Malpractice Rates Higher but Still Low in Psychiatry
Melville, Nancy A., Clinical Psychiatry News
TUCSON, ARIZ. -- Psychiatrists need to stay abreast of the evolving nature of legal responsibilities and patient rights, Dr. Barry Morenz said at a psychopharmacology conference sponsored by the University of Arizona.
About 7%-8% of psychiatrists are typically sued in a given year, and malpractice lawsuits against mental health professionals increased last year by about 10%, said Dr. Morenz of the university
But while the increase in lawsuits was about 40% the year before, there had been no increase for 5 years before that, he noted. And even though the malpractice rates for psychiatrists have increased, they're not nearly as high as other specialties, such as neurosurgery.
Insurance figures from the American Psychiatric Association for 1984-1990 show that about 50% of lawsuits stemmed from treatment-related complaints. Among those, a common complaint was that the medication did not have a desired result. Most of the cases settled with no payment; only 1.5% of cases went to trial and in only two of those cases did the patient prevail, Dr. Morenz said.
Suicide is still the single largest reason why people sue, but about a third of people sue for amorphous patient dissatisfaction reasons in what Dr. Morenz said was a relatively new trend that has emerged over the past few years.
The threat of lawsuits presents moral dilemmas that can be especially gut wrenching for mental health professionals, and can prompt hesitation before acting even on basic human instincts of kindness.
If a patient commits suicide, for instance, mental health professionals may find themselves wondering whether they should apologize, offer condolences to the family, or attend the funeral. he suggested that erring on the side of kindness is justified.
"These are tough questions," Dr. Morenz said. "Lawyers will tell you not to do those things, but humanity ethics dictate that you should approach the family."
Dr. Morenz predicted that families would respond positively to such efforts, and he described a case at his hospital in which the psychiatrist reached out to the family by making himself available to them in every way.
"The family responded with great appreciation for being offered help in understanding what had happened to the patient," he said.
Legal guidelines in other areas of prescriptive medicine are not as ambiguous, however, and psychiatrists need to keep them in mind to avoid making themselves vulnerable to litigation.
In underscoring the importance of making patients aware that medications are a treatment option, for instance, Dr. Morenz cited Osheroff v. Chestnut Lodge. In that case, a patient sued the mental hospital for failing to inform him that medications were a treatment option, even after he had received months of treatment there. The litigation ended in an out-of-court settlement.
"It's not that you can't treat patients with psychotherapy alone and without medications, but the point is you first have to make patients aware that medications are a treatment option," Dr. …