Case Study: Self-Mutilation

Confidential Settlement

On Nov. 27 the then 37-year-old plaintiff was admitted to a local hospital with a diagnosis of chronic paranoid schizophrenia. The plaintiff had a significant history of auditory hallucinations and intrusive voices that instructed him to mutilate himself. The plaintiff was a single male who had never been involved in a romantic relationship, had not been employed since working in a paper bag factory at the time of the onset of his symptoms, and had lived at home with his mother his entire life with the exception of numerous inpatient psychiatric hospitalizations.

The plaintiff brought this action, through his co-guardians, against two psychiatrists, the first of whom was the plaintiff's attending until she took a brief leave to attend to a death in her family. The second defendant thereafter served as the plaintiff's attending psychiatrist.

Upon admission, the plaintiff was noted as being "markedly paranoid and delusional, expressing a desire to mutilate himself at his genitals." His care consisted primarily of the administration of various medications and participation in group therapy.

The plaintiff's expert testified that there were two primary deviations from accepted standards of practice. The first was the failure to consider the use of electroconvulsive therapy (ECT), where such therapy had been effective on a prior admission at the same hospital, where ECT had also been effective on an uncle of the patient, and where medications had a history of producing no effect on the patient's longstanding symptoms.

The second deviation, as reported by the plaintiff's expert, was "the failure to assess the impact on this extremely impaired individual of the apparent first residential move in his history away from his mother." The plaintiff's mother had objected to his discharge and refused to allow him to return home in his condition. Testimony at trial also focused on mother's inability to care for the plaintiff given the extent of his illness and the fact that she was caring for at least one other sibling who also suffers a significant mental illness.

The hospital record revealed that the plaintiff continued to report the need to castrate himself throughout his 18-day hospitalization. On Dec. 12, the plaintiff was noted as "much more openly delusional this shift. Very verbal about auditory hallucinations and persecutory delusions. Fixated on castration. Repeatedly asked this writer to 'cut them off' and get it over with ... Reported no relief from voices from medication."

Despite his condition, the plaintiff was discharged three days later to Parker Street Shelter, located at the Erich Lindemann Mental Health Center, where the plaintiff's primary physician and case manager were located. On Dec. 22, the plaintiff left the shelter, where he was free to come and go, went to his mother's house and cut off his testicles with a pair of scissors.

The defendants argued that they did consider the use of ECT, but that the limited benefits of such treatment did not outweigh the side effects that the plaintiff had exhibited during his prior hospitalization. They further argued that they attempted to work with the patient's mother and the patient on the issue of discharge, that discharge to the Lindemann Center complex was appropriate given the level of services available to the patient in that building, and that they had done all that they could for the patient by stabilizing him and effectuating an appropriate discharge, all in accordance with accepted standards.

Finally, the defendants argued that there was no doctor-patient relationship when the plaintiff mutilated himself two weeks after his discharge. The first attending further argued that the plaintiff had not been discharged and was receiving appropriate care at the time her treatment of the plaintiff terminated.

The case settled after the jury agreed to return for a fourth day of deliberation despite having twice reported being deadlocked.

The outcome of every case is dependent upon the specific facts, circumstances and applicable law in that particular case. Results in other cases are not a guaranty or indication that a similar result is likely in any other case.