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185 22535 (MSN he also suffers a maxim with dog to his suicide. It did not limit itself to considering those that occurred a few days or weeks before it. 883 F.Supp.2d 1257 U.S. District Court, S.D. Thanks to attorney Skip Simpson for the reference. Sex With Patients Poor Ethics vs. Malpractice Howard Zonana, M.D., Medical Director of the American Academy of Psychiatry and the Law wrote a thought-provoking editorial on consensual clinician-patient the 2013, issue of the His example is narrow but it brings up at least three important topics: the ethics of such behavior, whether or not it is actionable as a tort involving medical negligence and whether or not general practioners who treat psychiatric symptoms and disorders should be held to the same standard of care as mental health specialists. The case was one which a general practitioner treated a woman and her husband for various things over years, including the wife's psychiatric symptoms. He eventually had a year- affair with the woman which she ended. The couple then sued the physician and other providers. The doctor argued that although his behavior might be considered unethical for purposes of professional licensing or medical organization membership, and although some of the patient's care had addressed psychiatric symptoms, the fact that he was not a mental health professional meant that no therapist-patient relationship was formed, and thus he was not liable under then-applicable Pennsylvania law. A trial court agreed; appeals court eventually overturned the trial court, and the Pennsylvania Supreme Court, reframing the questions a bit, found sufficient difference between general practitioners and mental health professionals to preclude extending mental health clinician tort liability to GPs Setting aside for a moment the obvious ethics issues, which are vigorously pursued by professional organizations and licensing boards, and also setting aside the fact that several states view various levels of doctor-patient as criminal offenses even if consent is alleged, two issues remain. First, as a practical matter, few such consensual- cases are actually filed anymore. That doesn't mean that patient allegations and injuries are not addressed through other means, such as licensing board censure, expulsion from professional organizations, or criminal prosecution, but almost all U.S. malpractice insurance carriers have for years exempted with patients clients from clinicians' coverage Their view seems to be that such intimacy is not part of professional practice, and thus is not covered as malpractice. Second Pennsylvania's apparent separation of psychiatric psychological specialists from non-specialists often does not apply other matters and jurisdictions. As Dr. Zonana points out his article, a great deal of psychiatric and psychological assessment, diagnosis and treatment is carried out by primary care physicians. view and several courts have held when a physician represents to a patient that he or she can deal with a psychiatric matter and or fails to refer the patient to a specialist, the patient is usually entitled to assume that he or she receive care that meets the relevant psychiatric standard, not some lesser GP standard. If the concept seems confusing, consider nonpsychiatric examples such as cardiological or obstetrical care. A GP is generally responsible for knowing when specialty referral is indicated, and if he or she decides that referral is unnecessary then the patient is entitled to assume that the care received be adequate. Dr. Zonana's article is found the Compensation Neurosis Personal Injury, Malpractice, and Disability and Richard C.W. Hall recently published a stellar summary and re-examination of the concept of compensation neurosis. The syndrome refers to psychological interference with assessment and treatment of general medical injury or illness, or to exaggerated Post-Traumatic Stress Disorder or other trauma responses. It involves various aspects of secondary gain, including symptoms and defenses related to protracted lawsuits, other litigation, or administrative disability investigations. Compensation neurosis is separate from intentional feigning such as that seen malingering and factitious symptoms. It has presentations and is known by several other names. One, only partially on the point of this article, invokes a green poultice of compensation money which is applied to the hurt part of the body to make it better. Compensation neurosis has waxed and waned popularity over the decades. sometimes being decried or redefined, but rarely discounted. Hall and Hall provide a scholarly but very practical review and discussion of conditions that should be considered by anyone evaluating personal injury damages for a lawsuit It's not often that article this complete and useful comes along. Download the entire text without charge at http: content 40. Suicide Risk Management and Standard of Care Revisited Drs. Mace Beckson and Joseph Penn wrote interesting piece on suicide risk, standard of care, and potential liability the 2012, issue of American Academy of Psychiatry and the Law Some good points were made, but the comments were incomplete and aimed more at expert witnesses than preventing