MALPRACTICE Harvey Dondershine, MD, JD

1. MALPRACTICEHarvey Dondershine, MD, JD • COMPENSATE INJURED PARTIES • RETROSPECTIVE REGULATION (DICTA) • EFFECT ON HEALTH CARE SYSTEM • IMPROVE QUALITY OF CARE • INCREASE COST • EFFECT ON CLINICIAN • PRACTICE DEFENSIVE MEDICINE • NARCISSISTIC INJURY / THREAT TO LIVELIHOOD

2. WHERE DOES IT FIT? • MALPRACTICE IS A TORT • A TORT IS A CIVIL WRONG • SEEKS COMPENSATORY (MONEY) DAMAGES • THREE TYPES OF TORTS • INTENTIONAL • UNINTENTIONAL (NEGLIGENCE) • STRICT LIABILITY • TERMS: BURDEN OF PROOF, STANDARD OF PROOF • NO INSURANCE FOR INTENTIONAL WRONG

3. NO MALPRACTICE UNLESS DR-PT RELATIONSHIP • FORMATION, DURATION, TERMINATION • DUTIES • FIDUCIARY • QUID PRO QUO • OBJECTIVITY, CONFIDENTIALITY, ABSTINENCE, NEUTRALITY, UTMOST BEST INTERESTS • PROFESSIONAL • CLINICAL COMPETENCE / STANDARD OF CARE • ADHERE TO STANDARDS SET BY LAW

4. ELEMENTS • DUTY • TO WHOM, WHAT • DERELECTION • A BREACH OF STANDARD OF CARE THAT CREATES AN UNREASONABLE RISK OF FORESEEABLE HARM • DAMAGE • DIRECT CAUSATION • BUT FOR • PROXIMATE • DEFENSES • STATUTE OF LIMITATIONS

5. STANDARD OF CARE • STANDARD OF CARE • MIXED QUESTION OF LAW & FACT • NOT SAME AS OPTIMAL CARE, BEST PRACTICES, ETC • “ORDINARY, REASONABLY PRUDENT, PSYCHIATRIST UNDER SAME OR SIMILAR CIRCUMSTANCES” • DOCTOR DOES RISK:BENEFIT CALCULUS BEFORE ACTING • SOURCE • EXPERT TESTIMONY • SCIENTIFIC PUBLICATIONS, GUIDELINES, ETC. • JURY • JUDGE • STATUTES • CAPTAIN-OF-THE-SHIP DOCTRINE

6. COMMON CAUSES OF ACTION • GENERAL • BREACH OF FIDUCIARY DUTIES • PROCEDURAL NEGLIGENCE • DIAGNOSIS, MEDS, CHARTING, FOLLOW-UP • SPECIFIC TO PSYCHIATRY • SUICIDE • INADEQUATE RISK ASSESSMENT / RISK REDUCTION • INJURY TO THIRD PARTIES • TARASOFF, RELEASE / RESIDENTIAL PLACEMENT • DEFECTIVE INFORMED CONSENT PROCESS • FAILURE TO REPORT • CHILD ABUSE, DMV • ABUSE OF TRANSFERENCE • NEGLIGENT SUPERVISION / SUPERVISEE NEGLIGENCE

7. QUALITY ASSURANCE – RISK MANAGEMENT • THERAPEUTIC ALLIANCE • BE NICE • PRACTICE IN RIGHT WAY • PRACTICE ONLY W/I COMPETENCE • HISTORY / EXAMINATION / RECORD REVIEW / DOCUMENTATION • IDENTIFY RISK: PATIENTS / SITUATIONS / TRIGGERS • RISK IDENTIFIED NEEDS PLAN, PLAN NEEDS ACTION AND FOLLOW-UP • KNOW WHEN LESS REQUIRES MORE • PRESCRIBING DANGEROUS DRUGS • AVOID SMALL BORDER VIOLATIONS • YOUR CHART MUST SPEAK FOR ITSELF • ANTICIPATE EVIDENTIARY USE OF CHART • SECOND OPINION

8. LIMITATIONS ON LIABILITY • DUTY • FORESEEABILITY • ENTITY IMMUNITY • GOVERNMENT • HMO • MEDICAL INJURY COST RECOVERY ACT (MICRA) • STATUTE OF LIMITATIONS

9. ANATOMY OF A SUIT • PRELITIGATION PHASE • INCIDENT DATE, PRE-LITIGATION SUBPOENA, CERTIFICATION • PLEADINGS PHASE • COMPLAINT & SUMMONS, ANSWER • DISCOVERY PHASE • DISCOVERY SUBPOENA, INTERROGATORIES, DEPOSITIONS, EXAMINATIONS, REQUEST FOR ADMISSIONS • MOTIONS PHASE • DEMURRER • SUMMARY JUDGMENT • TRIAL PHASE

10. INSURANCE • UNDERSTAND POLICY • OCCURRENCE, CLAIMS-MADE, NOSE, TAIL • LITIGATION EXPENSES, INDEMNIFICATION COSTS • INCIDENT DATE VS INCIDENT REPORTING • KNOW WHAT ACTIVITIES COVERED • FORENSICS, COMMITTEES, SUPERVISION, OTHER? • MOONLIGHTING (INDEPENDENT CONTRACTOR?) • MBC / OTHER ADMIN ACTION • OTHER • HAMMER CLAUSE

11. MEDICAL BOARD OF CALIFORNIA • PRIMARY CONCERN IS PUBLIC SAFETY • SECONDARY CONCERN IS IMPAIRED PHYSICIAN • RECEIVES INPUT FROM VARIOUS SOURCES • 805 REPORTS • COURTS • PATIENTS • MALPRACTICE ACTIONS • INVESTIGATES, LIMITS/ REVOKES, REHABILITATES • COST RECOVERY PROGRAM • NO DIVERSION PROGRAM • WHAT TO DO IF YOU GET A CALL