Three years after driving his family off a cliff, this radiologist’s charges have been dismissed

In January 2023, Dharmesh Patel, a radiologist from California, allegedly drove his Tesla off a 250-foot coastal cliff on the Pacific Coast Highway with his wife and two young children inside. Against extraordinary odds, everyone survived. ^[]

The decision has reignited debate over how the justice system handles serious crimes committed during acute psychiatric illness—but it also raises uncomfortable questions for physicians about recognizing severe mental illness in colleagues and patients alike.

What happened?

Patel was charged with three counts of attempted murder after investigators concluded the January 2023 crash was intentional. ^[]

The defense presented a very different picture. Psychiatric experts testified that Patel was experiencing episodic major depression with hallucinations and delusions. ^[]

According to court testimony, he believed his children were in imminent danger of being trafficked by kidnappers. 

In 2024, a judge ruled that Patel would undergo California’s mental health diversion program rather than proceed directly to criminal trial. Over the next 2 years, he underwent outpatient treatment supervised by mental health professionals.

“If the person who’s given mental health diversion follows the treatment plan, there’s nothing that can be done and at the end of the two years he gets it wiped out of his record,” said San Mateo County District Attorney Steve Wagstaffe. ^[]

California’s diversion statute allows certain defendants with qualifying mental illnesses to receive treatment instead of criminal prosecution when the illness is judged to have played a significant role in the offense and the individual successfully completes court-ordered treatment.

Why this case matters to physicians

Most physicians will never encounter a case this dramatic. But the underlying clinical themes are surprisingly familiar.

Major depression, or major depressive disorder, is often viewed primarily through the lens of sadness, hopelessness, or suicidality.

Prompt recognition generally requires urgent psychiatric evaluation and aggressive treatment, often involving antidepressants combined with antipsychotics or electroconvulsive therapy in severe cases.

For clinicians outside psychiatry, the challenge is that psychosis may initially present as unusual certainty, bizarre explanations, increasing paranoia, or fixed false beliefs rather than overt behavioral disorganization.

The physician mental health dimension

Physicians themselves are not immune to severe psychiatric illness, of course.

That context makes early recognition by colleagues especially important. Significant personality changes, increasing social withdrawal, paranoid thinking, marked functional decline, or behavior that seems strikingly inconsistent with a physician's baseline deserve attention—not dismissal.

Clinical takeaway

For physicians, several reminders stand out:

• Psychotic depression can present with convincing but profoundly false beliefs that drive dangerous behavior.

• Rapid changes in thinking, new delusions, or paranoid ideation warrant urgent psychiatric assessment.

• Colleagues may be among the first to notice deterioration in a physician’s mental health.

• Encouraging early treatment—and reducing stigma around seeking psychiatric care—may prevent crises long before they become medical, legal, or public tragedies.

The Patel case will likely remain controversial because it sits at the intersection of criminal accountability and psychiatric illness. 

But from a clinical perspective, it reinforces a lesson physicians encounter every day: Severe mental illness can dramatically alter judgment, and recognizing it early may be one of the most important interventions healthcare professionals can make.