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Discharged patient commits murder-suicide — were her docs to blame?

family-visiting-grave

Can doctors be held responsible for the actions of a mentally ill patient they treated four months earlier? A new court case aims to find out.

A family is suing McLean Hospital in Belmont, Massachusetts, as well as two of its psychiatrists and a staff social worker, for providing improper care to Marcelle Thibault and for the wrongful death of Thibault and her young niece and nephew. The suit is being brought by Ken and Danielle Lambert, the parents of the two children. Thibault was Danielle Lambert’s twin sister.

In September 2007, Thibault was diagnosed and treated at McLean Hospital for bipolar disorder. She was hospitalized for six days, then released with a recommendation to continue with outpatient therapy and psychotropic prescriptions.

According to the Lamberts, Thibault appeared to improve over the next few months, and they had no reason to be concerned that she posed a risk to herself or other people. So on Jan. 11, 2008, they didn’t hesitate to let Thibault take the children, five-year-old Kaleigh and four-year-old Shane, for a sleep-over at her home.

Driving home with the children, Thibault crossed the median of a major highway, stopped her car facing the wrong way and stripped off her own clothes and and the childrens’. According to eyewitnesses, she then grabbed the kids and ran into oncoming traffic, screaming about religion. All three were killed.

Tragic — but was it preventable?

At first glance, it seems like a tragic, unforeseeable event. But the Lamberts later learned of information that they say would have prevented their childrens’ death — and Thibault’s — had it been shared with the family.

The night of her death, Thibault had stopped her car on the way to pick up the children and assaulted a passerby who stopped to assist her. At the time, she informed a state trooper who arrived on the scene that she was “debating good and evil.”

Thibault calmed down quickly and the other motorist declined to press charges. Lacking information on Thibault’s medical history, the trooper declined to hold her for a psychiatric evaluation and sent her on her way with a warning. Thibault didn’t tell the Lamberts about the altercation when she arrived at their home.

The family’s attorney said they considered filing suit against the police for not holding Thibault after the traffic stop, but felt the case against the trooper would be too hard to prove. But they did move forward with a suit against the doctors at McLean, claiming they should have informed Thibault’s family that she could be a risk to herself or others.

McLean Hospital didn’t comment on the case, but it’s worth pointing out that the clinicians treating Thibault had a difficult balancing act to perform.

Disclosing too much information about her mental state to her extended family could easily be seen as a breach of patient confidentiality. And that assumes that her doctors could predict such a violent outburst. If Thibault’s own family could see nothing wrong in her demeanor just prior to her death, could the doctors be expected to do so months in advance of the actual incident?

What’s your take on the case: Was it  preventable or just a tragic incident no one could foresee? Share your thoughts in the comments.

  • Annoyed

    Blaming the treatment facility/doctors/social worker for a patient’s mental instability is not appropriate. Blaming the state trooper is not appropriate. Even blaming that patient is not appropriate. She did not choose to be mentally ill. The hospital/staff treatment treated the patient. Patients cannot be forced to have treatment.

    Disclosing information to family has been so seriously handicapped by all of the privacy rules. As soon as the staff would have violated her privacy, would have been another issue. It is an awful, tragic situation that only someone else having experienced may even begin to understand, and even then, it would near impossible to comprehend. The death of the children is horrific and my heart goes out to the parents. For the courts to make the providers responsible should result in more discretion in choosing patients and more people left untreated which increases danger for many more people.

    If people continue to want to sue providers, they will eventually be sorry when they may need treatment there’s no one to treat him or her because providers would have to pick and choose patients so as not to be in the line of fire of every lawsuit seeking individual.

  • A.Cornell

    Obviously not enough information from the physicians treating, but you do have to wonder: How could doctors predict behavior 4 months ahead when her own family could not predict mere hours before? I dont know much about Bipolar disorder, but my understanding is that there is still much unknown by physicians about it as well. As people, we are all very unique and difficult to predict, and it gets tiring for me to read about people wanting to put blame on everyone but the person who actually commits the crime. Very sad situation; very sad disorder… It will be interesting to see the outcome.

  • S Denny

    Somebody has to accept some responsibility for the state of patients released fro mmental health facilities. My son was in a mental health unity for 5 days with suicidasl tendencies – he was released an d committed suicide 4 days later. His therapy papers that he did while he was there with a therapist said he was going to kill himself when he left. I understand the confidentiality issues but if a patient is that close to the edge – there should either be a way to keep them or notify someone of the situation. Four months does seem like a long time but where does any responsibility or at least ethical practice start and end???

