A Saskatoon doctor is worried how the long wait times to see a psychiatrist could affect her patients, and is wondering who is liable if a patient dies by suicide while waiting for help.
Dr. Marlys Misfeldt has lost patients to self-harm before — one, several years ago, gave no warning.
“She wasn’t in my office saying, ‘I’m getting really bad,’ or ‘I’m deteriorating,’ ‘I’m struggling,’” Misfeldt told Global News.
“It was our usual conversation, and yet she killed herself.”
She’s worried she or other family doctors could lose more patients. She told Global News, over Zoom, that she had referred one for further treatment 15 months ago and they still haven’t been able to see a psychiatrist.
Many Saskatoon psychiatrists use a pooled referral system, which directs a patient referred from a family physician to the specialist with the shortest wait time.
But there’s a backlog.
Last week, a letter to Misfeldt from the heads of the pool system said more than 300 patients are currently waiting to see a psychiatrist. The letter said the COVID-19 pandemic had created “unprecedented volumes of referrals.”
The week before, the family physician received a different letter, stating a psychiatrist cancelled one patient’s referral.
Misfeldt’s patient who died by suicide did so before the Saskatoon psychiatrists implemented the pooled system, but she worries the wait gives too much time to those whose mental health is deteriorating.
The associate CEO of the Canadian Medical Protective Association (CMPA) told Global News psychiatrists could be liable if a patient harms himself or herself, if they’ve accepted the referral.
“Any kind of medical legal risk would fall to the circle of care that’s been established for that patient,” Dr. Todd Watkins said, speaking over Zoom from Ottawa.
The CMPA is a not-for-profit association that provides legal assistance and advice to member physicians. Parliament passed an Act to incorporate it in 1913.
Speaking generally and not about the specific situation in Saskatoon, Watkins said the onus would likely fall on the primary care physician, unless a psychiatrist failed to triage the referred patient appropriately.
“If the referral has been made and it’s been made on an urgent basis, and that specialist is aware that that patient needs to be seen and didn’t appropriately triage… then they could be drawn into any kind of litigation that may occur as a result,” he said.
He said any system responsible for referring patients could become a party to litigation “that alleges the process didn’t support a proper referral process and a proper triage process,” if survivors of a patient level legal charges.
Watkins also said referring doctors must be clear about the urgency of the request and the receiving doctor must be clear about their ability to take on a new patient and with what timeline.
He said the physician’s governing body, the courts or both would decide the doctor’s liability.
Watkins added that the issue would revolve around the standard of care provided, but the deciding parties in the cause would need to decide what an appropriate standard is during a pandemic.
“This is kind of an unprecedented time and that standard of care is changing,” he said.
Misfeldt said she didn’t worry about liability and only focused on caring for her patients. If any issue arose, she said she would rely on her commitment to treating her patients as her defence.
She said she was determined to keep treating them.
“I think as long as you’ve got that hope… then that might be enough to prevent suicide, but not in every case,” she said.
The Saskatchewan Health Authority, the College of Physicians and Surgeons of Saskatchewan and the Saskatchewan Medical Association declined to comment. The Canadian Psychiatric Association did not respond to a request for comment.
If you or someone you know is in crisis and needs help, resources are available. In case of an emergency, please call 911 for immediate help.
If you are in need of support, you can call Health Link at 811 or the Mental Health Help Line at 1-877-303-2642, available 24 hours a day, seven days a week.
Crisis Services Canada’s toll-free helpline provides 24-7 support at 1-833-456-4566.