Psychiatrist Must Approve Patient’s Release, Court Rules

In a victory for psychiatrists, the California Court of Appeal recently overturned a lower court ruling that a psychologist acting alone could authorize the early release of a patient who is involuntarily hospitalized.

In the case Ford v. Norton, the appellate court concluded that “the early release of a dangerous or gravely disabled patient from an involuntary detention requires the expertise of a psychiatrist. . .a professional who has received training in the detection of organic illness.” The court’s decision clarifies the different scopes of practice for psychologists and psychiatrists in California.

The case involved a patient named Stanley Ford, who admitted himself to a psychiatric hospital for treatment. Robert Norton, Ph.D., a psychologist, along with a psychiatrist, evaluated the patient and found him to be “psychotic and/or schizophrenic.”

After a few days in the hospital, Ford’s mental health deteriorated, and the hospital staff deemed him to be gravely disabled and a danger to others.

Ford was then placed in the psychiatric intensive care unit under a 72-hour hold.

However, the following morning, Norton assessed Ford and said that he should be released from the hospital. After consulting for five minutes with Harvey Biala, M.D., the psychiatrist on call, who wrote a prescription for antipsychotic medications and medically cleared Ford for discharge, Norton wrote an order for Ford’s discharge.

Upon returning home from the hospital, Ford stabbed his roommate in the back, causing serious injury. Ford was charged with criminal assault, but found not guilty by reason of insanity and was committed to a maximum-security state hospital.

Ford filed a malpractice suit against Norton and Biala, alleging that if he had been held for the entire duration of the 72-hour hold, he would neither have stabbed his roommate nor suffered the resulting consequences, which included lost wages, medical and hospital expenses, and emotional distress.

The trial court dismissed the case, deciding that neither the psychologist nor the psychiatrist could be sued for malpractice.

This lower court relied on the California Supreme Court’s 1990 decision in California Association of Psychology Providers (CAPP) v. Rank, which said that a hospital may appoint clinical psychologists to its staff and may permit those psychologists to take primary responsibility for the admission, diagnosis, treatment, and discharge of their patients.

In Ford v. Norton, the lower court cited California’s Lanterman-Petris-Short (LPS) Act, enacted in 1967 to protect the rights of people with mental illness or who are gravely disabled. The LPS Act specifies that psychiatrists directly responsible for the patient’s treatment are immune from liability based on consequences from the early release of a patient.

Then, based on the CAPP v. Rank decision, the lower court in Ford v. Norton ruled that psychologists were thus immune from liability suits as well.

Ford appealed the case, and the California Medical Association and the California Psychiatric Association filed amicus briefs with the California appellate court in support of Ford’s appeal.

The appellate court agreed with the medical organizations’ position and found that the lower court overlooked a 1985 amendment to the LPS Act that restricts authorization of early release to psychiatrists who directly observe patients under a 72-hour hold.

Before 1985, the language of the LPS Act said that a “professional person or his designee” could authorize the early release of a patient on involuntary hold.

The court found that the defendants, Norton and Biala, did not have immunity from malpractice because of a statutory law that specifies that the psychiatrist must personally observe the patient before issuing an early release, and that the lower court did not take this into consideration in the original decision.

Because Biala did not directly observe Ford before clearing him for early release, and Norton was not authorized by law to release a patient committed involuntarily to a 72-hour hold, the court ruled that neither Norton nor Biala were in fact immune from liability.

According to the court ruling, “The decision on whether to release dangerous or gravely disabled patients early who are detained due to inebriation. . .mental disorder, chronic alcoholism, or being imminently suicidal must be made by a psychiatrist.”

According to attorney Daniel Willick, J.D., Ph.D., who wrote the amicus brief on behalf of the California Psychiatric Association, the outcome of Ford v. Norton is good news for psychiatrists everywhere. “The court recognized the greater expertise of psychiatrists—that only psychiatrists have the training to detect organic disease,” Willick told Psychiatric News.

He also said that the ruling undercuts the logic that psychologists used in their expansive reading of what CAPP v. Rank means.

The decision could also carry larger meaning. “The ruling in Ford v. Norton is information that can be used to oppose psychologists’ prescribing privileges, because it shows that the courts recognize the difference in the expertise between psychiatrists and psychologists,” added Willick.

San Francisco psychiatrist Renée Binder, M.D., chair of APA’s Committee on Judicial Action, also believes that the California appeals court decision is a good omen for psychiatrists. “The distinction between psychiatrists and psychologists in the detection of organic illnesses is an important one,” said Binder.

Now that the appeals court has ruled, the malpractice case against Norton and Biala is headed for trial.

The opinion published in Ford v. Norton can be found at www.cmanet.org under “Appeals court supports psychiatrists’ role.” ▪