Risk Management and Liability Considerations in Integrated Care Setting

An issue that often concerns psychiatrists as they gear up to practice in integrated care settings is the liability that may be incurred while doing “informal” consultations and working with other providers in varying models of “split treatment.” This issue was addressed today in a session at APA’s 2014 annual meeting by Lori Raney, M.D., Kristen Lambert, J.D., L.C.S.W., and Anton Bland, M.D.

Integrated care is on the radar of many psychiatrists these days as they prepare for new roles in the brave new world of health care reform. In the developing models of collaborative care in particular, the psychiatrist serves primarily as a consultant to teams consisting of primary care providers and care managers.

Lambert, vice president for risk management at American Professional Agency, the APA-endorsed malpractice insurance program, described the analysis used in medical malpractice negligence cases. One of the elements—“duty” to a patient—is usually based on whether a doctor-patient relationship exists. Although not true in all cases (and this may vary from state to state depending on local laws), she noted that there is very little evidence that courts have routinely found psychiatrists liable in medical malpractice cases for these informal consultations since it is difficult to prove a doctor-patient relationship exists.

Lambert then discussed “split treatment,” a term used to describe care for a patient by multiple providers. While this historically has meant the sharing of a patient’s care between a psychiatrist and a nonpsychiatrist therapist, in the context of collaborative care it often includes other team members. She pointed out that the supervisory role carries the most liability, with the collaborative role in the middle and the consultative role with the least liability.

Describing the collaborative care model, Bland noted how the psychiatrist moves between these roles based on the model of stepped care in use and how the particular team is designed. He said that the presenters were not aware of any lawsuits filed against psychiatrists serving as consultants on integrated teams. The team directed the audience to read a document they co-wrote, “resource document on risk management and liability issues in integrated care models.” The audience was cautioned that this presentation did not constitute a form of legal advice and to contact an attorney if they had concerns.

Raney is the chair of APA’s Work Group on Integrated Care and the editor of Integrated Care: Working at the Interface of Primary Care and Behavioral Health from American Psychiatric Publishing. APA members can preorder the book, scheduled for release in September, at a discount here. She can be reached at lraney@pcbhconsulting.net.