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Biomedical subjects

R I Simon

Publications and source records attributed to R I Simon.

At least 19 recordsLinked to original sources
PubMed2001

The psychologically vulnerable witness: an emerging forensic consulting role.

The role of witness consultant is emerging as forensic psychiatrists and psychologists provide valuable input as participants in witness development teams. Anecdotally, retained experts also have undertaken a witness consultant role when asked or pressured to do so by the retaining attorney. Forensic psychiatrists and psychologists with extensive treatment and testimony experience may be of assistance to attorneys in preparing psychologically vulnerable clients and nonparty witnesses to tell their stories effectively at trial. In addition to litigation, other venues of witness consultation include administrative, congressional, and state legislative proceedings. In litigation, the witness consultant works directly with the attorney in support of the attorney's counselor role with the client. As an agent of the attorney, the identity of the witness consultant is shielded by the attorney-client privilege. The witness consultant does not meet face to face with the witness unless otherwise indicated. Collateral sources of information are used in providing witness consultation. The witness consultant can identify and provide management techniques for the psychological issues that threaten to impair a witness's ability to testify effectively. The consultant also may be able to assist the attorney who is experiencing difficulty in his or her relationship with a client or a nonparty witness.

Adolescent↗
PubMed2000

Defensive psychiatry and the disruption of treatment boundaries.

Defensive psychiatry refers to any act or omission that is performed not for the benefit of the patient but to avoid malpractice liability or to provide a legal defense against a malpractice claim. Defensive practices that produce deviant treatment boundaries usually take the form of clinically unnecessary prohibitions that disturb the therapist's position of neutrality. A distinction is drawn between boundary violations, boundary crossings and boundary issues. Typical clinical issues that provoke defensive treatment boundaries include managing patients with sexual transferences and potentially violent patients that may require the therapist to warn and protect endangered third parties. Defensive boundaries are usually created by unrecognized or uncorrected therapists' countertransferences.

Adult↗
PubMed1999

Therapist-patient sex. From boundary violations to sexual misconduct.

It is the therapist's ethical, professional, and legal duty to establish and maintain treatment boundaries consistent with the provision of good clinical care. The therapist must guard against progressive boundary violations that are damaging to patient care and that may also lead to sexual exploitation of the patient.

Adult↗
PubMed1999

Forensic issues in the psychiatric emergency department.

To function effectively in the ED, mental health clinicians must be able to: Competently evaluate and manage psychiatric patients in acute crisis. Obtain informed consent for treatment or procedures from patients or substitute health care decision makers. Develop clinical data about patients from collateral sources, such as family members and current treaters. Retrieve records of previous admissions to the ED or hospital psychiatric unit. Conduct competent suicide and violence risk assessments that direct clinical interventions. Conduct risk-benefit assessments before discharging suicidal or potentially violent patients. Observe basic safety precautions and procedures with potentially violent patients. Work with community mental health facilities for the follow-up care of chronically mentally ill patients. Possess a working knowledge of the legal regulation of mental health practice, especially as it applies to evaluating and treating patients in the ED. Obtain legal consultation when in doubt about matters of law affecting patient care.

Emergency Service, Hospital↗
PubMed1999

Maintaining treatment boundaries in small communities and rural areas.

Psychiatrists and other mental health professionals practicing in small communities and rural areas encounter unique situations and customs that may complicate the task of maintaining treatment boundaries. Boundary adjustments are frequently required that do not disturb the psychiatrist-patient relationship. The authors discuss specific boundary problems that arise in maintaining the psychiatrist's neutrality; fostering the psychological separateness of the patient; protecting confidentiality; ensuring that the psychiatrist has no previous, current, or future personal relationship with the patient; preserving anonymity of the psychiatrist; and establishing a stable fee policy. Four vignettes illustrate boundary issues that may be encountered in psychiatric practice in small communities. The authors suggest that applying the rule of abstinence, which states that the therapist must abstain from obtaining personal gratification at the expense of the patient, can help therapists distinguish between boundary issues, crossings, and violations.

Adult↗
PubMed1999

Conducting forensic examinations on the road: are you practicing your profession without a license?

Psychiatrists and other mental health professionals retained in civil or criminal litigation are frequently required to travel to a state in which they are not licensed to perform assessments and offer testimony. Adverse professional and legal consequences may await the unwary peripatetic forensic expert. Failure to address local practice requirements may result in disqualification to testify as well as civil and criminal liability, professional disciplinary action, and denial of liability insurance coverage. In this article, the authors address preventative measures to avoid charges of practicing without a license when the forensic expert crosses state lines.

Expert Testimony↗
PubMed1999

The suicide prevention contract: clinical, legal, and risk management issues.

In the managed care era, mental health professionals increasingly rely upon suicide prevention contracts in the management of patients at suicide risk. Although asking a patient if he or she is suicidal and obtaining a written or oral contract against suicide can be useful, these measures by themselves are insufficient. "No harm" contracts cannot take the place of formal suicide risk assessments. Obtaining a suicide prevention contract from the patient tends to be an event whereas suicide risk assessment is a process. The suicide prevention contract is not a legal document that will exculpate the clinician from malpractice liability if the patient commits suicide. The contract against self-harm is only as good as the underlying soundness of the therapeutic alliance. The risks and benefits of suicide prevention contracts must be clearly understood.

Humans↗
PubMed1999

Attorneys' pressures on the expert witness: early warning signs of endangered honesty, objectivity, and fair compensation.

While most attorneys practice ethically and treat their retained experts fairly, there are a few that do otherwise. The authors describe "early warning signs" of the likelihood that the attorneys attempting to retain the psychiatric expert witness may compromise the expert's honesty and striving for objectivity. Experts themselves may have certain vulnerabilities that interfere with their ability to detect those early warning signs. Recommendations for the expert are offered.

