Incident
Psychiatric patient who had threatened her therapist was involuntarily hospitalized after she was found with a loaded gun.
Background
In the course of treatment, a 43-year-old woman diagnosed with depression and suicide ideation mentioned to her therapist that she owned a gun, and made vague references to shooting him. On the day of the incident, the patient came for her regularly scheduled appointment (after having called repeatedly to reschedule) and left a message with support staff that she `had a surprise' for her therapist. During the appointment the patient offered to provide her `surprise' in exchange for the therapist's home telephone number. The therapist declined this request. The patient then reached for her purse and the therapist, suspicious of its contents, took1 it from her. The purse contained a loaded and cocked .22 caliber pistol.
Security2 was called and the gun secured. After consultation with other psychiatric staff, the decision was made to hospitalize the patient involuntarily, where she remained for seven days. After consult3 with legal counsel, criminal charges were filed against the patient alleging unlawful possession of a firearm and assault with a dangerous weapon against the therapist. The patient raised an insanity defense and was found not guilty. She then sued the therapist claiming negligence and malicious prosecution.
Disposition
The malpractice case went to trial five years after the incident. Testimony was presented that the defendant met the appropriate standard of care, and that his actions were within the bounds of acceptable practice when he took steps to protect himself and to report the matter to the police.
Evidence that the plaintiff had committed a crime was also presented. Historically, the law has looked with disfavor on any threat of civil liability to those who, in good faith, come forward to expose persons who may be guilty of a crime. After approximately two hours of deliberation the jury returned a verdict in favor of the defendant.
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1- The therapist acted in good faith regarding his concerns for personal safety and in securing the advice of counsel about filing charges against the patient. Health care providers, like other citizens, should report actions of others which appear criminal, regardless of whether those actions are directed specifically at them or pose a threat to others present in the health care setting. The possibility of later claims of malicious prosecution or other allegations cannot overshadow basic rights and duties of citizenship.
2- Protective measures (e.g., access control, hidden "panic buttons") should be considered where appropriate. Internal reporting and evaluation of violent events or "near misses" can yield valuable information to help avoid future incidents. After a violent or other untoward incident has occurred, offering counseling for involved staff may be appropriate.
3- Incidents or threats of this nature should not be dealt with solely on an ad hoc basis. Crisis teams can be formed to develop policies and procedures to deal with potential threats, actual threats, or violent incidents. Train staff and management on handling disturbed persons, identifying aggressive and violent predicting factors, and defusing potentially violent situations before they get out of hand.
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