There's this statement in the plaintiff's motion: “… husband should not be subjected to having personal and harassing information about himself available to the public.” Well, that's ironic.
It's impossible to say for sure without more info whether the psychiatrist actually was negligent in the strictest of medicolegal senses. If the facts are as reported (started on a med, 90 days before follow up, then started on a controlled med, and no follow up), I would consider that poor care particularly if the patient was medication naive. The timing of the patient's requests for refills is broadly supportive of being given 90 day supplies, and her two requests to the NP would time with a responsible patient requesting refills. So I do suspect this psychiatrist was at minimum a subpar physician. Agree the expert opinion is crap though. The random mention of ECT (bonus points for "additional ECT testing", a phrase that has been uttered by exactly zero psychiatrists ever) particularly gives it away as nonsense.
Interesting insight, I didn't catch that about ECT! Its very clear an attorney who *thinks* they understand psychiatric care wrote the opinion and a psychiatrist just decided to sign it to make a few thousand dollars.
I know!! I was racking my brain about what else they could possibly mean, because surely it couldn't be ECT?! There are about 1500 options to try before going there.
With all sensitivity for the decedent and her survivors, this was a truly juicy case.
It seems odd to me for the psychiatrist to start treatment for depression and only follow up in 90 days - although maybe the psychiatrist told the patient to follow up with the nurse every 4 weeks until then or something.
I don't know of any study of the validity of suicide risk assessments, but it does seem odd that one was never done by the psychiatrist or the nurse. Not that I know anything about the scope of practice of counsellors.
Wow. And there's not even the benefit of COVID-19 to blame this on.
It makes me wonder if the psychiatrist or his reception staff could have been potential targets of KKK. That might explain the lack of return phone calls. But it doesn't explain the perceived failure or lack of documentation for referral to another provider....
A pretty gratuitous kitchen sink opinion by the Plaintiff's expert (for example, jumping right to ECT on the first assessment of depression would be very strange) and I agree it looks rubber-stamped.
On the surface I would at least suspect liability for patient abandonment (not sure why the NP gets subsumed into the liability theory here unless they also neglected a risk assessment after the patient confided depressive symptoms). But my academic theorizing aside...holy cow what a twist.
I'd be curious to see more info about the attempts to schedule more appointments before I felt comfortable asserting patient abandonment. Did she call a bunch of times and they just neglected to call back? Did she call once and they returned her call but she never picked up? Lots of potential for shades of gray.
Did not see that coming…. We had to let a MA go who was not passing on phone messages, but just deleting them ‘because she was so overwhelmed with the volume of calls’. The only way I figured it out was a long time patient who brought it up to me during an office visit…. ‘You used to call back within 24 hours now I sometimes don’t hear back at all..’. Wait, what?!?
I'm convinced this is become more and more common. Front office staff are going to get their doctors sued. Need to have someone you really, really trust answering the phones and doing scheduling, but its often a task given to someone with little to no training and very high turn over.
They're often poorly paid and they're are crucial to the health of the practice and care of the patients. I often say, "Don't bite the hand that feeds you" when providers get into unnecessary spats with front desk staff.
I'm an MOA (same thing as MA but in Canada) and holy hell is this true, my work often hires students for limited terms, throws them on phones with extremely little training and then has to deal with the fallout. I document EVERY conversation I have with pts if it's anything more than booking a routine appt
I also wonder what they specifically mean about there being no suicide risk assessment. Was there no documentation about suicidal ideation what so ever or were they looking for an official copy of a suicide risk screener? I didn't think the standard of care requires completing a screener or questionnaire . I have a hard time believing the psychiatrist didn't write a thing about evaluating for risk of harm at either visit.
Impossible to tell without seeing the documentation. I wonder if some offices are switching to an official suicide risk screen, not because it helps the psychiatrist, but just for legal protection reasons.
For legal reasons, using something like that is a great idea. It is relatively bullet proof, as long as the rest of their clinical actions are sound. The safety plan is another useful method for liability and definitely for the patient. There are subtle, nuanced ways of evaluating for suicide risk an experienced clinician may use, which are challenging to articulate in clinical documentation. I was also thinking how terrible it was that this patient kept calling and not getting a return call. But I also wonder for liability reasons, if on their voicemail greeting they provided any contact information for local crisis services. Psych is a field where there are so many medicolegal weak areas by nature and low reimbursement rates. It is very hard to cover all bases and work enough to make a living.
