Conviction of French psychiatrist no cause for alarm for U.S. psychiatrists

Recently, French psychiatrist Daniele Canarelli was convicted of manslaughter for failing to protect the public from a seriously ill patient who went on to kill an elderly man with an ax.

The patient had a history of involuntary admissions for increasingly dangerous behavior, and had eloped from a consultation with Dr. Canarelli 20 days before the offense. Although Dr. Canarelli notified the police about the elopement and the potential risk, the French court criticized the doctor for failing to refer the patient to another medical team and alleged that she was “blind” to the risk he represented.

She was given a 1-year suspended prison sentence and fined 8,500 euros, or about $11,000. The victim’s son was pleased with the outcome and hoped the case would set a precedent. The French state psychiatrist’s union protested the action and called it a “dark day” for clinicians.

Here in the United States, clinicians and patients alike expressed concern that the case would lead to harsher treatment of the mentally ill and an increase in civil commitments. Others felt that the case might lead to a new wave of criminalization of psychiatry similar to laws passed for boundary violations or mandatory reporting of child abuse.

Presently, 39 states have made failure to report child abuse a misdemeanor criminal offense, and many have laws that criminalize sexual contact between patients and therapists. While most states have Tarasoff laws that impose a duty to protect or warn third parties when a patient is dangerous, to date no states have created any criminal penalties for failure to carry out this duty.

The conviction of Michael Jackson’s physician notwithstanding, here in the United States, very few physicians are ever criminally prosecuted for clinical care. This is because the level of culpability, or the required mental state, for a criminal conviction is higher than that required for civil liability. In order to be guilty of criminal negligence, the behavior must show that the defendant deliberately disregarded a significant risk of serious injury to another. Drunk driving is a typical example of criminally negligent behavior, and a drunk driver could be prosecuted if someone dies as a result.

In order for a physician to be guilty of criminal negligence, the doctor must have been aware that a risk of harm existed and have deliberately ignored the risk. Most malpractice claims are based on a lower level of culpability than that and typically do not involve an intent to cause harm. Mere carelessness is not a criminal act.

In America, the distinction between carelessness and intentional harm is maintained by our two separate criminal and civil procedures with their differing levels of proof. A criminal conviction requires proof beyond a reasonable doubt, while civil liability only requires proof by a preponderance of the evidence. This is why O.J. Simpson could be acquitted of murder but found civilly liable for the killing in a separate hearing.

The French legal system co-mingles civil and criminal procedures, and the alleged victim plays a larger role. While the decision to prosecute a case lies with the state’s attorney in America, in France, an alleged victim has the opportunity to appeal a decision not to pursue criminal charges. French criminal procedure is a non-adversarial system in which the judge or magistrate acts as a lead investigator, and both the defense and the prosecution act in support of that role. The goal is to seek the truth, for the benefit of the victim.

French victims also have a higher level involvement in criminal proceedings than American victims. Under the Federal Crime Control Act of 1990, American victims have a right to receive notice of the trial and the trial outcome, and to be present at trial. However, victims cannot call witnesses or compel the production of evidence, and they have no right to testify.

While the facts or the Canarelli case are not publicly known, it’s possible that what started out as a civil matter was later determined by the magistrate to be more serious than that, once the investigation was complete.

As a forensic psychiatrist working in corrections, I have a reason to be concerned about new liability risks related to dangerous patients. However, I do not see the Canarelli case as a cause for alarm.

DR. ANNETTE HANSON is a forensic psychiatrist and co-author of Shrink Rap: Three Psychiatrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.

Recently, French psychiatrist Daniele Canarelli was convicted of manslaughter for failing to protect the public from a seriously ill patient who went on to kill an elderly man with an ax.

The patient had a history of involuntary admissions for increasingly dangerous behavior, and had eloped from a consultation with Dr. Canarelli 20 days before the offense. Although Dr. Canarelli notified the police about the elopement and the potential risk, the French court criticized the doctor for failing to refer the patient to another medical team and alleged that she was “blind” to the risk he represented.

She was given a 1-year suspended prison sentence and fined 8,500 euros, or about $11,000. The victim’s son was pleased with the outcome and hoped the case would set a precedent. The French state psychiatrist’s union protested the action and called it a “dark day” for clinicians.

Here in the United States, clinicians and patients alike expressed concern that the case would lead to harsher treatment of the mentally ill and an increase in civil commitments. Others felt that the case might lead to a new wave of criminalization of psychiatry similar to laws passed for boundary violations or mandatory reporting of child abuse.

Presently, 39 states have made failure to report child abuse a misdemeanor criminal offense, and many have laws that criminalize sexual contact between patients and therapists. While most states have Tarasoff laws that impose a duty to protect or warn third parties when a patient is dangerous, to date no states have created any criminal penalties for failure to carry out this duty.

The conviction of Michael Jackson’s physician notwithstanding, here in the United States, very few physicians are ever criminally prosecuted for clinical care. This is because the level of culpability, or the required mental state, for a criminal conviction is higher than that required for civil liability. In order to be guilty of criminal negligence, the behavior must show that the defendant deliberately disregarded a significant risk of serious injury to another. Drunk driving is a typical example of criminally negligent behavior, and a drunk driver could be prosecuted if someone dies as a result.

In order for a physician to be guilty of criminal negligence, the doctor must have been aware that a risk of harm existed and have deliberately ignored the risk. Most malpractice claims are based on a lower level of culpability than that and typically do not involve an intent to cause harm. Mere carelessness is not a criminal act.

In America, the distinction between carelessness and intentional harm is maintained by our two separate criminal and civil procedures with their differing levels of proof. A criminal conviction requires proof beyond a reasonable doubt, while civil liability only requires proof by a preponderance of the evidence. This is why O.J. Simpson could be acquitted of murder but found civilly liable for the killing in a separate hearing.

The French legal system co-mingles civil and criminal procedures, and the alleged victim plays a larger role. While the decision to prosecute a case lies with the state’s attorney in America, in France, an alleged victim has the opportunity to appeal a decision not to pursue criminal charges. French criminal procedure is a non-adversarial system in which the judge or magistrate acts as a lead investigator, and both the defense and the prosecution act in support of that role. The goal is to seek the truth, for the benefit of the victim.

French victims also have a higher level involvement in criminal proceedings than American victims. Under the Federal Crime Control Act of 1990, American victims have a right to receive notice of the trial and the trial outcome, and to be present at trial. However, victims cannot call witnesses or compel the production of evidence, and they have no right to testify.

While the facts or the Canarelli case are not publicly known, it’s possible that what started out as a civil matter was later determined by the magistrate to be more serious than that, once the investigation was complete.

As a forensic psychiatrist working in corrections, I have a reason to be concerned about new liability risks related to dangerous patients. However, I do not see the Canarelli case as a cause for alarm.

DR. ANNETTE HANSON is a forensic psychiatrist and co-author of Shrink Rap: Three Psychiatrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.

Recently, French psychiatrist Daniele Canarelli was convicted of manslaughter for failing to protect the public from a seriously ill patient who went on to kill an elderly man with an ax.

The patient had a history of involuntary admissions for increasingly dangerous behavior, and had eloped from a consultation with Dr. Canarelli 20 days before the offense. Although Dr. Canarelli notified the police about the elopement and the potential risk, the French court criticized the doctor for failing to refer the patient to another medical team and alleged that she was “blind” to the risk he represented.

She was given a 1-year suspended prison sentence and fined 8,500 euros, or about $11,000. The victim’s son was pleased with the outcome and hoped the case would set a precedent. The French state psychiatrist’s union protested the action and called it a “dark day” for clinicians.

Here in the United States, clinicians and patients alike expressed concern that the case would lead to harsher treatment of the mentally ill and an increase in civil commitments. Others felt that the case might lead to a new wave of criminalization of psychiatry similar to laws passed for boundary violations or mandatory reporting of child abuse.

Presently, 39 states have made failure to report child abuse a misdemeanor criminal offense, and many have laws that criminalize sexual contact between patients and therapists. While most states have Tarasoff laws that impose a duty to protect or warn third parties when a patient is dangerous, to date no states have created any criminal penalties for failure to carry out this duty.

The conviction of Michael Jackson’s physician notwithstanding, here in the United States, very few physicians are ever criminally prosecuted for clinical care. This is because the level of culpability, or the required mental state, for a criminal conviction is higher than that required for civil liability. In order to be guilty of criminal negligence, the behavior must show that the defendant deliberately disregarded a significant risk of serious injury to another. Drunk driving is a typical example of criminally negligent behavior, and a drunk driver could be prosecuted if someone dies as a result.

In order for a physician to be guilty of criminal negligence, the doctor must have been aware that a risk of harm existed and have deliberately ignored the risk. Most malpractice claims are based on a lower level of culpability than that and typically do not involve an intent to cause harm. Mere carelessness is not a criminal act.

In America, the distinction between carelessness and intentional harm is maintained by our two separate criminal and civil procedures with their differing levels of proof. A criminal conviction requires proof beyond a reasonable doubt, while civil liability only requires proof by a preponderance of the evidence. This is why O.J. Simpson could be acquitted of murder but found civilly liable for the killing in a separate hearing.

The French legal system co-mingles civil and criminal procedures, and the alleged victim plays a larger role. While the decision to prosecute a case lies with the state’s attorney in America, in France, an alleged victim has the opportunity to appeal a decision not to pursue criminal charges. French criminal procedure is a non-adversarial system in which the judge or magistrate acts as a lead investigator, and both the defense and the prosecution act in support of that role. The goal is to seek the truth, for the benefit of the victim.

French victims also have a higher level involvement in criminal proceedings than American victims. Under the Federal Crime Control Act of 1990, American victims have a right to receive notice of the trial and the trial outcome, and to be present at trial. However, victims cannot call witnesses or compel the production of evidence, and they have no right to testify.

While the facts or the Canarelli case are not publicly known, it’s possible that what started out as a civil matter was later determined by the magistrate to be more serious than that, once the investigation was complete.

As a forensic psychiatrist working in corrections, I have a reason to be concerned about new liability risks related to dangerous patients. However, I do not see the Canarelli case as a cause for alarm.

DR. ANNETTE HANSON is a forensic psychiatrist and co-author of Shrink Rap: Three Psychiatrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.