Psychiatric claims under the spotlight
Clinical negligence claims involving psychiatrists are analysed here by Dr Shabbir Choudhury, who offers some useful tips on managing common risks.
The MDU supports psychiatrist members with issues ranging from regulatory investigations, service complaints, performance concerns, inquests and tricky medico-legal or ethical scenarios.
We also support members working in private practice who find themselves facing a clinical negligence claim and this article focusses on those cases.
In claims settled on behalf of the MDU’s members working in psychiatry over a recent ten-year period, we successfully defended more than 90% of cases.
What are the reasons for claims involving psychiatrists?
Risk of self-harm or suicide
A number of claims focused on allegations that there was a failure to recognise a patient was at risk of suicide or self-harm or that the patient was inadequately managed, often following multiple consultations.
There may be a great number of factors which lead a patient to take their own life, so it can be difficult for a claimant to prove causation. That is to say, for a claim to be successful, the claimant would have to demonstrate that, but for the alleged negligent act by the doctor, the patient would not have committed suicide.
Deprivation of liberty
In a number of cases, it was alleged the patient had been inappropriately detained in hospital for treatment. Only one such case was settled in the review period, but it highlights the importance of ensuring all appropriate alternatives are considered.
However, when there is no reasonable alternative to detention, it’s important to ensure there is appropriate input from all involved parties and that the reasons and discussions are thoroughly documented.
This is a complex area of the law and it is always worth getting medico-legal advice if there is any doubt about detaining a patient.
Addiction
A handful of cases involved patients with an alcohol or drug addiction. These claims tend to have long histories with many doctors involved and, therefore, establishing where accountability lies can be very difficult.
It is always important to ensure all clinicians involved in a patient’s care communicate thoroughly with each other and agree who takes responsibility for each aspect of care.
Other reasons for claims included:
- The treatment of bipolar disorder;
- Medication errors;
- An incorrect psychiatric diagnosis being made;
- Breach of confidentiality.
Managing risks
Claims involving psychiatrists are very diverse. However, there are some common risk factors, which, if managed appropriately, can help to reduce risks.
These include:
Ensuring that where there is a significant risk of suicide or self-harm, both the patient and the medication prescribed are appropriately reviewed. Be aware of and follow appropriate guidelines.
Being prepared to refer patients for specialist treatment when necessary. This is in line with GMC requirements to ‘recognise and work within the limits of your competence’ (paragraph 14, Good Medical Practice). You should ensure that you have the appropriate qualifications, skills and experience for the care you provide.
Being aware of the current available guidance on the prescription of antidepressants, including the BNF and NICE.
Having a system in place to review patients on long-term medication.
Getting expert advice from your medical defence body if there is any doubt about whether a patient’s detention is appropriate and lawful.
Clearly documenting your discussions with patients and family members.
If things go wrong, be open and honest with the patient by providing an explanation of what has happened and the likely short- and long-term effects of this.
Say sorry and get advice from the MDU if you believe the incident triggers the organisation’s duty of candour requirements. (See ‘Your duty to own up’.)
It can be very troubling to find out a patient is bringing a claim against you. If you face a claim, you can be assured that the MDU understands how stressful this is and the importance of mounting a robust defence of your position.
While claims numbers have remained steady in recent years, the cost have spiralled. This is not due to clinical standards but to a deteriorating legal environment which the MDU is campaigning to reform. You can see more at www.themdu.com/faircomp.
Dr Shabbir Choudhury (right) is a medico-legal adviser and former senior medical claims handler at the Medical Defence Union