An Evolving Field, An Expert Voice

PRMS Risk Manager Emerges as National Expert in Forensic Psychiatric Liability

Medical malpractice laws remain fairly stable, and the related risk management tips become stalwarts: topics like proper documentation, standards of confidentiality, and informed consent. What is a risk manager to do, then, when encountering a field of medical malpractice law that is rapidly evolving and changing?

If you're Donna Vanderpool, you push up your sleeves and get to work.

Donna Vanderpool, MBA, JD, Vice President of Risk Management at PRMS, has become one of the nation's top experts in professional liability for forensic psychiatrists. The recently published and critically lauded book Ethical Issues in Forensic Psychiatry: Minimizing Harm, by Robert Sadoff, MD, includes a chapter by Ms. Vanderpool that addresses the unique liability concerns of forensic psychiatrists.

At the heart of Dr. Sadoff's book is the directive to physicians to "do no harm." How does this apply to forensic psychiatrists who do not have a traditional relationship with an examinee and whose work may, in fact, do harm to an examinee? Ms. Vanderpool's chapter addresses the effect these questions have on the physician's liability exposure. She explores the nature of -- and the consequences resulting from -- the relationship between the psychiatrist and examinee: is there a duty owed if there is no physician-patient relationship? Years ago, the answer was No. More recently, however, that has changed.

"Psychiatrists can erroneously assume that since there is no treatment relationship, that there can be no medical malpractice liability," said Ms. Vanderpool. "While this used to be the case, we are seeing a change across the nation and more courts are finding ways to impose liability for forensic activities."

The evolving law means that forensic psychiatrists need to be aware of their risk exposure and its potential consequences. "Medical boards are moving away from a traditional stance of not getting involved in complaints from individuals complaining about forensic activities and are now taking more of an interest in investigating and disciplining related to forensic activities," said Ms. Vanderpool.

Making this issue even more complicated is a lack of consensus among the courts. According to Ms. Vanderpool, "These cases are relatively infrequent, but in the cases we do see, there is no consistency among courts in different jurisdictions or even within jurisdictions."

How should forensic psychiatrists face these changing laws and inconsistent rulings to minimize liability risk? Ms. Vanderpool suggested ensuring familiarity with state requirements, including those from medical boards, as well as understanding the expectations of professional associations.  Also, forensic psychiatrists need to ensure they have appropriate professional liability insurance coverage, as not all policies offer forensic coverage. (Learn how The Psychiatrists' Program protects forensic psychiatrists.)

Dr. Sadoff's book has been lauded in its examination of the legal and ethical questions surrounding the role of the forensic psychiatrist. Ms. Vanderpool's contribution to this book, surveying the legal landscape, serves as a valuable resource to forensic psychiatrists seeking answers to evolving laws.  As a national leader in this ever-changing liability area, Donna Vanderpool could write the book on forensic liability for psychiatrists; with this recent publication, she has already contributed a very important chapter.

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Donna Vanderpool participated in a course at the 2014 APA Annual Meeting "Can't Work or Won't Work? Psychiatric Disability Evaluations" with Liza Gold, MD and Marilyn Price, MD, CM. She covered legal liability issues and risk management related to the provision of disability evaluations.