Tele-behavioral Health: Important Legal Considerations for Mental Health Providers

By Amanda I. Forbes, J.D.

Starting in 2020 and throughout the COVID-19 pandemic, tele-behavioral health services, also known as “e-counseling,” rapidly expanded. Because individuals were quarantined or fearful to venture out, remote mental health care services became very popular among patients. A study published in The Journal of the American Medical Association (JAMA), including 36 million working-age individuals, revealed that tele-health services increased by 766% in the first three months of the pandemic.

Thanks to remote services like tele-behavioral health, the doctor’s “house call” is making a comeback;  but instead of ringing the doorbell, your doctor will be ringing your smartphone.

What is Tele-behavioral Health?

The National Institute of Mental Health defines telebehavioral health as “the use of telecommunications or videoconferencing technology to provide remote mental health services.” Providers can use video conferencing, text messaging, or smartphone apps. Additionally, many different types of behavioral health services are available remotely.
The U.S. Department of Health and Human Services (HHS) says remote visits are a safe and convenient way for mental and behavioral health providers to offer services such as:

1. One-on-one and group therapy
2. Substance abuse counseling
3. Medication management and prescribing
4. Anxiety and depression monitoring
5. Mental health screening
6. Referrals

What Are the Potential Benefits?
Tele-behavioral health services enable clinicians to reach more patients, such as people living in rural areas, working irregular hours, and homebound patients. It removes patient barriers to attending in-person appointments, such as taking time off work, transportation, and arranging childcare.

The Downside to Tele-behavioral Health.

In addition to its convenience, tele-behavioral health also ushers in a new era of risks for treatment providers to be aware of.  It’s particularly true if the counseling occurs via text or a similar instant messaging application. As a licensed mental health care professional, you must know about liability exposures and ways to improve patient safety.
Click here to read about a case study demonstrating the issues that can arise when conducting tele-behavioral health.
When it comes to tele-behavioral health services and technology, there are significant legal considerations to think about.
To make sure you can provide remote counseling effectively while handling the risks that come with it, follow these risk management tips and recommendations:

1. Obtain the necessary training to provide telebehavioral health services. Take continuing education units (CEUs) in tele-behavioral health and retain any certificates of completion associated with those CEUs.

2. Determine whether tele-behavioral health treatment is in the client’s best interest. The provider should consider the following: Can the client effectively use the technology required for tele-behavioral health?  Does the client’s insurance cover telebehavioral health services?  Is the client emotionally and cognitively compatible with this treatment modality?

3. Obtain informed consent from the client.  In addition, document the purpose of the counseling, the use of technology to facilitate the tele-behavioral health services, and confidentiality and privacy. Obtain informed consent by having the client sign a consent form.  Have a document record of the consent process and consent form in the client’s file.

4. Providers must adhere to encryption standards. Some examples are using a secure platform, ensuring that the vendor signs a HIPAA Business Associate Agreement, which is required by HIPAA laws and regulations, and stating the vendor will follow federal privacy requirements.
5. Ensure client confidentiality by advising them of their responsibility to be in a private space during the telebehavioral health session. Document this discussion and include this as part of your agreement with the client.

6. Providers must check their state and third-party requirements related to tele-behavioral health services, credentialing, and licensure. Contact your respective licensing board for additional information and consult a health law attorney if unsure.

To read one of our prior blogs on telehealth services and learn more information on this growing area of practice, click here.

Contact Health Law Attorneys Experienced Investigations of Mental Health Counselors, Psychologists, Social Workers, and Family Therapists.

The attorneys of The Health Law Firm provide legal representation to mental health counselors, psychologists, psychiatrists, social workers, and family therapists in Department of Health (DOH) investigations, Department of Regulatory Agencies (DORA) investigations, board hearings, FBI investigations, and other types of investigations of health professionals and providers. We also defend health professionals and health facilities in general litigation matters and business litigation matters.
To contact The Health Law Firm, please call (407) 331-6620 or toll-free: (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Counselor Liability Claim Report: 2nd Edition.”CNA AND HPSO COUNSELOR SPOTLIGHT: Telebehavioral Health”. Healthcare Providers Service Organization (HPSO). (2019). https://www.hpso.com/getmedia/f9369f13-7035-4955-bcb6-9843b9ff44c2/counselor-spotlight-telebehavioral-health.pdf 
Department of Health and Human Services (HHS). “Telehealth and behavioral health”. (July 25, 2023).https://telehealth.hhs.gov/patients/telehealth-and-behavioral-health#:~:text=Telehealth%20is%20a%20safe%20and,a%20long%2Dterm%20treatment%20plan. 
National Institute of Mental Health (NIMH). “What is Telemental Health?” (Accessed on December 12, 223). https://www.nimh.nih.gov/health/publications/what-is-telemental-health 


