Background
This information is presented to give consumers some understanding of the services available to protect them from unprofessional practices and to make complaints when necessary. As a clinical psychologist in Illinois, I am most familiar how these mechanisms operate in my profession in this state. In general, the same principles should be applicable to other mental health professions in other states. These comments are based on my interpretation of various materials. If you are considering any action, you should obtain official documents and brochures from the appropriate organizations and agencies.
Therapists
The vast majority of licensed psychologists, psychiatrists, social workers, and counselors are proud of our identity as mental health service providers. Very few of us will ever have occasion to face a licensing board or a malpractice suit. For psychologists, for example, the risk is somewhat less than 1%. Unfortunately, a small number of unethical psychotherapists make the newspaper headlines and give all professionals a bad name. Most therapists will make every effort to assist you in obtaining high quality mental health care.
If you have a complaint against a therapist, you may be able to resolve your concerns by discussing the problem with the therapist. Many times, consumer dissatisfaction is a result of poor communication or a misunderstanding between the provider and the client. If you have concerns about billing, appropriateness of treatment or failure to benefit from services provided, in many cases, the problem can be resolved by a discussion of the issues. Your therapist should be willing to explain his/her charges, billing practices, and treatment philosophy. You have a right to seek a second opinion and to have your records sent to another provider. With certain limitations, you have a right to review your own file and have a copy of your records.
If you are receiving services in a clinic, agency, or group practice, you may want to contact someone in a supervisory and/or administrative role about your concerns. In most cases, you should be able to resolve your difficulties at this level.
People sometimes wish to make complaints about services someone else is receiving. If you are not the client or patient or the legal parent or guardian of such a person, you will have more difficulty making your concerns known. Confidentiality laws in most states prohibit a professional from releasing information to third parties without a signed release of information. Providers may not even acknowledge that they are providing services to an individual without a signed release.
If you participated in the therapy in any way, such as in a family session, you may have a right to a discussion of the aspect of the treatment you participated in and the therapist should be ready to assist you or provide a referral if you are upset by the experience. Some professionals and consumers feel that family members should have access to records in such circumstances but in most cases, this would require a change in the confidentiality statutes or a legal ruling.
Some people may choose to write a letter to another person's therapist, explaining their concerns. You should expect that if you do so, the therapists may show the letter to the client. You should think carefully about the implications of such an action since it could adversely affect your relationship with that person.
Ethics Committees
One of the hallmarks of a professional association is its willingness to develop, promulgate, and enforce a code of ethics among its members. The Ethics Committee is composed of volunteer members who donate their time to educate the public and members about the ethics code, respond to inquiries, and investigate complaints. The activities of an ethics committee are funded by membership dues. Typically, the Ethics Committee is one of the most expensive, demanding, and time-consuming activities of a professional association.
Both national associations and state associations maintain ethics committees. The ethical standards are typically developed at the national level, with input from the state organizations. Consumers may contact either or both organizations to request information or to initiate a complaint. You will need to ask for a complaint packet, which should contain a copy of the Ethics Code and a detailed explanation of how to lodge a formal complaint.
In general, complaints must be made by the recipient of services (or their parent or guardian). While the specific procedures may differ from one professional organization to another, ordinarily, complainants must be willing to identify themselves and authorize release of records to the Ethics Committee. They must also be willing to have a copy of the complaint and any related materials sent to the person they are complaining about. Complaints can only be lodged against current members of the professional association. State and national association ethics committees have no authority to investigate members of other professions or members of their own profession who are not members of the association.
It is important to realize that there are limits to the sanctions a professional organization can levy against one of its members. In many cases, where the infraction is relatively minor, the professional may be educated about the ethical standards or they may be required to take additional training or agree to limit their practice to areas in which they are competent. The most severe sanction a professional association can enforce is expulsion from the organization. While a report of this action can be sent to other professional groups the person belongs to and to the licensing board, professional organizations are private groups and have no legal authority to stop a licensed professional from providing services to the public.
Despite this inability to enforce serious consequences for unethical conduct, most professionals take complaints to their Ethics Committee very seriously. This is because hospitals, licensing boards, managed care plans, and malpractice insurers inquire into any past history of complaints.
The role of Ethics Committees in adjudicating complaints is becoming increasingly complex and some organizations are not equipped to conduct the appropriate investigations. Because of the consequences for both providers and consumers, professional organizations are considering whether they have the expertise and resources to handle increasingly complicated matters with significant legal implications. You may find that a professional association does not adjudicate complaints about its members. In that case, they should be able to provide you with information on how to make a complaint to the appropriate licensing board.
Licensing Boards
The state Department of Professional Regulation (the title may differ from state to state) is charged with enforcement of the various licensing acts under its jurisdiction. Each profession has a licensing board, composed of professionals and citizen representatives, who make recommendations to the department regarding complaints against licensees. Citizens may make complaints by contacting the department either in writing or in person and describing in as detailed a manner as possible the exact nature of the complaint. Anonymous complaints are accepted but it is very difficult to develop a successful case without a complainant or witness.
While the department is committed to investigating all cases that appear to have merit, the state legislature is responsible for budgeting the necessary funds. When there is a shortage of investigators, the department may not be able to fully investigate all cases. When a case appears to have merit, there is an extensive series of procedures which determine how the case is resolved. Complaints against licensees can result in loss of a license or some lesser sanction, depending on the results of the investigation, the recommendations of the licensing board, and the decisions of the department director. Criminal prosecution by the appropriate legal authorities may result from a department investigation.
It is also possible to complain against an unlicensed person who is practicing in violation of an existing licensing act. If the case has merit, the department can issue a cease and desist order but can take no further action against such a person. If criminal action is involved, the case will be forwarded to the proper authorities. Criminal prosecution of licensed and unlicensed persons has resulted in numerous convictions.
Coordination with Malpractice Litigation
When there is an ongoing malpractice case, ethics committees and the licensing board may choose not to act on complaints until the malpractice case is settled. There can be difficulties in securing the cooperation of a complainee while a case is in progress. Furthermore, complainants may be advised by their attorneys not to share information with ethics committees and licensing boards until after a malpractice case is settled because it might do harm to their case.
Malpractice insurance companies, or the provider, if self-insured, must inform the licensing board of any financial settlement. This should automatically trigger an investigation by the licensing board. Action against a person's license would depend on the cause of the malpractice action. It is possible for a person to lose a malpractice case for negligence, for example, but not meet the standard in the state for losing a license, which generally requires gross negligence. Finally, action may also depend on the complainant's willingness to cooperate with the licensing board in an investigation. Complainants may see the malpractice award as sufficient and be more interested in getting on with their life than in challenging the provider's right to practice.
The Role of Citizens in Licensing
Most challenges to licensing acts involve reducing standards rather than increasing them. This is because licensed professions are seen as "protecting their turf" and "reducing competition" when they attempt to raise or even maintain the standards for practice in their field. Providers who do not meet licensing requirements regularly go to legislators with proposals to reduce licensing standards in existing professions to provide mental health services. Consumer groups are especially important in making legislators aware of problems in licensing acts or in proposed licenses that may result in unqualified people providing mental health services to the public.
Adequate funding of the agencies that investigate licensing complaints is also a legislative issue. Obviously, it is in the best interest of both professionals and citizens for complaints to be carefully investigated and acted on in a timely manner.
Comments may be directed to:
Mary Kay Pribyl, Ph.D.
Clinical Psychologist
1775 Glenview Rd., Suite 218
Glenview, IL 60025
847-729-6290
mpribyl@aol.com