Treatment Guidelines vs. Standard of Care

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 care.

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 state?

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 posted at<www.psychprogram.com>; calling (800) 245-3333, ext. 389; or sending an e-mail to<[email protected]>.▪