About the Author:
Amanda I. Forbes, practices health law with The Health Law Firm in its Altamonte Springs, Florida, office. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com. The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or toll-free: (888) 331-6620.


Attorney Positions with The Health Law Firm.
The Health Law Firm is always looking for qualified attorneys interested in health law practice. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2024 The Health Law Firm. All rights reserved. No part of this work may be reproduced in any fashion in any medium for any purpose without the written permission of the copyright owner.  The copyright owner asserts the right to have its name associated with the use of any part of this work.
By |2024-01-02T16:27:10-05:00January 2, 2024|Categories: Mental Health Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

16 Tips For Health Professionals to Avoid Sexual Harassment Complaints & Allegations

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By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Throughout my decades of representing health care professionals, I have seen cases where an economic competitor of a physician generated false sexual harassment complaints to eliminate competition. I have seen cases where an ex-employee invented false allegations of sexual harassment after that employee was caught embezzling money from the employer. There have been cases where administrative and nursing staff have conspired to create complaints against a demanding and unpopular physician in a hospital setting. Therefore, I am never surprised when a physician claims they are the subject of a fabricated sexual harassment complaint and contacts me seeking a consultation.

As a result, I have come up with a list of tips that any individual health professional should follow to avoid such complaints and allegations.

Below are helpful tips that all medical professionals should know to avoid sexual harassment complaints or allegations:

1. Avoid all office and workplace romances.

2. Do not touch others, especially those of the opposite sex.

3. Never even consider having a romantic relationship with a patient.

4. Do not tell off-color or sexually suggestive jokes.

5. Do not compliment a worker, staff, or colleague of the opposite sex on their appearance, clothes, etc. This is a good rule to follow, even if the other person is of the same sex.

6. If your remarks or conduct is perceived as inappropriate by a staff member, or they say this, apologize immediately and assure them this was not intended and will never happen again. Then document the incident with a note to your own file or a memorandum to yourself. Consider reporting the incident your group’s administrator or office manager.

7. Do not socialize inappropriately with anyone who may be considered your subordinate or over whom you have perceived authority, especially where alcohol is involved. The exception is for sanctioned, official group functions.

8. Do not socialize with patients.

9. Do not use obscene language in the workplace, in front of other staff, employees, or patients.

10. If anyone alleges you acted inappropriately, report it to the group’s administrator immediately.

11. If a patient makes a sexually suggestive remark or asks you out, arrange to have that patient transferred to the care of a different health professional, immediately.

12. Know that plaintiff’s attorneys in sexual harassment and discrimination cases advise their clients to keep detailed notes and diaries concerning their contacts with a perceived abuser or harasser.

13. If a complaint is filed against you, report it immediately (to both the group administrator and your insurer) and retain an attorney to represent you regarding it. It could result in a lawsuit, a Board of Medicine complaint, termination of employment, peer review proceedings to revoke your clinical privileges or other actions.

14. Be familiar with your medical group’s and the hospital’s policies and procedures on sexual harassment, disruptive behavior, and reporting incidents. Follow it.

15. Act professionally when in contact with patients, staff, or colleagues.

16. Know that investigators and plaintiff’s attorneys in sexual harassment and discrimination cases often advise the alleged victim to contact the perpetrator by telephone and attempt to obtain incriminating statements. If a tape recording of the conversation is made by law enforcement officials, it will probably be admissible in proceedings against the alleged perpetrator. Never discuss any inappropriate activity over the telephone.

To learn more about the severe repercussions of such allegations, read my blog, where I discuss sex discrimination complaints against the University Of Southern California Medical School.

Contact Health Law Attorneys Experienced in Representing Health Care Professionals and Providers.

