Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

FORENSIC BOARDS > Psychiatric Malpractice > Flashcards

Psychiatric Malpractice Flashcards

1
Q

4 Largest Categories of Psych Malpractice Claims

A

Suicide/SA (27%)
Incorrect tx (23%)
Breach of confidentiality (15%)
Medication issues (8%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

7 Sources of Standard of Care

A

Research articles
Texts
Practice guidelines
Statutes/case law
Expert testimony
Pharmaceutical package inserts
PDR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Telepsych Considerations (3.2)

A

SOC same
Know pt’s location
Safety protocols/contingency plans for:
- Clinical emergencies
- Technical failures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

2 Types of Clinical Errors (& which one more likely to find negligence)

A

Error of fact (more likely)
Error of judgment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

4 Elements of Negligence

A

Duty
Dereliction
Direct Cause
Damages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

BOP for 4 Elements of Negligence

A

Plaintiff has BOP by POTE for all 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Stand of Care Def

A

“degree of skill and learning that is ordinarily possessed by members of that profession in good standing.”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

2 Standards of Care (& point)

A

Average Practitioner
Reasonably Prudent Practitioner
- Depends on jurisdiction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Average Practitioner Standard

A

Custom/norm in the area, general knowledge/skill by other members of profession in similar circumstances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Reasonably Prudent Practitioner Standard

A

Can still be held liable if failed to provide reasonable/prudent care in all circumstances, even though adhered to customary practice in the field

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Average vs Reasonably Prudent Practitioner State Proportions

A

> 50% have moved towards reasonably prudent practitioner

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Res Ipsa Loquitur (translation, gen, legal and medical significance)

A

“The thing speaks for itself”
Plaintiff just has to show particular result occurred & wouldn’t have occurred except for negligence
- Basically means so obvious that expert testimony might not even be needed
- Rare in medical malpractice, some states prohibit it for this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

4 Components of Res Ipsa Loquitur

A
  • The harm rarely occurs in absence of negligence
  • Means of harm within def’s exclusive control
  • Plaintiff did not contribute
  • Def has exclusive access to facts about harm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

2 Prongs of Direct Causation

A

Cause-in-fact (“actual cause”)
Proximate cause (“legal cause”)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Cause-In-Fact (Def & Other Name)

A

Necessary antecedent to injury
“But for” test: but for def’s act of negligence, injury would not have occurred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Proximate Cause (Def, Other Point, and Crux)

A

Event in natural unbroken sequence produces particular foreseeable result, without which wouldn’t have occurred (substantial factor in injury)
- Analyzed in terms of foreseeability: liable if reasonably foreseeable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Intervening Cause (other name and what it is)

A

“superseding cause”
Event that takes place after negligence, breaks chain of causation. Often rapidly precipitates injury and may supersede def’s negligence in causing injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

2 Doctrines Considering Plaintiff’s Role in Injury

A

Comparative and contributory negligence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Comparative Negligence

A

Plaintiff’s damages offset to degree fact finder determines plaintiff contributed to harm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

50% Rule of Comparative Negligence

A

Many states have rule where plaintiff recovers nothing if >50% responsible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Contributory Negligence

A

Plaintiff found by fact finder to be negligent; recovery may be totally barred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Defensive Medicine (& ethical problem)

A

Primary goal to limit future risk of successful lawsuit, only secondarily to adhere to standard of care
- Ethical: moves focus away from best interests of pt towards best interests of physician

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

3 Goals of Malpractice Litigation

A
  1. Deter unsafe practices
  2. Compensate injured persons from negligence
  3. Exact corrective justice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Duty

A

Once doctor-pt established, doctor has fiduciary obligation to treat patient according to prevailing standards of good medical practice, legal contract to continue to treat or properly terminate relationship

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

When Doctor-Pt Relationship Formed

A

When doc affirmatively acts in pt’s case by examining/diagnosing/treating, or agreeing to do so

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

3 Considerations for Respondeat Superior

A
  1. Committed w/in time & space limits of agency?
  2. Incidental to/same nature of responsibilities servant authorized to perform?
  3. Motivated to benefit master by committing act?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Possible Employer Defense for Respondeat Superior/Vicarious Liability

