A woman in her 30s was brought to the ER of another hospital by her brother. Two facts dominated the case: 1) at home, the depressed woman had threatened to kill herself and 2) the brother's gun was missing, and he was sure that the patient had taken it. A social worker was called in to do an evaluation and make a determination. The patient vehemently denied having any intention or plan to harm herself or that she had taken her brother's gun. She wanted to be discharged. A verbal contract for safety was made with the social worker.
The brother felt strongly that the patient's threat earlier that day to harm herself was real, and he demanded that she be certified. Believing the patient's claim in the ER that she was not suicidal, the social worker discharged her. Several days later, the patient drove to a neighboring state, checked into a motel and shot herself to death. The family sued the hospital.
I do not wish to second-guess the social worker's clinical evaluation, although I wonder if the brother's missing gun would have triggered my suspicion of the patient's suicidal intention and plan. I do not know all that went into the decision to discharge this woman from the ER, but I suspect that her contract for safety figured significantly.