COMMENTARY

Malpractice Dangers for Psychiatrists

O. Brandt Caudill, Jr, Esq

Disclosures

December 29, 2009

In This Article

Why Patient Suicides Bring Malpractice Risk

Whenever suicide is an issue, the quality of the psychiatrist's documentation of the patient's expression of suicidal ideation is the most important fact.

It is not enough to simply record what the patient says about suicide ideation. A psychiatrist also has to record what he or she did in response to it. If only the patient's expression of suicidal ideation is recorded, it can create the misimpression that the psychiatrist didn't do anything to respond. Your session note should be an accurate snapshot of what took place. The notes should particularly address whether the patient expressed a plan and the means to carry out the plan, and whether the psychiatrist considered having the patient hospitalized.

Sometimes it seems burdensome to continue to record the patient's expression of suicidal ideation. This can particularly be the case if the patient is borderline and frequently uses such expression to manipulate the psychiatrist. However, it could turn out that the time the suicidal ideation is not thoroughly documented is when the patient makes an actual attempt. Keep in mind that a suicide attempt does not have to kill the patient to cause harm to the patient that could lead to a lawsuit.

Unsuccessful attempts are more common than completed suicides. According to the National Institute of Mental Health, in 2006, suicide was the 11th leading cause of the death in the United States. It accounted for approximately 33,300 deaths, with 12-25 attempts per actual suicide completion. So a psychiatrist is far more likely to deal with expressions of suicidal ideation than an actual, serious attempt at suicide.

Sadly, sometimes patients trying to manipulate the psychiatrist miscalculate the dose of the prescription medication. In 1 case I handled, a borderline patient consistently abused her prescription medication. She actually purchased and read a Physicians' Desk Reference, so that she could determine how close to the edge she could take her experimentation. Unfortunately, one time, she took too many medications. It appeared that this was not a deliberate suicide, but a miscalculation that ended in tragedy.

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