At The Health Law Firm, we provide legal services for all health care providers and professionals. This includes physicians, dentists, nurses, resident physicians, mental health counselors, social workers, pharmacists, and health facilities. Our legal representation also includes medical students, medical school professors, and clinical staff. We represent health facilities, individuals, groups, and institutions in investigations, contracts, sales, mergers, and acquisitions. The lawyers of The Health Law Firm are experienced in complex litigation and both formal and informal administrative hearings. We also represent physicians and other healthg professionals accused of wrongdoing, patient complaints, and in Department of Health investigations.

To contact The Health Law Firm, please call our office at (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.ThehealthLawFirm.com

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2022 The Health Law Firm. All rights reserved.

 

 

Mental Health Counselors: Follow These Rules To Prevent Complaints and Keep Your Professional License

Author HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Licensed mental health counselors, psychologists, and other mental health care professionals are potential targets of licensure complaints from clients in any practice setting. Many legal situations and cases arise because the therapist has strayed over the line and crossed the therapist-client boundary. In reviewing the many disciplinary complaints and lawsuits I have handled, I have put together a list of simple “straightforward” rules. Following these rules can help save you many hours of stress and mental anguish and thousands of dollars in attorney’s fees and costs defending yourself.

These rules may appear to be so simple you would classify them as “common sense.” But you would be surprised at how often they are violated by even the best, most conscientious counselors.

These “Rules” May Seem Common Sense, But You Might Be Surprised:

1. DO NOT ever meet the client at an outside social activity or attend a social event with the client. These events include things like “just dinner” or “drinks.” Keep it professional.

2. DO NOT text the client. Texting is not secure and leads to casual and unprofessional thinking and conversations with the client. Many health care institutions prohibit their physicians and employees from texting with clients because of the HIPAA Security and Privacy Rules. You can use that as an excuse if you need it.

3. DO send an e-mail or a professional letter to the client instead of texting. Print out a copy and place it in the client’s health record because you will probably see it again.

4. DO NOT EVER make any suggestive or sexual remarks to the client in any communications, oral or written, text or e-mail. DON’T even think about it. This includes off-color jokes and comments.

5. DO immediately terminate the relationship with the client, transferring care to a different therapist, if the client suggests anything of a sexual nature involving you.

6. DO NOT talk about other clients with the client.

7. DO NOT talk about your personal life with the client. Especially DO NOT let the client have your private home address or personal e-mail address. Note that you can have your personal address excluded from most public licensing sites and directories.

8. DO NOT ever have a sexual relationship with a client or former client. Consider clients and former clients “off-limits.” See Rule 5 above

9. DO know what professional boundaries are and NEVER cross them. This includes allowing a personal relationship to grow between you and the client, selling anything to the client (e.g., Girl Scout cookies, candy bars for your kids’ school band, tickets to charity events, washing powder, plastic sealable containers, etc.).

10. DO know if you have a suspicion that your therapist-client relationship is getting out of bounds; it probably already is. See Rule 5, above.

11. DO call a more senior professional colleague to you and consult them about the “situation” if you think there is one.

These may sound like “no-brainers” to you, but you would be surprised at how many complaints against licensed mental health counselors and psychologists there are because of violating one or more of these “simple rules.”

(Note: These “rules” are merely guidelines meant to help you keep out of trouble; these are not rules meant to be enforced on anyone, nor are they meant to create or represent any “standard of care.”)

For additional information on how our firm can assist you in matters like this, click here to read one of our prior blogs.

Contact Health Law Attorneys Experienced Investigations of Mental Health Counselors, Psychologists, Social Workers, and Family Therapists.

The attorneys of The Health Law Firm provide legal representation to mental health counselors, psychologists, psychiatrists, social workers, and family therapists in Department of Health (DOH) investigations, Department of Regulatory Agencies (DORA) investigations, board hearings, FBI investigations, and other types of investigations of health professionals and providers. We also defend health professionals and health facilities in general litigation matters and business litigation matters.

To contact The Health Law Firm, please call (407) 331-6620 or Toll-Free: (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2022 The Health Law Firm. All rights reserved.

 

By |2023-09-08T20:00:29-04:00September 10, 2023|Categories: Mental Health Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments
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