how does your facility handle completed suicide or sucidal attempts?

[benjee]

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Hi ,
I am curious how psychiatrists in different settings to handle completed suicide and suicide attempts? eg.those in private practice and those worked for hospitals? And do you run the risks of losing your license? or get fired from jobs?

 

[OldPsychDoc]

Hi ,
I am curious how psychiatrists in different settings to handle completed suicide and suicide attempts? eg.those in private practice and those worked for hospitals? And do you run the risks of losing your license? or get fired from jobs?

If every psychiatrist who lost a patient to suicide were fired or had their license suspended, there would be no psychiatrists. We treat terminal illnesses--sometimes the disease wins.

In hospitals, it is usually treated as a "sentinel event" and a critical incident review occurs. In group practice, there is usually some sort of peer review process as well. I have no idea what a solo private practitioner might do, but seeking some sort of peer review would be the smart thing to do.

 

[benjee]

Thanks Oldpsychdoc. It's because in VA , as we know in the news, the suicide rate is so high either completed or attempts, I was wondering how they manage this overwhelming case load. Even there is internal review system, but they will review everyday since the rate is so high.

 

[whopper]

You can't blame yourself so long as you did a good job . Did you do a good job? If you want to be objective, let someone else in the dept go over your work just in case.

Where I'm at, they might do an M&M. There's also a committee that goes over it like a fine toothed comb and bring all the parties involved and ask questions.

A good thing about this process, at least for the docs, is that the docs reviewing the case don't treat you like it's an inquisition. If you're competent, they already know and they know that no matter how good a job you do, you could sometimes miss a suicide.

In private practice it all depends on the organization or lack there-of. Private practices can be 1 person, 2 people, 50 people (though if it's that big, it's usually something that's not really private anymore). Suicide doesn't mean action will be taken against you. The tripwires that cause these things to happen are people reporting the event as somehow negligent to authorities in the form of reporting to a state medical board, a lawsuit, etc.

State medical boards could investigate the case. From experience, I've rarely seen SMB's take real action against someone, and if so, it's usually so egregiously bad or the accusation egregiously bad (e.g. the guy was running a pill mill for like 10 years!, raping patients, vaginal exams on depressed patients, etc).

 

[CounselortoMD]

Hi ,
I am curious how psychiatrists in different settings to handle completed suicide and suicide attempts? eg.those in private practice and those worked for hospitals? And do you run the risks of losing your license? or get fired from jobs?

For any serious incident (or even a not-so-serious incident that caused bad PR, and thereby drama with administration) , we always got dragged into hours of tedious--and mostly unproductive--meetings to conduct a "root cause analysis" of the incident.

Fun times!

 

[whopper]

The NJ asylums (as they used to be called, but hey, they are still asylums) have a reputation for being underfunded and sometimes dangerous.

During residnecy, I sat through an M&M from an NJ asylum where a patient on a two-to-one (yes 2, not 1 to 1, 2-to-1) killed himself. It was apparent the staff weren't doing their jobs, and for years they've had a rep for not doing such.

The two nincompoops hardly ever watched the guy for real. He went to the bathroom and hung himself. The 2 idiots didn't check on him for about 30 minutes to an hour. He was high risk, they knew it and they left him alone in a bathroom.

The point being.....

The M&M went on for hours, it was apparent what the cause was, but because of PC, a desire to not make anyone feel bad, and state union/hospital politics, no one was willing to get to the heart of the matter--that the staff members of this hospital in general blow hot dogs, and a big reason was the entire management situation needed an overhaul.

Oh, and by the way, the state did a great job in solving the problem. They spent millions of dollars to make sure there was a metal detector placed everywhere in the hospital even though the guy's suicide had nothing to do with any metallic objects.

Given that the general public only knew a guy offed himself, knew the state pumped millions, the public was given notion all was well cause the newspapers couldn't report everything due to HIPAA violations. IMHO this was kind of like blaming the Jews and then initiating a pogrom as a diversion to a real problem faced by an ignorant community, or Roman Emporers wanting to seize more power from the people, then the people take it hook, line, and sinker because he gave them some awesome gladiator games.

A few weeks later, there was some type of issue that could've raised the pay of staff members that was defeated in the state government. Some angry staff members, in response, went to patients and tried to incite them up, telling the patients to tell everyone they weren't being treated well. (I'm not making this up. I sat through a treatment team meeting where the doctor was scolding the staff members for bringing in self-serving politics into therapy that wouldn't have helped the patients anyway, and reported them to the administration).

