LEGAL ISSUES IN TREATING PERPETRATORS AND VICTIMS OF VIOLENCE

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The United States is a violent country. In 1990, nearly one third of the 19 million crimes against victims involved violence.51 Psychiatrists increasingly are faced with the task of assessing perpetrators and victims of violence. Common situations involving an assessment of dangerousness include emergency psychiatric evaluations, civil commitment, release of a patient from the hospital, and the evaluation of outpatients who make threats towards others. Legal issues encountered in treating victims include mandatory reporting laws and domestic violence.

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MALPRACTICE LIABILITY

Psychiatrists are subject to being sued for malpractice after a patient commits a violent act or a victim of child abuse is diagnosed incorrectly. In a malpractice action, a plaintiff attempts to recover monetary damages by proving in a court of law that the psychiatrist was negligent.58 Ordinarily, a successful malpractice suit requires a plaintiff's expert psychiatric opinion that the defendant psychiatrist practiced below the standard of care. The only exception is in cases of res ipsa

Assessment of Risk for Violence

Although psychiatrists often are asked to predict violent behavior, they have not demonstrated the ability to do this well.39 They typically overpredict violence by 40% to 95% (false positives). The tendency to overpredict is due in part to clinicians' fear of liability for the violent acts of their patients.29 Rather than attempting to predict violent acts, psychiatrists should simply assess the risk for violence.71

Because a psychiatrist is much more likely to be sued successfully for an

Child Abuse

Child abuse encompasses physical abuse, sexual abuse, emotional abuse, and neglect. In 1994, more than 3 million children were reported to child protective service agencies in the United States as victims of child abuse and neglect. More than 1 million of these cases were substantiated as victims of maltreatment. Physical abuse was involved in 21% of these confirmed cases, sexual abuse in 11%, neglect in 49%, and other forms of maltreatment in 19%.43 Nearly 90% of deaths from child abuse or

SUMMARY

Psychiatrists are faced increasingly with the difficult responsibility of evaluating perpetrators and victims of violence. The following guidelines will help the clinician avoid legal difficulty:

  • 1

    Become knowledgeable about your state statutes regarding civil commitment and duty to third parties.

  • 2

    Document thoroughly your risk assessment and the factors you considered in reaching your judgment.

  • 3

    Consider obtaining a second opinion in difficult cases.

  • 4

    Follow hospital policies regarding seclusion,

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  • Cited by (8)

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      2006, Journal of the American Academy of Psychiatry and the Law
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      2003, Principles and Practice of Forensic Psychiatry, 2Ed
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    Address reprint requests to Phillip J. Resnick, MD, University Hospitals, Cleveland, OH 44106

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