Litigation Against Health Care Professionals

LITIGATION AGAINST HEALTH CARE PROFESSIONALS

"We do not have duels to the death anymore. Instead, we have instituted an even more painful technique of anger management called the lawsuit. We are the most litigious nation on earth. Our lawyers are the beneficiaries of our inability to solve anger problems like grown-ups. It would be much cheaper for all of us if we could learn to remove the anger component that turns a difference of opinion into a legalized grudge match. If we can identify our vulnerabilities to taking the ups and downs of life personally, we would be likelier to resolve disputes on a business-like basis in an atmosphere of mutual respect" (p. 127).

Messer, Mitchell. H.; Coronado-Bogdaniak, Roman; & Dillon, Linda J. (1993). Managing Anger: A Handbook of Proven Techniques. C.O.P.E. Publications. The Anger Clinic, 111 N. Wabash, Suite 1702, Chicago, Illinois 60602. 312-263-0035

"Of all the people whom psychiatrists treat, persons with borderline personality disorder are among the most difficult. They relate to their therapists with the various behaviors described above [mixing fantasy and reality, using lies and rumors as weapons, self-deception, splitting, projection, acting out, dissociation] and usually distort, conceal, or lie about aspects of their personal lives, both past and present. When they start treatment, they tend to idealize the therapist, but later they are prone to angry devaluation. They are manipulative and often claim to others that the therapist said something that, in fact, was not communicated. They may also threaten, or execute, suicidal or other self-destructive behaviors. If sufficiently angry, borderline persons may file malicious malpractice suits or make false allegations about their therapists (or other physicians) to ethics committees or medical licensing boards (M.D. Feldman and Ford, 1994)" (p. 120).

Ford, Charles V. (1996). Lies! Lies!! Lies!!!: The Psychology of Deceit. Washington, DC: American Psychiatric Press, Inc.

Feldman, M.D. & Ford, Charles V. (1994). Patient or Pretender: Inside the Strange World of Factitious Disorders. New York: Wiley.

"A particular complication with a patient whose syndrome of malignant narcissism has evolved through psychotherapy into a severely regressive paranoid transference is the patient's acting out of primitive sadistic object relations by dragging the therapist into legal threats and involvements. At times this paranoid development takes the form of unremitting and sometimes violent provocations of the therapist, which eventually give rise to sadistic countertransference reactions. When the therapist enacts these responses, in however attenuated a form, the patient then triumphantly uses these enactments as the basis for initiating legal actions against the therapist. Or else the patient enters into a new psychotherapeutic relationship with a new idealized therapist, who may be drawn into encouraging or condoning the pursuit of legal action against the previous therapist. After (p. 382) some time, the new therapist is also transformed into a persecutor; the patient may now initiate legal actions against him or her, and look for a third therapist as part of this chronic pattern. The primitive, violent, sadistic internalized object relations of such a patient require the therapist's ongoing concern--not only for his or her own survival but also for the survival of efforts to liberate the patient from destructive internal tormentors. The therapist must realistically feel secure in the treatment situation in order to be able to break this vicious circle" (p. 383).

Kernberg, Otto F. (1998). The psychotherapeutic management of psychopathic, narcissistic, and paranoid transferences. In Theodore Millon, Erik Simonsen, Morten Birket-Smith, & Roger Davis's Psychopathology: Antisocial, Criminal and Violent Behavior. New York: The Gilford Press.

"As distasteful as it may be, there are certain persons who are undeserving of presumed goodness or an attribution of high esteem. It is a fact that many legal complaints filed against practitioners are based on clients' pathology, lies, and criminality. Amongst practitioners, there are a few 'bad apples.' Unfortunately, the few errant practitioners have contributed greatly to the exaggerated criticisms and accountability measures directed at all practitioners by consumers and governmental regulators" (p. xii).

