BERNADETTE WILLIAMS ROBERT JAMES WILLIAMS v. STATE OF ILLINOIS (2013)

OPINION

This matter comes before this Court on the complaint of Bernadette Williams as Special Administrator of the Estate of Robert James Williams, deceased, Claimant, and against the State of Illinois, Madden Mental Health Center, Respondent, alleging wrongful death, and seeking damages in the amount of $100,000.00.

FACTS

Robert Williams (hereinafter Robert), born February 13, 1974, was a high school graduate, certified as an electricians apprentice, and was unemployed at the time of his death. Robert was involved in a triangular relationship with his girlfriend “Patty,” and with “Erin,” the mother of his child. During early June of 1996, Robert attempted to breakup with Patty in an effort to spend more time, and place more focus, on his relationship with his child. On June 16, 1996, he went to see Patty to retrieve his personal properly. An argument ensued and Patty called the Bridgeview Police. Patty signed a complaint against Robert who was arrested and charged with Disorderly Conduct.

While being transported to the police station, Robert became upset and kicked out the squad car door. Upon arrival at the Bridgeview Police Department, Robert was processed and placed in a cell where he was monitored by cameras. He tied a shirt around his neck and appeared to be looking for a place to attach it. He became further agitated and began banging his head against the cell bars.

Police Officer LaBuda heard Robert saying, “I'm going to kill myself, I'm going to kill somebody. Life is all fucked up.” Robert further reported to the officer that he had attempted to hang himself the night before. Officer LaBuda signed a certificate relating his observations and transported Robert to Christ Hospital where he was admitted. Roberts status remained subject to police hold.

At Christ Hospital Robert was examined by Dr. File. A petition for involuntary admission was completed and supported by certification of the examining doctor and also by social worker Mark Roy. Roberts aggressive and agitated behavior continued, resulting in the imposition of physical restraints. Robert successfully freed one arm and was again restrained. The physician at Christ Hospital contacted Madden Mental Health Center (hereinafter MMHC) and requested to transfer Robert. After a MMHC social worker agreed to accept Roberts transfer, he was promptly transported by ambulance.

An admitting nurse at MMHC noted Robert to be “neat/clean,” “sociable,” “cooperative,” but “irritable.” She further noted an “appropriate” affect and a “coherent” thought process. Robert was also interviewed by intake worker Romona Larry from the Crisis Network Center. She found Robert to be “alert and oriented” and “denied homicidal/suicidal ideations”. She determined his thought process to be clear and his speech appropriate. Robert also reported to Ms. Larry, “I didn't want to stay there (jail). I told them I was going to kill myself. I thought it was going to get me out of trouble. It was stupid.”

Robert was also assessed by Dr. Marianna Danet, a physician completing her residency, and under contract with MMHC. Dr. Danet's evaluation determined appropriate behavior, feelings, and perceptions with “slight or occasional” issues with depression or sadness, insight or judgment. Robert disclosed to Dr. Danet that he had feigned suicidal gestures in an attempt to get out of jail. Dr. Danet determined Robert to by psychologically stable, sequential and logical, and convincing in his protestations that his statements about suicide had been an attempt to avoid incarceration. Based on her findings she authorized Robert's release.

Intake worker Larry mistakenly thought Robert had been released by police on an “I” bond (on his own signature) and Robert was released directly to his mother on June 17,1996, instead of being returned to police custody.

Robert's discharge papers referred him to outpatient care at Greaterlawn Mental Health Care Center. His discharge paperwork further advised his agent to seek voluntary admission, or to appeal the decision to deflect his involuntary admission. Robert neither sought treatment nor appealed the decision to deflect.

Following his release Robert returned home with his mother. He told his mother that he had attempted to hurt himself in an attempt to get out of jail and his mother believed him. They ate dinner together and watched a Bulls game. She indicated his behavior was normal. The following morning, June 17, Claimant indicated Robert's mood was good, and he continued to demonstrate unremarkable behavior on June 18 and 19.

On June 20, Robert contacted police and confirmed that Patty had not dropped the charges and that the arrest warrant remained outstanding. On June 21, Claimant told her son that she would accompany him to the police station to address the issues and assured him he would only be held in jail for one day. Robert hanged himself at home before his mother arrived that same evening.

Claimant produced expert witness Dr. George Bawden, M.D., a practicing psychiatrist who is board certified n Psychiatry and Neurology. Upon review of Robert's medical records, Dr. Bawden noted a Christ Hospital social worker had indicated Robert had a mood disorder, a major depression and was at risk for suicide, which indicated an outpatient assessment. He further noted that a Christ Hospital attending nurse noted Robert had a “potential for violence, self-directed ineffective coping, drug abuse, alteration thought processes…”

Dr. Bawden testified that the petition and certificate prepared at Christ Hospital for Robert's involuntary admission were complaint with statutory requirements and testified that it normally would have resulted in the patient's admission to the facility for assessment. In this case Robert was deflected and released.

Dr. Bawden testified that considering the totality of the circumstances, including Christ Hospital's pending petition and certificate for involuntary admission, Robert's history of threatening behavior toward his girlfriend, his suicide attempt the day prior to the admission, his lack of credibility and self-incited manipulative intent, his aggressive police, the documentation of depressive and mood disorder, and history of substance abuse, all deemed Robert's suicide as reasonably foreseeable. Dr. Bawden testified that the standard of care would require Robert's admission and assessment prior to release, and that Robert's deflection and release to his mother established deviation from the established standard.

