Malpractice risks in the treatment of dangerous patients.

Reviews areas of special vulnerability and the legal penalties that may befall psychotherapists who improperly manage dangerous patients (DPs). General rules of malpractice are discussed. While ethical and professional principles are important in the management of DPs, emphasis is placed on legal principles. The potential pitfalls include the failure to report suspected child abuse, abandonment of DPs, the duty to refer, the duty to protect 3rd parties, the failure to commit, the negligent release of DPs from inpatient facilities, and the inadequate treatment of suicidal patients. Leading cases illustrate the legal points. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Statutory remedies to the duty to protect: A reconsideration.

Offers a brief history of duty-to-protect statutes, which limit the liability of psychotherapists who treat life-endangering outpatients and protect therapists who make good-faith warnings when danger to identifiable victims is predictable. Fears are discussed that surround the possibility that courts will continue to expand the Tarasoff (1976) decision beyond its original parameters. Current statutory remedies to problems related to the Tarasoff decision are discussed, and the intent of duty-to-protect laws is examined. Alternative wording to these statutes is offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical and Patient Management Issues With Older, Impaired Drivers.

As the population of America ages, psychologists will be treating more older adults who are, or are at risk of becoming, impaired drivers. Consequently, psychologists will need to address the issue of driving impairment with many of their patients. Although psychologists should generally respect the autonomy of patients to determine the direction and nature of treatment, their concern for patient and public welfare caused by driving impairments may sometimes override respect for patient autonomy. This article suggests ways to protect patient and public welfare while minimizing the infringement on patient autonomy. Relevant clinical features and a decision making process are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Application of the duty to protect to HIV-positive patients.

The spread of acquired immune deficiency syndrome (AIDS) has led to new questions regarding the limits of confidentiality in the psychotherapeutic relationship. We describe the duty-to-protect doctrine that has arisen out of Tarasoff and subsequent court decisions and apply it to situations in which human immunodeficiency virus (HIV)-positive patients may pose a health threat to others. No courts have as yet applied the duty to protect to cases of HIV infection. We conclude that although parallels exist between Tarasoff and HIV-infected patients, following good clinical practices can significantly reduce instances in which a duty to warn might arise. We recommend statutory solutions that would permit but not require warning potential victims of the HIV infection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Legal and ethical issues in billing patients and collecting fees.

Reviews the legal and ethical issues in billing patients, filing insurance claims, and collecting fees by psychologists. It is hoped that the likelihood of patients, insurance companies, and psychologists having disputes over fees and reimbursements is reduced. Guidelines are provided on how psychologists should proceed when financial disputes arise. These guidelines include using risk management techniques such as carefully screening the patients accepted into practice, clarifying financial arrangements in advance, understanding the parameters of what can and cannot be billed, and acting promptly when patients incur debts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client anticipations and preferences for confidentiality of records.

116 new clients requesting services during one semester at a medium-sized university counseling center participated in a survey of preferences and anticipations about confidentiality of their client records. The survey asked Ss to rate the amount of information that they preferred and anticipated would be released by the psychotherapist under 13 request scenarios. Generally, Ss preferred less information to be released than they anticipated would be, but differences existed by scenario and recipient. Homogeneous clusters of Ss were identified who expressed unique anticipations and preferences about confidentiality. Some clusters of Ss preferred absolute confidentiality, but other clusters preferred broad release of their information. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk management for psychologists: Treating patients who recover lost memories of childhood abuse.

The mental health community and, in certain respects, society itself have become polarized over the issue of lost and recovered memories of childhood abuse. Psychologists who treat patients who recover lost memories of childhood abuse during psychotherapy may find themselves vulnerable to lawsuits from patients who later recant the memories of abuse or, in unusual circumstances, from family members of the patients. Psychologists can reduce their legal risks by following certain basic precautions, including maintaining appropriate boundaries with their patients, following acceptable procedures in diagnosing and treating patients, obtaining informed consent (especially when using experimental procedures), and showing concern for patients' long-term relationships with their families. Consultation on difficult cases and careful documentation are also indicated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical responses when patients' religious beliefs appear to harm their well-being.

Although religious affiliation is generally associated with good mental health, at times patients may present with religious beliefs that appear to harm their well-being or social functioning. On the one hand, it would appear that respect for the patient's religious traditions requires psychologists to refrain from challenging those problematic religious beliefs. On the other hand, the goal of promoting patient welfare requires psychologists to challenge those beliefs that appear to inhibit patient well-being. This article analyzes this apparent dichotomy and suggests ethically based responses consistent with good clinical care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mandatory continuing education for licensed psychologists: Its rationale and current implementation.

We review literature on effectiveness of continuing education (CE) in enhancing quality of services in health professions. We conclude that if CE is properly implemented, health care can be positively impacted. Two examples of effective CE programs are described. We also review current status of mandatory CE (MCE) in health fields, especially psychology. Most MCE systems do not meet criteria of good CE systems. The profession of psychology is encouraged to shift to more effective systems of MCE. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Experiences of parents of children with congenital limb differences with health care providers: A qualitative study.

This article describes a qualitative, participatory action research study based in grounded theory, in which an online survey was developed and utilized to explore and generate suggestions for further research about the needs and health care experiences of parents of children with congenital limb differences (CLD) during the first year of the child’s life. Participants: Fifty parents completed an online survey that was developed through review of themes in the literature and input from people with CLD and their families. Primarily with open-ended questions, the survey targeted the respondents’ perceptions of the attitudes and approaches of health care providers. Results and Discussion: Results indicate that parents consistently commented on three main areas of interaction with health care providers: attitudes, information, and emotional or psychological support. Research hypotheses generated from the data are presented. Implications and suggestions for future directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)