The treating psychiatrist as forensic evaluator in release decisions

In a previous paper, the author argued that clinicians who perform initial forensic evaluations might be better able to assume subsequent treating relationships with those they have evaluated than independent evaluators. In this paper, the author discusses the problems involved when clinicians who have established treatment relations with patients are then called upon to testify in release hearings. He concludes that the conflicts potentially are more significant in this situation, and that treating clinicians should not evaluate their patients for release.     

Prearraignment forensic evaluation: the odyssey moves east of the Pecos

Although the ethical guidelines of both the American Psychiatric Association and the American Academy of Psychiatry and the Law explicitly prohibit the forensic examination of criminal defendants before appointment of counsel, except for the purpose of providing emergency medical care and treatment, the practice continues in many parts of the country. This article presents a recent case in which this practice was challenged on appeal, to serve as a focus for discussion of the evolution of, and rationales for and against, these ethical positions. It will also serve as a focus to examine the legal views concerning such examinations, derived from the appeal of the decision in the case itself as well as decisions in similar cases.     

The role of substitutes in policy analysis: acute care services in state Medicaid programs

Using four acute care equations (inpatient, physician, outpatient, and clinic) from a larger model of Medicaid, this research examines the "contents" of policy outcomes. This closer examination of outcomes brings to light the interactions between redistributive programs and services and the role of substitutes and complements in state-level policy analysis. (A substitute is a benefit or service that can be used instead of another to produce a similar outcome; a complement is a benefit or service that is likely to result in the use of another benefit or service.) Support is found for the inclusion of these theoretical constructs in policy analysis. Regarding Medicaid, the author concludes that physician, outpatient, and clinic services all complement hospital services; that physician and outpatient services substitute for one another; that state AFDC and SSI policy decisions have a greater impact on utilization than Medicaid-specific eligibility and service decisions do; and that the factors driving utilization (supply, demand, etc.) vary dramatically across acute care settings. The implications for Medicaid policymaking are also discussed.