Liability of treating patients who don't get labs done

Discussion in 'Psychiatry' started by Freedoc, Sep 24, 2014.

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  1. Freedoc

    Freedoc 2+ Year Member

    Oct 4, 2013
    Wondering what peoples take is on treating people with Li, Depakote, Tegretol or other meds in community Psych setting w/ low functioning patients who refuse or for whatever reason don't follow though on getting blood levels done or other labs and may be sustaining iatrogenic organ damage.
    In event of renal failure, hepatotoxicity, thyroid, Blood cell aberration etc do you believe Psychiatrist can be held liable?
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  3. milesed

    milesed 5+ Year Member

    Jun 25, 2011
    I give them a 5 days supply and tell them no refills until labs are done- same with missing appts.
    wolfvgang22 and SteinUmStein like this.
  4. alina_s

    alina_s Senior Member 10+ Year Member

    Sep 24, 2001
    I don't know about the liability side, but when I worked with that kind of population, I ended up using very little Li. Clozapine may be a little easier, since the pharmacy helps to enforce the labs. Patients and providers around the rural clinic were pretty clueless. One 60-something year old patient quit coming for over a year and it turned out that a NP in primary care clinic had continued his Li that entire time without ever ordering labs (or contacting my clinic).
  5. whopper

    whopper Former jolly good fellow 10+ Year Member

    Feb 8, 2004
    See if there are realistic alternatives. Lamictal is not a realistic alternative for a person who has a history of severe mania who is also likely not going to be compliant if they don't get the labs done. An antipsychotic could be.

    If they don't get the labs done, and we got time, I tell them they got to get the labs done. What I mean by we got time is if it's the three-month period, they didn't get it done, I'm not going to lose sleep over it if they get it done within the next month.

    After that it depends (for me). If otherwise healthy, I allow it to stretch to 6 months while documenting that they are not following my recommendations and have already been warned of the risks. If past 6 months and there are no alternatives, I terminate the patient/doctor relationship. I cannot treat a patient on Lithium or Depakote where they will not get the labs done for an extended period.

    If the patient has health issues, e.g. already has some renal problems and is on lithium, I will likely not allow them any grace period. For you greenhorns there are sometimes situations where one still has to be on lithium despite renal problems.

    Warn patients ahead of time of these things. I've noticed when this happened, the majority of them won't freak out at you because they understand why you did what you did.
    GroverPsychMD and Freedoc like this.
  6. milesed

    milesed 5+ Year Member

    Jun 25, 2011
    I'm getting about 40% of my child-adol patients on risperdal with elevated prolactin levels. With all the class action commercials about this in my area, I don't wait around for them to decide to comply. Get it done or no more meds.
  7. hamstergang

    hamstergang Chief Resident 5+ Year Member

    May 6, 2012
    Just to be clear, are you checking prolactin levels on all your patients on Risperdal, or only if they're showing symptoms of hyperprolactinemia?
  8. Freedoc

    Freedoc 2+ Year Member

    Oct 4, 2013
    Thanks for the input guys, appreciated!

    Posted using SDN Mobile
  9. milesed

    milesed 5+ Year Member

    Jun 25, 2011

    I check them all at the same time I check lipids and glucose- initially, then every 3-6 months. This is the current standard of care. I quickly switch meds if developing problems even if the med is helping in most cases (do no harm).
    My ARNP was sued a few years ago and her malpractice insurance chose to settle her case even though she did follow all guidelines and intervened appropriately when a patient developed an abnormal lab. The PCP was the one at fault for not managing the problem as they should have.

    My malpractice does not allow settlements w/o my consent. I think her was cheaper and it's now obvious as to why.

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