## Facts

- Gerald Stepakoff was treated by psychiatrist Dr. William G. Kantar from November 1973 until Gerald’s death by suicide on or about February 16, 1975.
- Dr. Kantar diagnosed Gerald as a manic-depressive psychotic and considered him potentially suicidal, but believed Gerald was less likely to take decisive action and had agreed to contact Dr. Kantar if suicidal.
- In 1974 and early 1975, Gerald and his wife Helen Stepakoff experienced marital difficulties; on February 13, 1975, Helen left for Florida after telling Gerald to be out of the house when she returned.
- Around the time of the suicide, Dr. Kantar arranged coverage during his vacation, planned periodic contact with Gerald, and met with Gerald and the covering psychiatrist to consider possible involuntary hospitalization; Gerald assured both psychiatrists he did not intend to commit suicide.
- Helen Stepakoff, as executrix, sued Dr. Kantar for psychiatric malpractice, alleging negligent failure to warn her of suicide risk and to arrange protection, seeking damages for (1) Gerald’s conscious suffering and (2) wrongful death.
- At trial, the judge directed a verdict for Dr. Kantar on conscious suffering; the jury found for Dr. Kantar on wrongful death; judgment entered for Dr. Kantar on both counts.

## Issues

1. Whether the trial judge erred by refusing to instruct that a psychiatrist who knows or should know a patient is likely to self-harm has a duty to take reasonable precautions to prevent that harm.
2. Whether the trial judge erred by refusing to instruct on the psychiatrist’s statutory authority to pursue involuntary hospitalization.
3. Whether the jury instructions improperly stated or heightened the plaintiff’s burden of proof.
4. Whether directing a verdict for the defendant on the conscious-suffering claim was error.

## Decision

- Judgment for Dr. Kantar affirmed.
- The general professional-malpractice instructions adequately conveyed the applicable duty and standard of care; the judge was not required to use the plaintiff’s proposed, suicide-specific phrasing.
- Refusal to give a separate instruction on statutory involuntary-commitment authority was not reversible error because the statute did not itself define the standard of care and the issue fit within the malpractice framework and expert testimony.
- Considering the charge as a whole, the jury was properly instructed on the preponderance-of-the-evidence standard; any imprecision did not warrant reversal.
- The directed verdict on conscious suffering was proper due to insufficient evidence that any compensable conscious suffering was caused by negligent treatment rather than by the underlying illness and circumstances.

## Legal Principles

- Psychiatric malpractice is governed by ordinary professional-negligence standards: the defendant must exercise the degree of care and skill of the average qualified practitioner in similar circumstances, typically evaluated through expert testimony.
- A trial judge need not give a requested instruction in the requested words when the substance of the law is fairly and adequately covered by the charge as given.
- Statutory authorization to seek involuntary hospitalization provides a lawful option but does not, by itself, establish the professional standard of care or require a separate jury instruction when general malpractice instructions cover the point.
- Civil plaintiffs must prove malpractice and causation by a preponderance of the evidence; appellate review assesses challenged instructions in context of the full charge.
- A conscious-suffering claim requires evidence permitting a non-speculative finding that the decedent experienced conscious pain or suffering attributable to the defendant’s negligence before death.

## Conclusion

The court affirmed verdicts for the psychiatrist, holding that general malpractice instructions sufficiently framed the jury’s task in a patient-suicide case, no separate instruction on involuntary-commitment authority was required, the burden-of-proof charge was adequate when read as a whole, and the evidence did not support sending the conscious-suffering claim to the jury.


Stepakoff v. Kantar, 393 Mass. 836, 473 N.E.2d 1131 (Mass. 1985)