Psychiatric malpractice claims in Maryland

Abstract

Historically, professional liability issues have not been a major focus of concern among psychiatrists or psychiatric institutions. In 1975, the American Medical Association (AMA) reported that the malpractice claims rate against psychiatrists was the second lowest of all physician specialities (AMA, 1975). A major study by the National Association of Insurance Commissioners (NAIC) of all reported medical malpractice claims closed during 19751978 in the United States, found that claims against psychiatrists represented only 0.3% of the 71,788 malpractice claims included in the analysis (NAIC, 1980). Several reasons have been advanced for the low rate of psychiatric claims filed during the 1970s. Slawson and Guggenheim (1984) note that the NAIC data base contains no claims brought by patients of Veterans Administration or other public hospitals-a factor possibly leading to underreporting of claims and/or lower levels of claims filed against psychiatrists who are more likely than most other clinical specialists to be employed in such settings. In addition, it has been argued that psychiatric treatment, unlike obstetrical and other surgical procedures, for example, rarely leads to grave or permanent physical injuries -the type of unanticipated treatment outcomes most likely to result in large malpractice claims and substantial awards. Slawson and Guggenheim (1984) also speculate that most malpractice claims result from a breakdown in the doctor-patient relationship and reason that psychiatrists may have experienced few claims because they are the medical specialists most likely to focus on interpersonal relationships. An alternative (or additional) explanation has been offered by Stone (1984) in a discussion of legal and judicial concerns regarding the prescribing behavior of many mental health professionals with respect to neuroleptic drugs. Stone notes, “Were it not for the reformer’s zeal of mental health litigators and the readiness of federal courts to deal with these cases as a matter of constitutional rights applicable to all patients in similar circumstances, they might well be tried as cases of medical malpractice” (1984, p. 1385). Thus, it could be argued that one reason the rate of psychiatric claims has been relatively low is that a large number of concerns about the quality of care provided to psychiatric patients have been dealt with in the courts as constitutional issues regarding a