Medical Malpractice in Psychiatry: When Can You File a Lawsuit?

Medical malpractice in psychiatry may occur when a psychiatrist or treating professional deviates from the accepted medical standard, resulting in psychological or physical harm to the patient. A claim in this field may involve medical malpractice in misdiagnosis or delayed diagnosis, inappropriate drug treatment, insufficient attention to suicide risk, or negligent conduct in an involuntary hospitalization procedure.

Table of Contents:

• What is medical malpractice in psychiatry?
• Most common grounds and hotspots for malpractice in psychiatry
• How to prove a causal link between the psychiatric failure and the psychological or physical damage
• What compensation can be received?
• Statute of limitations in psychiatric malpractice claims
• Practical guide for the injured party or their family members: Step by step
• Medical Malpractice in Psychiatry - Frequently Asked Questions (FAQ)

Medical malpractice in psychiatry can cause harm just like other cases of medical malpractice, but it is often harder to prove. These claims are frequently met with skepticism, especially due to the vulnerable nature of patients seeking treatment in the first place.

What is medical malpractice in psychiatry?

Psychiatric treatment plays a critical role in helping people cope with conditions like depression, anxiety, bipolar disorder, schizophrenia, and more. When diagnosed and treated properly, psychiatric care can dramatically improve quality of life. But when a misdiagnosis occurs, the consequences can be devastating.

A psychiatric misdiagnosis happens when a mental health professional incorrectly identifies a patient's condition or their treatment. The reasons for negligence vary and include lack of testing, failure to review medical history, ignoring physical causes for symptoms, or misinterpreting the patient's behavior.

The impacts of a psychiatric misdiagnosis can be both emotional and practical. When a mental health condition is not treated (or when inappropriate treatment is given), patients may experience worsening symptoms, an increased risk of self-harm, or even long-term psychological trauma.

Incorrect psychiatric labeling can have severe social and professional consequences. Some people lose their work or professional licenses after being incorrectly diagnosed with a severe mental disorder. Others are accidentally exposed to involuntary hospitalization or forced medication, which harms their rights and damages their trust in the healthcare system.

Conversely, patients who are denied appropriate diagnosis may remain without the support, medications, or treatment they desperately need. This negligence can cause harm not only to the patient but also to family members and employers who depend on them.

The Legal Difference Between a Natural Deterioration in Mental Condition and Negligent Treatment

A natural deterioration of a mental condition is considered an expected progression of the illness. In contrast, negligent treatment stems from a failure by a member of the medical staff while deviating from the accepted standard. In this case, the worsening of the mental condition is a result of negligence, with the liability for causing the harm resting on the shoulders of the treating entity.

Most Common Grounds and Hotspots for Malpractice in Psychiatry:

Negligence in Psychiatric Diagnosis (Missing a Diagnosis or Giving a Wrong and Stigmatizing Diagnosis)

Medical malpractice in diagnosis in psychiatry can lead to treatment that is inappropriate or inaccurate for the patient, and sometimes leaving them without treatment at all. Wrongly labeling a patient – such as diagnosing personality disorder instead of trauma or depression – can lead to inappropriate treatment and long-term damage.

Negligence in Psychiatric Drug Treatment and Failure to Perform Vital Physical Monitoring (Blood Tests and Organ Function)

Psychiatrists must prescribe and monitor medications safely. Negligence can occur when drugs are combined unsafely, when insufficient attention is paid to other medications the patient is taking, or in cases of ignoring side effects. Negligence can also manifest in refilling prescriptions without conducting monitoring.

Another form of negligence is the sudden discontinuation of antidepressant medications without a gradual taper or medical supervision. Sudden discontinuation can cause severe withdrawal symptoms, a return or worsening of depression, anxiety, or suicidal thoughts, headaches, fatigue, or insomnia.

Negligence in Assessing Suicide Risk and the Legal "Foreseeability" Test in Suicide Cases

Psychiatrists must carefully assess a patient's risk of self-harm or suicide. Failure to properly assess warning signs or take necessary precautions, such as hospitalizing a patient at risk, can lead to tragic outcomes. Psychiatrists and medical institutions that do not act with reasonable care in these situations may face legal consequences for medical malpractice.

Israeli courts recognize that not every suicide is a result of medical malpractice by the treating entity, and therefore, these claims are complex and difficult to prove. The legal ruling relies on the foreseeability test: the court will examine whether, under the circumstances, a reasonable psychiatrist should have foreseen the immediate risk of suicide and acted to prevent it.

Negligence in the Decision to Hospitalize or Premature/Negligent Discharge (When the Patient Poses a Danger to Themselves or Others)

Psychiatric patients are sometimes discharged earlier than necessary, both for financial reasons (such as a shortage of hospital beds) and when the medical staff incorrectly assessed their condition.

