1. MALPRACTICE Harvey Dondershine, MD, JD  COMPENSATE INJURED PARTIES  RETROSPECTIVE REGULATION (DICTA)  EFFECT ON HEALTH CARE SYSTEM  IMPROVE QUALITY OF CARE  INCREASE COST  EFFECT ON CLINICIAN  PRACTICE DEFENSIVE MEDICINE  NARCISSISTIC INJURY / THREAT TO LIVELIHOOD

2. WHERE DOES IT FIT? MALPRACTICE IS A TORT MALPRACTICE IS A TORT A TORT IS A CIVIL WRONG A TORT IS A CIVIL WRONG SEEKS COMPENSATORY (MONEY) DAMAGES SEEKS COMPENSATORY (MONEY) DAMAGES THREE TYPES OF TORTS THREE TYPES OF TORTS INTENTIONAL INTENTIONAL UNINTENTIONAL (NEGLIGENCE) UNINTENTIONAL (NEGLIGENCE) STRICT LIABILITY STRICT LIABILITY TERMS: BURDEN OF PROOF, STANDARD OF PROOF TERMS: BURDEN OF PROOF, STANDARD OF PROOF NO INSURANCE FOR INTENTIONAL WRONG NO INSURANCE FOR INTENTIONAL WRONG

3. NO MALPRACTICE UNLESS DR-PT RELATIONSHIP FORMATION, DURATION, TERMINATION FORMATION, DURATION, TERMINATION DUTIES DUTIES FIDUCIARY FIDUCIARY QUID PRO QUO QUID PRO QUO OBJECTIVITY, CONFIDENTIALITY, ABSTINENCE, NEUTRALITY, UTMOST BEST INTERESTS OBJECTIVITY, CONFIDENTIALITY, ABSTINENCE, NEUTRALITY, UTMOST BEST INTERESTS PROFESSIONAL PROFESSIONAL CLINICAL COMPETENCE / STANDARD OF CARE CLINICAL COMPETENCE / STANDARD OF CARE ADHERE TO STANDARDS SET BY LAW ADHERE TO STANDARDS SET BY LAW

4. ELEMENTS DUTY DUTY TO WHOM, WHAT TO WHOM, WHAT DERELECTION DERELECTION A BREACH OF STANDARD OF CARE THAT CREATES AN UNREASONABLE RISK OF FORESEEABLE HARM A BREACH OF STANDARD OF CARE THAT CREATES AN UNREASONABLE RISK OF FORESEEABLE HARM DAMAGE DAMAGE DIRECT CAUSATION DIRECT CAUSATION BUT FOR BUT FOR PROXIMATE PROXIMATE DEFENSES DEFENSES STATUTE OF LIMITATIONS STATUTE OF LIMITATIONS

5. STANDARD OF CARE STANDARD OF CARE STANDARD OF CARE MIXED QUESTION OF LAW & FACT MIXED QUESTION OF LAW & FACT NOT SAME AS OPTIMAL CARE, BEST PRACTICES, ETC NOT SAME AS OPTIMAL CARE, BEST PRACTICES, ETC “ORDINARY, REASONABLY PRUDENT, PSYCHIATRIST UNDER SAME OR SIMILAR CIRCUMSTANCES” “ORDINARY, REASONABLY PRUDENT, PSYCHIATRIST UNDER SAME OR SIMILAR CIRCUMSTANCES” DOCTOR DOES RISK:BENEFIT CALCULUS BEFORE ACTING DOCTOR DOES RISK:BENEFIT CALCULUS BEFORE ACTING SOURCE SOURCE EXPERT TESTIMONY EXPERT TESTIMONY SCIENTIFIC PUBLICATIONS, GUIDELINES, ETC. SCIENTIFIC PUBLICATIONS, GUIDELINES, ETC. JURY JURY JUDGE JUDGE STATUTES STATUTES CAPTAIN-OF-THE-SHIP DOCTRINE CAPTAIN-OF-THE-SHIP DOCTRINE

6. COMMON CAUSES OF ACTION GENERAL GENERAL BREACH OF FIDUCIARY DUTIES BREACH OF FIDUCIARY DUTIES PROCEDURAL NEGLIGENCE PROCEDURAL NEGLIGENCE DIAGNOSIS, MEDS, CHARTING, FOLLOW-UP DIAGNOSIS, MEDS, CHARTING, FOLLOW-UP SPECIFIC TO PSYCHIATRY SPECIFIC TO PSYCHIATRY SUICIDE SUICIDE INADEQUATE RISK ASSESSMENT / RISK REDUCTION INADEQUATE RISK ASSESSMENT / RISK REDUCTION INJURY TO THIRD PARTIES INJURY TO THIRD PARTIES TARASOFF, RELEASE / RESIDENTIAL PLACEMENT TARASOFF, RELEASE / RESIDENTIAL PLACEMENT DEFECTIVE INFORMED CONSENT PROCESS DEFECTIVE INFORMED CONSENT PROCESS FAILURE TO REPORT FAILURE TO REPORT CHILD ABUSE, DMV CHILD ABUSE, DMV ABUSE OF TRANSFERENCE ABUSE OF TRANSFERENCE NEGLIGENT SUPERVISION / SUPERVISEE NEGLIGENCE NEGLIGENT SUPERVISION / SUPERVISEE NEGLIGENCE

