Malpractice risks with suicidal patients.

Discusses the suicide of a patient as one of the most difficult events that a psychotherapist will ever experience. In addition to the emotional turmoil, a psychotherapist may encounter legal complications because patient suicides are potentially the basis of a malpractice suit. The malpractice risks when treating suicidal patients in inpatient and outpatient settings are explored. The legal principles of abandonment and duty to warn are reviewed and related to suicide. Psychotherapists should be certain they can provide adequate service to suicidal patients and should have back-up arrangements with a local hospital where patients may be hospitalized if necessary. Reasonable available coverage during evening hours and weekends is essential. Psychotherapists should also seek a consultation when treatment has reached an impasse or the suicidal potential is dangerously high. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Informed consent with suicidal patients: Rethinking risks in (and out of) treatment.

Informed consent is uniformly accepted as essential to the treatment process. However, the relevant literature has not discussed issues of risk specific to suicidal patients, nor has such information routinely been included in the informed consent process. The implications of including suicide-specific risk information in the informed consent process is discussed and examples provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Malpractice: Professional liability and the law.

Contends that psychologists typically possess only the most rudimentary understanding of the medical–legal concept surrounding today's professional malpractice suits. This article explores the elements making up the underlying concept of negligence and the related notion that it should ultimately be the profession itself, and not the jury, that determines the standard of care with which the accused provider must be compared. Although the proof of provider negligence, or "fault," is the present basis of malpractice, the inherent inappropriateness of such a conceptual model for most medical and especially therapeutic "injuries" is stressed. A recently enacted Hawaii statute establishing medical–legal "claim conciliation panels" is prefered as a logical step in the eventual evolution of a pure "no-fault" approach to the rising incidence of health care suits. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Malpractice in psychotherapy

Two cases of malpractice in psychotherapy are described. In one case there was a psychiatrist involved, in the other a non-medical psychotherapist. The legal aspects of malpractice in the view of Swiss legislation are shortly discussed. A legal liability for damages caused by the psychotherapist might arise if the following conditions are fulfilled: A deviance from the generally accepted standards of care in psychotherapy, a damage to the patient as a consequence of this deviance and a negligence on the part of the psychotherapist. Furthermore, there has to be an adequate causal nexus between malpractice and damage done to the patient. By some case reports the author tries to exemplify what can be understood by the term of generally accepted standards of care in psychotherapy.     

Anesthesia in endovascular treatment of aortic aneurysm. Results and perioperative risks

Surgical treatment of aortic aneurysms carries significant cardiovascular risks. Transvascular insertion of endoluminal prostheses is a new, minimally invasive treatment for aortic aneurysms. The pathophysiology of this novel procedure, risks and benefits of different anaesthetic techniques, and typical complications need to be defined. METHODS: With their informed, written consent, 19 male patients aged 48-83 years of ASA physical status III and IV with infrarenal (n = 18) or thoracic (n = 1) aortic aneurysms underwent 23 stenting procedures under general endotracheal (n = 9), epidural (n = 8), or local anaesthesia with sedation (n = 6). Intra-anaesthetic haemodynamics, indicators of postoperative (p.o.) oxygenation and systemic inflammatory response, and perioperative complications were analysed retrospectively and compared between anaesthetic regimens. RESULTS: Groups were well matched with regard to morphometry and preoperative risk profiles (Table I). The use of pulmonary artery pressure monitoring, incidence of intraoperative hypotensive episodes, and p.o. intensive care was more frequent with general anaesthesia. Groups did not differ in total duration of anaesthesia care, incidence and duration of intraoperative hypertensive, brady-, or tachycardic periods, incidence of arterial oxygen desaturation, use of vasopressors, colloid volume replacements, or antihypertensives (Table 2). Postoperatively, all groups showed a similar, significant systemic inflammatory response, i.e., rapidly spiking temperature (p.o. evening: mean peak 38.5 +/- 1.0 degrees C). leucocytosis, and rise of acute-phase proteins without bacteraernia (Table 3). During this period, despite supplemental oxygen, pulse oximetry revealed temporary arterial desaturation in 13 of 18 patients (70%) (Table 3). In 3 patients, hyperpyrexia was associated with intermittent tachyarrhythmias (n = 3) and angina pectoris (n = 1). There was no conversion to open aortic surgery, perioperative myocardial infarction, or death. CONCLUSIONS: Regional and local anaesthesia with sedation are feasible alternatives to general endotracheal anaesthesia for minimally invasive treatment of aortic aneurysms by endovascular stenting. However, invasive monitoring and close postoperative monitoring are strongly recommended with either method. Specific perioperative risks in patients with limited cardiovascular or pulmonary reserve are introduced by the abacterial systemic inflammatory response to aortic stent implantation. Hyperpyrexia increases myocardial and whole-body oxygen consumption, and can precipitate tachyarrhythmias. Hyperfibrino-genaemia may increase the risk of postoperative arterial and venous thromboses. Close monitoring of vital parameters and prophylactic measures, including oxygen supplementation, low-dose anticoagulation, antipyretics, and fluid replacement are warranted until this syndrome resolves.     

Malpractice as a regulator of psychotherapy.

