Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Ethical Dilemma
Kelsey Finch, Joseph Fox, Katie Frits, Julie Hewett, Ayla Leopold, Kim Karwhal
Case of Counselor Cammie 2
Statement of Charges
&
Statement of Facts
Case of Counselor Cammie 4
The Iowa Board of Behavioral Science (Board) files this Notice of Hearing
and Statement of Changes pursuant to Iowa Code sections 147.55(3) and chapter
chapters 272C.9 and 272C.10(2). Licenses issued by the Board are subject to the
laws of the State of Iowa and the administrative rules promulgated by the Board.
STATEMENT OF CHARGES
COUNT I
IAC Chapter 33.2(1), failure to comply with the national association’s code of
It is alleged you breached IAC Chapter 33.2(1) when you failed to consult with
intervened with a suicide attempt, once you had learned of the client’s intent.
COUNT II
It is alleged you breached IAC Chapter 33.2(3), section c. when you failed to
immediately respond and assess client’s need for higher level of care or suicide
COUNT III
harm.
It is alleged you breached ACA Code of Ethics Section B.2.a. when you
STATEMENT OF FACTS
Comes now the Iowa Board of Behavioral Science Examiners, and in support of
the grievances filed in this case, sets forth the following facts:
· May 26, 2017, Sophia, also receiving services from the respondent, disclosed
· May 28, 2017 Amanda overdosed on Hydrocodone, which was hidden within
· May 29, 2017 Sophia disclosed to on-site Case Manager the discussion with
respondent prior to the incident.
Case of Counselor Cammie 7
Opening Remarks,
Questioning
&
Closing Remarks
Case of Counselor Cammie 8
Opening Remarks
Prosecutor (P) [Kim]: I would like to begin this hearing by quoting the American
Counseling Association (ACA) Code of Ethics Purpose, “When counselors are faced with
ethical dilemmas that are difficult to resolve, they are expected to engage in careful
considered ethical decision-making process, consulting available resources as needed.”
This case will review the events that led up to a tragedy. A tragedy that could have been
easily avoided if this purpose had been followed by the respondent, Cammie Peterson. Our
victim in this case currently lies in the hospital. Julia Hew, a Case Manager at The Forks, a
renowned residential facility for women, will share with you the facts of the matter, that
Ms. Peterson did not meet her profound ethical duty, her duty to protect her client,
violating IAC Chapter 33.2(1), failure to comply with the national association’s code of
ethics, IAC Chapter 33.2(3), professional incompetency, and ACA Code of Ethics section
B.2.a. Serious and Foreseeable Harm. This is why the following charges have been against
Cammie Peterson:
Count 1: Respondent, Cammie Peterson, has been charged pursuant to Iowa Code for
failure to comply with the National Association’s Code of Ethics, the American Counseling
Association 2014 Code of Ethics, Consultation on Ethical Obligations, and Primary
Responsibility of a counselor is to promote the welfare of clients. Cammie was in violation
because she failed to consult with her supervisor or notify responsible onsite parties that
could have intervened with a suicide attempt, once she had learned of the client’s intent.
Count 2: Respondent is charged pursuant to Iowa Code, Professional Incompetency, section
c., Failure to Exercise the Degree of Care, which is ordinarily exercised by the average
practitioner acting in the same or similar circumstance. It is alleged that Cammie was in
violation when she failed to immediately respond and assess her client, Amanda’s need for
a higher level of care or suicide risk after receiving disclosure of the intent.
Count 3: Cammie is charged with violation of the ACA Code of Ethics Serious and
Foreseeable Harm and Legal Requirements, when she dismissed her client’s intent as
“attention-seeking” behavior and failed to intervene with the disclosed intent of harm.
If you are not currently familiar with Tarasoff vs. The State of California, you should be aware
that in this case and in many others nation-wide, the courts have found that if someone’s life
or health is at risk, the benefit from a breach in confidentiality significantly outweighs the
cost of that breach and should be undertaken to protect human life (Tarasoff vs. State of
California). Today’s discussion and you, the board’s decision, will come down to breaching
confidentiality or protecting and doing no harm to human life.
