Psychiatric malpractice lecture Flashcards
All are required for res ipsa loquitur except:
A) Harm rarely occurs in the absence of negligence
B) The defendant was physically present at the time of the negligence
C) The plaintiff did not contribute to the bad result
D) Only the defendants have access to information about what happened
B) The defendant was physically present at the time of the negligence
The most common cause of action against psychiatrists is:
A) Breach of confidentiality
B) Suicide
C) Homicide - suicide
D) Missed diagnosis
B) Suicide
From a forensic-legal standpoint, suicide malpractice cases turn on which two elements?
A) Malpractice
B) Foreseeability
C) Precautions taken
D) A and B
E) B and C
E) B and C
Civil sanctions for sexual malpractice include all of the following except:
A) malpractice
B) Felony conviction
C) Intentional tort
D) Breach of contract
E) Loss of consortium
B) Felony conviction
Negligence involves all of the following except:
A) Duty
B) Dereliction of Duty
C) Derogation
D) Direct causation
E) Damages
C) Derogation
Which of the following could potentially create transferred negligence via a duty to 3rd parties?:
A) Inviting a patient’s spouse to the therapy to confront him about abuse
B) Instructing a patient to sue her previous psychiatrist for negligent prescribing
C) Recommending a patient get a divorce
D) All of the above
D) All of the above
Which of the following is NOT a common error in malpractice case analysis?
A) Considering intervening causes
B) Hindsight bias
C) Identifying an excessive number of deviations
D) Opining on causation when issues are outside your area of expertise
A) Considering intervening causes
Clites v. Iowa (IA COA, 1982) involved all of the following issues except:
A) Freedom from unreasonable bodily restraints
B) Informed consent was not obtained
C) Medication use for the convenience of staff
D) Failure to monitor for tardive dyskinesia
A) Freedom from unreasonable bodily restraints
In Roy v. Hartogs (NY SC, 1976), punitive damages were denied by the court because:
A) compensatory damages had already been reduced
B) They were barred by statutory seduction suits
C) Defendant had no evil/malicious intent
D) Plaintiff was capable of knowing and meaningful consent
C) Defendant had no evil/malicious intent
Which of the following is true about Osheroff v. Chestnut Lodge?
A) Showdown between biological and psychoanalytic psychiatry
B) Claims included: failure to disclose alternative treatments
C) Settled out of court
D) All of the above
D) All of the above
All of the following should be avoided in malpractice case analysis, EXCEPT?
A) Using standard of excellence
B) Identifying 1 or 2 causally connected deviations
C) opining on causation outside your area of expertise
D) hindsight bias
B) Identifying 1 or 2 causally connected deviations
Vignette: Mr. A hospitalized for depression, SI. Improved over 4 days, no longer endorsed SI. Constant obs. reduced to 15” checks. During evening visit, wife told him he wanted a divorce. Mr. A returned to room, wrote brief note re: anger toward wife, suicided by hanging. Suit filed re: failure to prevent suicide. Regarding malpractice, which of the following is most correct?
A) Mr. A’s suicide was reasonably foreseeable
B) the likely deviation was a failure to implement appropriate precautions
C) Mr. A should have been moved to 5-minute checks
D) The wife’s rejection was an intervening cause
D) The wife’s rejection was an intervening cause
What is the most common claim against psychiatrists?
Incorrect treatment for tests and suicide in the real world.
Where does the standard of care originate?
multi-determinate, including research, text articles, practice guidelines, statutes, case law, expert testimony
What are the two types of clinical errors?
Error of fact - failure to gather relevant data; likely to be negligence if a bad outcome exists.
Error of judgment - informed, good-faith decision turns out to be a mistake.
What are the four elements of negligence?
Duty
Dereliction
Direct Cause
Damages
What are the standards of dereliction of duty?
Average practitioner - “customary practice standard,” practitioner meets average standards of knowledge and skill.
Reasonably prudent practitioner is held liable if a plaintiff proves that the physician failed to provide reasonable and prudent care in light of all the circumstances.
What are the two factors of Direct Cause?
Cause-in-fact - “the actual cause,” the cause without which the event could have occurred, the antecedent.
Proximate cause - “legal cause,” the event that causes a foreseeable result, without which the result would not have occurred. This may be a substantial factor bringing about the injury,
What is an Intervening Cause?
A superseding cause that were unforeseeable and break the chain of causation. For example, a patient improving on the inpatient unit kills themself after their wife informs him of a divorce while on the unit.
What are the two elements of suicide malpractice?
1) foreseeability of suicide potential
2) Precautions taken once the risk is acknowledged
What are the most common claims of suicide malpractice?
- failure to perform an adequate risk assessment
- failure to provide adequate safety precautions
- Failure to provide a safe environment
- Premature discharge/inadequate plan
What was the finding of Clites v. Iowa?
The psychiatrist failed to provide reasonable medical treatment, and this negligence was the direct cause of Clites’ condition.
What was the finding of Roy v. Hartogs?
Roy was found negligent for having sex with Hartogs, but damages were reduced b/c Hartog did not have “evil or malicious intent.”
What bias may lead experts to apply inappropriately high standard?
egocentric bias
