Adding Insult to Injury

A state Psychology Board recently hit one of its psychologists with a penalty that was perfectly tailored for the charges leveled against him.  It revoked his license for a minimum of five years.  It further held that if, by some unexpected turn of events, this doctor managed to get his license back, he would never be allowed to treat females.  It finally ruled that if he did get his license back, his practice would always be monitored by a Board-approved mental health professional.  By now, you can probably figure out the nature of some of the charges against Dr. A. 

From the mid-1980’s through 1996, Dr. A. provided psychotherapy to a female patient, referred to as “Client G.”  He initiated a sexual relationship with her from 1994-96.  The sex took place during weekly sessions.  The doctor billed the patient for those sessions.  While treating and having sex with her, he also made her a co-facilitator of a psychology group for sexually abused women.  He presented her to the group “in a way that suggested that Client G had qualifications as a mental health professional.”  I’m sure he billed for these sessions as well.  The Board also found that during this same period of time, Dr. A had an affair with Client R.

Meanwhile, Dr. A was also treating clients "S" and "M."  These women participated in group sessions for sexual abuse victims who had developed post-traumatic stress disorder.  On one occasion Dr. A called S to ask her to help M who was suicidal at the time.  The Board ruled that telling S that M was suicidal violated M’s privacy.  Dr. A argued that he made the call in an effort to save M’s life.  The Board dismissed this argument.

On appeal, Dr. A argued that it was error to allow “patient advocate” Board members to participate in hearing his case.  His state’s Psychology Licensing Act requires three board members to be members of the public “who are not mental health professionals.” Unfortunately, the statute refers to these members as “patient advocates.”  The Court threw out this defense because Dr. A offered no evidence of “specific bias or prejudice” on the part of these Board members.  

In a last ditch effort to save his license, Dr. A argued that Dr. Woodrow, one of the psychologist board members, should not have participated in his hearing.  He claimed that she was biased against him because she had treated patient “G.”  The evidence showed that almost 30 years before the hearing, Dr. Woodrow treated G.  However, she did not remember G and did not have records of her treating G. The Court found that this was not evidence of bias.

It’s hard to find a worse example of psychologist-patient abuse.  Dr. A chose a patient whom the Board described as “very vulnerable,” initiated a sexual relationship with her, charged her for the privilege of having sex with him, cheated on her, and had her misrepresent herself when she “facilitated” a group of sex abuse victims.  It is fortunate that the Board took this man’s license.  One can only hope he never gets it back.

The Best Predictor of Future Behavior

Since the beginning of time, man has tried to predict the future.  Wise men studied the stars to determine the best time to plant crops.  Soothsayers warned kings of events that could threaten their empires.  Today, ecologists predict a catastrophic global warming of our planet.  The tools of the trade run the gamut from delicate scientific measurements of carbon in ice cores to chicken entrails. 

Most licensed professionals sell knowledge of the future to their clients, patients, and consumers.  Your attorney draws up contracts that he predicts will protect you.  Your physician predicts the course of your illness.  The pharmacist tells you how certain drugs will affect your mind and body.  Psychologists administer tests, conduct interviews, and perform assessments in order to predict human behavior.

In my experience, the best predictor of future behavior is past behavior.  This is a lesson a couple of psychologists learned the hard way.

A young woman began therapy with Dr. Land in 1993.  The doctor determined that her patient suffered from alcoholism, family discord, boundary issues, depression, post-traumatic stress disorder, gender issues, fits of violence, and repercussions from sexual abuse.  Dr. Land admitted her patient to a hospital.  Within one week of the patient’s discharge, Dr. Land terminated her doctor/patient relationship with the patient and began an affair with her.  The affair was short-lived.  Dr. Land stated that there were problems with the patient’s drinking, fits of violence and other emotional issues.  Sound familiar?  The psychology board revoked Dr. Land’s license because she violated the ethical prohibition on having sex with a client or former client. 

In another case, a psychologist treated a patient who had a history of severe difficulties in employment relationships.  Confident that 18 months of therapy had cured his patient of these problems, the doctor released her from his care and hired her to work as his office manager.  Surprisingly the employer-employee relationship didn’t quite work out.  One morning, shortly after she reported for work, the doctor fired the former patient but asked her to finish out the day.  Mid-afternoon, the doctor heard a noise and, turning around, saw this lady lunging at him with a pair of scissors.  Fortunately, he was able to wrestle the scissors away from her and escape injury. 

With 20/20 hindsight, we can identify numerous poor choices that the doctor made.  First, by hiring someone with a documented history of problems on the job, he ignored the patient’s past behavior.  Second, he hired a patient immediately after terminating her therapy.   Doing so violated ethical prohibitions of entering into dual relationships with patients and former patients.  Third, he did not escort the patient away from the office when he fired her.  This gave a very angry former employee the opportunity to cause irreparable damage at work.