7. QUALITY ASSURANCE – RISK MANAGEMENT THERAPEUTIC ALLIANCE THERAPEUTIC ALLIANCE BE NICE BE NICE PRACTICE IN RIGHT WAY PRACTICE IN RIGHT WAY PRACTICE ONLY W/I COMPETENCE PRACTICE ONLY W/I COMPETENCE HISTORY / EXAMINATION / RECORD REVIEW / DOCUMENTATION HISTORY / EXAMINATION / RECORD REVIEW / DOCUMENTATION IDENTIFY RISK: PATIENTS / SITUATIONS / TRIGGERS IDENTIFY RISK: PATIENTS / SITUATIONS / TRIGGERS RISK IDENTIFIED NEEDS PLAN, PLAN NEEDS ACTION AND FOLLOW-UP RISK IDENTIFIED NEEDS PLAN, PLAN NEEDS ACTION AND FOLLOW-UP KNOW WHEN LESS REQUIRES MORE KNOW WHEN LESS REQUIRES MORE PRESCRIBING DANGEROUS DRUGS PRESCRIBING DANGEROUS DRUGS AVOID SMALL BORDER VIOLATIONS AVOID SMALL BORDER VIOLATIONS YOUR CHART MUST SPEAK FOR ITSELF YOUR CHART MUST SPEAK FOR ITSELF ANTICIPATE EVIDENTIARY USE OF CHART ANTICIPATE EVIDENTIARY USE OF CHART SECOND OPINION SECOND OPINION

8. LIMITATIONS ON LIABILITY DUTY DUTY FORESEEABILITY FORESEEABILITY ENTITY IMMUNITY ENTITY IMMUNITY GOVERNMENT GOVERNMENT HMO HMO MEDICAL INJURY COST RECOVERY ACT (MICRA) MEDICAL INJURY COST RECOVERY ACT (MICRA) STATUTE OF LIMITATIONS STATUTE OF LIMITATIONS

9. ANATOMY OF A SUIT  PRELITIGATION PHASE  INCIDENT DATE, PRE-LITIGATION SUBPOENA, CERTIFICATION  PLEADINGS PHASE  COMPLAINT & SUMMONS, ANSWER  DISCOVERY PHASE  DISCOVERY SUBPOENA, INTERROGATORIES, DEPOSITIONS, EXAMINATIONS, REQUEST FOR ADMISSIONS  MOTIONS PHASE  DEMURRER  SUMMARY JUDGMENT  TRIAL PHASE

10. INSURANCE UNDERSTAND POLICY UNDERSTAND POLICY OCCURRENCE, CLAIMS-MADE, NOSE, TAIL OCCURRENCE, CLAIMS-MADE, NOSE, TAIL LITIGATION EXPENSES, INDEMNIFICATION COSTS LITIGATION EXPENSES, INDEMNIFICATION COSTS INCIDENT DATE VS INCIDENT REPORTING INCIDENT DATE VS INCIDENT REPORTING KNOW WHAT ACTIVITIES COVERED KNOW WHAT ACTIVITIES COVERED FORENSICS, COMMITTEES, SUPERVISION, OTHER? FORENSICS, COMMITTEES, SUPERVISION, OTHER? MOONLIGHTING (INDEPENDENT CONTRACTOR?) MOONLIGHTING (INDEPENDENT CONTRACTOR?) MBC / OTHER ADMIN ACTION MBC / OTHER ADMIN ACTION OTHER OTHER HAMMER CLAUSE HAMMER CLAUSE

11. MEDICAL BOARD OF CALIFORNIA  PRIMARY CONCERN IS PUBLIC SAFETY  SECONDARY CONCERN IS IMPAIRED PHYSICIAN  RECEIVES INPUT FROM VARIOUS SOURCES  805 REPORTS  COURTS  PATIENTS  MALPRACTICE ACTIONS  INVESTIGATES, LIMITS/ REVOKES, REHABILITATES  COST RECOVERY PROGRAM  NO DIVERSION PROGRAM  WHAT TO DO IF YOU GET A CALL