Suicide of a Primary Care Patient Was Not Preventable – The Perils of Suicide in Litigation

Among the many clinical skills that Advanced Nurse Practitioners and General Practitioners must acquire, the ability to assess the risk of patients killing themselves is important and demanding.  It is often a crucial factor when making clinical decisions, such as in the choice of treatments, when deciding whether admission to a psychiatric hospital is necessary and when considering the provisions in the Mental Health Act.

In David Greenwood (on his own behalf and as Administrator of the Estate of Mrs Suzanne Greenwood (Deceased)) v Ms Lisa Higson and Dr Kumar and another [2020] Manchester CC, the Judge had to consider the problems in assessing suicide risk in primary care and whether the “but for” test should be modified to take account of the difficulties in establishing causation in such cases.

Mrs Greenwood had a history of anxiety, depression and had attempted suicide on two previous occasions.  Mrs Greenwood’s symptoms developed overtime due to stress at work and at home.  Mrs Greenwood had been managed by a Consultant Psychiatrist at The Priory, in Accident & Emergency and by her local primary medical practice.

On 23 December 2014, Mrs Greenwood had been found suspended from a tree by a rope.  The post-mortem report examination gave the cause of death as hanging.  The inquest into her death recorded an open verdict.

The Claimant’s legal team and experts asserted that Advanced Nurse Higson had conducted a negligent examination of Mrs Greenwood prior to her death.  It was alleged that Nurse Higson had failed to take a full history, failed to review medical records, to carry out a formal mental health examination, a failure to understand the rationale behind Mrs Greenwood’s medication, a failure to understand Mrs Greenwoods condition, a failure to follow appropriate guidelines, a failure to consult other more senior practitioners, a failure to properly counsel Mrs Greenwood as to the effects of reducing her medication and causing her mental state to deteriorate.

It was also alleged that the General Practitioners had been negligent in that they failed to adequately train Nurse Higson, failed to supervise her and allowed her to manage Mrs Greenwood when she was not appropriately trained to do so.

The Judge concluded that Nurse Higson was appropriately qualified to manage Mrs Greenwood, the examination had not been carried out negligently and the GPs had provided appropriate training and supervision.

In respect of causation, the Claimant asserted that had Mrs Greenwood been managed appropriately she would not have taken her life.  The Claimant sought to argue that if the court was not satisfied that the “but for test” had been satisfied, then he should modify the test and conclude that the breach had made a material contribution to the death of Mrs Greenwood.

The Judge said that in order for the Claimant to succeed in establishing causation there must be a chain linking the examination on 20^th November 2014 to the death of Mrs Greenwood. If he had been satisfied that there had been a breach of duty, the breach would have resulted in the decision to reduce Mrs Greenwood’s medication.  It has to then be shown that it was the reduction in medication that led to Mrs Greenwood subsequently choosing to stop taking it, and that as a result of stopping the medication that the events on 23^rd December 2014 took place.

The Judge was not satisfied that the evidence “is sufficient” to be able to find that.

Mrs Greenwoods death was tragic.  However, the blame for the events which led to Mrs Greenwood taking her life does not lie at the door of the Nurse and/or the GPs.

The claim was dismissed.

Simon Butler was instructed by BSG Solicitors LLP to represent all the Defendants.