Review of Arizona Board of Behavioral Health Actions: June 2023 (Ethics)

CASE NO. 2023-0044

• This is one of the most extensive issues in a board action, which ultimately led to the surrender of this clinician’s license.

• The clinician engaged in therapy with a client and had previously coached their sister. The dual relationship ultimately caused harm to the client, as the clinician would text the sister about the client without a release of information. The multiple relationship concern was not documented. Dual relationships are not necessarily prohibited, but they must be documented, especially if there is a concern for conflict of interest.

• The clinician engaged in a telehealth therapy relationship when the client needed a higher level of care. The client had reported alcohol use and suicidal ideations on several occasions. Additionally, the clinician did not document a suicide risk assessment or safety plan. Suicide risk should be documented throughout the course of treatment. A safety plan should be conducted if there is a medium to high risk of danger to self/other. Also, it is typically best practice to document a safety plan if there is a history.

• The clinician did not have any signed consents on file. Although they had been sent to the client, the client had never signed them. The clinician also did not have releases of information and frequently communicated to other entities about the client.

• The consents used in the clinician’s private practice were missing key elements.

• Several progress notes did not include the time of services. You should always document the exact time of service. Several progress notes did not include whether the session was individual, family, or couples.

• The billing record was inconsistent with billing policies, including charging for text messaging and coordination of care. The items were not in the informed consent, which was also not signed. The client must be informed of all fees. These fees likely precipitated the board complaint.

• This review aims to address the clinician's attempt to cover up errors in their record when they found out the board was auditing other case files. Note that electronic health records systems maintain a HIPAA audit log that tracks all actions by all users. Also, time stamps are used on documentation. You should NEVER attempt to alter records unless you clearly document a justifiable reason why. Additionally, contemporaneous documentation is ten days.

• I’ve noticed that many board complaints will include an accumulation of commonly made errors in the client record, which would likely never be noticed without an external audit from the board as clients would not likely make a complaint based on these errors. It is often due to issues around parental disputes, multiple relationships that cause harm to a client, or unethical billing practices that lead to uncovering these other errors. For the clinician in this case, it is clear they completely disregarded the ethics of our profession due to the vast number and severity of mistakes, so there are likely other ethical issues on their caseload that haven’t been reported, which demonstrates why it is so important for clients to know how to file grievances against their clinicians.