A

Employee engaged in “frloic and detour” (major or minor departure from service to employer)

28
Q

Respectable Minority Doctrine (other term, what it is, & justification)

A

“Two schools of thought” rule
- Preclude liability if can show physicians divided over appropriate tx course and def picked acceptable option “respectable” by peers generally
- Protects medical innovation

29
Q

Suicide Malpractice History

A

Generally had been quite rare, couldn’t hold responsible. Then in 1970-80s, started as possibility, by 2000 was leading cause of financial malpractice judgments

30
Q

2 Primary Elements of Suicide Malpractice (& gen summary)

A
  1. Foreseeability
  2. Precautions taken
    When foreseeability established, psychiatrist automatically incurs duty to take reasonable precautions to ensure pt’s safety
31
Q

6 Common Bases for Suicide Malpractice Suits

A
  1. Failure to conduct adequate risk assessment
  2. Failure to assess risk at key clinical times (changing precautions, discharge, worsening situation)
  3. Communication breakdowns
  4. Failure to provide safe physical environment
  5. Inadequate d/c plan/f/u
  6. Premature d/c
32
Q

Most Common Sentinel Event Reported to JCAHO

A

Inpatient Suicide

33
Q

Most Common Inpt Suicide Method

A

Hanging

34
Q

High Risk Times for Suicide (in relation to hosp)

A

1st week of admission and shortly after d/c

35
Q

3 Problems Relying Only on Self-Report for Inpt Suicide

A
  1. Psych as adversary - once decided to die by suicide
  2. Alienated/unsure perspective as new pt
  3. Respond honestly but misunderstand own sx/impulsivity
36
Q

3 Suicide Malpractice Defenses

A
  1. Lack of foreseeability
  2. Lack of deviation - appropriate precs for risk level
  3. Lack of causation (proximate cause) - intervening cause or no causal nexus
37
Q

6 Probable Standards of Care for SRA

A
  1. Gathering Info from Pt
  2. Gathering Data from Other Sources
  3. Estimating Suicide Risk
  4. Tx Planning
  5. Documentation
  6. Monitoring
38
Q

3 Requirements of Informed Consent

A
  1. Voluntariness
  2. Information
  3. Competence
39
Q

4 Areas Pts Right to be Informed of for Informed Consent

A
  1. Nature/extent of illness
  2. Risks/benefits proposed tx
  3. Risks declining tx
  4. Other reasonable alternatives
40
Q

4 Requirements for Off-Label Rx Negligence Finding

A
  1. Proof that use for specific condition not standard
  2. Peer-reviewed published evidence
  3. Off-label use is not just a difference of opinion
  4. Prescriber did not act on good-faith belief that off-label use would benefit
41
Q

Duty to Nonpatients w/ Prescriptions

A

Courts generally found can be held liable (e.g., effects from drugs cause them to injure family member)

42
Q

Psychotropics and School Shootings

A

No causal association ever found, most were not previously tx with psychotropic medications

43
Q

Structured Professional Judgment (SPJ) (What it is, SOC, accuracy note)

A

Elements of both clinical judg and actuarial assessments for identify violence risk
- Not required for standard of care
- More accurate ID’ing low risk (many false positives)

44
Q

Boundary Crossings vs. Boundary Violation

A

Crossing - deviation from standard psychotherapy custom of empathic neutrality, harmless/non-exploitive and possibly productive if processed appropriately, may allow for individual response to pt needs
Violation: Harmful/exploitative deviations from customs

45
Q

Mishandling of the Transference

A

Cause of action to file under malpractice when insurance cos exclude sexual misconduct coverage

45
Q

Negligent Psychotherapy

A

Very difficult to prove bc lack of established standards/efficacy, so most commonly found with unorthodox therapies resulting in physical/mental harm

46
Q

Attachment Therapies

A

Controversial alternative child therapies intended for attachment d/o - main technique “holding therapy,” but also like “rage-reduction,” “re-birthing”

47
Q

Holding Therapy

A

Child firmly held or laid on by parent or therapist, confronted and made to experience rage/despair/catharsis

