20 Surefire Steps to Increase Risk of Malpractice Suit or Board Complaint
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.
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Documenting only the first suicidal risk assessment done on a patient and failing to document ongoing monitoring and evaluation of suicidality.
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Allowing a patient with suicidal behaviors to be lost to follow-up.
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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.
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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.
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Failing to evaluate the safety of the environment for a patient with suicidal behaviors, for example, accessibility of firearms and other weapons.
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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.
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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.
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Prescribing lithium without conducting regular tests of lithium and electrolyte levels.
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Prescribing psychotropic medications without going through the informed-consent process (and documenting it), especially when prescribing off-label for children.
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Failing to document what medications have been ordered, the basis for prescribing the medications, and changes to medications.
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Sending a patient's overdue bill straight to collections without reviewing the chart and speaking to the patient about it.
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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.
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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.
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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.
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Ignoring steps in the clinician-patient termination process.
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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.
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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.
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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.
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Deciding not to establish a record for a patient who has very sensitive issues to discuss in treatment.
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Altering a patient record after an adverse event.
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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 [email protected].▪
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Published online: 2 March 2007
Published in print: March 2, 2007
Notes
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.
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