 

Predictably, the patient filed a complaint with the state Psychology Board.  She maintained that she wasn’t trying to hurt the doctor with the scissors.  She said she noticed that he was talking on a phone that didn’t work.  To resolve the issue, she was going to cut the phone cord.  She testified, “I guess he thought I was going to stab him . . . we got into a little altercation.  He nearly broke my arm.”  She further stated that she was angry because everyone in the office was conspiring against her to “drive me insane to the point where I would be mentally unable to testify against them.”

The Psychology Board found the patient to be a credible witness and, based on her testimony, it suspended the doctor’s license for three years.  The doctor appealed the ruling. 

Fortunately, for the doctor, the court did not agree with the Board’s psychological assessment of its key witness.  After the bailiff cleared the courtroom of all sharp objects, the court held that former patient was not credible.  It reversed the Board’s order.

Sometimes, we have to make important split-second decisions about a person.  This year, I was in a fairly serious car accident.  I hit my head in the wreck, was stunned, and had a hard time thinking.  As my car filled with smoke, I began to have trouble breathing.  I heard someone pounding on the passenger side door. The man managed to get the door open and then tried to pull me out of the car.  My initial instinct was to push him away and to stay in the car.  I didn’t know this man.  I was injured.  But then, I saw that he was wearing a cross on a chain around his neck.  

With his help, I got out of the car without further injury.  As I sat in his car waiting for the Highway Patrol, I saw devotional books on the seat.  He was a seminary student.  Finally, I could calm down.  He stayed with me until help arrived.

That morning, when this man woke up, he decided to wear a cross around his neck.  That was the only “past behavior” that I could assess at the time when I had to decide whether to trust this stranger.  My decision was a good one.  I only wish that I could have gotten his name before the ambulance arrived.  I would like to be able to thank him.

And to you dear reader, Happy Thanksgiving.

Doctor Disciplined for Frightening Children - Happy Halloween

I admit that I made one or two mistakes as a parent.  One of the worst errors was teaching the kids to question authority and to think for themselves.  When they hit their teenage years and began to view me as “an authority” whom they should question, I realized that I had given them extremely bad advice.  After one explosive encounter with the boys, their dad urged me to take a weekend off by myself at our lake house where I could escape the stress.  I realized only later that I had been put in time out.

As there wasn’t much to do at the lake, I had taken a few magazines along with a cross stitch project.  That afternoon, while reading a Southern Living magazine, I ran across an ad.  It asked whether we were “having discipline issues” with our teenagers.  If so, we could send them to a lovely camp in New England where they could learn to better communicate with us. 

My kids were communicating just fine, but I was intrigued by the camp idea. I read on until I came to a more promising ad.  It offered a “boot camp” experience in the Nevada desert that was guaranteed to teach kids to behave.  A former Army drill sergeant ran the camp.  This was exactly what we needed.  Upon returning home, I enthusiastically told the boys and their dad about the camp.  They confiscated my magazines and sent me back to the lake. 

In 2009, Dr. Smith, a psychologist, was working at a state-run youth detention camp.  In addition to housing delinquent juveniles, the facility had its own version of the “Scared Straight” show.  Parents and other “authorities” sent problem kids to the camp for a day.  The psychologist met them briefly and turned them over to security personnel.  The kids ranged in age from ten to 14.  At the camp, some had to wear handcuffs and leg shackles.  Some were “disciplined.”  Some had to do chores with inmates.  The intent was to convince kids how horrible it would be to continue on their path of crime and end up at the camp. 

I’m sure the “aversive experience” scared the children silly.  But after the state Psychology Board got wind of it, the experience turned out to be just as frightening for Dr. Smith.

The Board disciplined the doctor because he did not conduct initial psychological assessments of the children, he failed to get their parents’ informed consent, and he failed to document his work.  The psychologist appealed the Board’s ruling to the courts.

In court, the psychologist argued that these children were not his patients and that he was not providing psychological services to them.  However, the court noted that the psychologist, after his brief encounter with the children, decided which of them would be put into shackles, what chores would be assigned and what they would be doing on their “visit.”  The court held that because the doctor determined the intervention for each child, he was providing “therapy” for them.  Accordingly, he had to carry out his therapy as required by law.  He needed to obtain parental consent, do a thorough assessment of each child, and document his work.  The court upheld the Board’s discipline of the doctor.

The juvenile detention facility should never have gotten a psychologist involved with the program.  If they had read Southern Living Magazine like I did, they would know that they could have hired a former Marine drill instructor or even a retired member of Seal Team Six to frighten the children.  These highly trained personnel are expert at instilling terror and discipline and they don’t have to be licensed.  It would be a win-win for all involved. 

At Halloween, I often think about Dr. Smith.  While the rest of us delight in frightening kids with bats, ghosts, jack o’lanterns, vampires, and peeled grape eyeballs, those who visit Dr. Smith’s well-lit house probably find no Halloween decorations.   I doubt he wears his old vampire costume any more.  In fact, to be safe, he probably doesn’t even stay home for trick or treat.  The last thing he wants to do is to scare any more children. 

Happy Halloween.