Psychiatr News March 2, 2007
Volume 42, Number 5, page 32
© 2007 American Psychiatric Association
20 Surefire Steps to Increase Risk of Malpractice Suit or Board Complaint
The staff at PRMS, manager of the APA-endorsed Psychiatrists'
Professional Liability Insurance Program, has developed the following list of
behaviors or actions that tend to increase a psychiatrist's risk of being
sued.
Nobody enters medical practice planning to be the subject of a malpractice
lawsuit or a board complaint. Most psychiatrists are simply trying their best
to provide quality patient care, improve revenue streams, and reduce paperwork
under difficult, even hostile, circumstances. Unhappily, the compromises made
while juggling these goals can increase psychiatrists' professional liability
exposure.
Claims examiners and risk managers who review complaints and lawsuits
against clinicians often take note of certain behaviors that increase
clinicians' professional liability risk. The following list, gleaned from
actual cases, increases psychiatrists' risk of a malpractice lawsuit or a
board complaint. While the list is not inclusive, it points out many common
traps into which psychiatrists can fall.
- Documenting only the first suicidal risk assessment done on a patient and
failing to document ongoing monitoring and evaluation of suicidality.
- Allowing a patient with suicidal behaviors to be lost to follow-up.
- Neglecting to document the clinical basis for ordering a change in the
level of patient supervision and/or level of care for a patient with suicidal
behaviors.
- Not responding at all (even appropriately within professional standards) to
family members who call with concerns about a patient with suicidal behaviors
because there is no authorization from the patient to release treatment
information to family members.
- Failing to evaluate the safety of the environment for a patient with
suicidal behaviors, for example, accessibility of firearms and other
weapons.
- Failing to warn a third party (or take alternative appropriate steps) when
a dangerous patient has identified the party as a potential victim, as allowed
or required by law.
- Thinking that the other clinician in a collaborative treatment (shared or
split treatment) relationship will know what patient information is important
to discuss with the psychiatrist and when to call without ever having had an
agreement or discussion about these expectation with the other clinician.
- Prescribing lithium without conducting regular tests of lithium and
electrolyte levels.
- Prescribing psychotropic medications without going through the
informed-consent process (and documenting it), especially when prescribing
off-label for children.
- Failing to document what medications have been ordered, the basis for
prescribing the medications, and changes to medications.
- Sending a patient's overdue bill straight to collections without reviewing
the chart and speaking to the patient about it.
- Assuming that the patient will be grateful and therefore not sue for
providing care that falls below the standard of care, because the psychiatrist
believes he or she is helping by providing at least minimal care since the
patient cannot sufficiently pay for services.
- Allowing patients to pay for services by doing personal tasks such as
mowing the clinician's lawn, washing his or her car, painting the house, and
babysitting.
- Failing to conduct a thorough neurological evaluation on a patient who
presents with decreased level of consciousness or an altered mental state or
who falls during hospitalization.
- Ignoring steps in the clinician-patient termination process.
- Summarily terminating treatment with a patient who is in crisis (for
example, a patient assessed to be a danger to self or others), believing this
will decrease potential malpractice risk in the event of an adverse clinical
outcome.
- Assuming that clinical rationale and professional judgment, which are the
basis for the patient's treatment plan, do not need to be documented in the
patient record.
- Ignoring a subpoena to provide patient records or to testify because of
uncertainty about the proper response; or, conversely, releasing the patient's
record immediately after being subpoenaed.
- Deciding not to establish a record for a patient who has very sensitive
issues to discuss in treatment.
- Altering a patient record after an adverse event.
- Becoming involved in a sexual relationship with a patient.
This column is provided by PRMS, manager of the Psychiatrists'
Program, for the benefit of APA members. More information about the Program is
available by visiting its Web site at
<www.psychprogram.com>;
calling (800) 245-3333, ext. 389; or sending an e-mail to The
Program{at}prms.com.
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American Psychiatric Association.
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