Inpatient Suicides Are Preventable

 Posted on September 13, 2016 in Personal Injury

By Timothy Tomasik

According to the Joint Commission on Accreditation of Health Care of Organizations (JCAHO), suicide ranks as the eleventh most frequent cause of death (third most frequent in young people) in the United States, with one person dying from suicide every 16.6 minutes.  Suicide of a care recipient while in a staffed, round-the-clock care setting has been the number one most frequently reported type of Sentinel Event since the inception of the Joint Commission Sentinel Event Policy of 1996.  Behavioral health hospitals and staff have a responsibility for the identification of individuals at risk for suicide, while under the care or following discharge from a health care organization.  Assessing a patient’s risk for suicide is the first critical step in protecting and planning the care of these at-risk individuals.  JCAHO 2007 Patient Safety Goals on Suicide

The vast majority of inpatient suicides are attributed to a failure of psychiatric staff to properly assess a patient’s risk for suicide and order the appropriate safety precautions, such as constant view or one-on-one observation.  Further, the American Psychiatric Association Practice Guidelines for the assessment and treatment of patients with suicidal behaviors has warned against the ineffectiveness of “suicide contracts” stating, “. . . patients in crisis may not be able to adhere to a contract because of the severity of their illness.  Suicide prevention contracts are also ill-advised with agitated, psychotic, or impulsive patients when the patient is under the influence of an intoxicating substance.”  Recognized experts who specialize in suicide study have plainly stated in literature that suicide contracts are unreliable.

Behavioral health facilities have a duty under the law to ensure that the physical hospital environment minimizes the risk of potential inpatient suicide.  Statistically, most impatient suicides by hanging occur in a patient’s bathroom. Therefore, the standard of care requires behavioral health hospitals to have ligature resistant door components including breakaway handles and hinges.  As early as 2007, behavioral hospitals began installing ligature resistant door handles and locksets with smooth rounded edges that substantially decrease the ability of a patient using the door handle or hinge as a  ligature point to hang themselves in their room.  In fact, most hospitals have installed breakaway doors and bathroom equipment, such as shower heads and closet rods, resulting in a much safer environment for behavioral health patients.

TKK Law proudly supports all efforts to increase awareness and suicide prevention.  September is Suicide Prevention Month, and next month the American Foundation for Suicide Prevention will again be organizing the Chicagoland Out of the Darkness Community Walk to Benefit the American Foundation for Suicide Prevention.  The American Foundation for Suicide Prevention is at the forefront of research, education, and prevention initiatives designed to reduce loss of life for suicide.  TKK is very proud to again be supporting The American Foundation for Suicide Prevention’s mission in creating awareness this year.  Cait's Rainbow Warriors

TKK has successfully represented family members who have lost a loved one as a result of a preventable inpatient suicide, having obtained a $3,250,000.00 settlement against a Chicagoland Behavioral Health Hospital and attending psychiatrist for failing to properly recognize the highest risk of suicide in a 23-year-old inpatient and provide the level of protection and appropriate care required.

For more information about the Chicago personal injury attorneys at Tomasik Kotin Kasserman, call 312-605-8800 or contact us online to schedule a free consultation.