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Book Review   |    
Legally Safe Mental Health Practice: Psycholegal Questions and Answers
Kathleen Thomsen Hall,, M.D.
Psychiatric Services 1998; doi:
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by Robert Henley Woody, Ph.D., Sc.D., J.D.; Madison, Connecticut, Psychosocial Press, 1997, 119 pages, $24.95 softcover

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This collection of memorable queries posed by mental health professionals to an attorney specializing in work with them runs the gamut from earnest and naive to preposterous and even alarming. The book consists of attorney-psychologist Robert H. Woody's no-nonsense legal responses to clinicians. Are there really therapists out there who still question the importance of keeping progress notes, the prohibitions against marrying former patients, the necessity of intervening when employees submit fraudulent insurance claims, or the wisdom of refraining from treating patients the therapist is unqualified to treat? Dr. Woody assures us there are.

Woody patiently responds to beleaguered-sounding clinicians who wonder how to safeguard records from insurers, the courts, and family members. He educates the reader about contingency fees, noncompete agreements, fee splitting, and association liabilities.

Reluctant clinicians who would prefer to ignore subpoenas or to refuse to testify are confronted with their obligations. Woody excels in describing how explanations of therapeutic practice come across in the courtroom. He highlights the importance of an appropriately deferential response to the court and the assistance of legal counsel. In one of his more intriguing remarks, Woody argues that court-ordered treatment by an unwilling therapist could be construed as a "taking" of intellectual property.

Woody diplomatically reminds clinicians to practice within the areas of their expertise and to refer elsewhere patients whom they are not qualified to treat, despite pressures to lower standards of care and to shift treatment responsibilities to less-qualified clinicians. However, this book would be more helpful if he were to directly tackle a discussion of liabilities such as failure to refer patients for indicated, discipline-specific interventions—for example, psychological testing or a medical evaluation—or the placement of entry-level clinicians in charge of diagnostic evaluations and triage decisions. Furthermore, Woody does not address legal issues surrounding biologically based illnesses or somatic therapies, and his endorsement of punting emergency coverage would cause most psychiatrists to break into a cold sweat.

A sampling of other topics clinicians may wish Dr. Woody had commented on include communications with referral sources and treatment team members; quality assurance and peer review activities; hazards of curbside consults and interpretive remarks about third parties; ethical issues of adapting to financial disincentives; risks of diverging from practice guidelines; high-risk patients and crisis intervention; treatment-setting concerns, such as the hazards of managing a patient in a less secure setting; and civil rights concerns, such as initiating involuntary treatment or use of restraints. Although Woody parenthetically refers to the advisability of setting risk management goals, some elaboration would be helpful. His brief treatment of managed care liabilities leaves much unsaid.

Woody seeks to help clinicians renovate their practices in the face of external demands for increased accountability, alternative providers, and reduced costs. His objective is partly met. The restricted scope and informality of the material and the lack of an index give the book an introductory quality.Legally Safe Mental Health Practiceis geared to nonphysicians; it is readable, practical, and even entertaining in spots. Throughout the book, clinicians who seek to get by with expedient decisions are confronted with the hazards of such an approach, which is perhaps the most useful theme.

Dr. Hall is affiliated with the psychiatry and law program of the University of Massachusetts Medical Center in Worcester.

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