The alert points out that 25% of suicides reported took place in non-psychiatric settings. Many of the patients who committed suicide had no history of psychiatric problems or suicidal attempts.

Risk factors for these patients include dementia, traumatic brain injury, chronic pain, intense acute pain, substance abuse, a poor prognosis or terminal diagnosis.

The alert urges health care providers to be more vigilant about the risk of suicide in these patients and to educate caregivers on warning signs of suicidal attempts.

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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.

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Reported events Jan.1 through Sept. 30, 2009:

• Wrong-site surgery — 126
• Unintended retention of foreign body — 97
• Delay in treatment — 94
• Operative/Post-op complications — 79
• Suicide — 72
• Patient fall — 65
• Medication error — 34
• Assault, rape or homicide — 27
• Perinatal death or loss of function — 26
• Patient death or injury in restraints — 9

Since JCAHO started tracking sentinel events in ’95, more than 6,500 patients have been affected, with 68% of the events resulting in death.

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