Legal risk associated with pediatric mental health telephone consultation programs.

1. Legal risk associated with pediatric mental health telephone consultation programs. Katherine Hobbs Knutson MD, Marlynn H. Wei MD JD, Bradley D. Stein MD PhD Financial disclosures: None. • Background: • An estimated 75% of children who may need psychiatric care are not receiving it.1 • Many children with mental health problems are treated in primary care settings.2 • Child Psychiatry telephone consultation programs are being developed throughout the US to support Primary Care Clinicians (PCCs) providing mental health care. • 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. • Results: • Clinical characteristics of each telephone consultation program are summarized in table 1. • 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. • There were no medical malpractice claims against clinicians related to their telephone consultation program activity. • 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. • 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 • 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. 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. 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 References 1. Kataoka 2002; 2. Bernal 2003; 3. Brendel 2007.