Girl who died in hospital ‘should have been watched at all times', inquest hears
Ruth Szymankiewicz was being treated for an eating disorder at Huntercombe Hospital in Berkshire and had been placed under strict one-to-one observation when on February 12 2022 she was able to shut herself in her bedroom alone for 15 minutes, a jury inquest held at Buckinghamshire Coroner's Court heard on Tuesday.
The 14-year-old girl self-harmed and died two days later at John Radcliffe Hospital in Oxford.
It later emerged the member of staff responsible for watching Ruth at the hospital's psychiatric intensive care unit – a man then known as Ebo Acheampong – had been using false identity documents and was hired under a false name.
The teenager was last captured on CCTV walking out of the ward's day room 'completely on her own' before going straight to her bedroom and closing the door behind her, coroner Ian Wade KC told the hearing.
Jurors were shown the footage in which 15 minutes pass before a nurse opens the door, then covers her mouth in what appears to be an expression of shock.
Ellesha Brannigan, who worked as a clinical team leader on the ward, told the court on Tuesday she ran to Ruth's bedroom after the alarm was raised and found the teenage girl lying unconscious.
'She was just still,' Ms Brannigan said, adding the teenage girl was not breathing and staff initiated chest compressions in an attempt to revive her.
About a week prior, Ruth's care plan had been escalated to 'level three observation' after a similar self-harming incident, Ms Brannigan told the court.
'Level three observation is within eyesight at all times,' she told the hearing.
Staff members would take turns watching Ruth for 60 minutes at a time, the inquest heard.
Ms Brannigan further told the inquest 'level two observation' would have still required a member of staff check on the patient 'every five or 10 minutes'.
Asked by the coroner if there were circumstances in which a member of staff responsible for a level three observation could take their eyes off the patient, she replied: 'No.
'If they (the patient) are prescribed level three observation, you must comply with what is prescribed.'
The coroner previously said Mr Acheampong will not be giving evidence at the inquest as he fled the UK for Ghana shortly after Ruth's death.
The inquest continues.
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The reason that it is a doozy is that it lays out violations and penalties for AI that provides unfettered therapy and psychotherapy services. The implication is that any generic generative AI, such as the popular ones I noted earlier, is now subject to potential legal troubles. Admittedly, the legal troubles right now would seemingly be confined to aspects of or within Illinois, since this is a state law and not a broader federal law. Nonetheless, in theory, the use of generic generative AI by users in Illinois that, by happenstance, provides therapy or psychotherapeutic advice is presumably within the scope of getting dinged by the new law. You can bet your bottom dollar that similar new laws are going to be popping up in many other states. The clock is ticking. And the odds are that this type of legislation will also spur action in the U.S. Congress and potentially lead to federal laws of a like nature. 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It would be usurping the cash cow, or like capping an oil well that is gushing out liquid gold. One aspect that the AI makers have already undertaken is to emphasize in their online licensing agreements that users aren't supposed to use the AI for mental health advice, see my coverage at the link here. The aim is that by telling users not to use the AI in this manner, perhaps the AI maker can shield itself from adverse exposure. The thing is, despite the warnings, the AI makers often do whatever they can to essentially encourage or support the use of their AI for this claimed-to-be don't use capacity. Some would insist this is a wink-wink of trying to play both sides of the gambit at the same time, see my discussion at the link here. The Services Question My commentary on these sobering matters is merely a layman's viewpoint. Make sure to consult with your attorney to garner any legal ramifications pertaining to your situation and any potential legal entanglements regarding AI and mental health. Let's take a look at the Illinois law that was recently passed. According to the Wellness and Oversight for Psychological Resources Act, known as HB1806, these two elements are a core consideration (excerpts): Regarding the use of unregulated AI in this realm, a crucial statement about AI usage for mental health purposes is stated this way in the Act (excerpt): There are varying ways to interpret this wording. One interpretation is that if an AI maker has a generic generative AI that also happens to provide mental health advice, and if this is taking place without the supervision of a licensed professional, and this occurs in Illinois, the AI maker is seemingly in violation of this law. The AI maker might not even be advertising that their AI can be used that way, but all it takes is for the AI to act in such a manner (since it provides or offers as such). Generic AI Versus Purpose-Built AI Closely observe that the new law stipulates that the scope involves 'therapy or psychotherapy services'. This brings us back to my opening question: Before we unpack the thorny issue, I'd like to clarify something about the topic of AI for mental health. You might have noticed that I referred to generic generative AI. What does the word 'generic' mean in this context? Let me explain. Well, first, there are customized generative AI systems and AI-based apps that are devised specifically to carry out mental health activities. Those are specially built for that purpose. It is the obvious and clear-cut intent of the AI developer that they want their AI to be used that way, including that they are likely to advertise and promote the AI for said usage. See my coverage on such purpose-built AI for mental health at the link here and the link here. In contrast, there is generic generative AI that just so happens to have a capability that encompasses providing mental health advisement. Generic generative AI is intended to answer all kinds of questions and delve into just about any topic under the sun. The AI wasn't especially tuned or customized to support mental health guidance. It just happens to be able to do so. I am focusing here on the generic generative AI aspects. The