Counselors License Defense
Case Study with Risk Management Strategies
Case Study: Failed to ensure that client was evaluated and monitored; failure to adequately monitor client for signs of any deterioration in the client’s mental health; failure to confiscate all items that could cause a client injury; failure to identify and prevent a client’s suicidal manifestations.
Total Incurred: Greater than $340,000
(Monetary amounts represent only the payments made on behalf of the counselor and as his role of the administrator/owner of the alcohol and drug rehabilitation facility.)
A 20-year-old female (client) had a history of suicidal ideation, depression/anxiety and suffering from Post-Traumatic Stress Disorder (“PTSD”) due to abuse she suffered beginning at age 10 and lasting until she was 16. As a result of the abuse, the client turned to alcohol and drugs. At the age of 12, the client began smoking marijuana and drinking on a regular basis and by her mid- teens she was abusing other illegal drugs. At the age of 16, she began non-suicidal self-injury activities, such as self-mutilation with razor blades. It was at this time her mother (plaintiff) decided her daughter needed counseling.
During one of the counseling session, the client revealed that she had suffered emotional and sexual abuse by a family member. She stated that she didn’t report the abuse because she was scared of the abuser. She recalled a time where the family member stated that if she ever reported the abuse, she would face “dire consequences.” The abuser was not arrested and after he became aware of the client reporting the abuse he fled the area and was “on the run.” Three years after the abuse was discovered, the parents divorced due to the stress it placed on the family. The client blamed herself for breaking up her family which added to her depression and furthering her drug abuse. After her parent’s divorce, the client had little contact with her father even though he supported her financially.
At one point, the client was found nonresponsive and was admitted to the hospital following what appeared to be an accidental drug overdose. The mother was insistent that the hospital admit the client into drug rehabilitation program once she was discharged from the hospital. Upon discharge from the hospital, the client was admitted to an alcohol and drug rehabilitation several states away. The client and mother were unhappy with the facility as they felt the facility was more of a ‘hotel’ than a treatment facility.The client expressed displeasure of the facility in her journal and during her 45-day residency, she tested positive for marijuana twice, was found with inhalants and attempted to run away. These issues persuaded her mother that the client needed to be transferred a different facility.
The mother found an alcohol and drug rehabilitation program that was closer to home and inquired about having her daughter transferred. Two days later,the client was admitted to a 20-bed drug rehabilitation facility. The facility offered a 30-day detoxification program followed by an additional 60-day group home admission, which allowed the clients to participate in normal everyday activities while under supervision. The mother agreed to the initial 30-day detoxification admission and told the client if she maintained sobriety and successfully followed the path to recover, she would allow her to come home after the 30-day program.
At the admission psychological exam, the insured found the client to be distant, depressed and anxious. He diagnosed the client with depression and anxiety with attention seeking behavior but felt that she was not a harm to herself or others.
During the first three weeks, the client participated in all group and individual activities, which was led by our insured counselor. The staff made several notes in the health record that the client appeared to be doing well and to be making positive future life decisions. She would comment about her plans to go home, begin college and reconnect with her boyfriend. Her focus seemed to be on discharge and pursuing a healthy lifestyle. However, one week before her completion of 30-day program she had an argument with her mother. The mother informed the client over telephone call that she could not come home after the 30-day program. Instead, she would have to stay to finish the 60-day group home program. Several staff members and clients overheard the client yelling and crying while on the telephone with her mother and made attempts to calm her. Over the next few days the client became withdrawn and showed obvious signs of major depression. The staff informed our insured counselor about the client’s phone call with her mother and the overall change in her disposition, to which the insured told the staff to “give her some space and see if she will work it out on her own.”
One morning, the client was not feeling well and following the group meeting told the staff that she was going to her room to lie down. Thirty minutes later, the client’s roommate came in and found that the client had hung herself in the closet by using shoestrings. Resuscitation efforts were made and 911 called, but unfortunately the client was pronounced dead at the hospital. The mother filed a lawsuit not only against our insured counselor and the drug rehabilitation facility. She alleged that the client did not receive proper treatment, including needed medications and supervision for her conditions.
Risk Management Comments
The mother claimed that despite the client’s known history of suicidal attempts, the counselor and facility did not properly monitor the client and did not prevent her from having access to items such as belts or shoelaces or anything that she might be able to use to harm herself. Her second claim was that the defendants did not properly monitor her daughter for signs of any deterioration in her mental health. Her final claim was that the counselor and the facility should never have admitted the client into the facility as it could not handle the severity of her daughter’s illness.
Defense experts maintained that the client was properly monitored by a competent and well-trained staff. The client was doing well until the mother backed out of an agreement she had with her daughter for her early release from the facility. Defense experts felt that the mother’s actions were the major contributory factor to the client’s suicide because the mother knew her child was emotionally unstable and when she broke their agreement the daughter would be very distraught.
The percentage chance of a defense verdict was estimated to be 25-35 percent. On admission there was a delay with starting the client on anti-anxiety medication and this was a concern. The defense experts commented that the staff’s knowledge of the mother’s discussion should have heightened observation of the client, which may have prevented suicide.
Experts assessed the potential exposure/claim value of the case for all defendants (including statutory prejudgment interest) as being between $750,000 and $1 million, with our insured counselor identified as having most of the liability. Given the deviations from the standard of care, the decision was made to settle the case on behalf of the defendant. The total incurred cost to defend and settle this case on behalf of the insured counselor was greater than $340,000.
Risk Management Recommendations with regards to treating Counselors:
Work in areas that are consistent with licensure, specialty certification, training and experience.
- Knowand practice within the state-specific scope of practice,and in compliance with the standard of care and state licensing/certifying board requirements.
- Considerthe findings of the client’s assessment, history andpsychologicalexamination,as well as the client’s expressed concerns, in establishing the diagnosis.
- Decline to perform requested actions/services if they are outside the legal scope of practice.
- Document all client and family interactions. Documentation includes telephone encounters, session notes, client’s informed consent for proposed treatment and noncompliance.
Risk Management Recommendations with regards to Counseling Firm Owners:
Encourage compliance with relevant legal, ethical and professional standards for clinical practice.
- Monitor clinical performance and professional development of supervisees.
- Evaluateand certify current performance and potential of supervisees for academic, screening, selection, placement, employment and credentialing purpose.
- Inform supervisees of professional and ethical standards and legal responsibilities of the counseling/therapy profession.
- Maintain a safe environment, to enhance the clinical experience and protect clients and others.