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Correcting Psychiatry's False Assumptions and Implementing Parity

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Correcting Psychiatry's False Assumptions and Implementing Parity 56 PSYCHIATRIC TIMES MAY 2015 www.psychiatrictimes.com PSYCHIATRIC MALPRACTICE Defending a whether the hospital and the doctor blessing. On the first day, I spent 55 The dismissal was “with prejudice,” did their jobs. minutes with the patient and on the which was significant. It meant that Malpractice Suit Engineers gave testimony about second day, 25 minutes. The plain- the matter can never be reinstated Continued from page 55 the window—its quality and manu- tiff’s attorney could not harass me against me anytime in the future, for facture. The patient’s sons and wife, about my short notes when he saw any reason. from my lips. I struggled to maintain the internist, the nursing director, those numbers. The following are some lessons I composure during that sad period of and the nurse in charge gave tes- • My attorney confirmed that the learned from this suit: my life. Often engulfed by tension, I timony. The latter had visited Mr statement “My father likes you; I • The service you have provided is the used the following “system of com- Kulik every hour that night up to 40 will like to bring him to you after one that you document; if it is not fort” to reduce the stress: minutes before he was discovered discharge from the hospital,” was documented, you did not perform it. Whenever I found my shoulders missing. They all said that Mr Kulik made by the patient’s son during Always record the amount of time tightening or my legs aching, I did had been improving, and there were his testimony. you spent with the patient. relaxation exercises, and I talked to no talk or behavioral changes to alert The jury deliberated. I was unsure • Make it a habit to question all pa- myself out loud about accepting the anyone of a problem. When it was whose side made more sense to the tients about suicidality, violence, worst and moving on. When I my turn to take the stand, I was deter- jury and worried about their deci- and adverse effects—and document thought of going to jail, I countered mined to remain consistent in my sion. Finally the verdict came in: the that you did; if they are present, with, “The worst is that I will go to testimony. During the testimony: hospital was found negligent be- document a rational reason for your jail. Well, Gandhi went to jail. If I • I kept a pleasant disposition in spite cause a nurse had seen a faulty win- decisions, actions, or inactions. have to, so be it. Murderers start a of my inner anxiety. dow but did not report it and get it • In your record, use the word “be- new life after incarceration. I will do • I answered in lay language: I used repaired in time. I was found not cause” frequently; it conveys that that too.” I did not realize that I my knowledge about bipolar disor- guilty of negligence. you are reflective and rational. hadn’t broken any laws, and there der, suicidality, and interviewing, I left the building. I wanted to cel- • Dictate records and work hard to was no chance that I could go to jail. and I made sure that what I said did ebrate by shouting with joy; how ever, improve your handwriting—it is When I thought about losing my not conflict with the hospital chart, I kept the dignity of a doctor. The embarrassing when you cannot read medical license, I told myself, form C (3), and my deposition. family was standing outside in the your own writing. “There are many people who are not • I looked straight into the eyes of parking lot. They saw me coming, the • Be sure that all collateral informa- doctors. They live full lives. I will the lawyers, except when I was son approached me, and he said, tion and its sources are included in open a 7-Eleven store.” My mantra asked to explain to the jury; I then “You are a good doctor, but we had to the record. became, “I will cross the bridge made direct eye contact with the do this. He was our father you know.” • A lawyer is your best friend during when I see the bridge.” jury members. I wanted to yell at them and curse a lawsuit—you are very lucky if you Whenever I felt that I was project- • The plaintiff’s attorney asked, them for wasting 4 years of my life. I get a good one. ing my anger onto my patients, I “Why didn’t you ask Mr Kulik thought that they did not have to • Please read about malpractice to would say, “I am generalizing. It is about suicide?” I explained and en- apologize, but they did. It was my learn precautions that you need to unfair to the innocent others.” I