Physician Didn't Cause His Patient to Commit Suicide, Judge Rules; More

Wayne J. Guglielmo, MA

January 29, 2020

A judge dismissed a $10 million judgment against a New York primary care physician whose patient committed suicide while under his care, the Staten Island Advance reports.

For many years, Richard Shouldis was a patient of an internal and geriatric medicine doctor who also holds high-level administrative positions at both Staten Island University Hospital and its parent company, Northwell Health.

In early June 2012, Shouldis visited his physician, complaining of a series of worsening symptoms — panic attacks, depression, fatigue, worry, loss of concentration, and weight loss. The physician treated his symptoms with medications to calm his anxiety and help him sleep.

Despite this, Shouldis arrived at a follow-up visit on June 6, 2012, in an extremely agitated and disturbed condition, according to his wife's testimony at trial. The physician asked Shouldis whether he intended to hurt himself, and, when the patient assured him he didn't, the physician prescribed Shouldis antidepressants, which he cautioned would take several weeks to become fully effective. He also referred Shouldis to a psychologist.

At some point overnight, however, Shouldis took his own life.

In their lawsuit, Shouldis' family claimed that, while the primary care physician had prescribed certain appropriate medications, he had failed to "properly recognize and evaluate the decedent's progressively depressive and self-destructive state" and also failed to "adequately assess decedent for suicidal thoughts and ideation."

Asked at trial whether Shouldis should have been sent to the emergency department following his June 6 primary care doctor visit, neurologist Lawrence Shields, the plaintiff's sole medical expert, replied, "Ultimately, yes. Or [to] a psychiatrist or any other doctor knowledgeable about suicide patients."

The trial jury agreed and awarded the plaintiff nearly $10 million.

In his review of the verdict, however, New York State Supreme Court Justice Alan C. Marin found that the "causal link" between the physician's treatment and Shouldis' eventual suicide was too weak to establish culpability.

"There was nothing in Dr Shields' testimony that properly linked any departure [from standard and accepted medical practice] to the suicide when it occurred," Judge Marin wrote in his decision, which reversed the lower court's decision.

The attorney for the Shouldis family says it plans to appeal: "We believe the jury's verdict is correct and should be respected. The standard for setting aside a jury's verdict is very high, and we do not believe that Judge Marin met that standard in disregarding the jury's factual findings."

At press time, there was no word on when an appeal would be filed.

Physicians Misread Scans, Leading to Patient Injuries, Study Finds

The leading cause of patient injury involving diagnostic radiologists is the misinterpretation of scans and films — in particular computed tomography (CT) scans — according to a recent study by the nation's largest doctor-owned malpractice insurer, The Doctors Company. The study was published in Health Data Management .

The study used physician experts to review and analyze closed malpractice claims against both diagnostic and interventional radiologists. In regard to the former group, the review panel came up with a number of significant findings, including:

  • Misinterpretation of diagnostic studies occurred in 78% of cases, making it the top cause of patient injury.

  • In 34% of these cases, misinterpreted CT scans were a factor.

  • An undiagnosed malignancy was the most common injury stemming from a misinterpreted diagnostic study.

Poor communication between diagnostic radiologists and clinicians contributed to the misinterpretations. And while the latest study found a somewhat better level of communication versus the results of a previous study of claims, the percentage of injuries associated with poor communication indicates "we still have plenty of room for improvement," says Bradley N. Delman, a neuroradiologist and vice chair for quality in radiology at Mount Sinai Hospital, New York City.

Doctors Agree to Settle With Family of Misdiagnosed Cancer Patient

The estate of a New Jersey woman whose family claimed her doctors failed to detect her stomach cancer has reached a nearly $1.3 million settlement with the suit's defendants, reports the New Jersey Herald .

In 2013, Dina Wyckoff went to the emergency department at Saint Claire's Hospital, in Denville, New Jersey, complaining of severe abdominal pain. Admitted to the hospital, she underwent an endoscopy, during which tissue samples of her stomach were taken, followed by surgery to repair an ulcer.

In its March 2017 suit filed against a gastroenterologist and a pathologist who treated the patient, their respective practices, and the hospital, Wyckoff's family claimed not only that her tissue samples were incorrectly taken and interpreted but also that her doctors "failed to timely treat, diagnose, and determine the true nature" of her problem, which turned out to be aggressive cancer.

Wyckoff later received a diagnosis of stage IV cancer and died on August 29, 2016.

The physicians who were sued each denied the claims against them, arguing, among other things, that at the time of Wyckoff's surgery in 2013 her cancer had already metastasized to the point that her life expectancy wasn't materially affected by any delay in her diagnosis.

Still, the gastroenterologist agreed to settle his part in the suit for $1 million, while the pathologist agreed to settle his for $275,000.

States on Opposite Coasts Revisit Rules on Caps

Last month, a Florida appeals court upheld a law that limits noneconomic damages for plaintiffs who reject a healthcare provider's binding arbitration offer, as McKnight's Long-Term Care News and other outlets report.

Under existing Florida law, plaintiffs who enter into a binding arbitration agreement with a provider have their damages capped at $250,000. However, plaintiffs who rejected such agreements sometimes benefitted from a 2017 ruling by the Florida Supreme Court that declared caps on pain and suffering and other noneconomic damages unconstitutional.

Now, as per the new ruling by Florida's Third District Court of Appeal, which is seen as a victory for those who opposed the high court's 2017 decision, noneconomic damages for these plaintiffs will be limited to $350,000 if their suit ends up in court.

Out west, the campaign on behalf of an initiative that would lift California's long-standing cap on malpractice awards kicked off last month, as various media outlets have reported, including

Supporters hope to gather enough valid signatures to place the initiative before voters on the state's November 2020 ballot.

California's current $250,000 cap was enacted in 1975 during former Governor Jerry Brown's first term in office. During his second two terms as governor, from 2011 to 2019, Brown resisted efforts to raise the ceiling on medical malpractice awards. The new governor, Gavin Newsom, has not taken a public position on the current law but has signaled privately that it's unfair and overdue for a change.

If supporters get their way, the existing noneconomic damages cap would be linked to inflation, raising it immediately to $1.2 million in today's dollars and adjusting it annually going forward. In cases involving catastrophic injuries and death, the revised law would allow judges and juries to award damages in excess of the inflation-adjusted cap. Moreover, it would bar evidence of victims' insurance policies and other sources of financial support — evidence that has been used to limit awards to injured patients — and end mandatory periodic payments to plaintiffs.

A lobbying group for California trial lawyers has not taken a position on the initiative, but in the past the group has pushed for amending the current malpractice law legislatively.

Wayne J. Guglielmo, MA, is an independent journalist based in Mahwah, New Jersey.

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