A July 12, 2018 decision from the Maryland Court of Appeals (COA), the highest court in the State, provides some level of comfort to psychiatrists working on acute admission units. The case was brought by the estate of a man who committed suicide shortly after being discharged from a psychiatric hospital claiming a negligent action against the hospital and the decedent’s treating physician. The estate argued that the hospital and physician breached the standard of care for discharging an involuntarily admitted patient with a history of attempted suicides. The patient was discharged after he had been certified for involuntary admission by two physicians and admitted to the inpatient unit, but before the mandatory civil commitment administrative hearing scheduled by statute within 10 days of admission.

In short, the court said: “We hold that the process of involuntary admission begins with the initial application for involuntary admission of an individual and ends upon the hearing officer’s decision whether to admit or release that individual. During that process, if a physician applies the statutory criteria for involuntary admission and concludes in good faith that the individual no longer meets those criteria, the facility must release the individual. That decision is immune from civil liability and cannot be the basis of a jury verdict for medical malpractice.” (emphasis added)

In other words, if a patient is released after the point of involuntary admission but prior to the ALJ hearing, based on a good faith decision that the patient no longer meets involuntary admission criteria, the psychiatrist is statutorily protected from civil liability.

Essentially, the COA held that the statute allows the time between the certificates and admission and the later hearing to be used to continuously assess the patient against the civil commitment criteria. If the patient improves during that time and no longer meets those criteria, he MUST be released.

Note that an earlier decision provided similar protection to those working in ERs who decide in good faith not to certify for admission. The current case extends that good faith protection to decisions made throughout the involuntary admission process: the decision in the ER to admit or not admit, and, for those admitted, decisions made on each day up to the date of the hearing.

What this case does not address is the situation where the patient was involuntarily committed by the ALJ at a hearing, and at some later point a decision is made to release the patient who no longer meets civil commitment criteria. Such decisions are not statutorily protected under current law.

MedChi and the AMA filed an amicus brief defending the hospital and the physician.

Erik Roskes, M.D.