On December 18, 2012, French psychiatrist Daniele Canarelli, age 58, received a 1-year suspended prison sentence by the Criminal Court of Marseille. Dr Canarelli had been found guilty of multiple practitioner failures and misconducts after one of her patients—Joel Gaillard—killed 80-year-old Germain Trabuc on March 9, 2004. The court also sentenced Dr Canarelli to pay 7500 euros and 1000 euros, respectively, to each of Mr Trabuc’s sons.
French psychiatrists rarely face lawsuits.1 In cases involving harm by a patient to a third party, a hospital or insurance company usually assumes liability and pays for damages. Legal cases that result in prison sentences for psychiatrists remain exceedingly rare. That is precisely why this case has caused such a stir in Europe.
Some background on this case: Joel Gaillard had been Dr Canarelli’s patient for nearly 4 years, between 2000 and 2004. During that time, Gaillard was repeatedly and mandatorily hospitalized at the request of his family or the regional government’s social services.
On the day that Gaillard murdered Trabuc, he was on probation and being treated as an outpatient. As such, Gaillard was the legal responsibility of the psychiatric hospital. Twenty days before the murder, Dr Canarelli had ordered the re-hospitalization of her patient, but the patient escaped during a consultation.
The jury found numerous and repeated lapses in judgment and actions on Dr Canarelli’s part. At the start of the trial, the court pointed out that the “law does not require from the physician an obligation of result” and that “predictability and zero risk do not exist.” The court also reassured psychiatric professionals by declaring that the case did not pertain to the entire profession. It was said at the trial that “the court is not judging psychiatry here, but rather a very specific case with a specific misbehavior of the treating doctor.”2
Several acts of negligence were brought against Dr Canarelli. Charges outlined in the judgment text stated that under her supervision, the 4 years of therapy were marked “beyond any doubt” with “a succession of failures” and her attitude “resembled blindness.” These charges were based on the following:
Despite “an escalation of acts of aggression, of increasing severity” perpetrated by the patient while he was in treatment, “Dr Canarelli remained stubbornly attached to her treatment approach and ignored such obvious alarm signals. She did not question her methodology or change her approach, thus creating or helping to create the situation that led to the realization of the crime.”
The doctor also failed to “establish the correct diagnosis.” This assertion may be debatable, but her reports concerning the patient revealed that she sometimes ruled out psychosis, which was noted by all the other doctors who examined the patient as well as by the expert who was appointed to the court after the murder.
The court found a clear discrepancy between the mental disorder meticulously described by the doctors who recommended “hospitalization without consent,” and the therapeutic approach adopted by Dr Canarelli. The patient had repeatedly objected to his hospitalization, as unanimously stated by experts who examined him on those occasions.
1. Jonas C, Senon JL. Responsibility in adult psychiatry. Med Encycl Chir: Psychiatry. Elsevier SAS; 2003;37-900 A-30.
2. BBC News Europe. France psychiatrist guilty over murder by patient. December 18, 2012. http://www.bbc.co.uk/news/world-europe-20774516. Accessed February 25, 2013.
3. Article 3211-2-1 The Code of Public Health.
4. Jonas C. The detailed certificate of the Act of July 5, 2011: Why? How? [in French]. Ann Medico Psychologiques. 2012;170:699-702. ISSN: 0003-4487. doi:10.1016/j.amp.2012.09.011.
5. Senon JL, Jonas C, Voyer M. Care given under constraint for mentally ill patients since the act of the 5th of July “relative to the rights and protection of people subject to psychiatric care and the modalities of their treatment.” Ann Medico Psychologiques. 2012;170:211-215. ISSN: 0003-4487. doi:10.1016/j.amp.2012.02.019.