In my medical opinion, it did."Dr. Strahl also testified as follows:

"Q.And, Doctor, I want to clarify that, so let me ask you these questions.Did the standard of care dictate that Dr. Patton keep Ms. Ellis in the hospital beyond November 23, 1999?

"A.My medical opinion, it did.

". . . .

"Q.Doctor, do you have an opinion as to whether suicide was an eminent potential given Ms. Ellis's release on November 23, 1999?

"A.Yes.

"Q.And what is that opinion?

"A.That it was."

Dr. Patton and the Clinic moved for a judgment as a matter of law at the close of Thompson's case, which the trial court denied.Dr. Patton and Dr. Joseph Lucas, a psychiatrist, testified for the defense.Dr. Patton and the Clinic again moved for a judgment as a matter of law at the conclusion of all the evidence.The trial court denied the motion.The jury was unable to reach a verdict, and the trial court declared a mistrial.Dr. Patton and the Clinic filed a motion entitled "Defendants'Rule 50(b)[, Ala. R. Civ. P.,] Renewed Motion for a Judgment as a Matter of Law, or, Alternatively Styled, Motion for a Summary Judgment."In that motion, they argued that Thompson failed to meet his burden of producing sufficient evidence to prove that Dr. Patton's alleged negligence was the proximate cause of Ellis's death.The trial court denied the motion in the following order:

"Having given careful consideration to [Dr. Patton and the Clinic's] renewed motion for judgment as a matter of law, the court is of the opinion that [the] motion is due to be denied.Using the standard set out in Keeton v. Fayette County,558 So.2d 884(Ala.1989), the court finds that [Thompson] has proffered sufficient evidence that a genuine issue of material fact exists, so as to allow this case to proceed to trial.

"In Keebler v. Winfield Carraway Hospital,531 So.2d 841(Ala.1988), the Supreme Court held that recovery for failure to prevent a suicide is dependent upon whether the defendant reasonably should have anticipated that the deceased would attempt to harm [herself].Alabama law bases proximate causation in suicide cases on the foreseeability of the decedent's suicide.The Supreme Court has held foreseeability is legally sufficient if the deceased had a history of suicidal proclivities or manifested suicidal proclivities in the presence of the defendant or was admitted to the facility of the defendant because of a suicide attempt.Keeton,558 So.2d at 887.The record is clear — Ms. Ellis had a history of recent suicide attempts and a suicide attempt was the primary indication for her admission to [BMCM] preceding her final discharge and subsequent suicide.Further, the record indicates Ms. Ellis continued to experience some suicidal proclivities during her final hospitalization at [BMCM].The record also indicates Dr. Patton was aware of the manifestations of suicidal proclivities during [Ellis's] final hospitalization.

"Having reviewed the record as a whole, it is this court's opinion[that Thompson] met the required threshold of proof that a reasonable jury could reach the conclusion that Ms. Ellis's suicide was proximately caused by [Patton and the Clinic's] negligence."

This Court granted a permissive appeal under Rule 5, Ala. R.App. P., to answer the previously quoted controlling question of law.

The first part of the controlling question of law asks what degree of proof is necessary to establish the essential element of proximate cause in a medical-malpractice/wrongful-death action against a psychiatrist resulting from the suicide of the psychiatrist's patient.Dr. Patton and the Clinic contend that there is "an ostensible conflict between the case law discussing the concepts of foreseeability and proximate cause in suicide cases[i.e., Keebler v....