Respondent presented expert testimony of Dr. Dennis Beedle, who at the time of his testimony was the Deputy Director for inpatient Hospital System for the Illinois Department of Human Services (IDHS) with an extensive practice in emergency room and mental health facilities. However, at the time of Robert's death, Dr. Beedle wasn't associated with IDHS/IDMH.

In Dr. Beedle's opinion, review of the Christ hospital records was a part of an appropriate evaluation, but that MMHC's on assessment based on the patient and totality of facts presented would be necessary for complete evaluation.

Dr. Beedle testified that he was familiar with the criteria for involuntary admission in Illinois in 1996, which required that in order to detain a patient against his will, the psychiatrist shall determine that the patient poses a significant risk to himself or others. He further testified that where a cocaine user has demonstrated agitated and aggressive behavior and later demonstrated a claim, coherent and cooperative presence with staff, the patient would not be admitted on a voluntary or involuntary basis. Dr. Beedle scrutinized the medical records to determine whether Dr. Danet had missed a psychiatric issue, and concluded that she had demonstrated reasonable judgment in discharging Robert.

Dr. Beedle based his opinion on his education, experience and review of the relevant records. He concluded, based on reasonable degree of medical and psychological certainty, that Roberts death was the result of an unpredictable, unreasonable, and individualized fear of going to jail rather than depressive or schizophrenic illness. He opined that Robert's referral to a community mental health facility, upon deflection, was appropriate upon consideration of the totality of the circumstances, including the fact that Robert demonstrated normal behavior for four days after discharge until he was faced with the reality of returning to jail.

In sum, Dr. Beedle concluded that Dr. Danet and MMHC staff had not deviated from prevailing medical standards by Robert's deflection.

Respondent argues that Claimant's complaint should be denied for Claimant's failure to exhaust all administrative or judicial remedies prior to seeking final determination in the Court of Claims pursuant to the Court of Claims Act (705 ILCS 505/25). Respondent contends Claimant failed to pursue an action against Respondent personally, therefore barring this claim. Dr. Danet was a named defendant in Williams v. Davet, No. 01L5070, which was dismissed on the grounds that Claimant lacked jurisdiction in a case against the state and its agents. The finding was affirmed by The First District Appellate Court in Williams v. Davet, 345 Ill. App 3d 595 (1st Dist. 2003). Respondent previously filed a Motion to Dismiss for Claimant's failure to exhaust remedies with the Court of Claims. The motion was denied by the Court on September 12, 2006. Respondent's request that this claim be denied for failure to exhaust remedies is without merit and is again rejected.

Claimant contends Respondent deviated from the established medical standard of care by Dr. Danet's authorization for Robert's release considering his behavior and history of a recent suicide attempt.

The law is well established that in cases alleging negligence of hospitals and mental health facilities, Respondent is not the insurer of the patient, but has the duty to exercise reasonable care to protect him or her against foreseeable injury. Gianos v. State, 30 Ill. Ct. Cl. 373, 376 (1975). In determining whether proper care has been provided, the Court considers whether medical personnel made reasonable decisions at the time of examination and treatment. Sherrod v. State, 50 Ill. Ct. Cl. 23, 36 (1997), Stevens v. State, 31 Ill. Ct. Cl. 458, 464 (1976). It is well established that Respondent is not liable if reasonable care is exercised by the attending physician even where the physicians judgment may ultimately prove to be erroneous. Gianos, supra at 381. Standard of care is defined as the care which a reasonable, well trained medical professional would provide in the same circumstances. It is not sufficient for a patient's expert to testify that he would have acted differently in the circumstances. Williams v. State, 46 Ill. Ct. Cl. 221, 223 (1994).

In Sherrrod this Court concluded that a state psychiatric institute had met its duty of care where the patient committed suicide one day after deflection. The patient had been diagnosed with bipolar disorder mania, but prior to release he was calm and coherent and denied suicidal ideation. This Court found that the most critical information in making an assessment was the patient's appearance and condition at the time of treatment.

In this case Dr. Danet was aware of Robert's drug use. She was further aware of his actions and the medical records which diagnosed depressive and mood disorder. She considered the patient as he presented during her examination to be alert and oriented, with clear thought processes and appropriate speech. He was persuasive in his explanation of his suicidal indications as an attempt to obtain release from incarceration.

The prediction of the future course of mental illness is a professional judgment of high responsibility and in some instances it involves a measure of calculated risk. If a liability were imposed on the physician or the State each time the prediction of future course of mental disease was wrong few releases would ever be made and the hope of recovery and rehabilitation of a vast number of patients would be impeded and frustrated. This is one of the medical and public risks which must be taken on balance, even though it may sometimes result in injury to the patient or others. Gianos, supra, quoting Tig vs. State of New York, 241 N.Y.S. 2d 495 at page 496.

In light of the totality of the facts it was reasonable for the MMHC staff to determine that Robert did not pose an immediate threat to himself or others which is the criteria for involuntary admission.

Following examination of the factual record, the legal authority, and the well presented arguments of the parties, this Court concludes that though this case had a tragic and unfortunate result, it was within the reasonable judgment of the MMHC staff to conclude at the time of determination that Robert would not, within a reasonable time after release, physically injure himself.

Claimant further contends that Respondent's error in releasing Robert to his mother instead of police custody was the proximate cause of his suicide. But the evidence does not reasonably support the conclusion that his suicide, four days after his release, would have been avoided if he had been returned to police custody.

It is therefore hereby ordered that this claim is denied.

SPRAGUE, J.