custom-built AI entails somewhat similar concerns but has its own distinct considerations. I'll be going into those facets in an upcoming posting, so be on the watch. Definitions And Meaning Are Crucial An AI maker might claim that they aren't offering therapy or psychotherapy services and that their generic generative AI has nothing to do with therapy or psychotherapy services. It is merely AI that interacts with people on a wide variety of topics. Period, end of story. The likely retort is that if your AI is giving out mental health advice, it falls within the rubric of therapy and psychotherapy services (attorneys will have a field day on this). Thus, trying to dodge the law by being sneaky about wording isn't going to get you off the hook. If it walks like a duck and quacks like a duck, by gosh, it surely is a duck. One angle on this disparity or dispute would be to nail down what the meaning and scope of therapy and psychotherapy encompass. Before we look at what the Illinois law says, it is useful to consider definitions from a variety of informed sources. Definitions At Hand According to the online dictionary of the American Psychological Association (APA), therapy and psychotherapy are defined this way: The Mayo Clinic provides this online definition: The National Institute Of Health (NIH) provides this online definition: And, the popular website and publication Psychology Today has this online definition: Interpreting The Meanings Those somewhat informal definitions seem to suggest that the nature of therapy and psychotherapy includes these notable elements: (1) aiding mental health problems, (2) use 'talk' or interactive chatting as a mode of communication, and (3) undertaken by a mental health professional. Let's see what the Illinois law says about therapy and psychotherapy (excerpts per the Act): It is interesting and notable that some carve-outs were made. The scope appears to exclude peer support, along with excluding religious counseling. Contemplating The Matter It might be worthwhile to noodle on how an AI maker might seek to avoid repercussions from their generic generative AI getting caught up in this messy milieu. First, if therapy and psychotherapy were defined as requiring that a mental health professional be involved, this provides an angle of escape. Why so? Oddly enough, an AI maker could simply point out that their AI doesn't employ or otherwise make use of a mental health professional. Therefore, the AI cannot be providing these said services since it fails to incorporate a supposed requirement. Notably, the Illinois law seems not to fall into that trap, since it seems to simply indicate that there are services and does not name that a mental health professional is part and parcel of the definition. Some of the other definitions that I listed would potentially be in a murkier condition due to explicitly mentioning a required role of having a trained professional or other similar verbiage. Second, an AI maker might try to claim that their generic generative AI is more akin to peer support. The beauty there is that since peer support is a carve-out, perhaps their AI is no longer within scope. It would be a tough row to hoe. Peer support stipulates that individuals are involved. At this juncture, we do not genuinely recognize AI as having legal personhood, see my discussion at the link here, and therefore, trying to assert that AI is an 'individual' would be an extraordinary stretch. Third, an AI maker might go the route of claiming that their generic generative AI is a form of religious counseling. The advantage would be that the matter of religious consulting is a carve-out. In that case, if AI were said to be doing religious counseling when providing mental health advice, the AI maker would apparently be free of the constraint. This appears to be a failing strategy for several reasons, including that the AI is presumably not a clergy member, pastoral counselor, or other religious leader (maybe a desperate attempt could be made to anoint the AI in that fashion, but this would seem readily overturned). Caught In A Web Other potential dodges or efforts to skirt the coming set of laws will indubitably be a keen topic for legal beagles and legal scholars. If an AI maker doesn't find a viable workaround, they are going to be subject to various fines and penalties. Those could add up. For example, Illinois has a population of approximately twelve million people. Of those, suppose that half are using generic generative AI (that's a wild guess), and that half of those use the AI for mental health aspects from time to time (another wild guess). That would be three million people, and each time they use the AI for that purpose might be construed as a violation. If each person does so once per week, that's twelve million violations in a month. The Illinois law says that each violation is up to a maximum fine of $10,000. We'll imagine that instead of the maximum, an AI maker gets fined a modest $1,000 per violation. In one month, based on this spitball conjecture, that could be $12 billion in fines. Even the richest tech firms are going to pay attention to that kind of fine. Plus, once other states go the same route, you can multiply this by bigger numbers for each of the additional states and how they opt to penalize AI that goes over the line. Crucial Juncture At Hand An ongoing and vociferously heated debate concerns whether the use of generic generative AI for mental health advisement on a population-level basis is going to be a positive outcome or a negative outcome for society. If that kind of AI can do a proper job on this monumental task, then the world will be a lot better off. You see, many people cannot otherwise afford or gain access to human therapists, but access to generic generative AI is generally plentiful in comparison. It could be that such AI will greatly benefit the mental status of humankind. A dour counterargument is that such AI might be the worst destroyer of mental health in the history of humanity. See my analysis of the potential widespread impacts at the link here. So far, AI makers have generally had free rein with their generic generative AI. It seems that the proverbial rooster has finally headed home to roost. Gradually, new laws are going to be enacted that seek to prohibit generic generative AI from dispensing mental health advice that is absent of a human therapist performing counseling. Get yourself primed and ready for quite a royal battle that might determine the future mental status of us all.