With regards to the lack of returned phone calls, I’d definitely recommend having the practice manager know how to navigate the phone logs of whatever phone system the practice uses. I never thought about it coming up for legal reasons, but being able to look up phone numbers on it was helpful for tracking down employees not returning calls or for shutting down people yelling that of course they’d called but nobody answered/returned.
“Do not pity the dead, Harry. Pity the living and, above all, those who live without love.” (the spirit of school headmaster Albus Dumbledore, Harry Potter and the Deathly Hallows: Part 2)
Many chronically and pharmaceutically untreatable depressed and/or anxiety-ridden people, for example, won’t miss this world. It’s not that they necessarily want to die per se; it’s that they want their seemingly pointless corporeal suffering to end.
Thus, as crazy as it may sound, the greatest gift life offers such souls is that someday, likely preferably sooner rather than later, they get to die. Perhaps worsening matters for them is when suicide is simply not an option, for whatever reason(s), meaning there’s little hope of receiving an early reprieve from their literal life sentence.
I wouldn't be surprised if being reincarnated would be considered Hell for many of them — the repetition of mostly unhappiness. Notably, Zen Buddhism teaches that life is suffering or hardship interspersed with genuine happiness.
Ergo, to quote passages of a poem:
____
I awoke from another very bad dream, a reincarnation nightmare / where having thankfully died I’m still bullied towards rebirth back into human form / despite my pleas I be allowed to rest in permanent peace. // ...
... // Each second that passes I should not have to repeat and suffer again. / I cry out ‘give me a real purpose and it’s not enough simply to live / nor that it’s a beautiful sunny day with colorful fragrant flowers!’ //
I’m tormented hourly by my desire for both contentedness and emotional, material and creative gain / that are unattainable yet ultimately matter naught. My own mind brutalizes me like it has / a sadistic mind of its own. I must have a progressive reason for this harsh endurance! //
Could there be people who immensely suffer yet convince themselves they sincerely want to live when in fact / they don’t want to die, so greatly they fear Death’s unknown? //
No one should ever have to repeat and suffer again a single second that passes. //
Nay, I will engage and embrace the dying of my blight!
There's this statement in the plaintiff's motion: “… husband should not be subjected to having personal and harassing information about himself available to the public.” Well, that's ironic.
Hell of a twist.
It's impossible to say for sure without more info whether the psychiatrist actually was negligent in the strictest of medicolegal senses. If the facts are as reported (started on a med, 90 days before follow up, then started on a controlled med, and no follow up), I would consider that poor care particularly if the patient was medication naive. The timing of the patient's requests for refills is broadly supportive of being given 90 day supplies, and her two requests to the NP would time with a responsible patient requesting refills. So I do suspect this psychiatrist was at minimum a subpar physician. Agree the expert opinion is crap though. The random mention of ECT (bonus points for "additional ECT testing", a phrase that has been uttered by exactly zero psychiatrists ever) particularly gives it away as nonsense.
Interesting insight, I didn't catch that about ECT! Its very clear an attorney who *thinks* they understand psychiatric care wrote the opinion and a psychiatrist just decided to sign it to make a few thousand dollars.
Since they threw in ECT, they might as well have tossed in TMS - seems pretty commonly advertised these days.
I know!! I was racking my brain about what else they could possibly mean, because surely it couldn't be ECT?! There are about 1500 options to try before going there.
With all sensitivity for the decedent and her survivors, this was a truly juicy case.
It seems odd to me for the psychiatrist to start treatment for depression and only follow up in 90 days - although maybe the psychiatrist told the patient to follow up with the nurse every 4 weeks until then or something.
I don't know of any study of the validity of suicide risk assessments, but it does seem odd that one was never done by the psychiatrist or the nurse. Not that I know anything about the scope of practice of counsellors.
Wow. And there's not even the benefit of COVID-19 to blame this on.
It makes me wonder if the psychiatrist or his reception staff could have been potential targets of KKK. That might explain the lack of return phone calls. But it doesn't explain the perceived failure or lack of documentation for referral to another provider....
Wow, this is like an episode of Law and Order or something. Exhilirating reading!
A pretty gratuitous kitchen sink opinion by the Plaintiff's expert (for example, jumping right to ECT on the first assessment of depression would be very strange) and I agree it looks rubber-stamped.
On the surface I would at least suspect liability for patient abandonment (not sure why the NP gets subsumed into the liability theory here unless they also neglected a risk assessment after the patient confided depressive symptoms). But my academic theorizing aside...holy cow what a twist.