48
Q

3 Situations for Abandonment Claims

A

Vacation w/o coverage
Failure to f/u after prescribing medication
Failure to properly terminate tx relationship

49
Q

5 Steps for Termination

A
  1. Written notice by certified mail
  2. Provide brief explanation for terminating relationship
  3. Provide appropriate referrals for continued tx
  4. Agree to continue to provide tx for reasonable period to allow secure tx elsewhere
  5. Offer to xfer records to new provider upon signed authorization
50
Q

3 Potential Consequences for Breach of Confidentiality

A
  1. Breach of Contract (implied)
  2. Breach of Statutory Duty
  3. Professional Misconduct
51
Q

Transferred Negligence Doctrine

A

3rd Party Direct Vitim
Strong advice given to pts involving 3rd parties, or bring 3rd parties into session, may create legal duty toward 3rd party/make as a “quasi-patient” if harm from actions reasonably foreseeable

52
Q

Actions Potentially Creating Duty to 3rd Party (5)

A
  1. Participating in confrontation of 3rd party
  2. Instructing patients to take actions implicating a 3rd party
  3. Recommending pt initiate suit against 3rd p
  4. Rec pt make public accusations of criminal behavior
  5. Advising pt to make major changes in relationships
53
Q

National Practitioner Data Bank (NPDB) (Act, what it is, availability)

A

Created by Congress 1986 Health Care Quality Improvement Act
- Basically info on medical malpractice payments & other adverse actions related to healthcare practitioners/orgs/etc
- Available to orgs that use them for licensing/credentialing/privileging etc

54
Q

10 Actions Recorded in NPDB

A
  1. Med mal payments
  2. Adverse clinical privileges actions
  3. Adverse professional society membership actions
  4. State licensure/cert actions
  5. Fed licensure/cert actions
  6. Neg actions/finding by peer review org
  7. Neg actions/findings by private accred org
  8. Exclusions from participation in Medicare/Medicaid
  9. Other adjudicated actions or decisions
  10. HC-related civil/crim judgments in Fed or state court
55
Q

4 Types of Med Mal Reform Approaches (& most common/consistent type)

A
  1. Fewer lawsuits by creating barriers to filing (merit reviews pre-filing cert)
  2. Caps on damages (most common/consistent to reduce, over 50% states, imposing caps on noneconomic damages/suffering)
  3. DOT vs. large lumpsum settlements
  4. Alternative dispute resolution (ADR)
56
Q

Communication and Resolution Programs (CRPs)

A

Encourage open communication/transparency w/ pts to facilitate restitution for injured parties, and support physicians in disclosure convos

57
Q

Apology Laws

A

Gen BS bc don’t go far enough, some protections against statements in apologies being used against you, but not complete enough, so still might leave you more exposed

58
Q

Affidavit of Merit

A

Many states require plaintiff show “merit” b4 suit can be brought, usually outlined in some expert report or briefer affidavit

59
Q

Locality Rule (What it is, purpose, state distr, problems)

A
  • Def physician must provide to same degree of skill/care req’d of physician practicing in same/similar community
  • Originally to protect rural physicians from being held to same SOC as academic/city centers, before standardizations of training/accreditation
  • 45 states nat’l standard, only 5 w/ some degree of locality rule
  • Limits plaintiffs too much providing specific community’s SOC and finding expert from same/similar area
60
Q

4 Kinds of Bias that Might Interfere as Malprac Expert

A

Egocentric bias
Hindsight bias
Omniscient perspective
Confirmation bias

61
Q

Egocentric Bias

A

Exaggerated view of own abilities or applying own higher SOC

62
Q

Hindsight Bias

A

Poor outcome known beforehand, overestimate probability that could’ve been anticipated

63
Q

Omniscient perspective

A

Failure to use from def’s perspective due to having access to all records/depositions etc

64
Q

Ipse dixit (trans and significance)

A

“He said it himself,” “It is so, because I said it”
Basically unsupported conclusory evidence by expert, just bc it’s his own belief

65
Q

3 Exceptions Can Testify about SOC in Other Field of Medicine

A
  1. SOC essentially same for case at issue
  2. Methods of tx essentially same for case at issue
  3. Def adopts tx methods of other school

FORENSIC BOARDS (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions