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Tribunal Hears Shin Suit

By Kevin R. Lang

NEWS AND FEATURES DIRECTOR

A Middlesex Superior Court medical malpractice tribunal yesterday heard arguments from both sides in the suit filed by the parents of Elizabeth H. Shin ’02 against MIT and numerous administrators, police, and MIT Medical staff.

The tribunal is expected to rule within the next week whether the malpractice claims are likely to succeed, but Shin family attorney David A. DeLuca noted that the suit would not stop regardless of the outcome.

“It’s certainly not decisive,” DeLuca said.

Attorneys representing MIT Medical mental health doctors Linda L. Cunningham, Peter Reich, Kristine Girard, Lili Gottfried, and Anthony Van Niel responded to claims from the plaintiffs that misdiagnosis and mishandling of Shin’s case ultimately led to her suicide in April 2000.

DeLuca presented three letters from outside mental health experts that Shin’s parents claim show that MIT doctors acted negligently and failed to provide an adequate standard of care. Citing instances where Shin sought care through MIT medical approaching the time of her death, DeLuca said MIT doctors “failed to address what was a very clear need at that time.”

“The best that MIT could do for her at a very critical time ... was provide her with a telephone consultation,” he added.

“That is the sad story,” DeLuca said. “Dr. Cunningham, Dr. Gottfried simply passed her off.”

In his closing statement, DeLuca argued that MIT did not make use of an exception in its privacy policies, based on the Family Educational Rights and Privacy Act, allowing parents to be notified in case of danger to the patient.

“There couldn’t have been a more clear risk,” DeLuca said.

Tribunal questions Shin’s history

The tribunal comprised a medical doctor, a legal expert, and a judge. The legal expert questioned whether Shin sought treatment over the summer of 1999, after having been treated at MIT that spring. DeLuca said that the Shin family relied on MIT Medical doctors’ advice, which did not include a recommendation for additional treatment over the summer.

Regarding Shin’s mental health problems in high school, allegedly resulting from her graduation as salutatorian instead of valedictorian, DeLuca said “her parents were aware that she was upset about that,” but did not know the extent to which the incident troubled Shin as she described it to MIT Medical doctors in 1999.

Outside experts evaluated case

DeLuca’s arguments were largely based on letters from doctors Virginia Wright, director of suicide prevention at the University of Virginia; Bernard Katz, a forensic psychiatrist; and Thomas Gutheil, a Harvard Medical School professor of psychiatry and expert on suicide and psychiatric care.

Attorneys for the MIT doctors claimed that Wright and Katz did not have access to notes from Eleanor Temelini, a social worker who helped coordinate Shin’s care with Cunningham. The MIT attorneys claimed that Gutheil did have these notes, and thus his evaluation of the case was much more favorable toward MIT.

However, in a rebuttal following the defendants’ closing statements, DeLuca said that all three doctors had full access to Temelini’s notes. “That frankly was a very surprising inaccuracy,” DeLuca said. “We did indeed provide all the records.”

Attorneys for the defendants could not be reached for comment.

Cunningham’s actions contested

Cunningham, who worked most closely with Shin, gave her “a rather thorough evaluation,” DeLuca said. However, he presented Wright’s argument that “she failed to take any appropriate action that would have kept Elizabeth safe.” Wright cited numerous deviations from the standard of care Shin should have expected, including a failure to provide an adequate support system and discuss the option of medical withdrawal from MIT.

DeLuca also cited Katz’s opinion that Cunningham failed to appreciate the severity of Shin’s case, and that this failure directly contributed to her suicide.

However, Edward T. Hinchey, one of Cunningham’s attorneys, cited counterexamples to many of DeLuca’s arguments. He said that even though Cunningham was only a part-time MIT employee working one day per week as a psychiatrist in the medical department, Shin preferred seeing her on a regular basis rather than another doctor.

In addition, Cunningham sought additional help for Shin, through Associate Dean Arnold R. Henderson, the head of counseling and support services at MIT, to lighten Shin’s courseload in the spring of 2000. Hinchey argued that Shin needed to be kept involved in MIT because she was receiving support from friends and professionals there, but Shin chose not to involve her parents. She also worked with Temelini to coordinate outside care with a behavior-therapy group in Cambridge, which Hinchey called “a premier program from a patient like Ms. Shin.”

As time progressed toward Shin’s April 2000 suicide, Hinchey said, all of the steps were in place to begin intensive treatment. Shin told Cunningham that she was not suicidal, and that she was speaking to her parents despite being afraid of disappointing them. “The care provided by Dr. Cunningham was appropriate,” Hinchey said.

Reich led MIT Medical at time

The claims against Reich allege that as the director of MIT Medical, he was in a position to set policies for his staff that could have given Shin more aggressive treatment that might have prevented her death, DeLuca said. Reich was “in a position to provide that kind of treatment policies and procedures,” he said.

DeLuca also alleged that Reich failed to follow up on Shin when she did not see a staff psychologist in November of 1999. Shin was originally referred directly to Reich, but he subsequently directed her to the staff psychologist.

However, Reich’s attorney noted that Katz saw no negligence for Reich. He also cited precedents in which department heads were not held liable for the negligence of doctors working under them.

Girard’s care called ‘inadequate’

DeLuca said that Wright was particularly critical of Girard, citing “a number of deficiencies” including failure to diagnose, failure to provide adequate treatment, failure to provide continuity of care, failure to follow up, and failure to take protective measures for Shin’s own safety. DeLuca called Girard’s actions “inadequate and irresponsible,” saying that she diagnosed Shin with the same “broad brush” she used to diagnose many other students.

However, John Ryan, Girard’s noted that in Gutheil’s letter, he said Girard provided care within reasonable standards, and Katz did not comment at all on the quality of Girard’s care.

“They affirmatively support Dr. Girard,” Ryan said. He also noted that Girard did not become associate director of MIT Medical until August 2001, making the argument of administrative responsibility irrelevant.

Gottfried saw Shin before suicide

While Cunningham was Shin’s primary contact with MIT Medical, Gottfried had contact with her at a critical time, DeLuca said. He cited Shin’s arrival at MIT Medical on April 4, 2000, when she appeared “almost delusional,” DeLuca said. Gottfried, who was there at the time, met with her for 30 minutes before recommending that she continue treatment with Cunningham.

However, DeLuca said Katz was “extremely critical of Dr. Gottfried’s cursory review of Elizabeth’s condition at that time.” DeLuca claimed that Gottfried did not review her medical records at that time.

Ryan, also Gottfried’s attorney, noted that Gottfried saw Shin on only one occasion as a walk-in patient, that she recommended Shin see Cunningham on April 6, and that Gutheil’s report was supportive of Gottfried’s care.

Discovery ongoing in case

The discovery phase of the case against MIT and non-medical faculty and staff is ongoing, DeLuca said, with depositions continuing.

Shin’s family filed the lawsuit against MIT and its employees on Jan. 28 and indicated their intent to seek damages of $27.65 million. The family alleges that MIT administrators, medical workers, and campus police officers acted with gross negligence and failed to provide adequate care to their daughter.