5 Major Lawsuit Risks with Psych Patients
Leslie S. Zun, MD, chairman of the department of emergency medicine at Rosalind Franklin University of Medicine and Science in North Chicago, IL, says that if a patient discharged from the ED later commits suicide, "there are a number of issues that can place the emergency physician at risk." Zun gives these five major areas of risk involving ED psychiatric patients:
1. Consent for treatment.
"At times, these patients may need a mini-mental state examination, assessment of drug or alcohol impairment, or glucose check during the triage process," says Zun. "It is essential to err on the side of treatment of these patients."
Psychiatric patients may present to the ED but do not wish to be treated. "For some, this is part of their disease process," says Zun. "Implied consent is presumed until a complete evaluation is performed."
2. Medical problems.
An appropriate medical clearance process needs to be performed on all patients who present with psychiatric symptoms to ensure that medical problems are properly addressed.
"A history provides information on prior psychiatric illness, and a physical examination provides evidence of medical illness," says Zun. "A mental status examination determines consistency with medical or psychiatric disease and clinically directed laboratory testing looking for medical problems."
Zun notes that it is the obligation of the ED physician to determine whether the patient who presents with psychiatric symptoms has a medical problem that is causing or exacerbating his psychiatric presentation.
3. Suicide assessment.
"Emergency departments do a poor job assessing a patient's suicide risk unless the patient presents with a psychiatric illness," says Zun. "Many of these patients presenting with medical complaints have occult suicide ideation that is not identified unless a proper assessment of suicidality has been completed."
Collateral information from patients, friends, or others may assist in determining the suicide risk determination. "Just mentioning that they have thought about suicide is different than someone who has a plan and means to complete it," says Zun.
Like other medical complaints, the emergency physician must determine the patient's probability of suicide. "Use of suicide scales or assessment of suicidality based on certain risk factors will assist in this determination," says Zun.
4. Signing out against medical advice (AMA).
A mental status examination must be performed and documented prior to sending a patient out AMA, whether a psychiatric patient or otherwise, says Zun. "Just because a patient presents with a psychiatric complaint does not mean they do not have the capacity to understand the risks and benefits of treatment," he adds. "There is a liability risk in forcing treatment on competent patients, as well as letting patients leave AMA who are unable to make medical decisions."
5. Suicide contracts.
Some EDs have social workers or mental health personnel who evaluate patients. These individuals may develop a safety plan, including a contract not to commit suicide. Zun notes that a recent malpractice case involved an emergency physician sending a patient home with a suicide contract; the patient committed suicide a day after discharge. "Unless the patient is placed in a controlled, environment with close observation and known therapeutic alliance, I would recommend against using a contract," says Zun. "There is no way one can ensure that a patient will commit to such a contract."
Source
For more information, contact:
Leslie S. Zun, MD, Chairman, Department of Emergency Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL. Phone: (773) 257-6957. Fax: (773) 257-1770. E-mail: [email protected].
Leslie S. Zun, MD, chairman of the department of emergency medicine at Rosalind Franklin University of Medicine and Science in North Chicago, IL, says that if a patient discharged from the ED later commits suicide, "there are a number of issues that can place the emergency physician at risk." Zun gives these five major areas of risk involving ED psychiatric patients:You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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