Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label licensure. Show all posts
Showing posts with label licensure. Show all posts

Wednesday, July 3, 2024

Fake therapist fooled hundreds online until she died, state records say

Brett Kelman
CBS Health Watch
Originally posted 2 July 24

Hundreds of Americans may have unknowingly received therapy from an untrained impostor who masqueraded as an online therapist, possibly for as long as two years, and the deception crumbled only when she died, according to state health department records.

Peggy A. Randolph, a social worker who was licensed in Florida and Tennessee and formerly worked for Brightside Health, a nationwide online therapy company, is accused of helping her wife impersonate her in online sessions, according to an investigation report from the Florida Department of Health.

The Florida report says the couple "defrauded" patients through a "coordinated effort": As Randolph treated patients in person, her wife pretended to be her in telehealth sessions with Brightside patients. The deceit was discovered after the wife died last year and a patient realized they'd been talking to the wrong person, according to a Tennessee Department of Health settlement agreement.

Records from both states identify Randolph's wife only by her initials, T.R., but her full name is in her obituary: Tammy G. Heath-Randolph. Therapists are generally expected to have at least a master's degree, but Randolph's wife was "not licensed or trained to provide any sort of counseling services," according to the Tennessee agreement.

Here are some thoughts:

This case of an impostor therapist masquerading as a licensed professional in online therapy sessions raises numerous ethical, healthcare, and psychotherapy concerns. The most obvious issues include the severe breach of trust between therapist and patient, the potential harm caused to vulnerable individuals seeking mental health support, and the serious violations of patient privacy.  The incident also highlights the critical importance of proper licensing and credentialing in healthcare, especially in telehealth settings.

This case also reveals less apparent but equally significant problems. It exposes potential vulnerabilities in telehealth systems, particularly in verifying the identity of online therapists, suggesting a need for more robust authentication methods.

The alleged involvement of the therapist's wife introduces complex ethical dilemmas regarding personal relationships in professional healthcare contexts. Furthermore, the fact that this deception went unnoticed for an extended period might indicate systemic issues such as therapist burnout or inadequate oversight in the mental health field. The case also demonstrates the challenges in regulating and monitoring telehealth services that operate across multiple states.

Interestingly, this real-life impostor scenario could potentially exacerbate feelings of imposter syndrome among both genuine therapists and patients. The posthumous discovery of the deception presents unique challenges in addressing the harm caused and seeking appropriate resolutions.

Lastly, the financial aspect of this case, where compensation was received for fraudulent sessions, raises important questions about the potential for monetary incentives to compromise ethical standards in healthcare. This incident underscores the urgent need for stronger safeguards in telehealth, improved oversight mechanisms, and a renewed focus on maintaining the integrity of the therapist-patient relationship in the evolving landscape of digital healthcare.

Sunday, December 31, 2023

Problems with the interjurisdictional regulation of psychological practice

Taube, D. O., Shapiro, D. L., et al. (2023).
Professional Psychology: Research and Practice,
54(6), 389–402.


The U.S. Constitutional structure creates ethical conflicts for the cross-jurisdictional practice of professional psychology. The profession has chosen to seek interstate agreements to overcome such barriers, and such agreements now include almost 80% of American jurisdictions. Although an improvement over a patchwork of state laws regarding practice, the structure of this agreement and the exclusion of the remaining states continue to pose barriers to the principles of beneficence and nonmaleficence. It creates a system that is extraordinarily difficult to change and places an unrealistic burden on professionals to know, address, and act under complex legal mandates. As psychological services have moved increasingly to remote platforms, cross-jurisdictional business models, and a nationwide mental health crisis emerged alongside the pandemic, it is time to consider a national professional licensing system more seriously, both to further reduce barriers to care and complexity and permit the best interests of patients to prevail.

Impact Statement

Access to and the ability to continue receiving mental health care across jurisdictions and nations has become increasingly urgent in the wake of the COVID-19 pandemic This Ethics in Motion section highlights legal barriers to providing ethical care across jurisdictions, how those challenges developed, and strengths and limitations of current approaches and potential solutions.

My summary: 

The current system of interjurisdictional regulation of psychological practice in the United States is problematic because it creates ethical conflicts for psychologists and places an unrealistic burden on them to comply with complex legal mandates. The system is also extraordinarily difficult to change, and it excludes psychologists in states that have not joined the interstate agreement. As a result, the current system does not adequately protect the interests of patients.

A national professional licensing system would be a more effective way to regulate the practice of psychology across state lines. Such a system would eliminate the need for psychologists to comply with multiple state laws, and it would make it easier for them to provide care to patients who live in different states. A national system would also be more equitable, as it would ensure that all psychologists are held to the same standards.