Medical Malpractice Insurance for Psychiatrists
According to Psychiatrists' Purchasing Group-a non-profit organization-psychiatrists consider the following factors when selecting professional liability insurance (3):
- Competence of Counsel
- Access to Attorneys for Pre-Suit Advice
- Consent to Settle
- Company Reputation and Financial Strength
- Understandable Policy Language
- Coverage Designed for Psychiatrists
- High Quality Customer Service
Psychiatrists looking for medical malpractice insurance should consider these factors as well as premium cost when choosing a carrier. Premiums will be higher in litigious states like Florida, Illinois and New York; lower in less litigious states like Idaho and Minnesota. In order to ensure that premiums remain stable, psychiatrists should support the efforts of interest groups and politicians to advance tort reform efforts around the country.
Medical malpractice in psychiatry is a delicate issue. Lawsuits can occur in response to alleged negligence in any of several areas. When prescribing medication, psychiatrists should be careful to avoid actions that may be deemed negligent. In order to prescribe responsibly, doctors should be sure to see patients frequently enough to provide good care, follow trends in the industry, seek help and second opinions when necessary, pay careful attention to dosages and never prescribe to someone who is not a patient. (1)
The most common source of malpractice suits brought against psychiatrists is patient suicide. It is very difficult to predict suicide attempts, but there is a standard for assessing the risk of suicide. The psychiatrist can assess risk by conducting a thorough interview with the patient, reviewing past psychiatric records, and learning of specific risk factors through contact with the patient's family. Sometimes it is necessary to arrange for emergency care or hospitalization of a potentially suicidal patient. Even when a patient is not eligible for involuntary hospitalization, it may still be prudent to consider partial hospitalization or intensive outpatient treatment. (1) Risk factors for suicide include expressed intent, mental illness and past suicide attempts, as well as social factors like access to firearms and drug abuse. Psychiatrists should also be sure to scrupulously document the entire treatment process to protect themselves against lawsuits.
In order to further protect themselves against malpractice suits, psychiatrists should understand the implications of the California Supreme Court's 1976 ruling in Tarasoff v. Regemts of the University of California. In this precedent-setting case, the court ruled that doctors and medical professionals have a "duty to protect" a third party individual whom a patient has threatened. This duty can be fulfilled after a threat is made by informing law enforcement, warning the threatened individual or taking some other reasonable and prudent action to protect the individual. The standard established in this ruling has been adopted in most U.S. states (2). All psychiatrists practicing in a Tarasoff jurisdiction should be aware of their responsibilities under the ruling. It can be difficult to understand exactly what the "duty to protect" entails, which individuals require protection and what steps must be taken. It is essential to understand that issuing a Tarasoff warning does not violate in any way the standard of physician-patient confidentiality. Reticence because of confidentiality concerns can be a costly mistake in Tarasoff cases. The industry publication Psychiatric Times (1) recommends taking the following steps if a patient makes a threat against a third party:
- Assess the threat for imminence and likelihood.
- If the threat is determined to be imminent and likely, establish a method of protecting the victim.
- Execute the method of protection.
- Follow up with the method to make sure it was effective.
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