Jury Rules in Favor of Man Suing Therapist for Sparking Relationship with his Wife during Counseling

by TaMaryn Waters

Tallahassee Democrat

This is not a made-for-television-movie scenario, but it felt like one for Richard Webb. His 25-year marriage was crumbling so he sought counseling from Kevin Ragsdale from September 2007 to January 2008, court records show.

Within the four-month span of counseling, Webb's wife was brought in to joint counseling sessions.

But Webb didn't know Ragsdale conducted private sessions with his wife and later sparked a relationship.

Webb sued Ragsdale, who married Webb's wife in January 2010, for emotional damages and a Leon County jury has ruled the therapist violated several code of ethics...

<snip>

Dana Brooks, Webb's attorney, said the jury ruled Ragsdale was 65 percent responsible for negligence that caused a "legal cause of harm or loss" to Webb and 35 percent of the negligence was caused by Webb.

Brooks, however, said there was no evidence presented at trial related to Webb's role in negligence.

She plans to file a motion for a post trial hearing.

Brooks said a judge will make a judgment on what the final verdict should be for Webb, including damages, during the post trial, which could be sometime next month.

She said her client, the father of three children ages 14, 18 and 21 during the time of the counseling, said Webb continues to have "a great deal of difficulty on any kind of parenting issues" now that Ragsdale has married his ex-wife.

"My client feels like he is being completing supplanted and replaced," she said.

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Thanks to Ken Pope for this story.

For some reason, the Tallahassee Democrat no longer has the full story on their web site.

Ask the Ethics Committee: Releasing Third Party Reports

Dear Ethics Committee:

I have a question about the release of third party records.  I understood that we are NOT to release records from third parties that we have in our charts (e.g., from other medical providers).

A colleague recently told me that this has changed.  If 3rd-party information is in our charts, then the expectation is to release it when asked for records.

Can the committee offer some guidance on this?

Thank you.

Ethics Committee Response:

There is no absolute prohibition against sending records received from third parties in response to a signed patient release. However, this may not be a good practice.  In many cases, the psychologist cannot ensure that the third party records are the most recent or the most comprehensive set of records available.

For example, a psychologist receives a release of information from a patient that graduated from therapy about one year ago.  The release specifies that the psychologist send “all records.”  In file, there is a report from a physician in file that is now five years old. By sending the old report from the physician, the psychologist may be doing a disservice because the psychologist does not know if the patient has had more recent contact with the physician.  Additionally, the psychologist cannot be sure if the physician's report is now inaccurate or misleading.

Therefore, we suggest that it is preferable to have the patient get the information directly from the third party.

There are certain situations in which good clinical and ethical judgment may indicate a different course.  As stated above, there is no rule that prohibits a psychologist from sending out information generated from third parties, if legally compelled or clinically indicated.

For example, a psychologist receives a copy of a psychiatric evaluation in file from the outpatient clinic of a psychiatric hospital that had closed several years ago. The former patient is now working with a different psychiatrist.  An appropriately signed release asks for “all records” to be sent to the current treating psychiatrist.  In this situation, the patient’s current treatment may be enhanced with this longitudinal data.

In another situation, a former patient, who is applying for Social Security Disability, requests that “all records” be sent to a State Agency.  In file, there are old reports from several inpatient psychiatric interventions.  Instead of sending a seriously mentally ill, and perhaps disabled, patient on a long and potentially futile effort to find out what happened to those old records, the patient may benefit from releasing those older records directly to that State Agency so that the most accurate decision can be made.

In forensic cases, it is sometimes expected that psychologists will send information gained from third parties, especially if it was used as a basis to formulate their opinions.

There may be other situations where it is legally or clinically indicated to send out records from third parties that psychologists have in their charts. The examples provided are not meant to be exhaustive.

However, as noted above, it is usually better for patient records to come directly from the original source.

Thoughts and comments about this response are welcome.

Ethics and the Invisible Psychologist

Ethics and the Invisible Psychologist

This article can be found in the public domain here.

Working with Adult Suicidal Patients

Weissberg Suicidal Patients

Limited Right to Confidentiality with Research

By Scott Jaschik - Inside Higher Ed

A federal judge on Friday ruled that he would conduct a private review of confidential research interviews by Boston College to determine whether they should be turned over to the British government, as it and the U.S. Justice Department have requested.

The decision by Judge William G. Young said that Boston College and the two governments both have "significant interests" in their positions in the dispute -- with the governments seeking to enforce the law and treaty obligations, and the college seeking to preserve confidentiality promised to research subjects.