The more things change, the more they stay the same.

 

[benjee]

The NJ asylums (as they used to be called, but hey, they are still asylums) have a reputation for being underfunded and sometimes dangerous.

During residnecy, I sat through an M&M from an NJ asylum where a patient on a two-to-one (yes 2, not 1 to 1, 2-to-1) killed himself. It was apparent the staff weren't doing their jobs, and for years they've had a rep for not doing such.

The two nincompoops hardly ever watched the guy for real. He went to the bathroom and hung himself. The 2 idiots didn't check on him for about 30 minutes to an hour. He was high risk, they knew it and they left him alone in a bathroom.

The point being.....

The M&M went on for hours, it was apparent what the cause was, but because of PC, a desire to not make anyone feel bad, and state union/hospital politics, no one was willing to get to the heart of the matter--that the staff members of this hospital in general blow hot dogs, and a big reason was the entire management situation needed an overhaul.

Oh, and by the way, the state did a great job in solving the problem. They spent millions of dollars to make sure there was a metal detector placed everywhere in the hospital even though the guy's suicide had nothing to do with any metallic objects.

Given that the general public only knew a guy offed himself, knew the state pumped millions, the public was given notion all was well cause the newspapers couldn't report everything due to HIPAA violations. IMHO this was kind of like blaming the Jews and then initiating a pogrom as a diversion to a real problem faced by an ignorant community, or Roman Emporers wanting to seize more power from the people, then the people take it hook, line, and sinker because he gave them some awesome gladiator games.

A few weeks later, there was some type of issue that could've raised the pay of staff members that was defeated in the state government. Some angry staff members, in response, went to patients and tried to incite them up, telling the patients to tell everyone they weren't being treated well. (I'm not making this up. I sat through a treatment team meeting where the doctor was scolding the staff members for bringing in self-serving politics into therapy that wouldn't have helped the patients anyway, and reported them to the administration).

The more things change, the more they stay the same.

So there is no consequences to those staff who did not do their job? What happened to the psychiatrist? I was told some psychiatrists have their own lawyer ( for defending themselves from getting fired or lawsuits) in case neglience happened involved with supportive staff and faulty policy ( 2to 1 obs on very high risk suicidal pt) .
Can this be reportable to state board eg NJ about 2 to 1 obs ? I find this is very unethical..

 

[benjee]

Oops,Sorry , my mistake, I thought you meant :1 to 2 obs . Just ignore the second part about unethical.

 

[whopper]

So there is no consequences to those staff who did not do their job? What happened to the psychiatrist?

Nothing as far as I know. That's why I tell you those NJ facilities are screwed up.

The psychiatrist eventually left her job. She went to a different facility in the NJ system that was still bad but not as bad.

That same doc (who IMHO was excellent) was attacked while on the job and as a result still had headaches as a result of the attack months after it happened. Further, the forensic psychiatrist I followed while a resident, was on the defense team of the attacker and, well ahem, let's just say that he argued in court that patients shouldn't be held responsible for attacking mental health providers. The patient allegedly wasn't even mentally ill, but was just one of those antisocial types that some shmuck intentionally misdiagnosed as having psychosis. (The doc that was attacked wasn't one of them. For weeks she took off the psychosis diagnosis).

The NJ state mental hospitals have a long tradition and rep for not being safe. A lot of it has to do with the simple fact that the buildings they are in were built over 150 years ago and are the equivalent of dungeons. There's plenty of studies showing that when people are put in environmental conditions like this, even if they have no history of violence, bad things happen. Many of the doctors where I did residency refused to work in the state system even though the pay in that system was literally about 1/3 more.

The good news is that the state at least when I was in NJ, it may have changed, was trying to fix it up though IMHO they're really only going to make good headway if they demolished a lot of those buildings and just make new ones despite that it'll cost several millions.

Another problem is the people that have responsibility in keeping bad staff members in line don't do their jobs either, and it's the state government. They don't get paid more for doing their jobs, but do get the same amount for sitting on their butts.

When I was a 4th year, I knew the attendings in the administration of that hospital and they were actually very good docs trying to fix the problems, but they were IMHO kind of the equivalent of one of those teachers in those 80s-90s teacher movies put in an impossible class to fix and really busting their butts trying to make it better. They were trying to change a culture of the state asylum that was going on in NJ (and several other states) since the founding of the first ones in the country.

