Navigating the Complexities of Liability and Causation in Psychiatric Malpractice Cases.

Recently, mental health has been met by the public with greater understanding. However, psychiatric malpractice, a specialized area of medical malpractice law, is less often discussed. An article posted by Kevin Hale at Bogoroch Associates emphasizes the importance of understanding psychiatric malpractice and knowing what to do if it occurs. 

Distinguishing between mental health practitioners can often be perplexing. While psychologists and psychiatrists share similarities in assessing patients and diagnosing mental health disorders, the key distinction lies in their ability to prescribe medications. Psychiatrists, being medical doctors, possess the authority to prescribe medications, whereas psychologists, who do not require a medical degree, do not have this capability. As medical doctors, psychiatrists fall under the regulation of the College of Physicians and Surgeons of Ontario (CPSO) and are mandated to be members of the College in order to practice medicine in Ontario.

To be successful in a psychiatric negligence case, a plaintiff must prove, on a balance of probabilities, a breach in the standard of care and its causation to harm. Determining the standard of care entails evaluating what a reasonable practitioner in the same specialty would have done under similar circumstances. Psychiatric negligence cases present unique challenges due to the subjective nature of the work. 

Unlike interpreting an X-ray, psychiatrists rely on subjective interactions with patients, responses, and behavior when assessing, diagnosing, and treating them. This subjectivity makes it challenging for experts to determine the standard of care and identify breaches. Psychiatrists also often refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM) for classification and diagnosis, but conflicting views within the mental health community on its usefulness and validity can further complicate matters.

Psychiatric negligence may occur in several instances. Psychiatrists may be held liable for causing harm to their patients, as well as for the harm caused to someone else by one of their patients. It is often difficult to prove a psychiatrist is liable for harm caused to their patient, and even more challenging to prove harm was caused to someone else by a patient. 

Psychiatric patients are vulnerable to malpractice in various ways, such as incorrect medication prescriptions and failure to diagnose serious conditions. In the case of Keith v Abraham, for instance, a male plaintiff was treated by a psychiatrist who prescribed anti-depressant and anti-anxiety medications for unipolar depression over a span of five years. However, it was later discovered that the plaintiff actually had bipolar disorder. Despite the difficulties in proving liability and causation in psychiatric malpractice cases, the psychiatrist in this instance was not found to be liable, as the standard of care was not breached. Nonetheless, the trial judge determined that, had liability been established, the plaintiff would have been awarded $100,000 in 2011 (approximately $130,000 in 2022, adjusted for inflation).

Psychiatrists may face liability for the wrongful death of their patients if they fail to take necessary actions to prevent self-harm. However, establishing causation in cases where a psychiatrist’s patient commits suicide can be highly challenging. Proving that the suicide would not have occurred “but for” the psychiatrist’s act or omission is complicated by the presence of various other factors in the patient’s life that could impact their mental well-being. Attributing the harm solely to one psychiatrist becomes difficult due to these intervening causes.

Proving the liability of psychiatrists for harm caused to a third party by their patients can be exceptionally challenging due to the involvement of various intervening factors. However, in the case of Ahmed v Stefaniu, the Ontario Court of Appeal affirmed a finding of negligence against a psychiatrist in relation to her patient’s care, which ultimately led to a tragic homicide. 

The patient had initially been admitted to the hospital involuntarily due to psychosis, but his status changed to voluntary after approximately two months, following an assessment by the defendant psychiatrist. Subsequently, the patient left the hospital and, two months later, committed murder in a state of intense psychosis and acute delusion. The victim’s family initiated legal action, resulting in a jury finding the psychiatrist negligent. The Ontario Court of Appeal upheld this decision, and the Supreme Court of Canada denied leave to appeal.

Importantly, in line with other medical malpractice cases, as demonstrated in Ahmed, it is crucial to acknowledge that a psychiatrist can make an error yet still adhere to the standard of care. In such instances, the psychiatrist may be shielded from liability, as the error could be considered common or known to occur within the field. Conversely, even when a breach of the standard of care does occur, liability may not be established if causation cannot be proven. Given the complexities and challenges discussed earlier, it is clear that psychiatric malpractice cases can be highly demanding to prove, though not insurmountable.


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From Bogoroch Associates