I'd be curious to see more info about the attempts to schedule more appointments before I felt comfortable asserting patient abandonment. Did she call a bunch of times and they just neglected to call back? Did she call once and they returned her call but she never picked up? Lots of potential for shades of gray.
Did not see that coming…. We had to let a MA go who was not passing on phone messages, but just deleting them ‘because she was so overwhelmed with the volume of calls’. The only way I figured it out was a long time patient who brought it up to me during an office visit…. ‘You used to call back within 24 hours now I sometimes don’t hear back at all..’. Wait, what?!?
I'm convinced this is become more and more common. Front office staff are going to get their doctors sued. Need to have someone you really, really trust answering the phones and doing scheduling, but its often a task given to someone with little to no training and very high turn over.
Good luck. In 40 years of practice I had exactly 2 very good employees, 2 truly terrible ones, and all the rest were mediocre…
They're often poorly paid and they're are crucial to the health of the practice and care of the patients. I often say, "Don't bite the hand that feeds you" when providers get into unnecessary spats with front desk staff.
I'm an MOA (same thing as MA but in Canada) and holy hell is this true, my work often hires students for limited terms, throws them on phones with extremely little training and then has to deal with the fallout. I document EVERY conversation I have with pts if it's anything more than booking a routine appt
That's so scary, and I think most docs are blind to what their front office staff is doing.
I also wonder what they specifically mean about there being no suicide risk assessment. Was there no documentation about suicidal ideation what so ever or were they looking for an official copy of a suicide risk screener? I didn't think the standard of care requires completing a screener or questionnaire . I have a hard time believing the psychiatrist didn't write a thing about evaluating for risk of harm at either visit.
Impossible to tell without seeing the documentation. I wonder if some offices are switching to an official suicide risk screen, not because it helps the psychiatrist, but just for legal protection reasons.
For legal reasons, using something like that is a great idea. It is relatively bullet proof, as long as the rest of their clinical actions are sound. The safety plan is another useful method for liability and definitely for the patient. There are subtle, nuanced ways of evaluating for suicide risk an experienced clinician may use, which are challenging to articulate in clinical documentation. I was also thinking how terrible it was that this patient kept calling and not getting a return call. But I also wonder for liability reasons, if on their voicemail greeting they provided any contact information for local crisis services. Psych is a field where there are so many medicolegal weak areas by nature and low reimbursement rates. It is very hard to cover all bases and work enough to make a living.
With regards to the lack of returned phone calls, I’d definitely recommend having the practice manager know how to navigate the phone logs of whatever phone system the practice uses. I never thought about it coming up for legal reasons, but being able to look up phone numbers on it was helpful for tracking down employees not returning calls or for shutting down people yelling that of course they’d called but nobody answered/returned.
“Do not pity the dead, Harry. Pity the living and, above all, those who live without love.” (the spirit of school headmaster Albus Dumbledore, Harry Potter and the Deathly Hallows: Part 2)
Many chronically and pharmaceutically untreatable depressed and/or anxiety-ridden people, for example, won’t miss this world. It’s not that they necessarily want to die per se; it’s that they want their seemingly pointless corporeal suffering to end.
Thus, as crazy as it may sound, the greatest gift life offers such souls is that someday, likely preferably sooner rather than later, they get to die. Perhaps worsening matters for them is when suicide is simply not an option, for whatever reason(s), meaning there’s little hope of receiving an early reprieve from their literal life sentence.
I wouldn't be surprised if being reincarnated would be considered Hell for many of them — the repetition of mostly unhappiness. Notably, Zen Buddhism teaches that life is suffering or hardship interspersed with genuine happiness.
Ergo, to quote passages of a poem:
____
I awoke from another very bad dream, a reincarnation nightmare / where having thankfully died I’m still bullied towards rebirth back into human form / despite my pleas I be allowed to rest in permanent peace. // ...
... // Each second that passes I should not have to repeat and suffer again. / I cry out ‘give me a real purpose and it’s not enough simply to live / nor that it’s a beautiful sunny day with colorful fragrant flowers!’ //
I’m tormented hourly by my desire for both contentedness and emotional, material and creative gain / that are unattainable yet ultimately matter naught. My own mind brutalizes me like it has / a sadistic mind of its own. I must have a progressive reason for this harsh endurance! //
Could there be people who immensely suffer yet convince themselves they sincerely want to live when in fact / they don’t want to die, so greatly they fear Death’s unknown? //
No one should ever have to repeat and suffer again a single second that passes. //
Nay, I will engage and embrace the dying of my blight!
Click bait
What do you mean?