The psychiatrist-patient relationship is one of the most intensely personal in the field of professional health care. As a result, a psychiatrist’s errors or missteps in treatment can carry significant consequences for patients. And like any other doctor or health care provider, a psychiatrist may be liable for medical malpractice in the event that a mistake harms a patient. This article will first describe some types of medical malpractice cases that might emerge from the psychiatrist-patient relationship. It will then discuss what a patient must prove in court in order to win a psychiatric malpractice lawsuit.
Common Psychiatric Malpractice Cases
There are three types of malpractice cases that are especially relevant to the psychiatrist-patient relationship. They include exploitation of the trust relationship and improper prescriptions, and third party liability.
Exploitation of the Trust Relationship. What happens when a psychiatrist takes advantage of his or her position of trust or power, and begins crossing boundaries (by sleeping with a patient, for example)? Obviously, the psychiatrist has broken about a dozen provisions of the psychiatrist's code of ethics. But can the patient sue the psychiatrist for medical malpractice?
In many cases, the answer is yes. A patient has a right to expect competent and professional conduct from a psychiatrist. If the psychiatrist’s conduct fails to meet that standard and causes harm to the patient, the psychiatrist will be liable for that harm. This can be true even if the patient consented to a sexual relationship. The harm in this situation can come in many forms. The most common form is emotional harm resulting from a breach of trust.
Improper Prescriptions. Obviously, prescribing the wrong medication or the wrong dosage of the right medication can have dire consequences. For that reason, all doctors (including psychiatrists) are required to exercise care when prescribing drugs. As a result, a psychiatrist will be liable for any harm resulting from an improper prescription, assuming other reasonably competent doctors would not have made the same mistake under similar circumstances.
Third Party Liability. Imagine that a patient informs a psychiatrist that the patient intends to kill someone. The psychiatrist attempts to persuade the patient to reconsider, but believes that the patient will commit the act anyway. The psychiatrist has a problem. It might seem obvious that the psychiatrist should report the conversation to the police in order to prevent the murder. But strict rules of confidentiality apply to the psychiatrist-patient relationship.
Assume the psychiatrist decides to honor the confidentiality and does not call the police. The patient commits the murder. Can the family of the victim sue the psychiatrist for failing to report the conversation to the police? Although it is a close call, and the answer can vary by state, the answer is probably yes. The family of the victim can probably sue the psychiatrist if the patient clearly informed the psychiatrist of an intent to kill, and the psychiatrist believed that the threat was legitimate, but failed to act.
How to Prove a Psychiatric Malpractice Case
In order to prevail in a psychiatric malpractice case, a patient must prove three basic elements:
- doctor-patient relationship
- negligence, and
- harm caused by the negligence.
When a doctor examines a patient or provides treatment, a doctor-patient relationship is generally established. In any situation in which a psychiatrist holds him or herself out as a mental health professional and provides treatment to a patient, a doctor-patient relationship is typically created. Of course, this element can be firmly established through documentation (treatment records, bills, etc.).
A psychiatrist can be considered negligent for, in administering health care services, failing to act as other reasonably competent psychiatrists would have acted under similar circumstances. In medical malpractice lawsuits, patients must prove two things to demonstrate negligence:
- standard of care, and
- breach of the standard of care.
Standard of Care. In legalese, "standard of care” refers to the level of competence that most psychiatrists would have conducted themselves with, under the circumstances which gave rise to the alleged malpractice. In the vast majority of cases, expert testimony is required in order to establish the appropriate standard of care -- meaning the patient (usually through an attorney) consults a specialist (usually another psychiatrist) who offers an opinion as to what the proper course of conduct would have been under the circumstances.
Breach of the Standard of Care. The next step is to prove that the defendant psychiatrist breached the standard of care in treating the patient, by failing to follow the proper course of conduct. For example, if the standard of care required the psychiatrist to assess a fairly common psychiatric disorder and prescribe the correct medication to treat it, failure to take those steps might constitute a breach of the standard of care.
Harm Caused by the Negligence
In order to win a medical malpractice lawsuit, the patient must prove that the psychiatrist’s negligence caused foreseeable harm. This harm can take many forms, including:
- pain and suffering
- cost of future treatment
- loss of earning capacity, and
- loss of the ability to enjoy life
The critical issue is whether the negligence actually caused the harm. This causal link can be difficult to prove, and this is another element that can best be established through the professional opinion of a trained expert. For example, assume that a depressive patient is prescribed medication that carries suicidal ideation as a known side effect, and the patient commits suicide a few weeks after starting the prescription. In that case, an expert witness will work to show that the psychiatrist's failure to prescribe a different medication caused (or was a significant factor in) the patient's death.