Biomedical subjects
Publications and source records attributed to P F Slawson.
This article presents a survey of recent trends in psychiatric malpractice litigation and its consequences in the United States. More particularly, it investigates the factors that trigger such litigation, the nature of the complaints and claims, the characteristics of patient and psychiatrist and the cost it involves for the parties concerned.
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The authors examine the outcome of 217 malpractice actions against psychiatrists from 1974 to 1978. Claims against psychiatrists represented only 0.3% of the 71,788 claims against all physicians. Loss experience was developed as a function of procedure (ECT, psychotherapy), type of injury (suicide, diagnostic error), and the patient's psychiatric diagnosis. Over one-third of the claims were closed without payment; the average paid indemnity was $31,000. Diagnostic errors and suicide were the major sources of loss. Only a few cases went to trial. These data illustrate that psychiatry has one of the best malpractice claim records.
The legal concept of malpractice is rooted in the issue of negligence. Liability and duty are related matters which bear on the doctor-patient relationship. The quality of the doctor-patient relationship appears to be the crucial factor related to the emergence of malpractice claims in general medicine and surgery and also in psychiatry. Two methods for assessing negligence are described and their limitations discussed. An alternative concept of a "malpractice threshold" is proposed. This threshold is derived from the arithmetic product of two variables (risk and doctor-patient rapport) which, when exceeded, triggers a patient response in the form of a lawsuit. Brief clinical examples are provided. Review of a large number of psychiatric malpractice cases may permit quantification of these variables. The identification and study of such factors is a rational step toward the prevention of incidents which may give rise to claims of malpractice.
The cost of psychiatric malpractice insurance has increased dramatically in recent years. To shed light on the extent to which this increase is justified the author polled 133 California psychiatrists who had indicated experience with some form of claims activity over the past 5 years. The 107 respondents reported 105 cases, of which 57 (54%) resulted in no more than a notification of a possible claim, 22 (21%) did not proceed beyond legal deposition, 20 (19%) were settled by dollar payment before trial, and 6 (6%) were left to the courts. The author recommends tort reform and refinement of reported claim and loss data to contain the cost of malpractice insurance.
The authors cite seven case histories of inpatients who committed suicide over a five-year period and analyze staff reaction and the changes in policy and procedures that followed. They conclude that staff feelings of guilt and failure brought about by inhospital suicides may result in the implementation of procedures designed to decrease risk, but that such procedures would not necessarily have prevented the suicide that led to their introduction. They maintain that staff acceptance of total responsibility for preventing suicide may achieve short-term safety at the expense of increased long-term risk, and that suicides can occur even when all reasonable precautions have been taken.
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The authors note that although the psychiatric hospitals is often used as a means of preventing the suicide of disturbed patients, some hospitalized patients succeed in committing suicide; such as an event is distressing for hospital staffs as well as for patients and families. However, the authors believe that the occasional occurrence of in-hospital suicide is inevitable. They present data on the frequency and characteristics of suicides among hospitalized psychiatric patients in Los Angeles County during the period from 1967 to 1972.?23AUTHOR
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