Legal Considerations for Psychiatric Care

Tort

A civil wrongdoing that causes loss, harm, or injury, and results in civil liability.

4 Elements of Negligence

1) Obligation of reasonable care, 2) Duty to care, 3) Breach of duty, 4) Injury caused by breach of duty.

Malpractice

Professional negligence; claims usually arise from failure to prevent harm and uphold the standard of care.

Tarasoff v. Regents (Tarasoff Rule)

Mental health professionals have a duty to warn of threats of harm to others (homicidal ideation).

M'Naghten Rule

Cognitive standard/Insanity defense: Due to 'disease of the mind,' the defendant did not know the nature and quality of the act.

Wyatt v. Stickney

Right to treatment: Individuals with mental illness have a constitutional right to individualized treatment, qualified staff, and humane least restrictive environment.

Rogers v. Okin

Right to refuse: Patients cannot be forced to take psychotropics against their will, except in emergency situations.

Capacity vs. Competency

Capacity is determined by a physician/psychologist (ability to make informed decisions). Competency is determined by law (ability to communicate choices and understand risks/benefits).

Suspension of Patient Rights

Privileges on and off unit may be restricted based on patient’s ability to follow unit rules and risk to self/others

Right to Treatment in the Least Restrictive Environment

Freedom from unnecessary restriction when less restrictive, appropriate interventions are
available

Seclusion and Restraint Guidelines

Needs an order by provider within 1 hour and re-ordered every 2 hours; requires constant observation and every 15-minute documentation by nurse.

Voluntary Commitment

Patient consents to treatment and maintains their civil rights
• May sign out AMA, unless psychiatric provider determines imminent risk to self or
others is present

Involuntary Commitment

Used when a patient with legal capacity refuses treatment AND poses an imminent risk to self or others, or is gravely disabled.

Emergency Detention (ED) in Indiana

Can last up to 72 hours (excluding holidays and weekends).

HIPAA in Psychiatric Care

Psychotherapy notes cannot be released without specific WRITTEN authorization; SUD info generally cannot be used in criminal proceedings.

Cultural Humility (Cultural Competence)

Ongoing commitment to self-reflection, acknowledgment of personal biases, and recognition of limitations of one's knowledge.

Cultural Preservation

The nurse's ability to acknowledge, value, and accept the cultural beliefs of the patient.

Cultural Negotiation

The nurse's ability to work within the patient's cultural belief system.

Cultural Repatterning

The nurse's ability to incorporate cultural preservation and negotiation to identify patient needs, develop outcomes, and evaluate plans.

Define Ethnopharmacology

Study of pharmacogenetic, pharmacodynamic, and pharmacokinetic influences based on cultural, racial, and cultural groups

Spirituality vs. Religion

Spirituality: personal awareness to make sense of life (no institutional framework). Religion: involvement in tradition with organized beliefs for identity/belonging.