Physicians who treat inmates are at greater risk of litigation

Most psychiatrists and primary care physicians who work in corrections long enough will end up being named in a lawsuit or having a complaint filed against them with their licensing board. So, from a risk-management standpoint, is it worth the potential hassle?

Yes, in most cases I think it is.

It is a fact that physicians who treat inmates are at greater risk of litigation. I don’t have specific figures to give you, but I know that malpractice carriers are quite aware of this risk. Beginning a few years ago, the major malpractice insurer in my state decided not to underwrite policies involving greater than 50% work with inmates. Sounds discouraging, doesn’t it?

It does, but it needs to be kept in context. Most physicians and other practitioners who provide services in U.S. prisons are employed either by their state’s department of corrections, or, if the health services are outsourced, by the agency which contracts with the state to provide these services. Therefore, at least in state prisons, most providers either do not need malpractice insurance at all (if the state covers work-related lawsuits of its employees), or the professional liability coverage will be provided by the employing agency.

The situation is sometimes different in county jails. Larger county jails may either directly employ health care professionals or contract with an outside agency just as prisons do. However, there are many small county jails that neither require nor can afford on-site health care services. These facilities will often utilize the services of local community practitioners, shuttling their inmates to and from clinics as necessary. Some of these jails will also hire physicians and nurse practitioners as independent contractors for the few hours per week that they need in-house providers. It is in this latter situation where one is most likely to need to obtain a personal professional liability policy.

Okay, so most professionals treating inmates don’t have to worry about either obtaining or paying for malpractice coverage. But, still, isn’t it risky working with a population with a track record for filing lawsuits?

First, nobody wants to be sued or have complaints filed against them. But, if you’re conscientious and competent, and you document well, nothing filed against you is likely to go anywhere. Inmates threaten to sue far more often than they actually file lawsuits.

Most of the lawsuits that are actually filed are frivolous and typically don’t result in the practitioner needing to go to court. And, interestingly, most of the lawsuits are not filed for malpractice, either. Inmates commonly file legal complaints alleging “deliberate indifference” to their medical needs, a violation of  inmates’ Eighth Amendment rights. These suits get filed in federal court since the issue involves constitutional rights.

Of course some of the deliberate indifference lawsuits filed have been quite legitimate and have ultimately resulted in improving medical/psychiatric care. Ironically, more positions and better job security for practitioners often results as well. Most of the time, though, these lawsuits have no merit and are quickly dismissed.

Second, every job has its hassle factors. I think many new doctors switch jobs too quickly because they encounter uncomfortable hassles in one job only to find themselves in a new position with different challenges that are equally as frustrating. The potential for being sued is admittedly a hassle, and one more commonly associated with treating inmates than other populations. But I think the risk of being sued is often overblown, and the risk of having a successful judgment against a practitioner for malpractice is much less than one might think.

Finally, I want to mention a couple of caveats. The risk of litigation, which I hopefully have put into better perspective in this article, should not be a deterrent to working as a health care professional in corrections if:

1. You truly like working in the correctional setting. This work is not for everyone. If you don’t really like it anyway, then the thought of getting sued is just likely to decrease your career satisfaction further.

2. You have ability to be assertive yet get along well with most people. If you frequently find yourself in power struggles with people or cannot politely set limits, then do not work in corrections. If you let your ego get involved in you interpersonal interactions very often, then you’re likely to piss off many inmates, and you probably will become a target for lawsuits and complaints.

Jeffrey Knuppel is a psychiatrist who blogs at The Positive Medical Blog. This post originally appeared on Lockup Doc.

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  • Close Call

    Yes, I feel the same way about Medicaid patients. 

    What? Pardon?  You weren’t talking about Medicaid patients?  Oh, my mistake.

  • psychMD

    Great post. I love the correctional setting but don’t currently work in one. It’s definitely not for everyone. Still though I wouldn’t want to be sued, but if I later want to back to this setting, that wouldn’t stop me.

    getaheadwithdrg.wordpress.com

  • Anonymous

    Lord knows I know this. 

    Correctional psychiatry is like Tabasco sauce for me, I love it, but too much burns badly.  It’s been the most rewarding work I’ve ever done … honestly.  The challenge is invigorating.  The rawness of patients’ lives creates meaningful work days, especially when dealing with substance abuse.

    But … after several summary judgments in my favor, derogatory newspaper articles by reporters with agendas, and many, related sleepless nights … it was time to move on.

    I now work in a different part of the criminal justice system … a forensic hospital.  Meaningful work with very, very sick people … but, not the same raw, mind sharpening, keep-me-on-my-toes life.

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