  • D Gray

    This is absurd. As painful as the loss is, is there responsibility on the parents for letting their children be alone with someone that has a known mental illenss?

  • Susan

    If the parents knew that the woman had been hospitalized for mental issues, they were remiss in allowing their children to be with her alone. I’m sorry; that’s pretty clear to me as a mother.

    However, looking at the timeline and the separation of events, there was no way that anyone could have predicted this severe an outcome.

    Extremely sad! I feel for the parents.

  • MMAN

    Let me first say the my heart goes out to the family that lost not only two children, but a sister and sister-in-law as well. However, I do not feel that this is the moral or ethical thing to do- going after the Dr.’s who did what they thought was best. To put in plainly, this is just another round at playing the blame game.

  • Ted

    It is about time we begin to question the malpractice of the mental health care providers who use the absurd chemical cocktails to “treat” their patients. My son was labeled BP three years before he took his own life at age 24. The six drugs he was being treated with (at least 4 being taken simultaneously) did nothing but numb his conscience and feeling for life –not happy, not sad. My wife and I blindly accepted the “professionals” and the methods they employed. Since then I have learned that there is no science in the mental health care field –they simply label behaviors so reimbursements can be made by payors. Doping a person up is not treatment. Unfortunately it will be years before the majority realize the horror of what is being done today.

  • linda hooks

    Confidentiality has gone too far. The family should be made aware of a condition that could be harmful to the patient or to others. Bipolar!!!–Hmmm–as most people who deal with patients who have mental illness know, they are not compliant with taking their meds. I would never have let a 4 and 5 year old go on an ‘overnighter’ with a known bipolar patient. I was married to a person with a mental illness (didn’t know it when I married him). They do not ‘get better’ on their own. If they don’t take their meds and continue on follw up care (with family involved) they are extremely dangerous. I’ve been in the health care profession for over 30 years and I am sick and tired of HIPPA! No one ‘advertises’ a patients condition. However, sometimes it is important to discuss their problems with others, OBVIOUSLY!!!!!

  • Sharon Davis

    I am a Psychiatric CNS. Just recently we had an female individual return to our facility early (midnight) and floridly psychotic after a therapeutic leave. Upon her return she pulled out a very large hunting knife (about 9 inches) on the staff. All went well and no one was injured but the RN took a couple of punches in the interim. I point blank asked our CEO pf Administrative Services, the CEO of Nursing Services, and the Human Resource Director (AKA Labor Relations Coordinator) at our monthly Labor/Management meeting if the State Police were notified, per our policy, that she was in the possession of a weapon and were charges filed. I had the three (all men), look at each other, rather stupidly, and state “I’m not sure”. At this reponse I pointed out several facts to them: 1. I am concerned that you do not know the answer considering your level of management, 2. It happens throughout this country that critical information of this nature is not put on patient’s discharge summaries or histories, as then no outside alternate living arrangements/agencies will accept them, and 3. We (the healthcare provider) have a responsibility to note this information and press charges (so it is documented), to prevent or at least make our collegues aware and prepared, both in healthcare and law enforcement if she decompensates in the future. I received no response. However, the information is documented on our (the unions) minutes.

    I am truly sorry for the loss of these 3 persons. However, after 4 months I cannot see how the physicians or facility is accoutable. Where was community counseling services? Was she following up? Was she in day programming? There are a lot of questions to follow up with, but this much I can tell you for sure…it is almost a guarentee that she was going to decompensate. The empirical data shows that patients stop medicating for various reason’s; they don’t like the way they feel, it interferes with thier sexual performance, side effects, they don’t need it, stressor’s, or just biological changes within thier bodies after time.

    This is a field that constantly intrigues me and yet, with all my knowledge that I constantly keep current with, there continues to be no concrete answers.

  • Bewildered

    The fact that this suit has even been filed is nothing short of ridiculous. There is absolutely no way that the treating physicians could have predicted this outcome from a single admission, or even multiple admissions, for that matter. I realize that the treatment of mental disorders is poorly understood by the average member of society, and that the etiology of mental disorders is poorly understood even in the scientific community. However, the assertion that psychiatrists only “dope up” their patients is nothing short of ignorant and, frankly, dangerous. For every bad outcome, there are litererally hundreds, if not thousands of individuals whose lives are saved by mental health treatment that is validated and supported by quality randomized, placebo-controlled evidence published in peer-reviewed academic journals.

