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Forensic psychiatry is a medical subspecialty that includes areas in which psychiatry is applied to legal matters. Forensic psychiatrists often conduct evaluations requested by the court or attorneys.
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While some forensic psychiatrists specialize exclusively in legal issues, almost all psychiatrists have to work within one of the many spheres where the mental health and legal system overlap. These areas include the following:
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Legal issues are considered criminal in nature if someone is being charged with a crime. Civil cases involve other kinds of rights and may result in monetary awards. It is important to note that the specific laws pertaining to the various topics discussed in this chapter may vary by state.
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WARDS TIP
A wrong prediction or a bad outcome is not necessarily proof of malpractice.
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KEY FACT
Four Ds of malpractice: Dereliction of Duty that was the Direct cause of Damage.
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WARDS QUESTION
Q: What legal case set the precedent that physicians have a duty to report patients who are potentially dangerous to others?
A: Tarasoff v. Regents of the University of California which called for the duty to warn.
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STANDARD OF CARE AND MALPRACTICE
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The standard of care in psychiatry is generally defined as the skill level and knowledge base of the average, prudent psychiatrist in a given community.
Negligence is practicing below the standard of care.
Malpractice is the act of being negligent as a doctor.
The following four conditions typically must be proven by a preponderance of the evidence in order to sustain a claim of malpractice:
The physician had a duty of care (psychiatrist–patient relationship).
The physician breached their duty by practice that did not meet the standard of care (negligence).
The patient was harmed.
The harm was directly caused by the physician's negligence.
If a malpractice case is successful, the patient can receive compensatory damages (reimbursement for medical expenses, lost salary, or physical suffering) and punitive damages (money awarded to “punish” the doctor).
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KEY FACT
Doctors are required to report child abuse, but lawyers are not.
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All information regarding a doctor–patient relationship should be held confidential, except when otherwise exempted by statute, such as:
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When sharing relevant information with other staff members who are also treating the patient.
If subpoenaed—Physician must supply all requested information.
If child abuse is suspected—Obligated to report to the proper authorities.
If a patient is suicidal—Physician may need to admit the patient, with or without the patient's consent, and share information with the hospital staff.
If a patient threatens direct harm to another person—Physician may have a duty to warn the intended victim.