In Ohio, the asylum in the area was demolished and the state built a completely state of the art facility that is very safe. Attacks still do happen, but they happen not because of the problems you'd see back in the NJ hospitals such as poor lighting, poor staff (though on occasion that happens too but nowhere to the degree you saw it in NJ), etc.

Of course the Ohio hospital, just like anyone, had it's problems but they weren't on the order of staff members having sex with patients as was going on in the NJ hospitals, or staff members, out of anger because they wanted more pay, attempting to incite patients.

 

[benjee]

Nothing as far as I know. That's why I tell you those NJ facilities are screwed up.

The psychiatrist eventually left her job. She went to a different facility in the NJ system that was still bad but not as bad.

That same doc (who IMHO was excellent) was attacked while on the job and as a result still had headaches as a result of the attack months after it happened. Further, the forensic psychiatrist I followed while a resident, was on the defense team of the attacker and, well ahem, let's just say that he argued in court that patients shouldn't be held responsible for attacking mental health providers. The patient allegedly wasn't even mentally ill, but was just one of those antisocial types that some shmuck intentionally misdiagnosed as having psychosis. (The doc that was attacked wasn't one of them. For weeks she took off the psychosis diagnosis).

The NJ state mental hospitals have a long tradition and rep for not being safe. A lot of it has to do with the simple fact that the buildings they are in were built over 150 years ago and are the equivalent of dungeons. There's plenty of studies showing that when people are put in environmental conditions like this, even if they have no history of violence, bad things happen. Many of the doctors where I did residency refused to work in the state system even though the pay in that system was literally about 1/3 more.

The good news is that the state at least when I was in NJ, it may have changed, was trying to fix it up though IMHO they're really only going to make good headway if they demolished a lot of those buildings and just make new ones despite that it'll cost several millions.

Another problem is the people that have responsibility in keeping bad staff members in line don't do their jobs either, and it's the state government. They don't get paid more for doing their jobs, but do get the same amount for sitting on their butts.

When I was a 4th year, I knew the attendings in the administration of that hospital and they were actually very good docs trying to fix the problems, but they were IMHO kind of the equivalent of one of those teachers in those 80s-90s teacher movies put in an impossible class to fix and really busting their butts trying to make it better. They were trying to change a culture of the state asylum that was going on in NJ (and several other states) since the founding of the first ones in the country.

In Ohio, the asylum in the area was demolished and the state built a completely state of the art facility that is very safe. Attacks still do happen, but they happen not because of the problems you'd see back in the NJ hospitals such as poor lighting, poor staff (though on occasion that happens too but nowhere to the degree you saw it in NJ), etc.

Of course the Ohio hospital, just like anyone, had it's problems but they weren't on the order of staff members having sex with patients as was going on in the NJ hospitals, or staff members, out of anger because they wanted more pay, attempting to incite patients.

That's really bad esp when staff having sex with pts..will it help if somebody reports it to Nj state board to investigate or they just turn blind eye to this. I am just wondering how the hospital keep getting accreditation and continue to operate...

 

[whopper]

It already was reported. In fact one of the whistle blowers was a former governor that before he had that position worked undercover as a staff member. He wrote a report where he exposed staff members making recommendations to other staff members to take third shift because that's the easiest shift to have sex with patients, staff members used to take patients home on weekends and no one knew about it, and staff sneaking in candy and cigarettes then charging patients 10x what they cost for those items because they couldn't get it otherwise.

http://www.njsendems.com/senator.asp?sid=27

If you do a google search, a really hard one, you might be able to find a copy of his report. It used to be online a few years ago. I tried to find it again to show it to you here directly, but didn't want to spend an hour looking for it.

If you put in "richard codey undercover" it shows a more recent undercover job he did as a homeless man, and maybe the psychiatry stuff appears but I didn't spend time looking at the latter hits.

Codey's work led to one psychiatric institution in NJ being completely shut down and significant reforms, but IMHO it went from completely unacceptable and terrible (e.g. patients having sex with staff members, majority of staff members getting hit weekly, patients getting raped once in awhile), to still terrible but not as bad (e.g. now it's hard to have sex with a patient, staff members getting hit now and then but it's not the majority but still in an area where it could be greatly reduced). My last real experience in the NJ hospitals were about 5 years ago so things may be better now.

The problem IMHO isn't lack of funds. NJ has pumped a lot of money into the mental health system. It's that the institutions are in dungeons, and a cabal of specific employees in the state that would rather look the other way cause if they actually respond to something they'll have to get work done and the politics with state unions.