The PRMS Blog

PRMS Continues Longstanding Support of the Guttmacher Award

PRMS has a long history of supporting mental health organizations, initiatives and the mental health community.  Since the early 1990s, PRMS has endowed the prestigious Manfred S. Guttmacher Award, which recognizes outstanding contributions to forensic psychiatry literature.

The 2016 Guttmacher Award was presented on May 15 during the APA Annual Meeting in Atlanta. The recipients of the Guttmacher Award are Robert Trestman, MD, PhD, Kenneth Appelbaum, MD and Jeffrey Metzner, MD in recognition of co-editing the Oxford Textbook of Correctional Psychiatry (Oxford University Press, 2015).  The book is considered to be the first comprehensive textbook about correctional psychiatry, an evolving field that many say has not been focused on in literature. Charles David Cash, JD, LLM, ARM, Assistant Vice President of Risk Management for PRMS, was on hand during the presentation of the plaque and honorarium.

Trestman is a Professor of Medicine, Psychiatry, and Nursing at the University of Connecticut where he heads UConn Health Correctional Managed Health Care. Appelbaum is a Clinical Professor of Psychiatry at the University of Massachusetts Medical School and Director of Correctional Mental Health Policy and Research at Commonwealth Medicine. Metzner is a Clinical Professor of Psychiatry at the University of Colorado School of Medicine.

Designed to help address the overwhelming number of people with mental illness in the criminal justice system, the book highlights the plight of people with mental illness in the nation’s prisons and jails. Its co-editors say there is much more work to be done to expand research and the evidence base for psychiatric work in corrections. Opportunities for rehabilitation and raising mental healthcare standards in correctional facilities also need to be improved.

The book gives readers at all stages of their careers practical information to face common clinical, organizational, and ethical challenges. Among other things, it covers management issues, emergencies, psychopharmacology, suicide risk management, addictions treatment, aggression, self-injury, and other behavioral challenges. It also addresses unique assessment and treatment needs of many distinct population groups, forensics, psychological testing, sexual assaults and quality improvement.

“I was thrilled to be able to contribute to a chapter in this book,” said Donna Vanderpool, MBA, JD, Vice President of Risk Management.  “Providing psychiatric services in correctional settings presents unique liability risks, so I was very grateful for the opportunity to address those risks.”

The Guttmacher Award dates to 1975 and honors the late Manfred Guttmacher, MD, who served for 36 years as a forensic psychiatrist and chief medical adviser to the Supreme Bench of Baltimore. The award is co-sponsored by the American Academy of Psychiatry and the Law (AAPL) and the American Psychiatric Association (APA). It recognizes original works presented or published in the previous year.

For more information on the Oxford Textbook of Correctional Psychiatry, click here. For more information about the Guttmacher Award, click here.

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Guest Blog: New York County Psychiatric Society Meet & Greet

As a part of PRMS’ partnership with NYCPS, Executive Director Meagan O’Toole is a featured author on the PRMS Blog this month!

Do you know which of your colleagues went to medical school out-of-state? Who plays an instrument?  Or who speaks multiple languages? Could you spot the World Record holder in the room? You can learn the answers to all of the “important” questions while earning a chance to win a new iPad mini and other fun prizes!

The 2016 New York County Psychiatric Society Meet & Greet is back September 8th at the Boat Basin Café in Manhattan. The annual event has become a staple of the New York City psychiatry scene, with over 100 psychiatrists attending last year to meet new colleagues and socialize with old friends while admiring the beautiful views of the Hudson River.

Boat Basin_1

Attendees enjoying the BBQ and a Hudson River sunset

The event, one of NYCPS’ most popular every year, is sponsored by PRMS, manager of a medical malpractice professional liability insurance program for psychiatrists. The informal mix and mingling was kicked up a notch two years ago when a bingo-like game was added to the evening. The game has proven to be a big hit, encouraging attendees to get to know more about each other and NYCPS, while allowing everyone to show a bit of their competitive sides (a free iPad is on the line after all) in a fun and casual atmosphere.

But the best thing about the event? NYCPS President Dr. Daniel Safin says it is “the sense of community and camaraderie that is present.” He adds that it is the perfect opportunity to catch up with colleagues who work in different clinical settings and to “get a sense of what is going well and where the challenges are in our field.”

Dr. Jose Vito (center) says his favorite part of the event is catching up with old friends and meeting new ones.

Dr. Jose Vito (center) says his favorite part of the event is catching up with old friends and meeting new ones.

For people new to the field or new to the area, the event is a great introduction to the NYC psychiatric community. With thousands of psychiatrists working in Manhattan alone, it can be difficult to meet people in other specialties or overwhelming for residents to network with psychiatrists outside of their programs. As Dr. Jose Vito, Immediate Past President of NYCPS, points out, “attending the event is a great way to network and meet mentors for residents and doctors at all stages of their careers.”

