"If psychiatrists studied all the new trends in risk
management, they wouldn't have the time to do anything else."
This remark was overheard during the 2004 American Psychiatric
Association Annual Meeting in New York, spoken by a doctor who had not
yet heard of the workshop intended for busy psychiatrists like him:
Risk Management Issues in Psychiatric Practices, held on May 3, 2004.
This workshop, presented by The Psychiatrists' Program, the APA-endorsed
Professional Liability Insurance Program managed by PRMS, is an annual
feature during the conference. However, no two workshops are the same;
each year the speakers update the material to reflect emerging trends
and recent case law.
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Limiting
Your Risks When Prescribing SSRIs
-
Psychiatric News, October 2004
Psychiatrists
Advised on Ways To Avoid Legal Quicksand
- Psychiatric
News, June 2004
Courts
Interpret Boundaries Of HIPAA Privacy Rule
Donna Vanderpool, J.D., M.B.A.
-
Psychiatric News, May 2004
Patient-Safety
Strategies Can Reduce Suicide Risk
Jacqueline M. Melonas, J.D., R.N., M.S.
-
Psychiatric News, April 2004
Use
of S&R: Patient Safety, Risk Management Considerations
Donna Vanderpool, J.D., M.B.A.
-
Psychiatric News, March 2004
PRMS
Assistant Vice President Simplifies HIPAA at AOOP Conference
- PRMS, January 2004
by Ken Hausman, Psychiatric
News, 38, 13, (2003).
Workers’ Comp Cases Raise Complex Privacy Issues
- Psychiatric News, Nov. 2003
Here
Are Ways You Can Put Safety First
- Psychiatric News, Nov. 2003
Treating
BPD Patients Raises Risk Of Ending Up in Courtroom
- Psychiatric News, Aug. 2003
Psychiatrists
Can Minimize Malpractice-Suit Anxiety
- Psychiatric News, Aug. 2003
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Moderating the 2004 workshop was Alan I. Levenson, MD.
The speakers came from both legal and clinical backgrounds: Martin G.
Tracy JD, ARM, Ellen Fischbein MD, Jacqueline Melonas RN, MS, JD, and
David Cash, JD, LLM. About forty attendees came to listen to the speakers
and to ask their own questions.
To maintain close contact with psychiatrists and monitor
their concerns, The Program's risk managers field over 2,300 calls each
year to the Risk Management Consultation Service (RMCS) helpline. "RMCS
is a risk management reality show: it shows us what's going on here
and now in psychiatrists' practices," said Ms. Melonas, Vice President
of Risk Management. According to these calls, the topics on the minds
of psychiatrists have been patient suicide, treatment of the elderly,
and medication issues.
A top issue among RMCS callers this past year was
patient suicide, which also accounts for one of the most frequent claims
against psychiatrists. During the seminar, Dr. Fischbein noted the scary
truth that even the most knowledgeable psychiatrist cannot predict which
patients will or will not commit suicide.
"Psychiatrists don't have all the answers. Families
of patients want psychiatrists to be able to know for sure if a patient
will or will not commit suicide. We don't," said Dr. Fischbein.
While predicting patient suicide does not lie within the
standard of care, foreseeability does. Ms. Melonas described foreseeability
as "the reasonable expectation that acts or omissions would cause
injury; and based on information available, should the clinician have
known, for example, that not performing a suicide assessment creates
a foreseeable risk of injury to a patient? And if known, did the clinician
take sufficient actions?"
Dr. Fischbein spoke about the hard decisions psychiatrists
face when dealing with a potential patient suicide. "How do you
handle a patient? When you do hospitalize? When do you not? There is
a fine line between overreacting and not," she said. "Be sure
to work with the patient, make them part of the solution. And then be
available for additional support."
Risk managers have been monitoring trends in the
treatment of geriatric patients. This area poses a special risk: due
to an aging population and sympathetic juries, some malpractice carriers
report increased claims regarding treatment of geriatric patients.
Geriatric patients have a disproportionately high suicide
rate. While the general population has a suicide rate of 10.7 per 100,000,
it climbs to 20 per 100,000 for patients over 65, and 60 per 100,000
for patients over 85. Ms. Melonas stressed that psychiatrists do not
have to act alone when treating geriatric patients.
"Don't hesitate to get a second opinion or to consult
someone with a specialty in that area," said Ms. Melonas.
Mr. Cash, a senior risk manager at PRMS, discussed
liability risk concerns regarding psychoactive medications. "Patients
often look for that 'magic pill,' which is just human nature. It can
be difficult for patients to appreciate a non-event - like not attempting
suicide - as a benefit that offsets uncomfortable medication side effects,"
said Mr. Cash.
Recent issues regarding SSRIs, antidepressants and oxycodine
have made psychiatric medication issues a hot topic in the news. Despite
the widespread discussion, Mr. Cash said that it is risky for psychiatrists
to allow societal trends to dictate prescribing methods. Instead, he
urged psychiatrists to keep up with new information, and assess and
monitor patients closely. He also said that the media attention given
to this subject can be a helpful tool to psychiatrists in monitoring
patient concerns.
"By watching the Sunday night news exposés,
doctors can anticipate the questions that their patients might bring
to them that week," Mr. Cash said.
The panel concluded the workshop addressing questions
from the audience. Many audience members expressed concern over professional
liability issues related to technology. Questions covered cyberpsychiatry,
online Canadian pharmacies, and telepsychiatry. The psychiatrists' concerns
demonstrated that psychiatric risk management issues continually evolve
with society.
Upon the workshop's end, attendees received an education
in just how quickly risk management needs can change over time: treatment
of the elderly, off-label use of medications, cyberpsychiatry, online
pharmacies, and other emerging issues affect how mental health professionals
run their practices. This was not the workshop of last year, nor will
it be the workshop of next year, making regular risk management education
a vital concern for psychiatrists. But thanks to The Program's risk
managers, it is not a task they have to handle alone.
