Physicians have immunity for good-faith psychiatric discharges

One day after being discharged from involuntary commitment in a mental health facility, a Maryland man killed himself—a sequence of events that everyone fears.

But psychiatrists acting in good faith in their decision-making in such cases have immunity from medical liability in the event of adverse outcomes, Maryland’s highest court has ruled.

The opinion not only allows physicians to make good-faith clinical decisions, but protects patients’ civil liberties because physicians won’t err on the side of involuntary confinement for fear of being sued.

“All that is required for immunity is that the assessment [for release] be done in good faith following the process and applying the criteria in the statue,” the Court of Appeals of Maryland said in its decision in Bell v. Chance.

The justices’ opinion echoed many of the arguments that the Litigation Center of the American Medical Association and State Medical Societies, and the Maryland State Medical Society made in an amicus brief.

The organizations filed the brief in support of the physician in the case, Leroy C. Bell Jr., MD, and his employer, Bon Secours Hospital Baltimore Inc.

What Maryland’s law says

The question went before the Maryland high court after the family of 23-year-old Brandon Mackey sued Dr. Bell and Bon Secours for negligent discharge because Mackey committed suicide the day after the physician authorized the young man’s release.

The physician determined that Mackey did not meet two of the five statutory requirements for involuntary admission, which includes a person presenting a danger to the life or safety of self or others.

After a week’s stay at Bon Secours, Dr. Bell found that Mackey took his medication, was future-oriented and did not try to harm himself, court records show. Mackey said he wanted to return home and—given the improvements—Dr. Bell believed Mackey “was stable enough to go to a lower level of care and was not a danger to himself or others,” according to court records. He released Mackey on April 9, 2011, with a care plan and referred him to an aftercare program that was set to begin three days later.

A jury initially found in favor of Mackey’s family. However, the district court vacated the judgment and the appeals court agreed, saying Dr. Bell acted in good faith and Maryland law exempted him from the lawsuit. The family appealed to the state’s high court.

Civil liberties also at stake

The highest court in Maryland ultimately said that the state’s Mental Health Law provides immunity for physicians who decide whether to admit or discharge a patient, so long as they acted in good faith.

Throughout the opinion, the justices explained why the immunity is necessary, mirroring reasons outlined in the Litigation Center’s brief.

For example, both noted that the immunity helps prevent patients’ civil liberties form being violated. Historically, mental health patients have had their basic right to liberty denied, with their families being able to “purchase the confinement of unwanted relatives,” the Litigation Center brief told the court. Laws like Maryland’s Mental Health Law, the brief said, emphasize mentally ill patients’ due process rights and the need to find the least restrictive path for treatment.

Also, the law’s immunity for physicians protects patients’ civil liberties because without immunity, physicians in Dr. Bell’s position would be “wrongly incentivized to advance involuntary admittance against their medical judgment,” the brief told the court.

“The General Assembly provided immunity to an individual in Dr. Bell’s position because no psychiatrist or other physician can be a ‘guarantor of the success’ of his or her medical judgments,” the brief says.

“In the practice of medicine, physicians know that a plaintiff could almost always find someone to testify that he or she would have recommended a different course of treatment.”

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