ALLEGED HARM OF PATIENT

THE SITUATION

A working woman in her twenties attended a psychotherapy intake evaluation appointment.  Her father accompanied her and insisted that he be allowed to be present during the evaluation and in subsequent treatment sessions. The psychologist refused to allow the father to do this and informed the father that he would not be privy to what transpired during the psychotherapy sessions unless his daughter chose to make him aware of it.  The father filed an ethical inquiry and charged that the psychologist harmed his daughter by failing to conduct a risk assessment and because the psychologist didn’t force his daughter to continue treatment. 

ACTION TAKEN BY THE PSYCHOLOGIST

The psychologist submitted a copy of the intake evaluation report which included documentation that the young woman was fully capable of making decisions for herself, that a suicidal/homicidal risk assessment was conducted, and that the patient was offered a series of ongoing psychotherapy appointments at a set time on a weekly basis.  The patient said she would check her work schedule and call to confirm the appointments.  However, she never did make that call and didn’t return for psychotherapy. 

ALLEGEDLY VIOLATED ETHICAL CODE 

3.04 Avoiding Harm: Psychologists take reasonable steps to avoid harming their clients/patients, students, supervisees, research participants, organizational clients and others with whom they work, and to minimize harm where it is foreseeable and unavoidable.

 

LESSON

It is important to protect the patient’s right to confidentiality, document risk assessment, and record future appointment arrangements. Because the psychological record reflected these steps to have been taken, the Board found no ethical violation had occurred.

 PROFESSIONAL CONDUCT

THE SITUATION

A medical patient who exhibited cognitive deficits was referred by a hospital physician for a neuropsychological evaluation. The patient alleged that the neuropsychologist: [1] Lacked the qualifications and experience to conduct such an evaluation, [2] Used irrelevant neuropsychological tests, [3] Was intimidating and unprofessional and he alleged the behavior of the psychometrist was also unprofessional., and that [4] The psychologist’s opinions were not independent because the psychologist had a conflicting professional relationship with the referring hospital.  

ACTION TAKEN BY THE PSYCHOLOGIST

[1] As an ABPP and Board certified neuropsychologist, the psychologist was qualified to conduct the evaluation, [2] An extensive comprehensive neuropsychological test battery was employed, the results of which clearly supported the report’s conclusions and opinions, [3] The psychologist noted in the original report that the patient was difficult to evaluate because he reluctantly agreed to be evaluated under protest.  There was no evidence of unprofessional conduct, and [4] There was no evidence of a compromised relationship between the neuropsychologist and the referring hospital. 

ALLEGEDLY  VIOLATED  ETHICAL  CODE

Principle B: Fidelity and Responsibility: Psychologists establish relationships of trust with those with whom they work…Psychologists uphold professional standards of conduct, clarify their professional roles and obligations, accept appropriate responsibility for their behavior and seek to manage conflicts of interest that could lead to exploitation or harm. 2.01 Boundaries of Competence:  (a) Psychologists provide services…with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study or professional experience. 9.02 Use of Assessments: (a) Psychologists administer, adapt, score, interpret or use assessment techniques, interviews, tests or instruments in a manner and for purposes that are appropriate in light of the research on or evidence of the usefulness and proper application of the techniques. 3.06 Conflict of Interest: Psychologists refrain from taking on a professional role when personal, scientific, professional, legal, financial or other interests or relationships could reasonably be expected to (1) impair their objectivity, competence or effectiveness in performing their functions as psychologists or (2) expose the person or organization with whom the professional relationship exists to harm or exploitation.

LESSON:  Only agree to conduct evaluations you are qualified to conduct, utilize appropriate tests for the purpose of the evaluation, and maintain clear boundaries between you and the referring entity.  It was ruled that there were no violations of the ethical code.

SCOPE OF PRACTICE                                                               

THE SITUATION

The psychologist is licensed with a very narrow scope of practice, limited to conducting evaluations for Social Security, Disability Determination Services and Division of Rehabilitation Services.  Competency in forensic psychological evaluations and in the administration of the MMPI were NOT APPROVED because these areas were not declared at the oral examination nor did the psychologist take steps to include these activities in the psychologist’s scope of practice.   

ACTION TAKEN BY THE PSYCHOLOGIST

Hired by an attorney, the psychologist conducted a civil forensic psychological evaluation which included an MMPI assessment.  On the basis of the results of this evaluation, the psychologist opined in the report that the client, “is unable to make informed financial decisions.”  Then the psychologist appeared at a legal mediation meeting for the purpose of giving expert testimony in this civil case. 

ETHICAL CODE VIOLATED

Section 2.01(a): “Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience. 

