Mock Ethics Vignettes

Ethics Vignette #1

A mother brings in her 12-year-old daughter who is deaf for an ADHD evaluation. You are not trained in sign language, and the patient cannot read lips. You check with your hospital regarding getting an interpreter; none are available, but you decide to go ahead with the case anyway.

You decide that you will do the testing rather than your technician, given the child’s hearing impairment, although many of the tests you wish to administer you have never given before. You spend 5 minutes reading the manual before administering such tests. One of the tests is a new intelligence test, which you decide is too difficult to learn in the allotted 5 minutes. You decide to give the older version of the intelligence test, which was published 15 years ago. You also decide to videotape the testing session to later use for training purposes, as you have never tested a hearing impaired child.

Following the evaluation, you ask your graduate student to write up the report to save time and money. This student never saw the patient nor met with the family. You also warn your graduate student that if they don’t write up the report, you won’t pass them for their “externship” or training experience you are providing them. Your graduate student calls his academic advisor and talks about the case, giving all identifying information, wanting his advisor’s viewpoint on the case. Your graduate student, who had been working on the report, leaves his computer terminal turned on with the report he has been working on and the file out on his desk. A cleaning crew comes into the office every night.

Your financial billing requirements is that fee is due at the end of the assessment. At this time, the mother of the child finds that paying $8,000 is much higher than anticipated (she was under the assumption that it would be the hourly rate $200, and an estimated gross amount of $2500). The family happens to be an owner of a large car dealership, and strikes up a deal with you. You accept the $100/month Mercedes Benz 3 year lease, in exchange of reducing the rate to $2500. You then submit the insurance bill to the family’s insurance company, receive $1500 toward the evaluation, but keep the money for extra spending money, without crediting the family. You then decide to kick-back $500 to your colleague who is also the brother of the mother.

After picking up an APA Ethical Principles of Psychologist and Code of Conduct, and consultation with an attorney, you get a call from APA regarding several ethics violations. Where did you go wrong?

Ethics Vignette #2

A local psychiatrist is referred by his attorney for neuropsychological evaluation related to possible mild head injury (traumatic brain injury) from a MVA. You have shared a couple of patients with the psychiatrist in the past and have spoken with him by telephone a few times. The psychiatrist mentions that he has had cognitive difficulty since the accident, his work has suffered, and finances are tight. He asks you to bill the evaluation to the insurance company, citing his primary physician as the referral source. If the insurance company won’t pay, he asks for a professional courtesy discount or to accept a contingency arrangement based on settlement of his lawsuit.

During the evaluation, he provides a copy of a neuropsychological evaluation he had a month earlier. This was ordered by the medical board because they were concerned about his functioning after the accident. The report consisted of a WAIS-III and a WMS-III and concluded that there was no impairment. The psychiatrist asks that this report not be mentioned in any of your documents. You proceed with the evaluation and, because of practice effects, do not readminister the WAIS or the WMS. During the evaluation, the psychiatrist does badly on a test of effort. You point this out to him and tell him that he must try harder. Your evaluation concludes that the psychiatrist has mild, but definitely significant cognitive impairment.

After completing the evaluation, you have dinner with a colleague and state “I just did an IME on this psychiatrist who was in a car accident and claims to have brain damage.” The colleague mentioned that one of his patients sees a psychiatrist, Dr. Jones, who had a lawsuit for a closed head injury. The patient was concerned about seeing Dr. Jones, so the colleague contacted a friend at the medical board, who said, “Fortunately, Dr. Jones had an evaluation and was unimpaired.”

Ethics Vignette #3

A mother recently immigrated from Honduras brings in her 16-year-old daughter who is bilingual (Spanish and English) for an ADHD evaluation because she is having difficulty at school. While not proficient, you know some conversational Spanish and decide to do the evaluation yourself. You decide that you will do the testing rather than your technician, given the child’s bilingualism, although several of the tests you wish to administer you have never given before and several have been revised since you did much hands-on testing. You spend 5-10 minutes reading the manual before administering such tests. One of the tests is a current revision of a well-known intelligence test, which you decide is too difficult to learn in time. You decide to give the older version of the intelligence test, which was published 15 years ago. You also decide to videotape the testing session to later use for training purposes, as you have never tested a bilingual child before, in case this turns out to be a court case regarding school services.

You are short on time so you ask your graduate student who has never met the patient or the mother to write up the report, which you sign off on. You offer to pay your student a portion of the fee you will receive, as well as give them a good grade for their assessment course, which have been teaching at the local college. In order to work on the report, the student takes the test materials and patient file to a campus computer room shared by other students. He saves the report on the computer but does not password protect it or remove identifying information. In addition to the computer being used by other students, a cleaning crew comes in every night. He also asks some peers for help with the report so has emailed the report to several classmates who have been very helpful.

The report concludes the child is mildly mentally retarded based on the IQ scores and other cognitive exam results. In addition, her VIQ is 15 points lower than her PIQ so a verbal learning disorder is also diagnosed. The report does not mention the ADHD concerns of the mother. The report is sent to the mother by mail but is opened and read by the daughter herself. She becomes very upset and calls her father who lives in another city. The next day he comes to your office demanding a copy of the report as well as copies of all the test materials. To appease his anger, you copy everything in her file and give this to him. Worried, you also send copies of everything to the girl’s school counselor so she will be aware of the situation and the girl’s cognitive deficits. The next day, the girl herself comes to your office and demands the records too. She threatens to kill herself because she is “stupid” and leaves your office crying. Before she leaves, she also says something like “no wonder they always beat me” and shows you old scars on her back. When asked, she says this was long ago.

You receive reimbursement for the exam from the mother’s insurance company. Because they have questions about the charges, they also ask for copies of all the records, which you send by fax. The insurance has paid 80% of your fees, so you bill the mother for the balance. Given her financial situation, she offers office cleaning services from her small cleaning business to satisfy the bill. You accept but also ask for house cleaning services too. After six months, you tell her the bill is paid. In the meantime, after receiving your records, the insurance company has decided that it will pay the full fee and sends the remaining 20%, out of which you finally pay your graduate student and also send a thank you check to the colleague who originally referred the patient to you.. In the meantime, your office has upgraded its computers so the old computer with the girl’s report on it has been donated to charity. You aren’t worried because you have a hard copy in your garage with some old records. In the meantime, the mother has called and asked you to work with her daughter to build her cognitive skills and improve her test performances. You agree and decide to use the tests she had previously completed as the practice and homework exercises. Three months later, you re-evaluate the girl and discover she is now performing in the high average range. You report this success to the school and use it to advertise your clinical expertise, finally getting a chance to use the testing video for your television ads and workshop presentations! In your formal training, you only worked with adults, but are now seen as the local expert on children’s neurocognitive functioning and cognitive remediation. Congratulations! Uh-oh, the phone just rang; it’s APA and your local board calling…

Be Ready for ABPP in Neuropsychology