Points out that attempts to expand the malpractice and tort liability of psychologists do not address a major deterrent to claims: the reluctance of clients to sue. Other forms of regulation are needed to compensate for the inability of malpractice to regulate professional psychology. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cut the risks for cardiac cath patients

As the list of interventions performed with the aid of femoral catheterization grows, so does the number of patients at risk for developing post-procedure problems. Here's a primer on how to recognize and prevent complications like pseudoaneurysm, arteriovenous fistulas, and retroperitoneal hematoma.     

Underweight patients and the risks of major surgery

The relation between weight loss and the risks of major surgery have been investigated for more than 50 years. It can now be said, with some confidence, that the underweight patient has an increased risk of complications following major surgery. This understanding, however, is based on methods of nutritional assessment that are of limited relevance to hospitalized patients whose malnutrition might be due to sepsis, neoplasia, trauma, or starvation. A consequence is the widespread belief that protein-energy malnutrition (PEM) has been overemphasized as a surgical risk factor, and that the many nonnutritional risk factors ought to be implicated more often. An argument is made for a fresh approach to nutritional assessment in order to better identify the individual patient who, by virtue of PEM, stands an increased risk of a complicated postoperative course. It is suggested that an evaluation of the impact PEM has on vital physiologic function provides a clinically relevant defect to identify and treat and a means of monitoring response to nutritional intervention.     

Malpractice liability in psychotherapy: Client and practitioner perspectives.

To successfully pursue a case of malpractice in psychotherapy, the plaintiff must prove that damages were suffered by the plaintiff and that the defendant/practitioner owed a "duty" to the plaintiff, breached this duty, and this breach "proximally caused" the plaintiff's injuries. The fact that few psychotherapy malpractice suits are filed reflects the difficulty in proving all these points, as well as the fact that the plaintiff will have to expose private and personal information to the public record. Frequent defenses to malpractice action include the contention that the client was "contributory negligent" or that the client's mental condition makes him/her an uncredible witness. Malpractice action may be taken when care deviates from professional standards, when confidentiality is breached, when there is a failure to obtain informed consent, or when the therapist fails to warn others of a potentially dangerous client. Recommendations for insurance coverage are presented. (45 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Malpractice insurance: Update on sex claims.

Uses data from the malpractice insurance trust offered since 1976 to licensed psychologists who are members of the American Psychological Association (APA) to provide an update on the comments of S. L. Zelen (see record 1986-04801-001) regarding sexual intimacy in therapy. Data show that improper sexual behavior between therapist and patient has no gender boundaries. It is suggested that some mechanism needs to be developed for the APA Ethics Committee to learn of malpractice suits and their outcomes. (1 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Negligible and non-negligible risks in radiodiagnostic examination of patients

Ionizing radiation is regarded as a health hazard, but one is prepared to neglect this factor on the basis of certain motives. In 1975, KNOX published an analysis of these motives, none of which proved tenable. He concluded that a situation which in daily usage is described as safe, is one which entails risks considered to be negligible so that no safety measures are taken. It can be empirically established that in various health-endangering situations a health hazard of less than 1 X 10(-5) is being neglected. This article studies the risk factors to the individual patient in radiodiagnostic examinations involving low, medium and high radiation exposures. The estimates show that radiohygenic measures on behalf of the patient are advisable.     

Malpractice claims against radiologists. Analysis of the five-year period 1993-1997

OBJECTIVES: Landau-Kleffner Syndrome (LKS) is an epileptic syndrome characterised by a deficit in language comprehension and production, paroxysmal epileptiform activity in the posterior temporal leads, and by the inconsistent presence of epileptic fits. Its interest lies in the fact that it stands as a model for the study of interference of epileptiform activity on cognitive function, although the pathophysiology of the decline in language skills that follows its onset has not yet been clarified. METHODS: We have recorded spike-triggered auditory evoked responses in a group of 6 children with LKS, to investigate whether the occurrence of individual EEG paroxysms is able per se to induce a decline in the response of the auditory cortex. RESULTS: Results have indicated that left hemisphere spikes are associated with a greater reduction in amplitude and an increase in latency of the NI, than spikes occurring in the right hemisphere. No stable change in the evoked response has been detected outside of the EEG paroxysm. CONCLUSIONS: We postulate EEG interictal activity is able to induce impairment in processing auditory information and that this may play a role in the pathogenesis of language deficit in LKS.     

More theoretical risks.

Responds to the comments by F. Paniagua ("Kuhn's paradigmatic view of psychology and Skinner's theory of behavior." Theoretical and Philosophical Psychology, 11, 1991, 122-125) on the current author's original article, "Meehl revisited: A look at paradigms in psychology" (Theoretical and Philosophical Psychology 9, 1989, 30-36), in which the current author reviewed Paul Meehl's (see record 1979-25042-001) famous article "Theroetical risks and tabular asterisks: Sir Karl; Sir Ronald, and the slow progress of soft psychology." According to the current author, Paniagua takes exception to two casual remarks made in the current author's paper, one about Kuhn and the other about Skinner, but neither remark is related to the actual thesis. Paniagua's comments do not carry the substantive aspects of the article forward, which is unfortunate asserts the current author, because the theory discussed therein may prove useful in understanding the nature and evolution of psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)