Court: District Court of Appeal of Florida; February 18, 2014; Florida; State Appellate Court
Judge Silberman addressed a medical malpractice case initiated by Robert Granicz following the suicide of his wife, Jacqueline Granicz, who suffered from depression. Granicz, representing Jacqueline's estate, claimed Dr. Joseph S. Chirillo, Jr. failed to meet his duty of care in her treatment, leading to her suicide. The trial court granted summary judgment in favor of the defendants, asserting Dr. Chirillo had no legal duty to prevent the suicide. On appeal, Granicz contended that the court mischaracterized Dr. Chirillo's duty, arguing he was required to exercise reasonable care in treating Jacqueline, which included recognizing changes in her mental health.
Evidence presented indicated that Jacqueline had a history of depression and was prescribed Effexor, which she discontinued due to side effects. On October 8, 2008, she communicated her deteriorating mental state to Dr. Chirillo’s office but was not prompted to schedule an appointment for further evaluation. The following day, she was found dead by suicide. Granicz alleged that Dr. Chirillo breached his duty by failing to recognize Jacqueline's symptoms, not directly communicating with her, not referring her to a specialist, and inadequately evaluating her before prescribing Lexapro, an antidepressant associated with suicidal ideation. The defendants argued that Dr. Chirillo had no duty to prevent an unforeseeable suicide. The appellate court agreed with Granicz, reversing the summary judgment, highlighting the evidence of Dr. Chirillo's potential breaches of care.
Defendants contended that necessary expert testimony would be inadmissible due to the rule against stacking inferences. In response, Granicz submitted depositions from Dr. Chirillo and two expert witnesses, Dr. Tonia Werner and Dr. Michael Yaffe. Both experts asserted that Dr. Chirillo was required to see Jacqueline, assess her for suicidal thoughts, and intervene, given her deteriorating mental state, including ceasing antidepressant use and increased emotional distress. They characterized her phone call as a desperate plea for help, indicating that Dr. Chirillo's failure to meet with her directly contributed to her death, as he would have identified her suicidal ideations. The trial court ultimately granted summary judgment against Granicz, ruling that Dr. Chirillo did not have a legal duty to foresee and prevent the suicide of an outpatient. This decision was made in the context of Florida law, which holds that the duty of care involves determining whether a defendant's actions foreseeably created a risk of harm, rather than directly assessing the foreseeability of the specific injury. The court's analysis misapplied the standard for determining duty by conflating it with proximate cause issues. Under Florida law, medical professionals must adhere to a standard of care defined by the skills and methods deemed acceptable by similarly qualified providers, and the specifics of this duty often rely on expert testimony.
Granicz's expert testimony indicated that primary care physicians must personally assess patients exhibiting symptoms of worsening depression, specifically to evaluate suicidal thoughts and intervene as needed. This establishes that Dr. Chirillo had a legal duty to Jacqueline, which precluded summary judgment. The decision contrasts with the First District's ruling in Lawlor v. Orlando, where a psychotherapist was found not to have a duty to prevent an unforeseeable suicide. The appellate court in Lawlor rejected the plaintiff's expert testimony regarding the standard of care and its breach. However, the current case aligns with Judge Benton's dissent in Lawlor, emphasizing that the psychotherapist's duty is to provide appropriate care, and thus a jury should determine the proximate cause of the suicide. The conclusion is that Dr. Chirillo's duty to adhere to the standard of care in treating Jacqueline for depression prevents summary judgment, leading to a reversal of the lower court's ruling and remanding for further proceedings. The court also certified a conflict with the First District’s decision. Arguments raised by the defendants regarding the stacking of inferences were rejected, affirming that reasonable inferences from expert testimony are admissible. Additionally, the court noted that brief provider/patient relationships or non-psychiatric issues may not impose a duty for psychiatric treatment.
