Q.

Does our center and the psychiatrist have any potential liability for failure to hospitalize if the county decides not to hospitalize the patient contrary to the psychiatrist's recommendation?
 

A.

You have a contract with the county to provide crisis mental health services on an outpatient basis.  You do not provide inpatient hospitalization services and your psychiatrists and staff do not attend patients in the hospital.  You have no contract or other obligation requiring you to provide inpatient hospitalization services. You make recommendations to the county on whether to hospitalize a patient evaluated in your crisis care program.  However, the county pays for any hospitalization and makes the ultimate decision on whether to hospitalize a patient. Once a patient is hospitalized your involvement with the patient ends.

Your psychiatrists evaluate whether or not a person qualifies for involuntary treatment.  For the purposes of your question we are assuming that your psychiatrist concluded that a patient does not qualify for involuntary treatment because the patient is not imminently dangerous to himself or others. However, the psychiatrist has also concluded that without inpatient hospitalization the patient is likely to deteriorate and become imminently dangerous.  Your psychiatrist then recommends to the county that the patient be hospitalized.  We are also assuming that the psychiatrist's evaluation and ultimate determination are done within the standard of care.

Generally, there is no potential liability for medical malpractice unless a health-care provider (1) has a legal duty, (2) breaches that duty by not acting within the standard of care and (3) proximately causes injury as a result of the breach.  Under the circumstances you hypothesize it seems unlikely to me that a court would rule that your center or the psychiatrist have any legal duty to hospitalize the patient.  Of course, you should not "abandon" a patient. You should appeal any county decision you think is incorrect.  Within your capability you should arrange for whatever alternate treatment is most appropriate.  If alternate treatment is provided you should continue to make it clear to the county and to the patient that your recommendation is inpatient hospitalization. If the patient's status does deteriorate you should timely initiate involuntary evaluation and treatment.

If your contract with the county does not currently provide for some type of appeal mechanism, I suggest that you renegotiate the contract to include one.