common causes of malpractice

1. Psychiatrics Malpractice
By
Inena wa inena
Supervisor: Dr Ben FORRY

2. Plan
• Introduction
• Definition
• Epidemiology
• Element of Malpractice
• Types of Malpractice
• Effets
• Filing a PM Suits
• Evidences
• Ways to stop
• References

3. Introduction
• Face to trauma and mental health issues,
• We may turn to a mental health professional for support.
• However, far too often patients find themselves victims of malpractice
from the very people they expected to help them.
• The complexity of the human brain and the close relationships developed
between psychiatrist and their patients often make these types of medical
malpractice cases different from others.
• Any type of error, neglect, or mistreatment in this area of the medical field
can have profound consequences on patients and their families.
• Unfortunately, many victims of psychiatric medical practice don't come
forward out of fear and emotional distress, or they're not taken seriously
due to their unstable mental health history.

4. Introduction…
• Many years ago it was rare for a psychiatrist to be sued until
• Currently, Reasons for the surge in malpractice suits:
-The rise in consumerism along with patient's rights,
-Decreased respect for authority in general,
-The lowered prestige of the medical profession,
-Patient's unrealistic expectations based on stereotypic T.V. doctors,
-Failures in the doctor-patient relationship, and
-Increased willingness on the part of psychiatric patients to disclose
events of treatment and "come out of the closet"
(Horan, 1980).

5. Definition
Medical Malpractices
• Are the measurement of the lack of skill and care by a physician
• in a doctor-patient relationship
• against a professionally proved standard of community practice.
Differs from ordinary tort law by:
1. The existence of a doctor-patient relationship and
2. by proof of standard care and
3. its breach by expert testimony.

6. Psychiatric malpractice
is just as harmful as other types of malpractice,
• but ,often more difficult to prove.
• Claims are often met with skepticism, especially because of the
vulnerable nature of those patients who seek treatment

7. Epidemiology
• 41 %,of US psychiatrists have been sued for malpractice at least once
(Medscape Psychiatrist Malpractice Report 2019 ).
• The top reason for the legal action was
wrongful death (31%),
poor outcome/disease progression (23%),
failure to treat/delayed treatment (11%),
errors in medication administration (10%), and
complications from treatment/surgery (8%).
 44% said they were very surprised to be the subject of litigation.
 A similar percentage reported they were somewhat surprised (41%), while
 15% were not at all surprised.

8. Elements of a malpractice case include:
(1) Establishing that a duty exists between doctor and patient arising
out of the contractual relationship,
(2) Establishing the standard of care in the community relative to the
issue at the basis of the suit and demonstrating a breach of that
standard,
(3) Demonstration of injury to the patient, and
(4) Ability to prove a proximate causal relationship between the breach
of the standard and the specific damages that are alleged to have been
done to the patient.

9. Distinction between Malpractice and intentionally
tort
• If a physician sets out intentionally to wrong a patient (intentional tort, or
even a felony), he or she may be liable for the act, but this is not
considered malpractice (an unintentional tort).
• This distinction is an important one in that insurance carriers are not
obliged to defend intentional torts which usually are not covered by
standard professional malpractice policies.
• Thus liability insurance covers only negligent (unintentional) acts, not
situations in which for instance a physician defrauds a patient or has sexual
intercourse with the patient.
• Breach of contract (failure to provide expected treatment and the
anticipated outcome), if unintentional, would be covered by professional
liability insurance but not if it were deliberate.

10. Types of Psychiatric Malpractice
• Malpractice performed by psychiatrists is different than that of medical
doctors.
• These are typically negligence or an abuse of power.
1.Negligence
can occur during misdiagnosis or failure to document patient information,
as well as failure to prescribe the proper psychiatric medication.
Psychiatrists who take on too many patients may also find that they are
unable to provide their patients with adequate, reasonable care.

11. 2.The Abuse of Power
Numerous ways in which a psychiatrist can abuse his or her power
over a vulnerable patient.
Some ways include:
• Sharing information without the patient’s consent
• Abusing or threatening the patient (verbally or physically)
• Engaging in a sexual relationship with the patient
• Abandoning the patient
• Using restraints unnecessarily
• Sexual abuse

12. psychiatric malpractice can take
many forms, the following are a
few common types of cases:

13. Misdiagnosis/Delayed Diagnosis/Failure to
Diagnose
Due to :
-Complexity of mental health, diagnosing a patient and providing the
best treatment options can be a challenge.
-There's no definitive medical tests for specific mental illnesses, and
-Time and resources can limit a doctor's ability to dig deeper into a
patient's condition.
-When it comes to the brain, a misdiagnosis can have especially
disastrous consequences.

14. …
• Wrongly prescribed medications may make problems worse, and
• Some drugs warn against increased risk of suicidal thoughts and
behaviors in vulnerable patients.
• Since mental health can impact a person's ability to function,
 delays in diagnosis , prolonged misdiagnosis can also negatively
impact the employment, relationships, and physical well-being of
patients.

