AAPL Practice Guideline for the forensic psychiatric evaluation of competence to stand trial.

Competence to stand trial is a legal construct used to identify those criminal defendants who have the requisite mental capacity to understand the nature and objective of the proceedings against them and to participate rationally in preparing their defense. This Practice Guideline has described how psychiatrists should evaluate individuals concerning their competence to stand trial. The Guideline describes acceptable forensic psychiatric practice for such evaluations.

Psychiatric malpractice case analysis: striving for objectivity.

Forensic psychiatrists, acting as expert witnesses, must be able to perform objective analyses of psychiatric malpractice cases. Accurate malpractice case analysis requires careful attention to relevant legal concepts and consideration of potential biasing influences. If forensic psychiatrists are to avoid a reliance on "experts policing experts," individual forensic psychiatrists must be fully prepared to police themselves by recognizing and avoiding certain errors in malpractice case analysis.

Capacity of forensic patients to consent to research: the use of the MacCAT-CR.

The ability of psychiatric patients and prisoners to provide informed consent to participate in clinical research has given rise to much debate. Forensic psychiatric patients present a particular concern regarding their competence to consent to research, as they are both patients and prisoners. The primary goal of this research was to evaluate whether, by employing structured assessments of capacity to consent to research, we could determine if this combined vulnerability leads to differences in competence from the published abilities of nonforensic psychiatric patients.

Sell v. U.S.: involuntary medication to restore trial competency--a workable standard?

Competency to Stand Trial (CST) evaluations are common in the U.S. criminal justice system.

Sex offender registration and community notification challenges: the Supreme Court continues its trend.

All states and the District of Columbia have passed sex offender registration and community notification laws. While the specific provisions of these statutes vary, all have public safety as a primary goal. The authors discuss two recent cases heard by the United States Supreme Court that challenged the constitutionality of Alaska's and Connecticut's statutes.

Patients' rights and psychiatrists' duties: discharging patients against medical advice.

Every psychiatrist who treats voluntary inpatients has had or will have patients who leave the hospital against medical advice (AMA). Studies reveal that between 6 and 35 percent of voluntary psychiatric inpatients are discharged AMA. These patients often are acutely ill and have severe symptoms at discharge.

Managed care and ERISA: synopsis and case law review.

Managed care organizations (MCOs) have become the predominant health care model in the United States. Through cost containment arrangements with providers, incentives for patients to pursue less costly care and reductions in the provision of unnecessary care, MCOs are more intimately involved in the delivery of health care than their former fee-for-service insurance company counterparts. However, this new role has not implied increased liability, largely because of The Employee Retirement Income Security Act of 1974 (ERISA).