Law and Ethics Midterm

Practice Vignette - Malpractice

Dr. Smith decides to go out of town at the last minute.  He tries to get three other therapists to be on call for him while he is away, but he is unable to find anyone.  He decides to go anyway and check his messages regularly.  He knows most of his patients would text him if they were in trouble and needed him.

He has a great time away for the weekend, but comes home to several messages from Jim, his patient of three years.  Jim’s significant other has left him and he is terribly upset.  He leaves a message he does not know if ”I can go on anymore.”  In fact Dr. Smith has received several messages from Jim’s sister that it is an emergency.

You know Jim has a history of suicide attempts but they were all several years ago.  You immediately try to reach Jim but keep getting his voicemail.  It seems Dr. Smith forgot to check his messages all weekend.

If Jim has hurt himself in any way, is Dr. Smith responsible?

Using the four legal criteria, evaluate if Jane has a case.

Name the four elements of a civil suit of malpractice

1. Duty of Care

2. Standard of Care

3. Demonstrable Harm

4. Proximate Cause 

Name the two primary parts of the 2017 APA Ethics Code

1. Unenforceable

2. Enforceable

What does “unenforceable” mean in relation to the APA ethics code?

These are aspirational, idealistic, high standards that we strive for as clinicians and are comprised of 5 principles 

What does “enforceable” mean in relation to the APA ethics code?

These are numbered codes in the APA ethics comprised of specified mandates of our ethical principles as clinicians. 

What is the primary element that resulted from deinstitutionalization with regard to clinical treatment?

Do Courts Make Law? What are the two elements?

1. Written Statute (aka written law)

2. Case law

What is a statute?

A legislative process signed by the governor and codified thereafter

What is case law?

A higher court’s ruling based on a specific case which then sets the precedent for further guidelines.

Name the four elements of “standard of care.”

1. Reasonable therapist (how would another therapist react to this case)

2. Ethics codes

3. statute

4. case law 

APA

Ethics committee

BOP

Licensing board

Attorney General

Criminal allegations

Standard of Care

Reasonable therapist

Duty of Care

Relationship established

Proximate Cause

Therapist is cause of harm

Demonstrable Harm

Money damages

Expert witness

Gives expert opinion, generally enters after the case is at the legal stage

Fact Witness

On case before legal action, generally the treating therapist

What is “Privacy”?

Suggested by the 4th amendment, basic rights that a patient’s health information will be kept confidential 

What is “Confidentiality”

General standard of professional conduct

What is “Privilege”?

A legal term - referring to an individual’s right to keep their records from being released in legal proceedings EXCEPT for the case if a court mandates the release of these records.

What does the first “C” in CCARQ stand for?

Client’s Culture

What does the second “C” in CCARQ stand for?

Countertransference

What does the “A” in CCARQ stand for?

Area of Competence

What does the “R” in CCARQ stand for?

Rule out general medical condition/substance use

What does the “Q” in CCARQ stand for?

Question the reporter

What are the two types of “actions” the BOP can assign when a violationof the licensing law occurs 

1. Disciplinary and public

2. non-disciplinary and confidential

What are some examples actions that would warrant disciplinary and public action from BOP

1. sex with patient

2. breaches

3. insurance issues

4. failure to keep records

What is one example of an action that would warrant non-disciplinary and confidential action from BOP

Failure to put license on public documents or office displays

What are the requirements to make a mandated tarasoff report (original ruling)

1. Communicated directly to the therapist by patient

2. Serious threat of physical harm/imminent danger

3. Identifiable victim

What are some variables to consider for an assessment for threat?

1. gender

2. plan

3. feasibility

4. previous violence

5. current problem

6. substance use

7. symptoms

8. support system

What are the requirements a therapist needs to do if a mandated report needs to be made, and what additional step was added due to tarasoff?

1. Warn victims

2. Notify Authorities 

3. Take steps (from tarasoff decision)

Stipulation

Agreement between BOP and therapist

Revocation

complete loss of license

Revocation stayed

loss of license stopped

Surrender

Voluntarily give up license

Original Tarasoff

CSI

Veteran’s Administration

Seek past records

Ewing

Reliable other, for the purpose of advancing one’s therapy

Arson

Damage to property

What are the two primary additions to the original tarasoff ruling from the Ewing decision

1. Communicated to therapist by immediate family member or reliable other

2. for the purpose of advancing the patient’s therapy

How does this question “What are the two primary additions to the original tarasoff ruling from the Ewing decision” apply to Ewing? 

The client’s father informed the therapist about the client’s danger to other 

No empirically validated suicide risk assessment procedure exists (T or F)

True 

What does the current literature suggest is the strongest predictor of teen suicide attempts (separate from drugs)?

NSSI

What is a risk factor?

This is static and enduring over time (ex: age, gender, family hx, etc)

What is a warning sign?

This is episodic and variable (ex: mood, anger/aggression)

The use of a safety agreement is always a good, protective measure with a suicidal client (T or F)

False

Which age range has the highest suicide rate?

45-54 years old

What does SAD PERSONAS stand for?

1. Sex

2. Age

3. Depression

4. Previous attempt

5. ethanol abuse

6. rational thinking loss

7. social support lacking

8. organized plan

9. no significant other

10. access to means

11. sickness

Which is more serious with regard to assessment of danger to self or other 

False negative 

What are the two primary  elements of malpractice with regard to suicide according to Baerger and Bongar and Sullivan?

1. Forseeability

2. Causation

What is parity diagnosis?

Why is the Menendez decision important and what was added to case law

The decision was important because it became case law that once the therapist is threatened, therapy is over.

What is the Unruh civil rights act

Terminology for competent therapist, expert therapist, specialist

Lack of diversity training can lead to a misdiagnosis when using the DSM (T or F) 

True

What is an insurance diagnosis

What is the definition of cultural humility according to Melanie Tervalon and Jann Murray-Garcia

What are the three broad dimensions of multicultural counseling