Legal risk associated with pediatric mental health telephone
consultation programs.
Financial disclosures: None.
Katherine Hobbs Knutson MD, Marlynn H. Wei MD JD, Bradley D. Stein MD PhD
Background:
An estimated 75% of children who may need psychiatric care
are not receiving it.1
Results:
Clinical characteristics of each telephone consultation program
are summarized in table 1.
Many children with mental health problems are treated in
primary care settings.2
The total number of children referred nationally for mental
health telephone consultation since establishment of the first
program in 2004 was 3,652 per year.
Child Psychiatry telephone consultation programs are being
developed throughout the US to support Primary Care Clinicians
(PCCs) providing mental health care.
There were no medical malpractice claims against clinicians
related to their telephone consultation program activity.
Through telephone consultation programs, mental health
specialists provide clinical guidance without personally
examining patients or reviewing clinical documentation.
Mental health specialists providing consultation by telephone
are concerned about the legal risk associated with this practice.
Discussion:
In this study of an average of 3,652 mental health consultations
per year since 2004 involving six national telephone consultation
programs, we found no instances of medical malpractice claims
involving consulting clinicians.
Objective:
To report the rate of medical malpractice claims against clinicians
involved in mental health telephone consultation programs and
discuss medico-legal considerations of providing consultation in
general.
Methods:
Directors of six mental health telephone consultation programs
throughout the US were contacted from January through May
2011.
Each program director completed a survey on the following:
clinical aspects of the consultation program.
the number of children referred for consultation
per year since the program’s inception.
the number of malpractice claims per year against
clinicians associated with their involvement in the
consultation program.
We calculated the annual rate of malpractice claims per
number of telephone consultations.
The physician providing direct treatment has primary duty of
care to the patient, whereas the duty of the consultant is to the
requesting physician.3
Table 1. Program characteristics, annual average number of children referred for
consultation and annual rate of medical malpractice claims against consulting
clinicians versus state mental health telephone consultation program.
*Medicaid only
Abbreviation: PCC=Primary Care Clinician
When the consultant physician personally examines the patient,
reviews the patient’s chart, communicates directly with the
patient and/or bills for services, legal obligation between the
consultant physician and the patient may be assumed.3
The best way to mitigate liability is to provide sound clinical
consultations to the requesting physician.
References
1. Kataoka 2002; 2. Bernal 2003; 3. Brendel 2007.