In different parts of the decision, Judge Young sided with each party. In support of the government position, he rejected the college's request to quash the subpoenas, and said that the material they were seeking was important and related to legitimate government interests (law enforcement). But he sided with the college (and its scholarly supporters) in saying that academic freedom issues deserve consideration here. In so doing the judge directly rejected government claims in the case. Similarly, the judge discarded the notion that courts should simply grant such subpoenas without a review.

The case is attracting significant interest in Ireland and Britain -- and among historians in the United States who fear the implications the dispute could have for those who conduct oral history interviews. Many such interviews are conducted under pledges of confidentiality for set time periods or (as in the case of the Boston College interviews) until the deaths of the people being interviewed. Researchers say that confidentiality pledges allow scholars to obtain valuable information over the long run -- from people who would be reluctant for legal, political or safety reasons to talk frankly if the interviews were made public in the short term.

The whole story is here.

The Contribution of Philosophy and Psychology in the Ethical Decision Making Process

Ethical D Making

This article can be found in the public domain here.

Geisinger no longer to hire job applicants who use tobacco products

CONTACT: Marcy Marshall: 570-271-8081
Dec. 28, 2011
FOR IMMEDIATE RELEASE

DANVILLE, Pa. – Starting Feb. 1, 2012, Geisinger will no longer hire job applicants who use tobacco products, including cigarettes, cigars, and chewing or smokeless tobacco.

“Geisinger is joining dozens of hospitals and medical organizations across the country that are encouraging healthier living, decreasing absenteeism and reducing health care costs by adopting strict policies that make smoking a reason to turn away job applicants,” said Richard Merkle, chief human resources officer, Geisinger Health System. “Non-nicotine hiring policies are legal in 20 states, including Pennsylvania.”

This policy also affects any applicants receiving offer letters as of Feb. 1. During the hiring process, all applicants – including those seeking full- and part-time positions, flex, volunteers, and students enrolled in Geisinger-based schools – will be tested for nicotine as part of the routine drug screening.

The test will include screening for cigarettes, smokeless tobacco, snuff, nicotine patches, nicotine gum and cigars. The test only detects active nicotine users, not those exposed to second-hand smoke.

“Applicants who test positive for nicotine use will be welcome to re-apply in six months provided they are nicotine free at that time,” Merkle said. “A listing of smoking cessation resources will be provided to any applicant who tests positive for nicotine.”

Current employees are not affected by this new policy, but are encouraged to take advantage of the tobacco cessation programs offered through Geisinger’s Employee Wellness program.

Geisinger currently has a no-tobacco-use policy that extends across all of its properties.

About Geisinger Health System

Geisinger is an integrated health services organization widely recognized for its innovative use of the electronic health record, and the development and implementation of innovative care models including ProvenHealth Navigator, an advanced medical home model, and ProvenCare program. The system serves more than 2.6 million residents throughout 44 counties in central and northeastern Pennsylvania.

Moral dilemma: Would you kill one person to save five?

Michigan State University News
Released December 1, 2011

C. D. Navarrete, PhD

EAST LANSING, Mich. — Imagine a runaway boxcar heading toward five people who can’t escape its path. Now imagine you had the power to reroute the boxcar onto different tracks with only one person along that route.

Would you do it?

That’s the moral dilemma posed by a team of Michigan State University researchers in a first-of-its-kind study published in the research journal Emotion. Research participants were put in a three dimensional setting and given the power to kill one person (in this case, a realistic digital character) to save five.

The results? About 90 percent of the participants pulled a switch to reroute the boxcar, suggesting people are willing to violate a moral rule if it means minimizing harm.

“What we found is that the rule of ‘Thou shalt not kill’ can be overcome by considerations of the greater good,” said Carlos David Navarrete, lead researcher on the project.

As an evolutionary psychologist, Navarrete explores big-picture topics such as morality – in other words, how do we come to our moral judgments and does our behavior follow suit?

His latest experiment offers a new twist on the “trolley problem,” a moral dilemma that philosophers have contemplated for decades. But this is the first time the dilemma has been posed as a behavioral experiment in a virtual environment, “with the sights, sounds and consequences of our actions thrown into stark relief,” the study says.

The research participants were presented with a 3-D simulated version of the classic dilemma though a head-mounted device. Sensors were attached to their fingertips to monitor emotional arousal.

