The Ohio Supreme Court, which heard arguments Tuesday, will decide whether those providing mental health services are immune from lawsuits if their patients kill or harm themselves.
The case stems from southwest Ohio, where Bonita Stewart filed a lawsuit after her 30-year-old son Justin hanged himself with a sheet in his cell at the Warren County Jail. Her son had been arrested for not complying with mental health treatment, a condition of his probation.
The lawsuit – filed against the county and its jail's health services provider Solutions Community Counseling and Recovery Centers – claimed that the jail failed to properly supervise Justin and provide him mental health care despite him clearly needing it.
Solutions Community said the lawsuit has no grounds under a 2014 Ohio law, which lawmakers had passed in response to a prior court decision. Lawmakers disagreed then with the idea that therapists and others were completely responsible for patients' violent tendencies.
Instead, the 2014 law gives mental health workers and organizations immunity from liability and disciplinary action, unless they knew of "an explicit threat" that could harm "one or more clearly identifiable potential victims" and failed to take action to stop it.
The arguments
Solutions Community argued that "victims" can include oneself, and that is consistent with the intention of relieving mental health professionals from a "duty to predict."
"When a mental health patient or client commits suicide, that person becomes a suicide victim," said the organization's attorneys.
Solutions Community brought up the scenario where if a school shooter killed children then later committed suicide, a mental health service could be held liable to the shooter's estate but not the children's. That would be absurd, it added.
The mental health provider also noted that Justin Stewart never told people that he was going to kill himself, so there was no explicit threat.
But a lower court ruled in favor of the Stewart family that there is no immunity for suicide cases, explaining that the court case overturned by the 2014 law only applied to harm against other people. Furthermore, the 2014 law categorized the person making the threat and victims of the threat as two different people.
"If the General Assembly had intended to confer immunity upon mental health professionals or organizations in cases involving self-harm, it could have easily done so by including it in the statute," said the lower court.
In response to the claim that Justin made no threats, the Stewart family alleged the lack of checkups on him and negligent care, which are details to be hashed out if the courts let the lawsuit proceed.
What justices thought
During arguments, some justices questioned comments that it's problematic to have two different standards for murders and suicides.
"If there is a problem about an inequality or two different standards... the legislature can take care of that by explicitly amending this statute. Can they not?" asked Chief Justice Maureen O'Connor.
Justice Pat Fischer asked whether the law really said victims can't be a patient committing suicide, noting the law does point out "one or more" victims. That "one" could be the suicide victim.
Multiple justices questioned whether they should be hearing the case, asking if there was even the technical grounds to immediately appeal the case without a final decision or order from the trial court.
Justice Jennifer Brunner and others also tried to parse out differences between care in an institutional setting, such as a jail, versus an outpatient setting.
While opponents of medical liability say it's costly and discourages people from providing health services, a decision granting immunity would lead to more jail suicides and less accountability, according to the Cincinnati Black United Front and other advocacy groups.
"People in jail are more than three times as likely than their non-incarcerated counterparts to die by suicide," the groups said in a filing. "This failure is driven by the structure of correctional mental health systems, which is plagued by perverse incentives, market failures and accountability gaps."
A decision could take four to six months.
Titus Wu is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.
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