A regulatory board complaint may be filed against a counselor by a client, colleague, employer, and/or other regulatory agency, such as the Department of Health, or the Department of Family and Children Services. Complaints are subsequently investigated by the regulatory board in order to ensure that licensed/certified counselors are practicing safely, professionally, and ethically. Regulatory board investigations may lead to outcomes ranging from no action against the counselor to revocation of the counselor’s license/certification to practice. This case study involves a licensed clinical professional counselor (LCPC) who had been licensed to practice as a solo practitioner for about five years at the time of this incident.
Background
The LCPC involved in this matter owned and operated his own independent practice. The State Board of Professional Counselors (the “Board”) in the state where the LCPC was licensed received a complaint regarding the LCPC’s practice, filed by the Department of Homeland Security’s U.S. Citizenship and Immigration Services (USCIS). In the complaint, USCIS alleged that the LCPC had misrepresented his qualifications on federal immigration forms. Specifically, USCIS asserted that the LCPC signed over a dozen official psychological evaluation reports attesting that he was qualified as a “clinical psychologist” when he had not achieved that title. The complaint attached three different completed Medical Certification for Disability Exception forms as examples of some of the federal immigration forms that USCIS had received from the LCPC which he signed as a “clinical psychologist.”
After receiving the complaint from USCIS, the Board initiated an investigation into the LCPC and his practice. The Board’s investigation included obtaining psychological evaluation reports that had been completed by the LCPC, interviewing the LCPC, reviewing some of his client records, and reviewing the website of his practice.
Board Investigation
Board investigators completed a review of the three Medical Certification for Disability Exception forms that were included in USCIS’s original complaint, as well as “psychological evaluations” completed by the LCPC for seven additional clients that were subsequently submitted to USCIS. The review revealed that the forms specifically instructed that “only medical doctors, doctors of osteopathy, or clinical psychologists licensed to practice in the United States… are authorized to certify the form.” In addition, each form included a “Medical Professional Information” section, where the LCPC indicated that he was licensed as a “clinical psychologist,” though he listed his LCPC license number. At the end of each form, the LCPC signed and certified under penalty of perjury that the information he provided on these forms was true and correct.
Board investigators also reviewed the contents of the website advertising his practice. The LCPC frequently referred to himself as a “Psicólogo de la Comunidad Latino” on the website, which translates to “Psychologist for the Latino Community.” The services he reported to offer included clinical supervision, immigration assessments, and psychological therapy. The website stated that the “Immigration Assessment Services” the LCPC offered consisted of “psychological evaluations” to support “immigration cases of U-visas, T-visas, cancellation of deportation, hardship waivers, Violence Against Women Act (VAWA), and asylum applications.”
A Board investigator interviewed the LCPC under oath, as part of the Board’s investigation into USCIS’s complaint. The LCPC further admitted that he was only licensed as an LCPC; he did not hold a license in any other profession, or in any other state or jurisdiction besides where his practice was located. His educational background included a bachelor’s degree in developmental studies, a master’s degree in mental health counseling, and a postgraduate certificate in psychodynamic counseling. When asked to translate the word “psicólogo”, which the LCPC used to describe himself on his website, he stated that it could mean “psychotherapist, psychologist, or mental health counselor.” The LCPC explained that to his clients, the term “consejero”, which translates to “counselor”, is understood to mean “a person who gives advice.” The LCPC asserted that he used the term “psicólogo” because he believed that, in the context of his clients’ language and cultures, it was a better descriptor of the profession of an LCPC.
During his interview, the LCPC also admitted that, as part of his practice over the past four or five years, he had completed “hundreds” of psychological evaluations for clients involved in immigration cases. He admitted that he had intentionally indicated that he was a “clinical psychologist” on the federal immigration forms, although he did not actually meet the criteria of an individual who would be authorized to certify the forms. The LCPC explained that he had indicated that he was a “clinical psychologist” because it was the “closest term that [he] could find” that described his role. He further clarified that he did not send any federal immigration forms directly to USCIS, but, rather, he sent the reports he completed to his clients’ immigration attorneys or directly to his clients, and then the client and/or the client’s attorney would decide whether they wanted to submit the forms to USCIS.
Based on their review of the evidence and investigatory findings, the Board concluded that the LCPC had willfully filed false reports, misrepresented himself in the course of practicing counseling, and practiced outside the scope of an LCPC. These violations of the State Practice Act constituted grounds for the Board to suspend or revoke the LCPC’s license. Therefore, the Board issued a “Notice of Intent to Revoke License” which notified the LCPC that his license was suspended with the intention that it would soon be revoked. The notice also indicated that the LCPC had a brief window of opportunity to request a hearing before the Board to negotiate a resolution to his case. The LCPC worked with his attorney to quickly request a hearing and a case resolution conference.
Resolution
As a result of negotiations between the Board, the LCPC, his attorney, and an administrative prosecutor, the parties agreed to a consent order. As part of the consent order, the LCPC admitted to violating the State Practice Act and agreed to a three-month suspension of his license, followed by a three-year probation, and a $1,500 fine.
This matter took approximately nine months to resolve and incurred more than
$7,600 in legal expenses.
Risk Management Recommendations
For all counselors:
- Know and understand the scope of practice for your specific professional designation, certification and/or licensure in your state and understand the standard of care to which you will be held.
- Ensure that clinical practices comply with professional standards endorsed by professional counseling associations, state practice acts and facility protocols through consultation with legal counsel, as needed.
- Avoid advertisements that inflate client expectations or withhold relevant information. Do not exaggerate benefits, minimize risks, or otherwise encourage prospective clients to expect services beyond your professional capabilities or professional scope of practice.
- Select advertising terminology with care by avoiding superlative words and phrases such as “best care,” “highest quality,” and “state of the art,” which may lead to allegations of breaching an expressed or implied warranty.
- Never ignore a subpoena, whether it involves releasing clinical records, appearing for a deposition or testifying in court. Consult with an attorney knowledgeable about health law and request guidance about potential conflicts between legal mandates and client privacy rights when responding to a subpoena.
- Engage a healthcare attorney to prepare for any deposition or testimony under oath. The preparation should minimally include a scrupulous review of clinical records, as well as practice in responding to questions truthfully and accurately, without providing information that is not sought.
For counselors who work with immigrant-origin clients:
- Use appropriate language translation resources, when necessary, to ensure effective communication and comprehension by clients, including arranging for qualified medical interpreters and translators. (ACA Code of Ethics, Section A.2.c.)
- Participate in Diversity and Inclusion training to learn cultural preferences, world views, and decision-making processes of diverse client populations.
- Attend webinars and training sessions to connect with and learn from other bilingual and bicultural mental health providers. Check with the counseling or social work departments at local universities and colleges to find alliances of refugees, immigrants, or other minority groups.
- Acknowledge the harm caused by unconscious biases within the healthcare and mental health services industries and identify techniques to address such biases and mitigate their effects.
- Practice with compassion and respect for the inherent dignity, value, and unique attributes of all individuals.
- Find local organizations that provide services to immigrants and refugees and that focus on education and advocacy. Although these organizations may not concentrate solely on mental health and mental health services, they are often aware of the needs and gaps in services for immigrant and refugee populations and will probably be aware of local resource networks that help fill those gaps.
- Be aware of the local/national resources that exist to help immigrant families, including those families with at least one undocumented member. The following resources can help you get started:
References
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