 

LESSONS

[1] While it is enticing to accept lucrative referrals from attorneys and judges, if you are not approved for competency in forensic psychology, do not accept the referral. [2] Do not administer, score, and interpret psychological tests (i.e. MMPI), for which you did not declare competency. [3] If you want to expand your practice to include new domains, you are required to file a written request for expansion of your scope of practice and include proof of training and/or supervision in the new scope of practice.   

USE APPROPRIATE & ADEQUATE TESTS

THE SITUATION

The psychologist conducted a Fitness for Duty Evaluation [FDE] of a police officer.  No psychological tests were utilized by the psychologist.  Only a clinical interview and a homemade questionnaire were used to complete the FDE.  This procedure was based on the advice of the psychologist’s agency supervisor. 

ACTION TAKEN BY THE PSYCHOLOGIST

The psychologist opined that the police officer was unfit for duty.  This caused the police officer to be suspended from duty. 

ETHICAL CODE VIOLATED

Section 9.01(a) specifically requires that “psychologists base the opinions contained in their recommendations, reports, and diagnostic or evaluative statements, including forensic testimony, on information and techniques sufficient to substantiate their findings.” 

 

LESSON

When conducting psychological evaluations, administer psychological tests that are pertinent and sufficient for the purpose of the evaluation and sufficient to substantiate professional opinions that are rendered.  Psychologists should follow this principal regardless of the advice of the agency supervisor. 

IMPAIRED  PSYCHOLOGIST

THE SITUATION

A female head injury patient, involved in a law suit, was referred by a neurologist to a neuropsychologist.  The neuropsychologist conducted a neuropsychological evaluation.  One year later the neuropsychologist had failed to submit the report of the evaluation to the neurologist.  He submitted the evaluation only after the patient had filed an ethical inquiry against him.  The patient called the neuropsychologist repeatedly requesting the report and was told it would be “a couple of weeks.”  The patient’s inquiry charged the neuropsychologist with harming her because it delayed resolution of the lawsuit and her credit rating was ruined because of her inability to pay large medical bills. 

ACTION TAKEN BY THE PSYCHOLOGIST

Admitting that he acted unethically, the neuropsychologist immediately sent the report to the neurologist.  It was indicated by the neuropsychologist that he had become depressed for a year prior to the date of the evaluation and that the depression caused him to take a greater amount of time to complete all his reports.  He signed a consent decree in which he admitted that he failed to limit or suspend his work duties due the fact that he was impaired.  The Board ordered that he: [a] was on probation for one year, [b] had to be administratively supervised by a board approved psychologist, and [c] was required meet with the Board at the end of the probationary period and submit documentation that he met all the requirements of the consent decree. 

ETHICAL CODE VIOLATED

2.06 (b) Personal Problems and Conflicts: When psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they take appropriate measures, such as obtaining professional consultation or assistance and determine whether they should limit, suspend or terminate their work-related duties.

LESSON

If you become mentally and/or physically impaired and are unable to complete your psychological work duties, take steps to limit, suspend, or terminate your professional responsibilities.

SEXUAL INTIMACY WITH PATIENT - 1

THE SITUATION

While treating a child, the psychologist provided several psychotherapeutic sessions for the mother of the child as part of the child’s treatment. After the mother no longer had custody of the child, the psychologist provided individual psychotherapy for the mother for several months.  The Psychologist later terminated the individual treatment.  Three months later, the mother alleged that the psychologist romantically pursued her and that they had had sexual interaction several times. The mother further asserted that the psychologist continued the psychologist-patient relationship by reviewing and providing advice on her child’s psychological reports.  Once the psychologist ended the sexual relationship, she filed an ethical complaint against him.

ACTION TAKEN BY THE PSYCHOLOGIST

The psychologist asserted that this sexual relationship began a year and three months after psychotherapy was terminated.  The Board heard hours of testimony from both parties and third-parties. The Board voted unanimously to revoke the psychologist’s license.  

ETHICAL CODE VIOLATED

10.05 Sexual Intimacies with Current Therapy Clients/Patients
“Psychologists do not engage in sexual intimacies with current therapy clients/patients.”

10.08 Sexual Intimacies with Former Therapy Clients/Patients “(a) Psychologists do not engage in sexual intimacies with former clients/patients for at least two years after cessation or termination of therapy. (b) Psychologists do not engage in sexual intimacies with former clients/patients even after a two-year interval except in the most unusual circumstances. Psychologists who engage in such activity after the two years following cessation or termination of therapy and of having no sexual contact with the former client/patient bear the burden of demonstrating that there has been no exploitation, in light of all relevant factors….”

LESSON

As a general rule, sexual relationships with current and former clients/patients are unethical and unless stringent safeguards are in place, the passage of time does not affect the seriousness of the violation.  This sort of violation often results in the permanent loss of licensure.