Mansfield Mela1, Glen Luther2, Thomas G Gutheil3. 1. Department of Psychiatry, Royal University Hospital, University of Saskatchewan and College of Law, Saskatoon, Saskatchewan mansfieldmela@gmail.com. 2. College of Law and Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan. 3. Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Abstract
OBJECTIVES: To extract the themes pertaining to prudent psychiatric practice from written court judgments in Canada. METHODS: We searched the medical and legal literature for cases involving civil litigation against Canadian psychiatrist and reviewed all available written judgments. We completed a thematic analysis of the civil actions against psychiatrists as conveyed by those written court judgments. We classified the cases according to the disposal status and the essential lessons from the decisions on standard of care and practice by Canadian psychiatrists. RESULTS: Forty such cases were identified as involving psychiatrists over a 45-year period. A subgroup included those dealing with limitation periods and disclosure applications. Thirty of the 40 cases (75%) were decided in favour of the defendant psychiatrists, including 2 dismissed for running over the limitation period. The cases that actually went to trial suggest that documentation and obtaining second opinions are protective against claims of negligence. Inpatient cases resulting in successful litigation against psychiatrists involved fatal outcomes, but not all fatal outcomes led to successful litigation. CONCLUSIONS: The key lessons from these cases are the importance and relevance of regular best clinical practices, such as documentation, obtaining second opinions, following guidelines, and balancing competencies in the expert and manager or advocate roles. Incorporating these practices should allay concerns about litigation against psychiatrists.
OBJECTIVES: To extract the themes pertaining to prudent psychiatric practice from written court judgments in Canada. METHODS: We searched the medical and legal literature for cases involving civil litigation against Canadian psychiatrist and reviewed all available written judgments. We completed a thematic analysis of the civil actions against psychiatrists as conveyed by those written court judgments. We classified the cases according to the disposal status and the essential lessons from the decisions on standard of care and practice by Canadian psychiatrists. RESULTS: Forty such cases were identified as involving psychiatrists over a 45-year period. A subgroup included those dealing with limitation periods and disclosure applications. Thirty of the 40 cases (75%) were decided in favour of the defendant psychiatrists, including 2 dismissed for running over the limitation period. The cases that actually went to trial suggest that documentation and obtaining second opinions are protective against claims of negligence. Inpatient cases resulting in successful litigation against psychiatrists involved fatal outcomes, but not all fatal outcomes led to successful litigation. CONCLUSIONS: The key lessons from these cases are the importance and relevance of regular best clinical practices, such as documentation, obtaining second opinions, following guidelines, and balancing competencies in the expert and manager or advocate roles. Incorporating these practices should allay concerns about litigation against psychiatrists.
Authors: A R Localio; A G Lawthers; T A Brennan; N M Laird; L E Hebert; L M Peterson; J P Newhouse; P C Weiler; H H Hiatt Journal: N Engl J Med Date: 1991-07-25 Impact factor: 91.245
Authors: David M Studdert; Michelle M Mello; Atul A Gawande; Tejal K Gandhi; Allen Kachalia; Catherine Yoon; Ann Louise Puopolo; Troyen A Brennan Journal: N Engl J Med Date: 2006-05-11 Impact factor: 91.245
Authors: Liza H Gold; Stuart A Anfang; Albert M Drukteinis; Jeffrey L Metzner; Marilyn Price; Barry W Wall; Lauren Wylonis; Howard V Zonana Journal: J Am Acad Psychiatry Law Date: 2008