Depression and suicidal thoughts haunted Kirk Lloyd Jr. during his teen years. In 2010, the then 17-year-old wrapped his body in a blanket and set it on fire.
Fearing for his safety, Lloyd’s mother took him to the hospital for voluntary mental health treatment. Staff agreed he needed immediate care, but a few hours later determined he was no longer a danger to himself and sent him home.
Two days later, Lloyd killed himself in his bedroom. The family sued Allina Health System for negligence, an action the company claims is invalid because a nearly 50-year-old state law shields it from legal consequences in mental health cases.
The state Court of Appeals sided with Allina, leading to a date before the Supreme Court earlier this month. It was the first time the high court chose to review an immunity defense case involving the suicide of a mental health patient who wasn’t forced to take treatment.
“There was a glitch in the hospital’s system,” said Patrick Stoneking, who is representing Lloyd’s family. “There isn’t a dispute that he needed treatment. But Allina isn’t the government and shouldn’t be entitled to immunity. They have a duty to treat people with a certain standard of care.”
The suit, filed by Lloyd’s mother, Melinda Binkley, in 2013, centers on a law to safeguard mental health patients seeking treatment called the Minnesota Commitment and Treatment Act (CTA). The statute was originally passed by the Legislature in 1967. It sets guidelines for the involuntary treatment of a person in a mental health care facility who requires physical acts that inhibit the patient’s fundamental freedoms.
If the decision to deny a patient admittance for treatment is done in “good faith,” the health provider is immune from criminal prosecution or civil suit. There is no language about immunity for voluntary treatment.
“Our hearts go out to Mr. Lloyd’s family for their tragic loss,” said Allina Health spokesman David Kanihan. “The course of mental illness is difficult, sometimes impossible, to predict. Our providers work hard to understand each patient’s situation, and develop a plan based on the patient’s condition, circumstances and preference. Unfortunately, despite our best efforts, tragic outcomes like this sometimes do occur.”
In briefs filed with the Supreme Court, Stoneking argues that Allina’s interpretation of the CTA is that it gives the health care provider immunity even if it doesn’t treat and admit suicidal patients who request treatment. Such a broad immunity is without support under law and runs contrary to any reasonable reading of it, Stoneking wrote. Because the CTA encompasses other aspects of mental health treatments, Allina’s claim for immunity would bar all sorts of claims arising out of improper mental health treatment and medication administration.
“This law isn’t artfully written,” Stoneking said. “But the Legislature’s intent was to balance safety issues against a patient’s freedom.”
The first version of the CTA in 1967 had the immunity provision that is still part of the law today. Before then, patients seeking voluntary treatment had to make a formal application and were detained until they wrote a demand for release.
The Supreme Court examined a slight change in the CTA in 1982 and expressed doubt that the law’s language could ever grant the type of broad immunity that Allina is now claiming. The latest change to the law in 2001 requires patient-admitting decisions be consistent with standards established by two national psychiatric associations.
A history of problems
Lloyd’s final visit to United Hospital in St. Paul on May 11, 2010, wasn’t his first time for treatment. In July 2009, the same hospital staff noted during his examination that he was unstable and had potential suicide behaviors. He was admitted on a 72-hour hold and later placed in an outpatient program for three weeks.
When he set himself on fire in his Stillwater home, Lloyd told his mother it was an accident. He then told her he wanted to hurt himself and burn down their home. They went to the hospital, where he was diagnosed with depression, anxiety and as being “suicidal with a plan,” Stoneking wrote in his brief.
After consulting with a psychiatrist, a counselor told Lloyd and his mother he wasn’t going to be treated. Allina also refused to refer him to its outpatient program “because he wasn’t a good fit” and he didn’t follow through with the same program the previous year, Allina attorneys said.
Court documents citing opinions from the plaintiff’s experts said he was a high risk for suicide and that his discharge was a departure from accepted medical practices standards.
Allina contends staff discussed outpatient options with Lloyd. An appointment was set up with a school counselor for the next day, as well as one with a therapist.
He and his mother agreed on the plan and signed a statement saying he wasn’t currently a danger to himself and he would call for help if that changed, documents said.
Lloyd didn’t go to school the next day and “had a rough night,” according to a deposition Allina took from his mother. On the eve of his death, she said he was arguing on the telephone with his girlfriend.
His mood changed and he became so outraged that he damaged a car with a bat. Lloyd’s mother didn’t call police or return to the hospital, Allina contends. He would be found dead hours later.
The hospital’s refusal of treatment caused Lloyd’s death, Stoneking wrote. Allina countered that the decision was made in undisputed good faith “and there is no evidence or even an allegation to the contrary.” Without immunity, providers would be encouraged to use overly restrictive methods of care, Allina argued.
“When a patient presents for care, we do not refuse care — we provide assessment and work with the patient and family to determine an appropriate treatment plan to help position the patient for further care,” Kanihan said.
While Allina isn’t allowed to comment on Lloyd’s death, the company does review cases with unexpected outcomes such as this in order to determine what can be learned and if any improvements should be made going forward, he said. Whether or not specific improvements are identified, Allina Health believes the staff benefits from this review process through gaining a deeper understanding of these complex situations, he said.
In 2009, the state Court of Appeals upheld Allina’s immunity claim in a suit involving its refusal to place a patient on a 72-hour emergency hold against his will. He later killed his mother and injured other family members.
Allina lost its challenge in Ramsey County District Court to have Lloyd’s suit dismissed. The judge ruled that there wasn’t any legal precedent for the company to argue for immunity. In February, the appeals court reversed the lower court decision.
If the Supreme Court rules in Allina’s favor, the Legislature will need to take another look at the CTA, said Mark Hallberg, whose law firm handles many medical negligence cases. He believes the law wasn’t intended to apply to voluntary admissions.
“Would immunity then apply for every part of the CTA?” he asked. “The whole reason for immunity is to protect people coming into the hospital, not going out.”
Like many others who pursue medical negligence suits, Lloyd’s mother, Melinda Binkley, said she’s trying to make something good come from something terrible. She also wants schools and hospitals to be more aware of children facing depression.
Last year, her 16-year-old son Trés also killed himself.