Too bad the politicians cannot see the fruit of their lame-brained laws. My brother was murdered because of a paranoid schizophrenic who should have been locked up but because of these laws he wasn’t.

The schizophrenic was causing a disturbance in his home and his mother called the police for help. My brother was one of four officers responding. The mother forgot to mention the little thing this guy had for people in uniform, thought they were angels of Satan coming to kill him.

So, whose rights trump? The rights of the crazy guy to be “free” or the right of someone to be alive?

I think your comment illustrates what appears to be the fundamental problem – your profession relies far too heavily on the government, rather than the patient for reimbursement. (yes, I know you think it’s malpractice claims, but stay with me) This system exists as a result of only a little fault of your own at this point. There will always be some, and I would guess many psych patients, who don’t have the ability to pay, but instead of government picking up the costs for those who truly NEED it, it’s picking up the costs for everyone, causing those who we truly need to be helping to get less.

At my shop, up to 10% of our traffic is psych. And remember that what you are talking about here is a civil commitment against someone’s will. That has a couple of problems. First, beyond the assessment period (24 to 72 hours depending on the state), the hospital has to go to court to prove the need for continued hospitalization. A lawyer assigned as a patient advocate will generally fight this adamantly, so mere statements (unless repeated and serious) are rarely sufficent grounds. Second, hold them to what end? By this I mean psychiatrically treating a patient who does not want treatment is rarely successful. So when does he/she get released? Generally when they learn to stop vocalizing the threatening statements (which doesn’t mean the urges have stopped). This doesn’t stop or prevent the violence, merely delays it. There are precious few long term psychiatric facilities capable of holding patients involuntarily – and the number is shinking daily. And every ED doc can give you example after example of patients who were released that logically shouldn’t have been. (And no Matt, that fact is not related to tort reform, etc. It is from significantly decreasing government funding stemming from the “de-institutionalization” movement started under President Kennedy. So I don’t blame all of medicine’s ills on attorneys. Just most.)

How many potential psychiatric cases do you treat in the ER, generally? If it’s a small number, don’t you think it WOULD warrant an admit to be sure?

I have a relative who is bipolar and we never take for granted the words when a manic episode rears its head. Admitted. Every. Time. And unfortunately, the older the patient gets, the more frequent the episodes. I seriously doubt old age is in the cards, sadly.

Thanks for the reply.

This is a fundamental misunderstanding which you continue to have. Almost every attorney who does med mal gets an opinion from a physician as to whether negligence exists before they proceed with filing suit. The attorney may know the appropriate law, how to file the action, what they’ve got to prove, but at the end of the day whether or not there was negligence is going to come from a physician.

” but you can’t come up with one medical scenario in which a patient has a bad outcome but the physician should not be sued for negligent behavior? Rather ironic.”

Not ironic at all as I explain above. There are hundreds. Every medical malpractice suit ever filed has a bad outcome involved. After all, no damages=no case. But I can point you to every case that the physician prevailed as examples where a bad outcome did not equal negligence. What more do you want?

“Because I argue an alternative point of view does not make me “upset” or “outraged” as you repeatedly suggest. Good inflammatory language, though. What’s next, name calling?”

Seriously, is this what you’re reduced to? Complaining about “inflammatory language”? Do you ever recognize your own hypocrisy?

“Just because I choose not to answer every one of your repeatedly rebuffed question”

Rebuffed? Is that another way of saying you don’t answer? I’ve asked you very simple questions, like how many malpractice suits are filed every year. I don’t mind you not answering, because your non-answer I realize is as close as you getting to admitting you’re wrong. I just find it humorous that you then sanctimoniously accuse me of failing to answer you. Again, you’re missing the plank in your own eye.

” Those ad hominem attacks get you real far, though, don’t they?”

Ad hominem attacks? Is “ad hominem” your magic phrase for avoiding a very direct question? I guess it works in some situations, but to most it just seems evasive. Or that you don’t know what the term means.

“There are others where you give the perception of being one of those little puny lap dogs.”

So you whine about personal attacks and “inflammatory language” at the start, and end with this. Seriously, do you even read what you write?

I’m sorry you don’t like the truth. Many people don’t, and most react just as you do–whining, personal attacks, and using phrases like “ad hominem” in an attempt to avoid. But you don’t need to. Be bigger than that – I believe you can. Sometimes it’s just ok to say “I don’t know.” I tell you that all the time about medical procedures – I don’t know. I don’t comment much on those discussions, but I read them all, again, because I don’t know. It’s ok not to know things, doc. It’s also ok that other people may know more about a particular subject. That happens. You don’t have to be mean or petty about it. After all, it’s just the Internet.

I don’t think society needs to differentiate. A civil action is between two private parties. If person X runs a light and runs someone down and causes them significant injuries, I think there ought to be a private civil cause of action to pursue the injured party’s damages. Likewise, I see no reason that the state cannot pursue a criminal charge for violating the light.

As to medical actions, I think the difference between criminal and civil negligence is typically going to be recklessness. Do the actions, even if the intent is not there, rise to that level (recklessness, gross negligence, however the state wants to define it). For example, if you’re an alocholic and operate drunk and hurt someone, I think that person ought to have a private right of action for their damages. At the same time, I see no reason why society should not be allowed to punish you as well. Do you disagree?

In the case you’re so incensed about, I didn’t see what specific statute he was charged under. Do you know? Post it and let’s discuss that one. At some point though, it’s going to rely on the interpretation of the jury applying the facts to the language of the statute. If the term is recklessness or “gross negligence”, that’s a fact question for a jury to decide. We can’t draft a statute which says “in X situation this is reckless and this is not” for every possible permutation of human behavior.

There are some times that you make good points in your arguments. There are others where you give the perception of being one of those little puny lap dogs. When someone enters your room, you bark at them until they get annoyed. Then, when they stomp their foot at you, you run a little further away, turn around, and start barking at them again.

Give it a rest.