When a medical institution discharges a patient at high risk of suicide, or when a hospital discharges a patient without making appropriate arrangements for aftercare, the hospital may be held liable if the patient subsequently harms themselves or others.

Failures in Involuntary Hospitalization and Treatment (Breach of the Mental Health Treatment Law)

Regarding this topic, Supreme Court justices previously wrote (Civil Appeal 386/14 Almoni v. Ministry of Health, Paragraph 14) that it is a subject that "touches upon the meeting between the basic liberty of every person, especially the mentally ill person belonging to an extremely weak group in need of protection and support, and the right of those around them—and even their own right—to be protected from the mental illness that sometimes renders them dangerous to themselves and their surroundings," and that "this meeting also requires, in appropriate cases, making decisions that involve a violation of a person's liberty, as far as the law requires (Civil Appeal 8020/21)."

Negligence in involuntary hospitalization and psychiatric treatment refers to actions contrary to the Mental Health Treatment Law, which violates the fundamental rights of patients and is also considered a criminal offense. Because these are situations involving the deprivation of patients' liberty, strict guidelines and threshold conditions have been set in Israeli law to prevent a violation of rights without necessity.

Thus, the law stipulates that in cases of immediate danger (in situations posing a threat to the patient and their surroundings), a patient can be involuntarily hospitalized for up to 48 hours. Additionally, involuntary hospitalization can be ordered by a district psychiatrist for seven days (subsequently, the hospitalization period can be extended up to three and a half months via a reasoned application by the hospital where the patient is hospitalized). Afterward, the Psychiatric Committee can extend the hospitalization period (each time for a period of up to three months).

The patient is entitled to legal representation by the state upon arrival at involuntary hospitalization and can appeal the hospitalization before the Psychiatric Committee. A patient who believes they were unlawfully hospitalized can file a tort (negligence) claim against the treating institution or the medical entity that ordered their hospitalization on grounds of medical malpractice, false imprisonment, battery, and infringement of autonomy and fundamental constitutional rights.

Negligence in Follow-up and Continuity of Care (Lack of Information Transfer with Family Doctor or Follow-up Frameworks)

Every patient in Israel has the right to appropriate care, and this right also pertains to the transfer of information between the family doctor and the psychiatrist or another medical institution, and to collaboration between the various providers. This is to maintain continuity and appropriate follow-up care. If there is a failure in the transfer of information, it must be examined whether it constitutes medical malpractice.

Negligence in Psychiatric Treatment for Children and Adolescents

According to studies, most mental disorders begin to develop between the ages of 12-25 (about 75%); therefore, early diagnosis, support, and treatment are critical at these ages, for them and for their environment. Negligent treatment at a young age can cause damage, sometimes irreversible, and therefore the amount of compensation in these cases can be higher.

To establish a medical malpractice claim in cases of children and adolescents, the existence of a duty of care, the breach of that duty (the doctor's negligence), and the causal link to the damage must be proven—meaning, to prove that the negligence is what caused the deterioration in the minor's mental state or physical damage.

Boundary Violations and Exploitation of the Therapist-Patient Relationship in Mental Health

Boundary violations and exploitation of the therapist-patient relationship are a rare but important reason for medical malpractice claims against a psychiatrist. Boundary violation refers, among other things, to sexual relations and inappropriate behavior and is considered one of the most severe ethical and legal offenses in the field of treatment. The reason is, of course, the power imbalance between the parties and the dependency created between the patient and the therapist. Exploiting the relationship with the patient by the therapist is considered grounds for filing a claim and, in certain cases, grounds for criminal proceedings and license revocation.

Rights, Competence, and Patient Autonomy

In medical malpractice claims, patient rights constitute the pillars. In fact, an infringement of the patient's autonomy may constitute grounds for a claim in itself, even if the psychiatric treatment they received was appropriate.

Informed Consent and Legal Competence to Make Medical Decisions in Psychiatry

According to the Patient Rights Law, the medical staff is obligated to obtain the free and informed consent of the patient for any procedure. The patient is entitled to receive all the information necessary for them before performing the medical procedure, including the risks involved, before deciding whether to accept the treatment or not. Unlike the past, a psychiatric patient is considered competent to make decisions regarding their matter, unless determined otherwise, and even a patient who has been involuntarily hospitalized has rights.

Breach of Psychiatric Medical Confidentiality and Violation of Patient Privacy

According to the Patient Rights Law and the Protection of Privacy Law, any therapist or employee in a medical center is obligated to keep confidential any information regarding a patient that reached them during the course of their work. In cases where confidentiality was breached, there is grounds for a medical malpractice claim and financial compensation.

