TALLAHASSEE, FLORIDA – The Florida Supreme Court ruled on Aug. 25 that a Sarasota man, Robert Granicz, may pursue his medical malpractice lawsuit against his late wife’s primary care physician, Dr. Joseph Chirillo, for her 2008 suicide, reported Medscape Medical News in an Aug. 26 article.

"Although the inpatient duty to prevent suicide does not apply here, there still existed a statutory duty … to treat the decedent in accordance with the standard of care," Justice Patty Quince said in writing the court’s opinion.

Justices unanimously ruled that the case should go to trial, upholding a 2014 decision by the Second District Court of Appeal.

The summary judgement in favor of Chirillo was granted by the First District Court of Appeal, but the decision was later reversed by the Second District Court of Appeal that ruled in favor of Granicz. The Florida Supreme Court ultimately ruled to confirm the decision of the Second District that the case should proceed to trial.

Debra Pinals, M.D., director of the Program in Psychiatry, Law and Ethics at the University of Michigan in Ann Arbor, told Medscape Medical News that malpractice cases involving suicides are not new, but they can have a chilling effect on those who treat people with depression.

"Suicide as a cause of action for malpractice is one of the common reasons that physicians are sued," she said. "The standard of care related to suicide is something that malpractice cases have been hinging on."

According to court records, Jacqueline Granicz started taking the antidepressant venlafaxine (Effexor, Pfizer) in 2005, but stopped taking it in 2008.

The records say she called Chirillo's office the day before she died and told his medical assistant that she had stopped taking the drug because she thought it was causing side effects such as poor sleep and mental strain, and also causing her to cry easily and have gastrointestinal distress. She said she had not "felt right" since late June or July.

After reading the assistant's note, Chirillo changed her prescription from venlafaxine to a different antidepressant, escitalopram (Lexapro, Forest Laboratories). He didn't schedule an appointment, but said she could pick up a sample of the drug and a prescription at his office.

Jacqueline Granicz picked up those items that day, but hanged herself the following day.

“The decedent in this case was an outpatient of Dr. Chirillo’s. Therefore, under Florida law, there was no duty to prevent her suicide,” the ruling said. “However, the nonexistence of one specific type of duty does not mean that Dr. Chirillo owed the decedent no duty at all. ... Although the inpatient duty to prevent suicide does not apply here, there still existed a statutory duty ... to treat the decedent in accordance with the standard of care. We find that the Second District (Court of Appeal) properly evaluated the ... case based on the statutory duty owed to the decedent and also properly classified the foreseeability of the decedent’s suicide as a matter of fact for the jury to decide in determining proximate cause.”

Justices Charles Canady and Ricky Polston agreed with the result, but did not sign on to the opinion, which sent the case back to circuit court with instructions to move forward with a trial.

According to court documents, allegations of breach of duty included failing to recognize she was experiencing a change in symptoms, was depressed and was seeking medical intervention. They were also concerned that Chirillo didn't speak with her directly and that he didn't refer her to a clinician trained in management of depression. They also said he failed to properly evaluate escitalopram, an antidepressant known to cause suicidal tendencies in some patients.

"Dr. Chirillo owed no duty to prevent the defendant from committing an unforeseeable suicide while she was not in his control," the doctor’s medical group said.

Although the American Psychiatric Association declined comment, there are individual doctor’s opinions that address concerns for the court’s decision.

"There's a fine line between how you balance the standard of care with people's free will on an outpatient basis," Carolyn Stimel, Ph.D., executive director of the Florida Psychological Association, said in an interview with Medscape Medical News. "Presumably, if this person had been in therapy there would have been somebody monitoring what was going on with their mental state and also dealing with the issue that she had stopped taking her medications."

She said doctors have a legitimate question in asking what one can do when a patient won't take medications.

"Ultimately you can't shove pills down someone's throat," Dr. Stimel said. "The thought of doctors being responsible for whether patients kill themselves or not — that's pretty chilling."

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