Thanks to the PRMS sponsorship, this event is free for all NYCPS members and just $10 for APA members of other District Branches. For more information, or to register to attend, you can click here. We look forward to seeing you on September 8th!

Meagan O’Toole has served as the Executive Director of NYCPS since 2013.

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Telemedicine – Still So Many Unknowns

In the July 14th issue of the New England Journal of Medicine, there was a review article titled “State of Telehealth.” In it, Drs. Dorsey and Topol describe the following three current telemedicine trends:

“The first is the transformation of the application of telehealth from increasing access to health care to providing convenience and eventually reducing cost. The second is the expansion of telehealth from addressing acute conditions to also addressing episodic and chronic conditions. The third is the migration of telehealth from hospitals and satellite clinics to the home and mobile devices.”

The article discusses many barriers to telemedicine, including legal barriers. I think an important barrier not mentioned is the restrictions on prescribing controlled substances. This is an area that not many people are thinking about, and those who are end up thinking about it differently! After discussions with a DEA representative, here is my understanding – NOT TO BE RELIED UPON AS LEGAL ADVICE – just one risk manager’s thoughts on prescribing controlled substances via telemedicine:

Step 1: You have to comply with state prescribing law applicable to all prescribing. In addition to being licensed in the patient’s state, states can require state controlled substance registration in the patient’s state (if different from prescriber’s state), registration with the Prescription Monitoring Program in the patient’s state, or other requirements, such as CME requirements.

Step 2: You have to comply with state law regarding prescribing via telemedicine.Some states specifically prohibit prescribing controlled substances via telemedicine, and some states allow it only under certain circumstances, such as for the treatment of psychiatric disorders.

Step 3: You also have to comply with federal law applicable to all prescribing. Some prescribers are surprised to learn that federal DEA registration is required in each state where controlled substances are prescribed. If the remote patient is out of state, services are deemed rendered in the patient’s state. Federal DEA registration covers multiple prescribing locations within one state, but it does not cover multiple states.

Step 4: You also have to comply with federal law regarding prescribing via the internet. Under the Controlled Substances Act (CSA), no controlled substance … may be delivered, distributed, or dispensed [defined to include prescribing] by means of the Internet without a valid prescription. “Valid prescription” means a prescription that is issued for a legitimate medical purpose in the usual course of professional practice by—a practitioner who has conducted at least one in-person medical evaluation of the patient or a covering practitioner.

There is an exception to the federal one in-person visit requirement for “telemedicine.” BUT the exception for telemedicine is limited to telemedicine as defined by the CSA.The 7 definitions of the practice of telemedicine / 7 exceptions to the in-person visit requirement are:

  1. Patient is remotely treated “while the patient is being treated by, and physically located in, a hospital or clinic [with a federal DEA registration] AND by a practitioner acting in the usual course of professional practice AND acting in accordance with applicable State law AND [has federal DEA registration] in State in which patient is located unless the practitioner [is with the VA or Indian Health Service]” OR
  2. Patient’s remote treatment “is being conducted while the patient is being treated by, and in the physical presence of, a practitioner acting in the usual course of professional practice AND acting in accordance with applicable State law AND [has federal DEA registration] in State in which patient is located, unless the practitioner [is with the VA or Indian Health Service]” OR
  3. Patient is remotely treated by provider with the Indian Health Service OR
  4. Patient is remotely treated during a public health emergency OR
  5. Patient’s remote treatment “is being conducted by a practitioner who has obtained from the Attorney General a special registration…” (No such registration currently exists, but it is on the DEA’s agenda and the American Telemedicine Association has provided input for this special registration.) OR
  6. Patient is remotely treated during a medical emergency (defined) OR
  7. Patient’s remote treatment “is being conducted under any other circumstances” as designated by the Attorney General and the Secretary.

Again, these are just my thoughts – and not legal advice. If you are insured through PRMS, feel free to call your risk manager to discuss this further and receive resources to assist you in navigating these uncharted waters.

Donna Vanderpool, MBA, JD
Vice President

As Vice President of Risk Management, Ms. Vanderpool is responsible for the development and implementation of PRMS’s risk management services for The Psychiatrists’ Program. Ms. Vanderpool has developed expertise in the areas of HIPAA and forensic practice, and has consulted, written and spoken nationally on these and other healthcare law and risk management topics. She most recently contributed to a chapter in Gun Violence and Mental Illness (APPI), authored chapters on telepsychiatry in Mental Health Practice in a Digital World (Springer) andPsychoanalysis Online 2(Karnac). She also has co-edited and contributed chapters to several other clinical textbooks. Prior to joining PRMS in 2000, Ms. Vanderpool practiced criminal defense law, taught business and legal courses, and spent eight years managing a general surgical practice. Ms. Vanderpool received a Bachelor’s degree in Business Administration and Management from James Madison University. She also earned a Master of Business Administration degree and Juris Doctor degree from George Mason University.Follow Donna on LinkedIn.

