Not much can excite a response from medical professionals like the topic of medical malpractice and liability. Martin Tracy, JD, ARM understands this frustration, but seeks to allay the fear.
"With the risks involved in practicing psychiatry, you might think, ‘I should’ve become a real estate agent instead.’ No, you should be a psychiatrist. In the spectrum of medical specialties, psychiatry has a relatively low rate of claims,” said Mr. Tracy, president and CEO of Professional Risk Management Services, Inc., manager of The Psychiatrists’ Program.
During the American Psychiatric Association’s 2006 Annual Meeting,
Tracy addressed psychiatrists at a workshop titled, Risk Management Issues in Psychiatric Practice. Joining him at this workshop were fellow professionals in the mental health and legal professions.
Allaying psychiatrists’ liability fears can be a tall order, as some doctors feel overwhelmed and helpless in such a litigious society. The workshop, however, suggested several specific ways to significantly reduce risk. The first was to obtain a professional liability insurer with expertise in the psychiatric field. Mr. Tracy spoke of the benefits of The Psychiatrists’ Program, managed by PRMS. The Program is a professional liability insurer created exclusively for psychiatrists and endorsed by the APA.
"If it can go wrong in psychiatry, we at PRMS have seen it and know how to help psychiatrists with it. Our job is to share that information with you, whether through our web site, Rx for Risk, or other avenues,” said Mr. Tracy.
The next way for psychiatrists to reduce risk is to be aware of their greatest risks, and how to counter them. Regarding liability, Mr. Tracy said that psychiatrists’ fears are often misdirected. While the major concerns are involuntary commitments and confidentiality, these areas do not represent the greatest risk for doctors. Instead, the most frequent cause of claims in psychiatry is patient suicide or an attempted patient suicide. The most damaging claims, however, are those in which the patient does not die but needs long-term care. To effectively reduce the chance of a lawsuit in these or any areas, the speakers stressed that psychiatrists can arm themselves with the greatest weapon possible: The record. Or, to be more precise, the complete record.
What does a complete record include? For starters, Jacqueline Melonas, RN, MS, JD, offered a general guide: “Does this record meet the basic requirements of a medical record? Could another doctor see this record and have enough information to know what’s going on?” (Ms. Melonas serves as vice president of risk management at PRMS.)
Records should include more than what the patient offers; for example, psychiatrists should be diligent in assessing suicidal or homicidal ideation when appropriate, whether or not the patient introduces the topic.
The Information Age brings new considerations for record keeping. The assistant vice president of risk management at PRMS, Donna Vanderpool, MBA, JD, offered words of caution: “New technologies bring new risks.” Electronic recordkeeping creates risks such as security breaches, improper disposal, and theft. Computer entry is also a recent liability risk. Ms. Vanderpool cited a 2003 study (US Pharmacopeia’s 5th Annual Study of Medication Error Reports) in which computer entry was the fourth leading cause of medication errors, consisting of 13% of all errors, versus 2.9% due to handwriting issues.
What happens if a doctor notices that the record is incomplete? Never, ever, change the record, said Mr. Tracy. “Then a case of negligence can become a criminal case – in some states, it’s a crime to alter a record. Defense attorneys say they’ll take an incomplete record over an altered record any day. Once it’s altered, the case is indefensible.”
While liability concerns can seem overwhelming for psychiatrists, the speakers at this APA Annual Meeting workshop reminded the psychiatrists of their power to minimize risk. Armed with an experienced, specialized professional liability insurer and knowledge of complete recordkeeping, psychiatrists can actively and effectively reduce the chance of a lawsuit.
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About PRMS, Inc.
PRMS, Inc., specializes in professional liability insurance, risk management, and loss prevention services. We protect physicians and healthcare professionals and improve patient care through the design, development, and delivery of innovative professional liability insurance programs.
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