"The prescriptions and proscriptions, along with the actions taken by the rejuvenated ethics committees in professional associations and the burgeoning power accorded to regulatory agencies, often contribute support for malpractice legal actions" (p. 4).

"Among attorneys involved with defending mental health practitioners, conventional wisdom seems to be that any element of narcissism is a harbinger of litigation. Structurally, narcissism seems to be connected to such personality types as hysterics, psychopathic deviates, and sociopaths. When a patient in one of these diagnostic categories also has paranoid tendencies and/or a denial of responsibility for personal actions, the risk of blaming someone else for a negative lot in life is increased. Also, clients with a multiple personality are a high risk for complaints, as are parents who are involved in child custody, visitation, or abuse cases.
By this time, it is apparent that the above categories of client make up a large portion of most therapists' clienteles. In other words, it is impossible to be a therapist and not encounter clients with personality characteristics that will lead to complaining (p. 34) about the therapist. This is the nature of mental health services in this highly litigious era.
"Of course, the client with the greatest likelihood of filing some sort of complaint against a therapist is the client who has been allowed to build up a deficit in payment for services. It is almost axiomatic that attempting to collect an overdue debt from a client is tantamount to inviting an ethical, regulatory, or malpractice complaint, no matter how clear-cut the debt" (p. 35).

"In this litigious era, it should be assumed that every client is a potential litigant, and the therapist could be brought into a legal fray regardless of his or her expectations or preferences" (p. 103).

"Stated bluntly, while a debt to a therapist is subject to a collection effort, there is a strong likelihood of retaliation by the client to avoid the collection" (p. 111).

"No, is it not unethical per se to sue a client. . . .
". . . . For example, a client who physically assaults or harasses a therapist is potentially liable, both criminally and civilly.
"Therapists need to protect their personal rights. Because they serve clients with mental problems does not eliminate any personal right. All too often, a therapist erroneously believes that the privileged nature of the communications that occurred within the professional services relationship precludes legal action against the client" (p. 112).

Woody, Robert Henley. (1997). Legally Safe Mental Health
Practice: Psycholegal Questions and Answers. Madison,
Connecticut: Psychosocial Press.

"I do not think most psychologists understand how vulnerable we all are to being victims of false allegations that can quickly become career-threatening crises. On some occasions, I have even received initial calls from psychologists only after hearing that their license had been taken away. They had never imagined that their own colleagues could do such a thing based upon the flimsy allegations of a clearly borderline patient."

"All of us are really only one borderline away from professional ruin. And, of course, if we are the sort of flawed human being who ever makes a mistake, the outcome can be just the same.
"Unfortunately, licensure boards and ethics committees tend to be fertile ground for the 'return of the repressed.' All too often, the board's conscious or unconscious agenda is to prove how morally upstanding the board members are. In the cases I am seeing, they do it with a vengeance given license by the inherent morality of their position."

"It is a visit to the heart of darkness to attempt to defend oneself in front of a licensing board. The transparent fusion of narcissistic superiority and absolute power leaves the accused psychologist in a presumed state of guilt unless he or she can prove innocence. This takes place in an authoritarian ambiance where the very act of trying to prove one's innocence is interpreted as 'defensiveness.'"

"In contrast [to the legally accepted 'standard of care'], the licensing board standard used is often one of perfection determined by (p. 17) Monday morning quarterbacks not operating in the real clinical world as their colleague had to do. Very few of us ever do anything of any importance that upon critical retrospection could not have been done better.
"Neither ethical standards nor licensing standards were intended to be applied to that aspect of the human condition. They are, of necessity, coarse attempts to keep the rotten apples out of our professional barrel. When we begin to think they do more than that, we need to check the grandiosity of our own countertransference. We should do it before we sacrifice our colleagues on the alter of our own narcissism" (p. 18).

Welch, Bryant (1998). Why you better pay attention to the 'licensing board' issue. The National Psychologist, 7(4), 17-18.

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Re:Litigation Against Health Care Professionals, by T.J., 10/19/01

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