Vignette 9: Psychologist as Character Witness?

A psychologist receives a phone message from a former patient.  The former patient is asking for the psychologist to be a “character witness” as he has an upcoming hearing for a minor criminal offense. His attorney believes that some good, written character references will really help out with the case.

The psychologist pulls the former patient’s chart.  The psychologist has not worked with the patient for about two years. Additionally, none of the treatment issues had to do with impulse control or antisocial tendencies. Therapy lasted about a year and focused on depression and relationship issues. The psychologist recalls that the patient had always been good-natured, attended appointments regularly, and worked well in therapy.  The psychologist remembers the former patient as a likeable person.

How would you feel about receiving this request?

What ethical issues are involved?

What are your potential options?

If you decide to provide information, would you consider communicating with the prior patient’s attorney?  What would you need from the attorney?

One Ethical Decision-Making Model

Ethical Decision Making Model

This article can be found in the public domain here.

Company withdraws contracts controlling online comments by patients

The move comes after a complaint alleged that Medical Justice's business practices are unethical.

By ALICIA GALLEGOS, amednews staff. Posted Jan. 2, 2012.

Medical Justice Inc. is retiring its "vaccine against libel," a set of contracts providing authority to doctors over online comments posted by patients.

The contracts' demise follows a complaint made to the Federal Trade Commission alleging that Medical Justice is engaging in unethical business practices. A dentist is being sued for using one of the agreements.

The complaint and the lawsuit were filed on Nov. 29, 2011.

A day later, Medical Justice announced it will end its use of the contracts, said neurosurgeon Jeff Segal, MD, CEO and founder of Medical Justice. The company has informed its 3,000 physician and dentist members that the contracts are retired. Medical Justice recommends that doctors use its latest online tool -- the eMerit system -- to combat false posts and protect their reputations. But Dr. Segal said members are "free to do what they want to do," which includes continuing to use the contracts if they see fit. He said the company has not suggested that doctors call their patients to inform them of the contracts' retirement.

The entire story can be read here.

Lawsuit Accuses Company Of Fraudulently Cycling Patients Through Nursing Homes, Hospice Care

By Jordan Rau

Kaiser Health News Staff Writer

Originally published January 4, 2012

A national hospice company improperly cycled patients through nursing homes and hospice with a goal of making as much profit as possible from Medicare, according to a whistleblower lawsuit announced this week.

Federal attorneys also sued the hospice company, AseraCare, alleging it milked Medicare’s hospice benefit by pressuring its employees to enroll people into hospice who weren’t dying and resisted discharging them despite evidence they weren’t deteriorating. One hospice patient who should have been immobile from end-stage heart disease was healthy enough to go to his granddaughter’s graduation and a berry-picking excursion with a friend, the government charges.

For years, some critics of Medicare’s hospice benefit have said that the way the government pays providers gives them financial incentives to abuse the system. The suits against AseraCare, a Fort Smith, Ark.-based hospice company operating in 19 states, follow several other suits against big hospice companies but go further in their allegations that the company coordinated its use of nursing care and hospice care to maximize Medicare reimbursements.

The entire story is here.

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.

================

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.