Malpractice in psychiatry

[CaliforniaGreen]

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I have been looking online and have had trouble finding this information:

How much is malpractice insurance for a new psychiatrist?

How often do psychiatrist get sued... I couldn't find studies or statistics on this, would love to know. Like in 10 years how much does the average psychiatrist get sued?

Hows does it compare to other fields? Is it the field with least lawsuits?

In which situations is a lawsuit legitimate? What are the most common causes of successful lawsuits in psychiatry?

 

[mahasanti]

Not sure about the malpractice, but here is a report from the AMA about malpractice lawsuits:

http://www.ama-assn.org/ama1/pub/upload/mm/363/prp-201001-claim-freq.pdf

According to this report, psychiatrists are the among the least sued with 22.2% reporting they have ever been sued. Compare this to the 69% of general surgeons who report being sued.

There are some other interesting tidbits in the report. An interesting read.

 

[nitemagi]

Not sure about the malpractice, but here is a report from the AMA about malpractice lawsuits:

http://www.ama-assn.org/ama1/pub/upload/mm/363/prp-201001-claim-freq.pdf

According to this report, psychiatrists are the among the least sued with 22.2% reporting they have ever been sued. Compare this to the 69% of general surgeons who report being sued.

There are some other interesting tidbits in the report. An interesting read.

My malpractice company told me psychiatrists get sued on average once every 33 years. Surgeons were something like once every 3-5 years.

Psychiatrists are commonly sued for suicide and for sleeping with patients. Though I think psychologists moreso for the latter.

 

[CaliforniaGreen]

Not sure about the malpractice, but here is a report from the AMA about malpractice lawsuits:

http://www.ama-assn.org/ama1/pub/upload/mm/363/prp-201001-claim-freq.pdf

According to this report, psychiatrists are the among the least sued with 22.2% reporting they have ever been sued. Compare this to the 69% of general surgeons who report being sued.

There are some other interesting tidbits in the report. An interesting read.

Thank you 🙂

 

[CaliforniaGreen]

Psychiatrists are commonly sued for suicide and for sleeping with patients. Though I think psychologists moreso for the latter.

Woa, those seem like pretty extreme things - what about more typical things, like "the drug you prescribed kept by child from growing" or "the drugs you gave me didn't work"?

 

[Rhayven44]

Woa, those seem like pretty extreme things - what about more typical things, like "the drug you prescribed kept by child from growing" or "the drugs you gave me didn't work"?

The medications not working is usually not as big of a malpractice issue, as even our best treatments for certain psychopathology are known to work on the order of around 80%. I really don't hear much about these types of lawsuits at all.

But you are correct...side effect lawsuits do commonly happen, if they are bad enough. I haven't heard anyone get dinged for the "not growing", but God help you if give a pregnant woman Depakote and achieve a poor outcome🙁

 

[whopper]

My dad's a surgeon. His malpractice last time I asked (and this was years ago...) was on the order of 50K a year. He was someone who never had a malpractice suit against him ever.

My malpractice is less than 10% of that. It's less than 5% of what he paid for malpractice. Now granted, I only need it to pay for part-time work, but that's still very very cheap compared to other doctors. (The state job I do pays for my insurance for the state work).

I've also noticed that several psychiatrists do not practice defensively and that is good and bad. Defensive medicine is only bad if it leads to treatment decisions that defend the doctor in a liability sense but are bad for the patient. E.g. an ER doctor doing a chest x-ray on a young woman even though he does not believe she needs it. Defensive medicine, otherwise IMHO is a good thing. What's bad about good documentation, warning the patient of the risks of a treatment, and quickly responding to adverse effects? IF someone wants to criticize that as defensive medicine, well that also happens to be good practice.

Several psychiatrists I've noticed to not document well (E.g. they do not write that they explained the risks of a benzodiazapine), they do not write the DSM criteria that justifies their diagnosis etc. These are big no-no's in other fields of medicine where the risk of a lawsuit is much higher and the procedures very invasive.

Another issue is because psychiatry is a grey area, it adds a layer of protection because it adds uncertainty in legal cases. E.g. 10 doctors can look at a patient and not all 10 would agree on the diagnosis.

