PSYCHIATRISTS DUTIES IN DISCHARGING SICKER AND POTENTIALLY VIOLENT INPATIENTS IN THE MANAGED CARE ERA

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.