Hospital’s breach was not causative of psychiatric patient’s attempted suicide

by | Jun 18, 2017 | Health Blog

A Hospital’s failure to give clear instructions to the parents of a psychiatric patient on leave from an involuntary ward was not causative of the patient’s suicide attempt causing severe injury.

Daniel Smith, 25, reported depression, crying and insomnia to his GP on 15 April 2008. This was secondary to his break up with his ex-fiancée, pain from a motor vehicle accident in 2006, associated court proceedings, and his excessive consumption of alcohol. On 30 October 2008, Mr Smith consulted his GP reporting insomnia and anger following another break up with his ex-fiancée. He was provisionally diagnosed with depression, referred to a psychologist and prescribed Valium.

On 31 October 2008 he was found unconscious after overdosing on Valium, and was provisionally diagnosed with an adjustment disorder for which he was prescribed anti-depressants.

On 4 November 2008 he was found hanging in his parent’s garage and was taken by ambulance to the Liverpool Emergency Department, sedated, and later admitted as an involuntary patient in the Mental Health Unit. On 11 November 2008 he was assessed as low risk of suicide, and was granted weekend leave in the care of his parents.

On 16 November 2008 Mr Smith went on a road trip with some friends followed by two beers at the local tavern. He had had a text exchange with a friend of his ex-fiancée in relation to a debt Mr Smith owed her for some car tyres. He returned home around 7pm and ate dinner with his parents. He was reportedly in a reasonable mood and did not appear drunk or upset.

At around 10:45pm, Mr Smith was again found hanging in his parent’s garage. He survived and suffered severe hypoxic brain injury with neurological complications. He claimed that the Health Network was negligent in omitting to provide adequate advice to him and his parents about stressors to be avoided whilst on leave, and what his parents should do if concerned.

Before his leave, his parents were advised that alcohol and his ex-fiancée were psychiatric stressors for Mr Smith, but were not advised of the psychiatric significance of the stressors, the obligations on the parents with respect to avoiding those stressors, or a plan of action in the event of difficulty in enforcing the warnings and conditions. This failure to give clear instructions to Mr Smith’s parents on these issues was considered a breach of duty.

However, as upheld on appeal, there was no causal connection between the breach and Mr Smith’s attempted suicide. The parents observed that Mr Smith was not drunk when he returned, and any effects of the alcohol consumed more than 4 hours earlier in the afternoon would have long worn off. Further, there was no alcohol reading when he was tested after his attempted hanging. The text exchange with his ex-fiancée’s friend did not appear to upset Mr Scott, and he was not agitated or focused on his ex-fiancée for any part of the evening. The claim against the Health Network was dismissed.

To read the decision in Daniel Smith by his tutor Debra Smith v South Western Sydney Local Health Network [2017] NSWCA 123, click here.

Emma Jack

Emma Jack