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Psychiatric Liability: A French Psychiatrist Sentenced After a Murder Committed by Her Patient: Page 2 of 2

Psychiatric Liability: A French Psychiatrist Sentenced After a Murder Committed by Her Patient: Page 2 of 2

Dr Canarelli continued with the same therapeutic approach and prescribed successively longer “exit test” periods outside of the hospital, especially from October 2003 onward—despite several “alarming incidents and alerts” of which she had been aware.

Dr Canarelli was also accused of failing to take into consideration the experts’ recommendation in 2001 to transfer her patient to a specialized facility (at that time there were 4 such facilities in France where extreme cases were admitted). Nor did she consider the experts’ request to transfer the patient for treatment by another therapeutic team.

In January and February of 2004, Dr Canarelli had received alerts from the mental health center and the patient’s family. But “she did not make any concrete conclusion out of the information she received, and didn’t put it to proper use during her counseling appointment of February 19, 2004, with the patient.”

French Penal Code Article 121-3: When a Psychiatrist’s Patient Harms Someone…

There is [. . . ] transgression of the law, in cases of recklessness, negligence or breach of duty in terms of providing adequate care or safety, as stated by law or regulation, if it is established that the perpetrator has not completed the normal due diligence given, with regard to the nature of their duties, functions, skills and means put at their disposal.

Based on the above, individuals who did not directly cause any damage, but who created or helped to create the situation that led to the occurrence of the damage or who have not taken appropriate measures to prevent it, are criminally liable if it is determined that they have either manifestly violated, in a deliberate manner, their duty of providing care or safety as stated by law or regulation, or exposed others to serious risk that they could not ignore, through their own misconduct [emphasis provided by the authors].

Dr Canarelli justified the non-use of coercive measures during therapy by “the need to establish and maintain a trusting relationship with the patient.” The court did not share this reasoning and argued that while therapeutic alliance is of “major importance,” the relationship of trust “is not an end in itself but only a means for patient adherence for the best outcome.”

Dr Canarelli’s conviction was mainly based on the principles of Article 121-3 of the Penal Code (Box). According to the court, a series of faults or acts of negligence occurred that justified her 1-year suspended prison sentence.

This case has spread a feeling of anxiety among French psychiatrists, who are now bound to manage the “dangerousness” of their patients—as if they are able to predict and neutralize any possible dangerous acts that their patients might commit. The case also led to the creation of law 2011-803, on July 5, 2011. The objective of that law is to ensure that “dangerous” psychiatric patients are monitored and attended to.3-5

In particular, this law replaced the “exit test” with “ambulatory care without consent.” In principle, the law enables greater intervention by psychiatric teams. However, it also increases the responsibility of doctors by requiring more transparency (methodology, location where the treatment is administered, frequency of visits or consultations, etc) and obligates them to notify authorities if the patient does not adequately follow the therapeutic program. In this new, legally binding context, French psychiatrists now justifiably believe that lawsuits against them will become more frequent.

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References

References

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.

 
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