Communication↗
PubMed1998

Psychiatrists' duties in discharging sicker and potentially violent inpatients in the managed care era.

Psychiatrists have certain clinical responsibilities and legal duties to patients treated in managed care settings. They include disclosure of all treatment options, the exercise of rights of appeal for any care they believe will materially benefit patients regardless of allocation guidelines or gatekeeper directives, continuance of emergency treatment, and reasonable cooperation with utilization reviewers. An additional duty--to warn and protect endangered third parties--will likely increase as cost-containment measures curtail the length of hospitalization. The author discusses these duties in the context of sicker and potentially violent patients. He cautions psychiatrists to be careful not to prematurely discharge these patients because of pressures from managed care organizations. The policies of such organizations can place psychiatrists and patients in a precarious position by limiting the time and resources for diagnosis and the assessment of the risk of potential violence. These responsibilities and duties often can be turned into clinical opportunities that enhance the therapeutic alliance with patients.

Disclosure↗
PubMed1998

The credible forensic psychiatric evaluation in multiple chemical sensitivity litigation.

The forensic psychiatrist must be able to perform a credible psychiatric evaluation and render a competent psychiatric opinion in hotly contested multiple chemical sensitivity (MCS) litigation. Forensic psychiatrists are often requested to evaluate MCS claimants by third party payers, employers, lawyers, and government agencies regarding health care costs and disability payments, workers' compensation claims, unemployment benefits, workplace accommodation reimbursements for special housing and environmental needs, civil litigation, and other claims. The credible forensic psychiatric evaluation of MCS litigants is described using the multiaxial diagnostic system of DSM-IV. Forensic psychiatrists must avoid becoming polarized by the current MCS controversy. The ethical requirements of honesty and striving for objectivity can be met by keeping separate the roles of therapist and expert, staying abreast of the scientific literature regarding MCS, and understanding the role of the psychiatric expert in MCS litigation.

Ethics, Professional↗
PubMed1998

Murder masquerading as suicide: postmortem assessment of suicide risk factors at the time of death.

Postmortem assessments of suicide risk factors present at the time of death were used to expose a murder masquerading as a suicide. Postmortem assessment of clinically based suicide risk factors in equivocal suicide cases should readily meet prevailing evidentiary criteria of "reasonableness." Assessing the presence or absence of suicide risk factors can assist in clarifying the question of suicide intent at the time of death. However, discerning the motives for suicide is usually a more difficult task. Forensic opinions should avoid conclusory statements that invade the province of the fact finder in determining criminal responsibility.

Adult↗
PubMed1997

Clinically based risk management principles for recovered memory cases.

Controversy over cases involving so-called recovered memories of sexual abuse has threatened to divide the mental health field, just as lawsuits based on recovered memories have sometimes divided children from parents and others. The authors review issues in this controversy, including the role of misdirected advocacy for recovered memory by some practitioners, the distinction between the actual events and patient's narrative truth as a factor in the therapeutic alliance, and the contrast between therapeutic and legal remedies. They recommend nine clinically based risk management principles to guide clinicians in dealing with cases involving recovered memory. They include the need for documentation and consultation; the value of psychotherapeutic neutrality, maintaining a calm perspective, and understanding the difference between historical and narrative truth; the incompatibility of the roles of treater and forensic expert; the risks of special therapies such as hypnosis; awareness of the roles of other professionals and the significance of the patient's family; and the importance of knowing when to end treatment.

Adult↗
PubMed1997

Toward the development of guidelines for the conduct of forensic psychiatric examinations.

Guidelines for conducting forensic psychiatric consultations and evaluations have not been clearly established. The authors offer and discuss such guidelines, which are based upon the boundary guidelines in general psychiatric practice, ethics principles in general psychiatry, ethics principles in forensic psychiatry, and the relevant case and statutory law. These guidelines are intended to assist the psychiatrist in appropriately conducting forensic evaluations whether in litigation or administrative proceedings.

Disclosure↗
PubMed1997

Video voyeurs and the covert videotaping of unsuspecting victims: psychological and legal consequences.

Video voyeurs employ state of the art technology to gain access into the most private places where victims are covertly videotaped. Women are the usual victims of video voyeurs as they change their clothes, perform natural functions or engage in sexual activities. When the videotaping is discovered by the victim, serious psychological harm may result. A civil suit is the most common legal remedy sought. Criminal sanctions, when available, are often insufficient compared to the seriousness of the crime. While unauthorized, covert audiotaping is forbidden by both federal and state codes, videotaping is often not specifically mentioned. It appears that legislators do not fully appreciate the burgeoning of covert videotaping, the technological advances that have greatly expanded the possibilities for voyeuristic viewing and the harm done to victims of video voyeurs. Appropriate criminal sanctions need to be included in privacy statutes for unauthorized, video surveillance with or without accompanying audio transcription.

Adolescent↗
PubMed1994

Forensic psychiatry and the perturbation of psychiatrists' attention and neutrality during psychotherapy.

Most psychiatrists who practice the specialty of forensic psychiatry also conduct a general psychiatric practice. The free-floating attention necessary for the conduct of psychotherapy can be distracted by the many exigent demands a forensic practice places on the clinician. On the other hand, forensic psychiatrists are exposed to challenging cases and learn clinical skills ordinarily not obtainable from the general practice of psychiatry. The conduct of general practice is quite different from that of forensic practice. Understanding the essential differences should help maintain the equanimity of the psychiatrist and preserve the psychiatrist's attention to his or her patients.

Attention↗