15. Failure to Supervise a Suicidal Patient/Negligence
• Post-suicide lawsuits account for the largest number of malpractice
suits against psychiatrists.
• Doctors are expected to follow the medical profession's standard of
care and properly assess the risk of suicide in their patients, then
develop a treatment and safety plan accordingly.
• With vulnerable people under their care, it is especially important
that they're closely supervising their struggling patients.
• The lists of suicide warning signs and increased risk factors should be
known by doctors, patients, and their families

16. Malpractice and Suicidal Patients
• The law does require that a psychiatrist to contact a third party when
there is a risk that his or her patients may commit suicide or cause
harm to themselves.
• If the psychiatrist fails to take action and prevent a patient’s suicide
and knew that the patient had intended to commit suicide then he
or she could be held liable under a wrongful death action.
• Psychiatrists are also responsible for documenting all attempts at
suicide, noting their patient’s specific patterns, and looking for
indications that they may harm themselves.

17. Sexual Relations/Lack of Boundaries
• Due to the intimate nature and close relationships developed during psychiatric
treatment, it is easy for professional boundaries to become blurred.
• Due to poor judgement and emotional overload, mental health professionals
sometimes unload personal issues on their patients, causing unnecessary
distress.
• In certain cases, heightened emotions have also lead to cases of sexual relations
or abuse between doctors and patients.
• The American Medical Association states that "sexual contact concurrent with the
patient-physician relationship constitutes sexual misconduct" since they can
exploit the patient's vulnerability, impair judgement, and detract from the overall
health goals.
• Just like with any other medical cases, doctors must remain professional and not
take advantage of vulnerable patients for personal physical or emotional gain.
• These types of situations are especially contemptable because psychiatrists are
specially trained in the damage such exploitation can cause

18. Lack of Informed Consent
• Before administering any kind of psychiatric treatment, doctors are
legally required to obtain the patient's "informed consent."
• This includes providing patients essential information, such as a
description of the treatment, its purpose and desired outcome, risks
and complications, viable alternative treatment options, and
expectation of success.
• Patients can then follow up with questions and concerns, and take
adequate time to weigh the pros and cons

19. The Effects of Psychiatric Malpractice
• Psychiatric malpractice can lead to emotional distress or physical
injury.
• If a patient is prescribed a medication that is unnecessary for his or
her condition, it could have adverse side-effects, or even lead to
death.
• Also, a patient who requires medication to control his or her
psychiatric condition, but doesn’t receive such medication, could
suffer from adverse harm or possibly death.

20. …
• psychiatric malpractice can be even more damaging.
• Patients can become a danger to others, or suicidal from the trauma.
• Also, new psychological disorders could develop as a result of the
malpractice requiring longer treatment,
• or resulting in long-term disability.

21. Filing a Psychiatric Malpractice Lawsuit
• Psychiatric malpractice is handled under medical malpractice lawsuits.
• It requires the same criteria in order to file a successful claim, which is:
The patient must prove that a doctor/patient relationship existed
The patient must prove that the psychiatrist violated his or her duty of care
The patient must have experienced harm
The harm must be linked to the violation of the psychiatrist’s duty of care

22. Patient may sue his psychiatrist for malpractice?
• Like other medical professionals, a psychiatrist can be held liable for
negligence in a medical malpractice lawsuit. ... And
• like any other doctor or health care provider, a psychiatrist may be
liable for medical malpractice in the event that a mistake harms a
patient

23. Évidence?
In order to establish a malpractice lawsuit, a patient generally has to
establish four elements:
• There was a doctor-patient relationship.
• The doctor breached the duty of reasonable care (i.e., was negligent).
• The patient was injured (physically or mentally).
• There was a causal link between the negligence and the injury

24. What are the 4 D's of malpractice?
Lawyers sometimes refer to the proof required to bring a successful
medical malpractice claim as the “four Ds”:
• Duty,
• Deviation (or Dereliction) from Duty,
• Damages and
• Direct Cause.

25. Best ways to discourage malpractice and lawsuits
• Maintaining better documentation of their patient's chart
• Not taking on the patient in the first place ,
• Spending more time with the patient and his/her family ,
• Getting a second opinion from a colleague , and
• Reviewing the history/chart more carefully .
• Better patient communication and rapport and
• having a medical panel screen cases for merit

26. • Saying sorry ,Offering an apology to the patient cant prevent
malpractice and lawsuit.
• Medical organizations or state societies have to do more to
discourage malpractice cases.

27. References
• Lipkin and Apter; Types of Psychiatric Malpractice, Copyright © 2021
Lipkin & Apter· All rights reserved
• DIANE H. SCHETKY, Journal of the American Academy of Child
Psychiatric Malpracticeatry, 21, 5:521-526, 1982