Complex care delivery can involve rapidly changing symptoms, overlapping treatment relationships, medication adjustments, family concerns, and difficult decisions about when outpatient management remains appropriate. In these cases, the medical record may later be examined to evaluate clinical judgment and safe, effective care coordination: what information was available, what risks were assessed, how clinicians communicated, why a treatment plan was selected, and how the care team responded when the patient’s condition changed.
National attention on the Lindsay Clancy case has heightened provider concern about professional liability exposure. Public reporting and testimony have focused on psychiatric assessment, fragmented care occurring across multiple providers and programs, incomplete records, telehealth encounters, and transitions of care. Related civil claims allege failures in diagnosis, treatment coordination, medication monitoring, and response to worsening symptoms; these allegations remain unresolved and should not be treated as established facts.
Many healthcare claims do not arise from one identifiable error. Instead, they may involve smaller vulnerabilities: incomplete assessment, unclear follow-up expectations, fragmented records, unclear responsibility for clinical concerns, delayed escalation, or documentation that does not clearly reflect clinical reasoning. These are the types of concerns brought to the OmniSure Risk Consulting Helpline for clinical risk management support.
Examples from the Helpline
- Refusal of Higher Level of Care: A medical provider is treating an adult patient with multiple warning signs who wants to discontinue therapy, declines psychiatric support and a higher level of care, and does not want the provider to involve a household family member in safety planning. The patient expresses thoughts that raise concern for self-harm or death, and the provider seeks guidance about appropriate assessment, escalation, documentation, confidentiality considerations, and follow-up.
- Scope-of-Practice Limitations in Litigation: A therapist is asked to testify in a custody matter regarding a patient’s parenting effectiveness. The therapist has provided only individual therapy, has not performed a parenting-capacity or custody evaluation, has not observed the patient with their children, and lacks the training and information to offer an opinion on parental fitness.
- Intake Decision and Non-Establishment of Care: A provider conducts an initial screening and identifies concerns suggesting that the patient’s needs exceed the provider’s scope, available level of care, or ability to safely provide treatment. The provider does not intend to accept the patient for ongoing care but wants to ensure appropriate resources and referral options are provided.
The most defensible approach in each situation is a reliable clinical process supported by timely, objective documentation. The record should reflect the information known at the time, the provider’s assessment and clinical reasoning, consultation or escalation efforts, options and resources offered, the patient’s response, and the rationale for the plan or decision.
Risk Commentary & Best Practices
- Document risk assessment, recommendations, and refusal of care: When a patient declines the recommended evaluation, treatment, safety planning, family involvement, or a higher level of care, document relevant patient statements, observed presentation, risk and protective factors, recommendations made, the patient’s response, consultation and supervision obtained, and the follow-up, monitoring, or escalation plan. A patient’s refusal does not eliminate the need for continued assessment, clinical judgment, and appropriate action to address safety concerns.
- Maintain clear scope-of-practice boundaries in legal matters: Treating providers may receive requests for letters, testimony, or opinions in custody, disability, employment, and other legal matters. Distinguish factual information derived from the treatment relationship from opinions that require an independent forensic evaluation. Providers should not offer opinions beyond their training, direct observations, information reviewed, or professional role. When a provider is already delivering treatment services, assuming an additional evaluative role, such as assessing parental efficacy, custody-related issues, disability, or fitness for a legal purpose, may create a dual-role conflict. These evaluations require independence and objectivity that may be difficult to maintain within an established therapeutic relationship, creating significant ethical, clinical, and defensibility concerns. When appropriate, the provider should limit communications to factual treatment information and refer the request for a forensic opinion to an independent, qualified evaluator.
- Clarify intake status and decisions not to establish care: A screening or consultation does not necessarily establish an ongoing treatment relationship. Providers should clearly document the encounter type, basis for declining care, risk assessment, resources or referrals offered, and instructions for urgent assistance when indicated. Practices should establish intake and exclusion criteria to identify when a patient’s needs, acuity, risk level, or required specialty expertise exceed what the provider or setting can safely support.
High-quality documentation alone does not prevent a poor outcome. However, thoughtful assessment, coordinated care, timely escalation, and records that accurately describe clinical decision-making support safer care and reduce avoidable professional-liability exposure.
Risk Management in Real Time
High-risk decisions should not rest on an individual provider’s judgment alone when risk consultation, risk management support, supervision, or organizational escalation are available. Practices should establish clear pathways for providers and staff to obtain timely clinical guidance, discuss concerns related to scope of practice or patient safety, and escalate urgent issues without waiting for a scheduled appointment or a routine supervisory meeting.
Early consultation with a risk management partner and the use of established escalation pathways can support timely decision-making and intervention and reduce the likelihood that a concern will progress to patient harm, a complaint, or a professional liability claim.
Takeaway Summary
Reduce fragmentation. Repeated testimony in the Lindsay Clancy case highlights how quickly fragmented care can become difficult to reconstruct. Identify the treating team, obtain and review appropriate records, clarify roles, communicate material changes in condition, and document outreach and care-coordination. When clinically important information is siloed, the resulting record may become incomplete, contradictory, or difficult for the next provider to interpret.
Document for multiple audiences. This case also illustrates how documentation may be scrutinized line by line. Providers should document consistently enough that a review of other records demonstrates a recognizable, reliable approach to assessment, communication, follow-up, and clinical decision-making.Documentation should be written with the patient as an important audience, particularly in an open-notes environment, while recognizing that the record may also be reviewed by family members, consultants, subsequent treating providers, payers, regulators, attorneys, or a jury. The goal is not defensive or overly technical charting; it is an accurate, respectful, clinically useful account of the patient’s presentation, the provider’s reasoning, and the plan.
Screening tools should inform, not replace, clinical judgment. Public reporting has raised questions about crisis screening, whether a patient’s denial of a current plan was treated as dispositive, and what alternatives were available when a requested level of care was not provided. A negative response to a series of screening questions, standing alone, should not be treated as a complete clinical opinion or the endpoint of decision-making. The plan of care should integrate the screening tool used with the patient’s presentation, history, collateral information when available and appropriate, observed functioning, recent changes, protective factors, available supports, and the provider’s clinical judgment.
Plan for both acceptance and exclusion. When a patient does not meet criteria for admission, transfer, or a particular program, the response should not end with the exclusion decision. The organization should identify appropriate alternatives, communicate recommendations clearly, document the rationale for the disposition, the options and referrals offered, and establish follow-up or escalation expectations proportionate to the patient’s risk and circumstances.
Further resources
Refer to The Joint Commission’s suicide-risk reduction resources, SAMHSA’s National Guidelines for a Behavioral Health Coordinated System of Crisis Care, and AHRQ’s care-transition resources when developing policies for risk assessment, documentation, care coordination, referral follow-up, crisis response, and escalation. Organizations should also consult applicable state law, professional licensing requirements, and qualified legal counsel regarding scope-of-practice questions, subpoenas, confidentiality, and patient-specific risk concerns.