 

[michaelrack]

Defensive medicine, otherwise IMHO is a good thing. What's bad about good documentation, warning the patient of the risks of a treatment, and quickly responding to adverse effects? IF someone wants to criticize that as defensive medicine, well that also happens to be good practice.

Several psychiatrists I've noticed to not document well (E.g. they do not write that they explained the risks of a benzodiazapine), they do not write the DSM criteria that justifies their diagnosis etc. These are big no-no's in other fields of medicine where the risk of a lawsuit is much higher and the procedures very invasive.

Another issue is because psychiatry is a grey area, it adds a layer of protection because it adds uncertainty in legal cases. E.g. 10 doctors can look at a patient and not all 10 would agree on the diagnosis.

Documentation is a problem if it takes time away from patient care. What is better for the patient- spending 5 minutes discussing the risk of a benzo and 1 minute documenting, or 1 minute discussing and 5 minutes documenting? In the infamous LIbby Zion case, the intern writing notes instead of being at the patient's bedside may have played a role in Zion's death.

Documenting the treatment of a patient is important, but it is not a substitute for the actual treatment.

 

[CaliforniaGreen]

what are other common causes of lawsuits that you guys have heard of?

I am interested because I actually have not heard of a lawsuit against a psychiatrist (or at least none of those that I know at my school). I guess that's a good thing!

 

[whopper]

Documentation is a problem if it takes time away from patient care. What is better for the patient- spending 5 minutes discussing the risk of a benzo and 1 minute documenting, or 1 minute discussing and 5 minutes documenting? In the infamous LIbby Zion case, the intern writing notes instead of being at the patient's bedside may have played a role in Zion's death.

The best answer is the doctor should be doing the documentation and the education.

Which is a frustration I have with private practice. I'll only really be making much more money than my community mental healthcare job if I start bringing patients in for 10-15 minute medchecks.

I understand what what you're saying but there is such a thing as a doctor who does have the time to educate their patient and document but chooses to not do either out of laziness or the desire to bring in patients in an assembly-line fashion to make more money. About 20% of my patients in outpatient care appear to have been made a benzo dependent/addict by their previous treating physician. Those patients, when asked, tell me they were never warned of the possible problems with benzodiazapines. The documentation in the progress note didn't mention it either.

 

[whopper]

what are other common causes of lawsuits that you guys have heard of?

The most common cause according to several texts is the suicide of a patient. The second most common cause is abandonment. That is when a doctor drops a patient without a referral and other appropriate actions before termination of services to that patient.

A piece of advice, depending on the state, the definition of what is an appropriate termination of services differs. Make sure you follow your own state's rules. (e.g. some say simply refer the patient to another psychiatrist. Some say give at least 3 referrals, in writing, and documented in a manner that could be reproducible in court.)

The following are things where I don't know the frequency but have some knowledge. While sleeping with patients is a definite no-no, for some reason or another, the states I've seen appear to be more proactive on nabbing non-psychiatric mental health professionals. E.g. my wife who is a counselor had to register with a state service that openly tells patients if their therapist was ever caught sleeping with a patient. No, she wasn't sleeping with a patient, everyone in her profession had to do it. That is not required of psychiatrists. Why? I don't know.

I've never yet seen a case where a doctor was sued because he made his patient into an addict, yet I see that issue going on daily with patients where I've taken over their care from another doctor. I don't specifically bring up to the patient that he/she should sue their previous doctor, but in many of these cases malpractice did occur assuming the patient is telling me the truth. The previous doctor's notes also don't provide any layer of protection. Almost all of them did not document that they discussed the possibility of dependence and addiction.

I've noticed that patients appear to not want to sue a psychiatrist in comparison with other doctors. Why? I'm not sure. I speculated that some of it is the social stigma of mental illness. Another factor is perhaps because the patient will have to bring up very personal issues during the trial concerning their treatment. When people have physical ailments, they are likely more willing to talk about them in comparison with someone who has a psychiatric issue. When someone was raped multiple times and are suing their doctor for malpractice over PTSD treatment, those rapes may have to be brought up in court.