Psych Emergencies Belong in the ED

Thank you for publishing Dr. H. Steven Moffic's letter raising ethical questions surrounding the death of Dr. Wayne S. Fenton (“Dr. Fenton and Boundary Issues,” Letters, December 2006, p. 12).

The many ways in which he appears to have been an exemplary clinician should not obscure the possibility that his death may have been the result of a tragic and unnecessary mistake.

There is a real risk that the characterization of Dr. Fenton's practices as heroic may result in others attempting unnecessarily to provide urgent or emergent care in understaffed, underequipped, and unsafe settings. Despite the American Psychiatric Association's ethics committee's admonishment to the contrary, psychiatric emergencies should be handled in emergency departments. Clinicians who fail to advise callers to “hang up and dial 911” for emergency help are tacitly implying that they can provide immediate and adequate assistance for emergencies that may be medical or psychiatric.

If they cannot respond to such calls within minutes and provide appropriate emergency care in a setting suitably equipped to provide for safety of patient and clinician, they may be acting unethically.

H. Berryman Edwards, M.D.

Bellevue, Wash.

Clinical Psychiatry News Volume 35, Issue 2, Pages 14-15 (February 2007)