Managing Outpatient Behavioral Health Risks

Understanding the risks associated with practicing in an outpatient behavioral health care environment can go a long way toward avoiding a medical malpractice lawsuit or licensing board complaint. While psychiatry is one of the least sued medical specialties, the risk is not zero.

Below are some points that psychiatrists should consider while treating their patients.

Prescribing

When prescribing or monitoring patients, consider the following questions:

• Which medications are best suited for the patient based on age, comorbidities, and drug-disease interactions?

• Is there a black-box warning and written informed consent?

• Is there evidence supporting prescribed medication if used in an off-label manner?

• Are there contraindications with other supplements, street drugs, or medications?

• Was the Prescription Drug Monitoring Program reviewed before prescribing an opioid or controlled substance medication?

Children of Separated, Divorced, or Unmarried Parents

Determine decision-making authority prior to treating a minor or releasing records.

• Do you have a copy of the current custody agreement or parenting plan?

• Does one of both parents have medical decision-making authority?

• Is the child of an age that allows him or her to consent to the release of information?

• What are the expectations in co-parenting if one parent decides to change his or her position?

• Do the parents understand that refusal of treatment or noncooperation by one or both parents may lead to the child’s being terminated from the practice?

Telepsychiatry

• Are you using a HIPAA-compliant platform and secure internet connection?

• Do you have a Business Associate Agreement with the telehealth vendor?

• Are you licensed in the state or country where the patient is physically located for services?

• Will the patient consent to providing an emergency contact?

Patient Confidentiality

• Does your consent-to-treat policy include your obligations for mandatory reporting or duty to warn/protect in compliance with state regulations?

• Do you obtain the patient’s written informed consent for release of his or her mental health records?

• Do you have written informed consent for the use of unencrypted email for electronic communication with the patient?

Misdiagnosis/Incorrect Treatment

• Do you review the patient’s prior medical information when evaluating and treating patients?

• Is your communication with patients timely and relevant?

• Do you have a tracking system when ordering tests and labs to ensure they were completed and followed up?

Boundary Issues

• Do you have a policy that you and your staff do not accept “friend” requests from patients?

• Do you have a policy addressing treating multiple members of the same family?

• Are you engaging in a dual relationship with the patient?

Noncompliant Patients

• Is there a reason the patient is refusing to comply with treatment, including taking medications as prescribed and attending regularly scheduled visits?

• Do you obtain a written informed refusal when the patient does not follow the treatment plan?

Termination

• Do you have a policy on circumstances that may lead to terminating the relationship with a patient?

• Does the policy include the state requirements to properly terminate the relationship?

Suicidal/Violent Patients

• Are you regularly screening your patients for risk of suicide and violence, and is your screening documented each time?

• Is it within the scope of your practice to provide the appropriate level of care for a suicidal/violent patient?

Documentation

• Does your documentation provide the information to support your evaluation and treatment of the patient?

• Are your documentation policies and procedures up to date?

While these questions are just some of the areas of vulnerability to consider, addressing these types of questions can go a long way to avoiding risk and assisting in one’s own defense if a malpractice claim or licensing board complaint is brought. ■

This information is provided as a risk management resource for Allied World policyholders and should not be construed as legal or clinical advice. This material may not be reproduced or distributed without the express, written permission of Allied World Assurance Company Holdings Ltd, a Fairfax company (“Allied World”). Risk management services are provided by or arranged through AWAC Services Company, a member company of Allied World. © 2021 Allied World Assurance Company Holdings, Ltd. All Rights Reserved.