Ri. Simon, PSYCHIATRISTS DUTIES IN DISCHARGING SICKER AND POTENTIALLY VIOLENT INPATIENTS IN THE MANAGED CARE ERA, Psychiatric services, 49(1), 1998, pp. 62-67
Psychiatrists have certain clinical responsibilities and legal duties
to patients treated in managed care settings. They include disclosure
of all treatment options, the exercise of rights of appeal for any car
e they believe will materially benefit patients regardless of allocati
on guidelines or gatekeeper directives, continuance of emergency treat
ment, and reasonable cooperation with utilization reviewers. An additi
onal duty-to warn and protect endangered third parties-will likely inc
rease as cost-containment measures curtail the length of hospitalizati
on. The author discusses these duties in the context of sicker and pot
entially violent patients. He cautions psychiatrists to be careful not
to prematurely discharge these patients because of pressures from man
aged care organizations. The policies of such organizations can place
psychiatrists and patients in a precarious position by limiting the ti
me and resources for diagnosis and the assessment of the risk of poten
tial violence. These responsibilities and duties often can be turned i
nto clinical opportunities that enhance the therapeutic alliance with
patients.