Updated: Suicidal Patients Without Remedies
On April 28, 2015, the Minnesota Supreme Court granted a petition to review Binkley v. Allina Health System to decide whether hospitals are immune from suit when they choose not to hospitalize suicidal patients.
As readers may recall, this case involved the death of Kirk Lloyd, age 17. On May 10, 2010, Kirk tried to commit suicide by wrapping himself in a blanket and setting it on fire. When his mother entered his bedroom, the fire was put out and Kirk assured his mother that the fire was an accident. The next day he admitted to his mother that he had in fact been attempting to commit suicide, and they went to United Hospital in St. Paul to have him admitted to the adolescent psychiatric unit.
Although both a counselor and physician determined that Kirk should be admitted to the unit, he waited for hours in the emergency room until hospital staff decided not to admit him and discharge him to home. Kirk committed suicide two days later.
Kirk's mother, Melinda Blinkey, commenced a medical malpractice lawsuit against Allina Health System and various healthcare providers alleging that defendants negligently failed to admit her son to the hospital. Defendants moved for dismissal, claiming that they there were immune from suit under the Minn. Stat. 253B.23, subd. 4 of the Minnesota Commitment and Treatment Act (CTA). The district court denied the motion, and defendants appealed.
On February 9, 2015, the Minnesota Court of Appeals, in a published decision, held that Minn. Stat. 253B.23 immunized defendants from suit. The statute provides immunity to "[a]ll persons acting in good faith . . . who act pursuant to any provision of this chapter or who procedurally or physically assist in the commitment of any individual pursuant to this chapter . . . . " The court rejected the contention that the immunity provision applies only to involuntary commitment decisions and held that it extends to all acts covered the the CTA, including Minn. Stat. 253B.04, which addresses circumstances where patients seek voluntary admission to a mental health unit. Binkley v. Allina Health System et. al., A14-0794 (Feb. 9, 2015).
The Supreme Court's decision in this matter will be closely watched by advocates for mental health patients. The Minnesota Commitment and Treatment Act was enacted to lay out procedures for the involuntary admission of persons to psychiatric units. Certainly one could argue that those acting in good faith should be immunized from suit involving involuntary commitment, but to extend that immunity to a hospital's decision not to protect an actively suicidal patient who seeks voluntary admission to the hospital seems inconsistent with the legislature's intention in enacting the CTA.
If the Supreme Court determines that immunity provisions of the MTCA extend to hospitals that deny admission to suicidal patients seeking voluntary admission to the hospital, then the Minnesota legislature should amend the MTCA to remove immunity in those hospitals. As a society, we have historically minimized the needs of mental health patients. For years, health insurance companies provided little or no coverage for mental health care. Where coverage existed, insurance policies limited the amount of coverage for hospitalization and patients for too long were put on a track to discharge them at the time that insurance coverage lapsed.
According to the latest data from the 2012 U.S. mortality data, the suicide rate in the U.S. is at its highest rate in 25 years, with 12.6 suicides per 100,000 commiting suicide. In 2013, the Minneapolis Star Tribune reported that the suicide rate in Minnesota had risen sharply in the most recent Minnesota Department of Health reports, with 684 suicides in 2011, which represented a 13% increase in one year.
When patients present to the emergency room with life-threatening physical illness requiring admission to the hospital, we hold hospitals and doctors accountable when they negligently fail to diagnose and treat these patients and send them home and the patient dies. When mental health patients present to the emergency room and provide the diagnosis to the doctor by telling the doctor that they are actively suicidal and need admission to the hospital, we cannot grant license to the hospital to turn these patients away and send them home. Granting immunity in that circumstance does nothing to promote patient safety or our society's goal to provide equal treatment opportunities for the mental health population. If we want to reduce the suicide rate, we have to be willing to "walk the walk" and not simply "talk the walk."