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[PikminOC]

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[Attending1985]

No she found someone else

 

[Sushirolls]

For clarity, you were doing outpatient care and the ensuing inpatient care for this same hypothetical patient?

Or doing outpatient, had patient admitted, then called to inpatient unit to let the DC planner (or attending) know you were discontinuing care, and called into the pharmacy 30 days of medicine from your pre-admit med regiment, no communication to patient by yourself that you were terminating care?

 

[wolfvgang22]

No. She found a new psychiatrist immediately because she had been informed she was discharged from your clinic while still inpatient. Following up within 30 days post discharge is within standard of care most places, so she wouldn't be able to prove any abandonment in the first place, and in the second place she would have to prove harm happened to her because of negligence/abandonment. It's a non-starter.
People with borderline feel abandoned and angry about it frequently.
Be sure you document everything. Next time make sure you send a certified letter discharging the patient along with a list of referral options and offer to assist in referral. Include in the letter your discharge policy regarding meds, how to get emergency help, and how to obtain records. If this just happened within 30 days I'd go ahead and send such a letter to this patient.

If you are being sued inform your malpractice insurer and also inform your own attorney ( not your insurance attorney) so he or she is aware what is going on in case you ever need your own attorney, which is unlikely in this case.

 

[romanticscience]

I'm curious as to what you mean by "put her in the hospital." Was it an involuntary commitment? The reason I'm asking is that I have been in very tense situations with borderline patients where I'm toeing the line between protecting my own safety (medico-legal liability) v. hurting the patient therapeutically (over-reacting with the rapid escalation of the level of care effectively ending the therapy).

Basically, a move may not be legal abandonment; however, the patient could feel therapeutically abandoned. I'm coming from working with borderlines in long-term psychotherapy (TFP or GPM).

Helpful article: Medicolegal pitfalls in the treatment of borderline patients. - PubMed - NCBI

 

[PikminOC]

I'm curious as to what you mean by "put her in the hospital." Was it an involuntary commitment? The reason I'm asking is that I have been in very tense situations with borderline patients where I'm toeing the line between protecting my own safety (medico-legal liability) v. hurting the patient therapeutically (over-reacting with the rapid escalation of the level of care effectively ending the therapy).

Basically, a move may not be legal abandonment; however, the patient could feel therapeutically abandoned. I'm coming from working with borderlines in long-term psychotherapy (TFP or GPM).

Helpful article: Medicolegal pitfalls in the treatment of borderline patients. - PubMed - NCBI

This hypothetical patient saw me for two months total

 

[wolfvgang22]

Was I wrong not to give her 30 days of meds? She has a history of overdose of medicine. I wouldn't want her to have extra.
And I didn't know what inpatient changes were to the meds.

No. You did the correct thing. Always make sure you document what you did and why you did it.

 

[Bartelby]

To clarify, did you offer to continue seeing her for 30 days until she found a new psychiatrist?

 

[Jules A]

If you documented that you discussed discharge with patient and inpatient team and she was being treated at that time by someone else I think you fulfilled your obligation. I don't see why you should have written meds as the hospital would discharge her on the most current regimen and generally they need to document a follow up plan for med management, which was not you.

 

[psych md jd]

Abandonment really boils down to a subjective feeling from the patient's point of view.

The questions I have are:

What were the discharge orders from the hospital? Was she referred back to you for follow-up?​

​

How/when did you terminate or limit care? Did you notify the patient in writing?​

​

When you limited her care to "emergency" care was this an abrupt change or did you give the patient notice of this change?​

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Did you provide the patient a reasonable amount of time to find another treating provider after limiting your care?​

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Did you provide a referral to another provider?​

​

​

​

 

[Jules A]

Abandonment really boils down to a subjective feeling from the patient's point of view.

How could this even be reasonable? Not doubting what you are saying as I'd imagine if you are a lawyer that you'd know. But for crap sake does that even make sense?

 

[PikminOC]

I saw her for 2 months total.

 

[Mass Effect]

Abandonment really boils down to a subjective feeling from the patient's point of view

I'm not a lawyer, but I will eat my hat if a legal verdict is delivered due to a "subjective feeling from the patient's point of view." If that was the case, all of us would be sued by borderlines once a month.

 

[psych md jd]

I'm not talking about abandonment in the psychodynamic sense, but rather in the termination of care or services sense.

And, I'm not saying that just because a patient believes or feels something, rightly or wrongly, they will prevail. I'm saying that becomes the question to be decided.

 

[siliso]

She had 30 days notice with care still available and referrals to other sources of care for after the 30 days: you’re good.

 

[Mass Effect]

I'm not talking about abandonment in the psychodynamic sense, but rather in the termination of care or services sense.

And, I'm not saying that just because a patient believes or feels something, rightly or wrongly, they will prevail. I'm saying that becomes the question to be decided.

Can you cite the legal precedent for this please? I just don't believe that a subjective feeling becomes the question in any kind of lawsuit.

 

[siliso]

But, my official advice is consult your attorney or risk manager before you take action to make sure you CYA

 

[romanticscience]

Can you cite the legal precedent for this please? I just don't believe that a subjective feeling becomes the question in any kind of lawsuit.

My sense is that he's not talking about what's likely to be "judged" abandonment but that would be the grounds for which patient to sue. Patients can sue for anything, whether or not it's justified.

A point to consider is that even if you are doing what's right, it might help to resolve things interpersonally to prevent the lawsuit from happening at all.


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