Ruth Farrell, a 41 year old librarian in Westport, Connecticut, was admitted to Silver Hill Hospital in mid January, 2002. On January 28, 2002, in between 15 minute checks on her status, she hanged herself, using her own spandex pants.
The executor of her estate, David Kervick, a 60 year old lawyer from New Jersey, who she had met in 2001 when they were both inpatients, sued the hospital and Ms. Farrell’s psychiatrist, Dr. Ellyn Shander, for not preventing her death. On January 3, 2008, a Superior Court jury in Stamford, Connecticut, ruled in favor of the hospital and Dr. Shander.
The New York Times articles from November 23, 2007 and January 4, 2008, tell a painful story. Ms. Farrell was named for a grandmother who had died by suicide. She began cutting herself in high school. During college she was hospitalized for a year for depression. Her pastor said “I have no idea how she lasted as long as she did.” Ms. Farrell’s final admission to Silver Hill was her seventeenth.
Given that suicidal risk was so obvious, how could the jury find for the hospital and psychiatrist?
From my reading of the two New York Times articles, the answer is (1) clinical ethics and (2) a realistic view of the limits of what medicine can accomplish.
After the trial, a juror commented that she was “impressed that when Ms. Farrell could not afford the fees, the doctor often accepted homemade treats in lieu of payment…Ellyn [the psychiatrist] would take cookies, and a lot of doctors won’t do that.” The jury concluded that Dr. Shander cared deeply about Ms. Farrell, stretched herself to be available, and was not mercenary.
The juror conveyed a realistic view of psychiatry as helpful, but finite in its capacity, not omnipotent. “With Ms. Farrell’s history of suicidal thoughts and deeds…she could have done it at home, and the hospital and the doctor helped her all these years.” The jury saw the suicide as the end of a tragic life story, not as the fault of Silver Hill or Dr. Shander. Remarkably, the jury has planned a reunion for January 28, the anniversary of Ms. Farrell’s death, and invited the defense team to participate.
Some decades ago I was briefly involved in the treatment of a young person who committed suicide, elsewhere in the country, a few months after our last contact. I met at length with the family after the death – one of the most painful meetings in my career. The family expressed great grief and anger. They challenged me as to whether, in retrospect, I would have done anything differently. I told them that if I could turn back the clock I would indeed have taken a different course of action, and explained why I had not done so at the time.
Several years later a lawyer called about my late patient. I returned the call with great trepidation. The lawyer told me that the family was bringing suit against the facility where my patient had died, but had “said to get information from you, but to make sure that you were not part of the malpractice suit.”
Apparently the family had concluded that although I had not done what, in retrospect, we all agreed would have been the best thing to do, I cared about their family member and provided well thought out, though ultimately ineffective, treatment.
Health professional students are taught about the importance of genuine caring. The importance of loving one’s patients can’t be overemphasized. It is harder to conceptualize what it means for organizations to be loving, but I believe it can be done. This will be a topic in future postings.