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PRMS Helps Future Psychiatrists Understand Risks Down the Road

Psychiatry is one of the most rewarding fields in medicine, but psychiatrists face a myriad of liability risks, especially relating to issues such as telepsychiatry, suicidal patients, medication issues, use of social media, electronic health records and more. Unfortunately, risk management strategies related to these topics are not often formally addressed during residency training.

While the potential for liability is one of the more stressful aspects of today’s psychiatric practice, psychiatrists in training can learn ways to improve patient safety and steer clear of malpractice claims by attending the PRMS Residents’ Education Program (PREP®), a program which offers a critical overview of risk management practices.

PRMS offers PREP® free of charge to groups of residents and fellows. Just what makes the program so unique? As a leader in proactive risk management, PRMS has extensive experience handling claims against psychiatrists and fielding calls on the risk management helpline. That unique body of knowledge can go a long way to help our insured clients lessen the risk of having an adverse patient outcome or being sued.

During the past 30 years, PRMS has managed more lawsuits, claims and potential claims against psychiatrists than any other professional liability insurance program in the United States. According to the most recent data from PRMS claims on lawsuits closed in 2015, incorrect treatment was the most identifiable cause of loss for psychiatrists (35% of cases), followed by medication issues (19%) and suicide/attempted suicide (15%).

Donna Vanderpool, MBA, JD, states, “The PREP® program was developed to meet needs expressed by residency training directors. PRMS has provided the well-received PREP® courses to residency and fellowship programs across the country for 15 years, and our staff is often asked back yearly by training directors and attendees. PREP® program content supports ACGME core competencies relating specifically to system-based practice and interpersonal and communication skills.”

PRMS recognizes that the job of psychiatrists and these emerging practitioners could not be more important. Most Americans say untreated mental health has a significant impact on the United States economy, according to a poll released by the American Psychiatric Association in May. The poll also found that nearly one in five respondents has personally sought care from a mental health professional, and three in 10 know a family member who has sought care.

To provide insight into the intersection of psychiatry and the law, PREP® faculty include three seasoned PRMS risk managers: Donna Vanderpool, MBA, JD, Vice President of Risk Management; David Cash, JD, LLM, Assistant Vice President of Risk Management; and Ann McNary, JD, Senior Risk Manager.

PREP® is designed to run about 90 minutes, but its format is flexible and can be modified to suit various timeframes and audience sizes. It can be presented as a stand-alone seminar or Grand Rounds.

Interested in incorporating PREP® courses in your residency training programs? To learn more or to schedule your free PREP® session, call Donna Vanderpool, MBA, JD at (703) 907-3895 or email

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OCR and Advocate Reach Largest HIPAA Settlement to Date

The Office of Civil Rights (OCR) has announced its latest and largest HIPAA settlement to date.  Advocate Health Care will pay a settlement amount of $5.55 million and adopt a corrective action plan to bring a lengthy OCR investigation to an end.  In 2013, the Illinois-based health system first notified OCR of the theft of four unencrypted desktop computers, collectively housing the PHI of roughly 4 million individuals.  Shortly after the start of OCR’s investigation, Advocate also reported two additional unauthorized disclosures of PHI affecting 4,000 individuals.  OCR found that Advocate failed to conduct accurate risk assessments, obtain business associate agreements, implement appropriate policies and procedures, and reasonably safeguard a portable device.

After avoiding a number of class action suits arising from the breach, Advocate also awaits the conclusion of a separate investigation conducted by the Illinois Attorney General.  Advocate’s breach remains the eighth largest health data breach on record.

The resolution agreement can be viewed here.

Justin A. Pope, JD
Associate Risk Manager

Justin Pope joined PRMS in 2014. Mr. Pope is responsible for researching emerging legal issues, creating online risk management content, and providing advice to individual providers through the Risk Management Consultation Service.

As a law student, he focused primarily on international, administrative, and food law. During his final year at Howard, Mr. Pope gained additional insight into the FDA’s regulatory process while serving as a research assistant to his professor. He has also interned as a legal assistant for both the Ft. Monroe Garrison Office of the Staff Judge Advocate and the Office of the Naval Inspector General, opining on a variety of legal issues, including privacy law. Mr. Pope received his Bachelor of Arts degree in International Affairs from the University of Virginia and his Juris Doctor degree from the Howard University School of Law.

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