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Biomedical subjects

Robert I Simon

Publications and source records attributed to Robert I Simon.

18 recordsLinked to original sources
PubMed2006

Imminent suicide: the illusion of short-term prediction.

The concept of imminent suicide is examined. A search of National Electronic Library for Mental Health, the Cochrane Library, PubMed, OVID and MD Consult databases was conducted using the terms "suicide, imminent." The term imminent frequently appears in the mental health literature, finding common usage among clinicians. It is also a legal term of art embedded in civil commitment statutes; duty to warn and protect statutes and case law, usually under the rubric of dangerousness; and in seclusion and restraint policies. Managed care admission protocols may contain imminence criteria for patients at risk for suicide before approving insurance benefits, yet no suicide risk factors exist for the short-term prediction of suicide.

Commitment of Persons with Psychiatric Disorders↗
PubMed2006

Pejorative testimony about opposing experts and colleagues: "fouling one's own nest".

Circumstances sometimes require expert witnesses under oath to express opinions about opposing experts or professional colleagues who work within their own professional, geographic, or organizational circle. This requirement poses some common problems that have not been well discussed in the literature. This article addresses some of those problems and suggests some useful solutions.

Expert Testimony↗
PubMed2006

Commentary: Medical errors, sentinel events, and malpractice.

Medical errors do not necessarily represent negligence. Even when a mental health professional deviates from the standard of care, minor injury to a patient is unlikely to result in a lawsuit. The standard of care is not the same as the quality of care. Quality of care refers to the total care a patient receives, the patient's health care decisions, and the available mental health services. As defined by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), "sentinel events," such as a patient's suicide, do not necessarily imply that a deviation in the standard of care occurred. Psychiatrists and hospital staff are held to an "ordinarily employed" standard of practice. The Institute of Medicine (IOM) guidelines recommend evidence-based care related to patient needs and values. Both JCAHO and IOM promote best practices. Experts err when they testify to a best practice standard in malpractice cases.

Humans↗
PubMed2006

Attorneys' requests for complete tax records from opposing expert witnesses: some approaches to the problem.

As part of an impeachment attempt on cross-examination of opposing expert witnesses in trial or deposition, the cross-examining attorney may request the complete tax records of the expert. It is widely believed that expert witnesses may be expected to express opinions that favor the parties who engage them and who pay their fees. Theoretically, the purpose of this request is an attempt to paint the expert as a "hired gun" whose major source of income is forensic work. The different issues, statutes, and case law citations that bear on requests for tax records are reviewed, and the strategies for coping with this tactic are suggested.

Conflict of Interest↗
PubMed2005

Narcissistic dimensions of expert witness practice.

The authors review narcissism as it relates to expert witness practice. The review addresses stable versus unstable narcissism, normal confidence, perspective taking, the effect of flattery, the will to win, mirror transference, narcissistic excitement, narcissistic rage, narcissistic injury, and post-traumatic stress disorder (PTSD). The article closes with recommendations for resisting narcissistic pitfalls and achieving the egoless state.

Expert Testimony↗
PubMed2005

On sound and unsound mind: the role of suicide in tort and insurance litigation.

Suicide continues to be a recognized as a crime by common law in a few states. In those jurisdictions, the beneficiary of a claim must prove that the individual who attempted or committed suicide was of unsound mind, to avoid having the patient's act declared illegal, which would bar recovery of the claim. In malpractice and insurance cases, expert testimony is required regarding the mental state of the individual who attempted or committed suicide. Psychiatric testimony varies widely, depending on the legal definition of "unsound mind" and the highly subjective interpretation of legal definitions. Some experts equate suicide with an unsound mind, whereas others apply M'Naghten criteria. Some psychiatrists who disagree with criminalizing suicide refuse to participate in these proceedings. In suicide malpractice cases, the appropriate function of the expert witness is to provide testimony about the standard of care. When experts attempt to testify about "sound or unsound" mind, they must be mindful of the imperfect fit between psychiatry and the law.

Adult↗
PubMed2002

Non-sexual boundary crossings and boundary violations: the ethical dimension.

The ethical principles relative to nonsexual boundary issues derive from the first principle of respect for the dignity of the patient. Using a case vignette, the authors have explored the mutual derivation and inter-relations of these principles, with clinical approaches to patient care. Clinicians should be aware of the ethical underpinnings of sound therapeutic techniques that manifest respect for the patient.

Guidelines as Topic↗
PubMedDate not supplied

Distinguishing trauma-associated narcissistic symptoms from posttraumatic stress disorder: a diagnostic challenge.

Individuals with trauma-associated narcissistic symptoms (referred to in this paper by the acronym TANS for simplicity) display a discrete cluster of psychological symptoms that can closely mimic those of PTSD. In TANS, the underlying vulnerability to traumatic stress usually stems from a narcissistic personality disorder or narcissistic personality traits. However, narcissistic symptoms associated with an external traumatic event may be reflexively and erroneously attributed to PTSD, no matter how small or insignificant the traumatic stressor. Mistaking TANS for PTSD usually results in treatment failure. In litigation, distinguishing between TANS and PTSD assists the trier of fact in determining causation and assessing damages.

Adult↗
PubMedDate not supplied

Patients' rights and psychiatrists' duties: discharging patients against medical advice.

Every psychiatrist who treats voluntary inpatients has had or will have patients who leave the hospital against medical advice (AMA). Studies reveal that between 6 and 35 percent of voluntary psychiatric inpatients are discharged AMA. These patients often are acutely ill and have severe symptoms at discharge. They also, as a group, have high rehospitalization rates and worse outcomes than patients who do not leave AMA. When a mentally ill patient demands to leave the hospital AMA, a tension arises between the patient's rights and the psychiatrist's duties. These duties include those to the patient and, in many cases, to third parties. Patients discharged AMA may remain dangerous and can expose health care providers to a heightened liability risk. More importantly, because of such factors, decisions about handling the AMA discharge are more difficult than decisions about admission. This article analyzes the sources of increased liability risk posed by AMA discharges. It includes discussions of patients' rights, including the different types of voluntary admissions, and psychiatrists' duties. Malpractice litigation in this area is reviewed. The article concludes by suggesting risk-management techniques that can aid in protecting the psychiatrist while also respecting patients' rights and delivering good clinical care.

Humans↗