    The outcome in this case is truly tragic, and I feel deeply for those who have lost so much. But demonizing the caregivers for lacking the extra-sonsory perception that would be required to literally predict the future (obviously impossible), will result in nothing more that reduction of access to necessary and potentially life-saving care in the future.

  • MSW

    The parents of the children should have been more resposnible about who they left thier children with. As I parent with a mentally ill sibling, I would never leave my children alone with my sibling. It is absurd to think that an MD or MSW is responsible for this. The parents are focusing thier grief in the wrong area and need to examine themselves. Focusing thier anger on the providers who tried to help will only prevent a healthy resolution to thier grief.

  • Jim

    I think this tragedy is being compounded by the impression provided by lawyers, that everything bad that happens, has a legal remedy. Who were the doctors supposed to tell? The parents and the siblings? Suppose the patient’s sister in law had sent the kids by herself, would there still be a suit (which implies that the in laws must be told as well). Of course then it would not have been the relatives that were suing the physicians, but the federal government for violations of HIPPA. So who are the potential losers here? The Hospital, the doctors, and any subsequent patients with short term or long term mental illnesses who wish privacy are potential losers. Who are the potential winners here? Well the family of the dead children….maybe…..if having money matters when your children are still dead. Who are the inevitable winners here regardless of the outcome? The lawyers are. The more I see of this kind of behavior the more I think Shakespeare was right “first, kill all the lawyers.”

  • Gupta

    MD shouldnot be blamed. He has done best. There may be other factors he may not know. Pt. or Family will share what they think is important for them. Even best psychiatrist cannot predict aabout pt.’s future behaviour.

  • Sue

    Since it was 4 months out; the physician has no way of knowing if the patient is compliant with his/her treatment. Even under court ordered treatment it is difficult to enforce the use of the medications unless it is a court ordered injectible drug. Most patients can refuse treatment; and even if it was court ordered that usually is only for a period of 3 months and this patient probably would not still be under the court jurisdiction. When a tragic situation happens it is a normal human response to want to blame someone for the incident; but in this case I don’t see there was a duty to warn which does preclude HIPAA; and the article did not say this person was homicidal which would fall under the duty to warn.

  • Judy Buckley

    S Denny and Ted: I’m so sorry for your loss. I agree, Ted, in your son’s case it looks like the caregivers could have seen that coming and his meds don’t seem to have been balanced just right. I’m not a doctor, though I work in a outpatient mental health clinic and I’ve learned that the effectiveness of meds can be cyclical. They work well for a time and then may have to be adjusted. This case is so tragic. It would be, it seems to me, near impossible to predict this patient’s behavior with the timeline given. Ted, I don’t agree that treating patients with meds is not a sound treatment. Some illnesses are what they call “chronic and persistent” – a person usually cannot recover with “talk therapy” alone – especially with schizophrenia. Bipolar illness can be tough to treat, too, and a lot of people, especially young males, I understand, are really resistant to taking meds. Hence, the “dually-diagnosed” – mental illness and drug addiction because of self-medicating. Also, the statistics I’ve heard recently indicate a percentage in the range of 60% of people with mental illness being non-compliant with their meds. The thing that surprised me was that the same percentage of people with illnesses other than mental illnesses are also non-compliant. In California, the law is very specific that one has to be a danger to him/herself or others to be involuntarily committed – and then it’s for a 3-day hold for observation. And, “danger to oneself” doesn’t necessarily include that a person is not eating or keeping him/herself clean. We have a long way to go in the mental health and law enforcement fields in dealing with this.

  • Ms. Responsivie

    There is a lot to be said here, but at the end of the day, we need to look at the bigger picture.Yes, it’s heartbreaking that lives were lost; but these types of incidents are increasing across the country and blame will not remedy of of the end results. Persistent heighten of awareness and more education on mental illness is the key to recognizing the signs that a person needs help. Yes, the doctors have a responsibility and so does the siblings that lives with the patient and understands what is abnormal about his/her actions. At that point, any person with a known mental illness should be assigned a “caregiver” by the courts to assist with their care and psychiatric follow ups. I would agree that some doctors may be neglegent, but others just don’t have enough treatment time to get all the necessary details and they can’t force it if the patients is not agreeable to the suggested mental health prescriptions or counseling. We need to pose this very important feedback to our Courts to push this issue further. Now more and more Children are being abused stemming from these same ailments in addition to DRUG ABUSE (the same should apply). LETS SAVE OUR CHILDREN!

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