| "Medication
is more than writing a prescription. Care must be coordinated."
|
Psychiatric
malpractice lawsuits can give soap operas a run for their money in terms
of complicated and dramatic plots: dangerous secrets, medical mishaps,
incomplete records. To best communicate to psychiatrists the liability
dangers lurking in their field, Professional Risk Management Services,
Inc. presented a risk management workshop at the Annual Meeting of the
American Psychiatric Association in Atlanta, Ga., on May 23, 2005. And
what better way to communicate these risks than through the use of a
case study?
|
-
Eve Bender, Psychiatric News
- Charles D.Cash JD, LLMPRMS
Attends Bronx District Branch Annual MeetingNational
Health Care Risk Management Week 2005
June 2005
Get
to Know Jacqueline Melonas, RN, MS, JD -
May 2005
Limiting
Your Risks When Prescribing SSRIs
- Psychiatric News, October 2004
Psychiatrists
Advised on Ways To Avoid Legal Quicksand
- Psychiatric News, June 2004
Making
Risk Management Manageable: PRMS Seminar Keeps Psychiatrists on
Top of Trends
- PRMS, May 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
- January
2004
|
This
year's workshop focused on the fictional case of Ben, a fifteen-year-old
boy who committed suicide after a month of psychiatric and psychotherapeutic
treatment. The case incorporated issues including custody disputes,
medication, and transfer of care. After presenting the case, panelists
asked the attending psychiatrists what went wrong, then gave advice
on how to handle similar scenarios in their own practices.
The issue of custody complicated Ben's case. While
Ben's mother wanted him to get whatever treatment he needed, Ben's father
did not believe in psychiatry or medicating children. The two were in
the process of a divorce and custody battle at the time of Ben's treatment.
As with all areas of risk management, the panelists stressed the need
for detailed record keeping.
"Document
who has custody. It is not rare for one parent not to believe in psychiatry
while the other does. Keep both parents informed," said Ellen Fischbein,
MD, an APA Assembly Representative from the Connecticut
Psychiatric Society.
Another
area that caused trouble in Ben's case was the transfer of care between
the healthcare providers; in this case, between the psychiatrist, therapist
and pediatrician. Dr. Fischbein commented that in such a case, the psychiatrist
and therapist need to remain in communication with each other. In the
fictional case of Ben, the therapist was aware of a recent traumatic
event that was not communicated to the psychiatrist. She advises psychiatrists
to call their patients' therapists for information not only to do well
by the patient, but also to protect their practice. In Ben's case, the
psychiatrist might also have called the patient's referring pediatrician,
who would have more knowledge of Ben's and his family's history.
"Medication is more than writing a prescription,"
Dr. Fischbein said. "Care must be coordinated."
Medication was another area causing liability concerns
for Ben's psychiatrist. The doctor adjusted the dosage of Ben's antidepressant
without documenting his reasons for the change. The workshop panelists
stressed the need to document the reasoning behind prescribing decisions.
Once a patient has committed suicide, a doctor cannot go back to complete
his or her record keeping without appearing self-serving. In the words
of PRMS President and CEO Martin Tracy, JD, ARM, "that horse has
left the barn. Documentation needs to be completed at the time the treatment
was provided. Once the suicide has occurred, it's no longer a clinical
matter but a legal one."
During discussion of each of these liability risks,
the topic of documentation remained at the forefront. Mr. Tracy emphasized
that "complicated scenarios scream for documentation." He
recalled an analogy published in a behavioral healthcare magazine attributed
to Eric Harris, a behavioral healthcare attorney, that documentation
was like ninth-grade algebra: In that class, if you just show the teacher
your final answer, you're either right or wrong. If you show your work,
however, you can get a lot of partial credit.
"You
can't nail every situation every time," said Tracy. "But if
you show your work, even if you're wrong, you'll get a lot of points."
PRMS national risk management seminars are offered
throughout the year. If you would like more information on future dates,
please visit our Risk
Management Events page.