re- acted the inappropriate affect, talk, turn to be gracious. I said, “I under- take and ways to deal with a mal- peated my concept of the serenity and facial expressions of Mr Kulik. stand, but it was very hard on me.” practice suit. prayer so that I could focus on things Thus, I showed the jury that Mr All of them smiled wishing me good- that were in my control: “May I have Kulik was not capable of giving re- bye. I moved on. Dr Malhotra is Clinical Associate Professor the serenity to accept that I have no liable answers to my questions. Eight days later, I received a letter. at Rutgers New Jersey Medical School in control over the outcome of the suit. • I recorded the duration of my con- “Ordered that a judgment be and is Newark. He reports no conflicts of interest Let me have courage to continue my sult and follow-up visit on the hos- hereby entered in favor of the defen- concerning the subject matter of this article. practice, serve my patients, earn pital records. It was my practice for dant, Harish Malhotra, MD, and the money, and prepare for the suit. Let billing purposes and for Medicare complaint be and is hereby dismissed Acknowledgment—I am thankful to the US me have wisdom that the lawsuit is audit. That habit proved to be a with prejudice and without costs.” judicial process for its fairness. ❒ not in my control, but my ability to fight is under my control.” The trial COMMENTARY The attorney invited me to prepare me for the trial. “Do you have time?” he asked. “Yes, it is 2 pm,” I an- swered. He returned, “I did not ask Correcting Psychiatry’s what the time is. Your response should be ‘Yes, I have the time.’ If I ask, ‘What is the time?’ You should False Assumptions and say, ‘2 pm.’ Do not give more infor- mation than what he [the opposing attorney] asks. You may be giving Implementing Parity self-incriminating answers. I will be listening. If there is a fact that you need to clarify, I will ask later.” by Eric M. Plakun, MD (as funders of both care and re- clinical care and implementation of Jury selection was completed, and search), clinicians, hospitals, ac- parity. the trial began in mid-2009. The t is a source of shame for our na- countable care organizations, and plaintiffs had a lawyer, and the hospi- tion that for most Americans in insurers, as well as patients and Psychiatry’s false tal and I (the defendants) had sepa- I need—especially those with se- families, are key stakeholders. Only assumptions rate lawyers. A couple of days were rious mental illness—the mental the federal government has author- Psychiatry clings to 3 false assump- spent going over the case with the health system is dysfunctional. Pro- ity to convene all of the former, but tions despite evidence to the con- judge to come up with an opening vision of population mental health Washington’s current dysfunction trary, and psychiatrists, our patients statement. The three lawyers agreed services is a complex systems issue makes this unlikely. Nevertheless, and their families, and our nation on the following statement: “Mr Ku- that requires multiple stakeholders we can fix some of the ways the sys- pay a price as a result. The assump- lik jumped out of the window and to work in partnership to improve tem is broken. I will focus here on tions are that: died.” The lawsuit would decide it. Federal and state governments 2 critical areas—the paradigm of • Genes = disease 1505PTKnoll_Malhotra_etal.indd 56 4/30/15 1:24 PM MAY 2015 PSYCHIATRIC TIMES 57 COMMENTARY www.psychiatrictimes.com • Patients present with single dis- have been found, and the search for fectiveness of psychodynamic psy- orders and failure rates for our best orders that respond to single evi- them has been likened to that for the chotherapy and CBT for multiple treatments are high. dence-based treatments Holy Grail. individual and complex comorbid For example, in depression, 78% • The best treatments are pills Meanwhile, Tully and colleagues2 disorders—with the ability to distin- of patients in the large STAR*D offer us a glimpse of the importance guish therapy responders from non- sam ple presented with comorbidity Genes = disease of environmental factors in depres- responders on imaging.4 or suicidal ideation that would have Mental disorders are clearly herita- sion by demonstrating that mothers The assumption that disease is all excluded them from randomized tri- ble. Molecular genetic research who are depressed during childrear- about genes and biology does help als; however, these comorbid pa- teaches us that there are 2 kinds of ing often have depressed adoles- reduce blame and stigma.
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