Q. APA and other professional organizations publish treatment
guidelines. The facility where I work also maintains policies and procedures
addressing treatment. Are these treatment guidelines and policies and
procedures the standard of care?
A. Treatment guidelines and policies and procedures are not the
standard of care, nor do they—by themselves—definitively establish
the standard of care.
However, because reputable treatment guidelines and policies and procedures
often constitute a consensus of experienced practitioners, treatment
guidelines and policies and procedures may closely approximate the standard of
care and are used by judges and juries as powerful evidence of the
applicable standard of care.
Human variation precludes the development of a predetermined standard for
every possible clinical situation, and reasonable psychiatrists can disagree.
In fact, treatment guidelines sometimes conflict with each other. A defendant
psychiatrist who departs from authoritative guidelines will almost certainly
have to explain his or her reasoning for the departure in court. Therefore,
psychiatrists who deem it necessary to deviate from a recognized guideline
should take care to document their reasoning and decision-making process in
patient charts. Contemporaneous documentation is one of the most powerful
forms of evidence for a defense.
It is important to understand that reputable treatment guidelines and
policies and procedures developed by professional societies must not be
confused with utilization review or protocols used by managed care
organizations that are influenced by economic considerations. Adherence only
to utilization review and other similar protocols that do not necessarily have
an authoritative clinical basis will not protect psychiatrists in the
courtroom from allegations that their care fell below the standard of
Q. I am interested in attending a psychiatric-specific risk management
seminar. Do you have anything planned for the near future?
A. Professional Risk Management Services Inc., manager of the
Psychiatrists' Program, will be presenting the psychiatric-specific risk
management seminar "The Risk Management Puzzle: Putting the Pieces
Together" on September 8 in Pittsburgh at the Sheraton Station Square
Hotel. This all-day seminar addresses the top malpractice concerns of
psychiatrists and mental health care professionals. Attendees will have an
opportunity to participate in a "claims committee meeting" via an
audience-response system and to experience how risk management practices
impact the resolution of actual lawsuits. Distinguished physician and attorney
guest faculty will be speaking and participating in a panel discussion.
Upon successful completion of the seminar, attendees will be eligible to
receive up to a maximum of 6.25 AMA Category 1 credits. Detailed information,
full agenda, online registration, and directions are posted at<www.prms.com>.
Participants in the Psychiatrists' Program can attend these seminars at no
charge and, except for New York psychiatrists, are eligible to earn a 5
percent reduction on their insurance premium. As an alternative, participants
in the New York program can earn the premium reduction by taking an online
risk management course. Visit<www.prms.com>
and click "NY Seminars and Excess Program."
This seminar is open to all mental health care professionals. Non-Program
participants can attend for $299, which covers the costs of seminar materials,
continental breakfast, breaks, and lunch. There are several registration
discounts available including a $50 online registration discount and reduced
rates for groups, early career psychiatrists, and residents.
Q. I am currently insured with the Psychiatrists' Program and am
considering moving my practice to a different state. Will I be able to keep my
medical malpractice coverage through the Psychiatrists' Program, or will I
need to purchase a new policy from another carrier writing insurance in that
A. One of the many advantages of the Psychiatrists' Program is that
it is a national program. Your location may change, but your coverage may not
have to, depending on state regulations. All of the benefits of the
Psychiatrists' Program, including access to the Risk Management Consultation
Service helpline, move with you. Just contact your underwriter prior to moving
your practice so that any necessary adjustments to your policy can be made to
reflect the new location.
This column is provided by PRMS, manager of the Psychiatrists'
Program, for the benefit of APA members. More information about the Program is
calling (800) 245-3333, ext. 389; or sending an e-mail to<TheProgram@prms.com>.▪