In the virtual world, each participant was stationed at a railroad switch where two sets of tracks veered off. Up ahead and to their right, five people hiked along the tracks in a steep ravine that prevented escape. On the opposite side, a single person hiked along in the same setting.

As the boxcar approached over the horizon, the participants could either do nothing – letting the coal-filled boxcar go along its route and kill the five hikers – or pull a switch (in this case a joystick) and reroute it to the tracks occupied by the single hiker.

Of the 147 participants, 133 (or 90.5 percent) pulled the switch to divert the boxcar, resulting in the death of the one hiker. Fourteen participants allowed the boxcar to kill the five hikers (11 participants did not pull the switch, while three pulled the switch but then returned it to its original position).

The findings are consistent with past research that was not virtual-based, Navarrete said.

The study also found that participants who did not pull the switch were more emotionally aroused. The reasons for this are unknown, although it may be because people freeze up during highly anxious moments – akin to a solider failing to fire his weapon in battle, Navarrete said.

“I think humans have an aversion to harming others that needs to be overridden by something,” Navarrete said. “By rational thinking we can sometimes override it – by thinking about the people we will save, for example. But for some people, that increase in anxiety may be so overpowering that they don’t make the utilitarian choice, the choice for the greater good.”

A 2-D example of the virtual environment used in this study is available at www.cdnresearch.net/vr

Inviting Patients to Read Their Doctors' Notes

Patients and Doctors Look Ahead

Patient and Physician Surveys

Original Research: Improving Patient Care

Annals of Internal Medicine

By Jan Walker, RN, MBA; Suzanne G. Leveille, PhD, RN; Long Ngo, PhD; Elisabeth Vodicka, BA; Jonathan D. Darer, MD, MPH; Shireesha Dhanireddy, MD; Joann G. Elmore, MD, MPH; Henry J. Feldman, MD; Marc J. Lichtenfeld, PhD; Natalia Oster, MPH; James D. Ralston, MD, MPH; Stephen E. Ross, MD; and Tom Delbanco, MD

Abstract

Background: Little is known about what primary care physicians (PCPs) and patients would expect if patients were invited to read their doctors' office notes.

Objective: To explore attitudes toward potential benefits or harms if PCPs offered patients ready access to visit notes.

Design: The PCPs and patients completed surveys before joining a voluntary program that provided electronic links to doctors' notes.

Setting: Primary care practices in 3 U.S. states.

Participants: Participating and nonparticipating PCPs and adult patients at primary care practices in Massachusetts, Pennsylvania, and Washington.

Measurements: Doctors' and patients' attitudes toward and expectations of open visit notes, their ideas about the potential benefits and risks, and demographic characteristics.

Results: 110 of 114 participating PCPs (96%), 63 of 140 nonparticipating PCPs (45%), and 37 856 of 90 203 patients (42%) completed surveys. Overall, 69% to 81% of participating PCPs across the 3 sites and 92% to 97% of patients thought open visit notes were a good idea, compared with 16% to 33% of nonparticipating PCPs. Similarly, participating PCPs and patients generally agreed with statements about potential benefits of open visit notes, whereas nonparticipating PCPs were less likely to agree. Among participating PCPs, 74% to 92% anticipated improved communication and patient education, in contrast to 45% to 67% of nonparticipating PCPs. More than one half of participating PCPs (50% to 58%) and most nonparticipating PCPs (88% to 92%) expected that open visit notes would result in greater worry among patients; far fewer patients concurred (12% to 16%). Thirty-six percent to 50% of participating PCPs and 83% to 84% of nonparticipating PCPs anticipated more patient questions between visits. Few PCPs (0% to 33%) anticipated increased risk for lawsuits. Patient enthusiasm extended across age, education, and health status, and 22% anticipated sharing visit notes with others, including other doctors.

Limitations: Access to electronic patient portals is not widespread, and participation was limited to patients using such portals. Response rates were higher among participating PCPs than nonparticipating PCPs; many participating PCPs had small patient panels.

Conclusion: Among PCPs, opinions about open visit notes varied widely in terms of predicting the effect on their practices and benefits for patients. In contrast, patients expressed considerable enthusiasm and few fears, anticipating both improved understanding and more involvement in care. Sharing visit notes has broad implications for quality of care, privacy, and shared accountability.

Primary Funding Source: The Robert Wood Johnson Foundation's Pioneer Portfolio, Drane Family Fund, and Koplow Charitable Foundation.

The entire story is here.

Thanks to Ken Pope for this story.