The Dramatic Importance of the Medical Record (And the Consequences of Concealing, Deleting, or Omitting Psychiatric Documentation)

The law in Israel stipulates that a patient has the right to receive a copy of their medical file. In cases of medical malpractice claims, if the therapist or medical institution refused or lost the medical file, the court applies the "evidentiary damage" doctrine, and the burden of persuasion that there was no negligence shifts to the defendant.

How to prove a causal link between the psychiatric failure and the psychological or physical damage?

Medical malpractice claims (tort claims in general) are based on 3 pillars:

• Negligent treatment
• Damage/disability caused to the patient
• Proving the causal link between the treatment and the damage.

To prove the causal link between the psychiatric failure and the damage caused to the patient (mental/physical), a professional medical expert opinion is required. The professional opinion relies on both the medical file and the patient's condition.

What compensation can be received (heads of damage, loss of earning capacity, increased pain and suffering)?

In medical malpractice claims, the court examines several heads of damage when adjudicating compensation. A head of damage for pain and suffering (non-pecuniary damage) includes compensation for mental anguish, loss of quality of life resulting from the diagnostic error, etc. A head of damage aggregating loss of wages and earning capacity (reimbursement for the damage to the ability to work in the past, present, and future) following the damage. A head of damage for compensation for medical expenses, rehabilitation, and third-party assistance.

Statute of limitations in psychiatric malpractice claims (and exceptions regarding temporary or permanent incapacity)

According to the Statute of Limitations Law, the period during which a medical malpractice lawsuit can be filed is 7 years. However, due to the complexity of mental health and treatment and the fact that the damage is not always discovered immediately, laws were established allowing, in certain cases, to delay the start of the statute of limitations race. In these cases, the 7-year count will start on the day the damage was discovered, provided it could not have been discovered earlier; this condition is limited to 10 years from the negligent event.

There are exceptional situations regarding the counting of the statute of limitations. For minors, for example, the limitation period is counted from the day they reach age 18 (meaning they can sue for malpractice until age 25). In other cases, where the injured party is incapacitated and unable to take care of their affairs due to their mental state, the limitation period may be paused, and it will not be taken into account as long as they are unable to take care of their matter and had no appointed guardian capable of suing.

Practical guide for the injured party or their family members: Step by step

An injured party or their family members who believe that harm was caused to them due to psychiatric treatment should contact legal advice and representation as soon as possible to examine whether there are indeed grounds for filing a medical malpractice lawsuit.

Additionally, all medical documentation of the case should be collected – the entire medical file, meeting summaries, diagnosis and hospitalization reports, medication documentation, correspondence and conversations with the therapist, and any documentation of the damage caused.

Subsequently, and on the advice of the accompanying medical malpractice lawyer, one should turn to obtain an opinion from an expert psychiatrist. The expert will determine what the reasonable standard of care was, how the negligence manifested, and what the damage caused to the patient is (temporary/permanent disability and to what extent).

Based on the expert opinion and the medical file, the lawyer will formulate a tort claim to be filed in court demanding compensation, according to the case.

Medical Malpractice in Psychiatry - Frequently Asked Questions (FAQ)

Does every diagnostic error in psychiatry constitute automatic grounds for medical malpractice?

No. The courts recognize that psychiatrists are required to exercise judgment. Negligence will be recognized if it is proven that the doctor deviated from the reasonable medical standard and thereby caused actual damage to the patient.

Does a tragic suicide of a patient always prove that the medical staff was negligent?

No, every suicide of a patient does not prove that the medical staff was negligent. Although many medical malpractice claims are filed by family members whose loved one took their own life, these claims are difficult to prove. The claim must prove that the treating team failed the foreseeability test, breached supervision procedures, or incorrectly assessed the case.

Can a medical institution be sued for damages caused after premature discharge from hospitalization?

A medical institution or treating entity can be sued for damages caused after premature discharge from hospitalization. For this claim to be accepted, the professional opinion must prove that the deviation from accepted treatment procedures was negligent and that the damage caused to the patient was caused due to that deviation.

Does the appearance of severe side effects of a psychiatric drug allow for filing a lawsuit?

To prove medical malpractice, a deviation from the reasonable medical standard must be proven. In cases of administering medications, the mere appearance of severe side effects is not enough. It is necessary to prove that the doctor was negligent in the dosage, in long-term monitoring, or in reviewing the medical file and history. If a link is found between such conduct by the treating entity and the damage caused to the patient, there may be grounds to sue for negligence. Insofar as a doctor did not present the side effects in advance to the patient, the risks, and possible alternatives, a ground for breach of informed consent will arise.

When might an unlawful involuntary hospitalization be considered negligence or false imprisonment?

If as a result of an involuntary hospitalization, performed contrary to guidelines, damage was caused to the patient or their condition worsened, there may be grounds for a medical malpractice lawsuit. In this case, it must be examined whether the medical staff acted according to the law and according to the clear procedures for involuntary hospitalization.