Case of Counselor Cammie 9
Defense Lawyer (L) [Ayla]: A duty to protect. That is the statement that the prosecution
will attempt to demonstrate was broken in this case. But the duty to protect a client is more
than a simple implementation of a quoted code of ethics. The facts of this case stem back
months, through 14 visits between my client and the victim, Amanda. The duty to protect
Amanda was approached on May 26, 2017 when Ms. Peterson scheduled an appointment,
the start of the next business day. Ms. Peterson also adhered to her duty to protect
Amanda’s confidentiality, and the duty to protect Sophia, who cannot be excluded from the
equation of this case. In regards to Tarasoff, courts in Iowa have yet to recognize this ruling
as other states have, because this state comprehends its limitations. As Donald N. Bersoff of
Drexel University said in 2013, the Tarasoff decision is “bad law, bad social science, and bad
social policy”, because the limitations force the counselor to decide the seriousness of the
threat being made. You will hear in the evidence presented that Ms. Peterson made a
judgement that was soundly based in experience and knowledge of her client. My client, Ms.
Peterson did her due diligence to protect her clients, Amanda and Sophia.
Case of Counselor Cammie 10
J: “Client shares with this Case Manager that she talked with the therapist and is better
understanding why her attention seeking behaviors started.”
L: If Amanda had previously stated to you that she engages in attention seeking behaviors,
as this note demonstrates, would you have acted upon Sophia’s report had Sophia come to
you instead of Counselor Cammie?
P: OBJECTION! Leading the Witness.
L: Ms. Hew, let me rephrase, what actions should be taken for second-hand self-harm or
suicide intent?
J: As a Mandatory Reporter, I would alert on-site staff and according to policy, crisis
intervention would be implemented.
L: Thank you Ms. Hew. Please step down.
Case of Counselor Cammie 13
2017) shows that counselors who are self-aware and practice self-reflection while also
seeking peer consultation and supervisory input are more likely to practice ethically and
consider the alternatives from a metacompetence and metacognitive scope.
P: Dr. Fox, do you have any additional evidence to present to the board in support of these
charges?
F: In light of the charges against Ms. Cammie Peterson, so much of the counseling process is
listening for what’s not being said. For the record, I don’t believe that counselor (Cammie)
purposely or intentionally acted with negligence. There is much that transpires in the
understanding of the nature and dimensionalities of counseling as it relates to ethical
guidelines and practice. However, as suggested by (Welfel, 2016) “our profession demands
that we be able to justify our ethical decisions based on careful consideration of the facts
involved as well as the consistency with professional standards for practice.” As this situation
stands, counselor Cammie, as part of her professional responsibility and ethical
obligation(s), should have sought consultation and/or supervision on this matter.
Case of Counselor Cammie 15
counselor has a legal and ethical obligation to break confidentiality and protect all persons
involved.
L: By setting up a private appointment with Amanda did counselor Cammie do her due
diligence considering the circumstances to protect Amanda from harm?
F: (Pause for a deep breath and short sigh)...sly smile...that question is a bit ambiguous. By
that I mean she did, but I guess the question is, did she go far enough in her professional
responsibility and duty to serve Amanda? According to the ACA ethical codes and lack of
consultation with fellow colleagues and/or supervisors, it appears as Cammie didn’t
appropriately weigh the consequences of her actions or lack thereof.
L: I have no further questions, thank you for your time.
Case of Counselor Cammie 17
C: If you look at my running log of notes, I have detailed many types of attention-seeking
behavior throughout the time I have seen her. The case manager Julia has also noted these
types of behaviors. Amanda has admitted to using suicidal talk to get attention. We worked
on the root of these behaviors and on coping mechanisms to deal with stress. Amanda
acknowledged that these behaviors of hers get worse when she is more stressed out and
that attention for her, even if negative, is better than no attention at all. Again, because of
her history, I thought this event was similar to previous events.
L: Ms. Peterson, do you believe you did your due diligence in protecting your client Amanda
from harm in immediately setting up an appointment with her at the earliest appointment
time you had?
C: I do. My schedule for the rest of the day was full, and it was a 3-day weekend. I looked at
the details and assessed the risk. I did not think there was urgency because of Amanda’s
previous use of threats of suicide with her attention-seeking behavior. Additionally,
according to Griffith and Griffith 1978, professionals argue that patient confidentiality is
essential to effective mental health treatment and forcing a breach of confidentiality
essentially compromises effective mental health treatment.
Case of Counselor Cammie 19
P: Cammie, what is your agency’s required time frame from conducting a session to
summarizing the session in notes?
C: I know I wasn’t caught up with my notes, I was planning to do them over the long
weekend.
P: Cammie, I have one final question. I would like to bring your attention to the informed
consent form that was signed by you and your clients, Amanda and Sophia. What does this
consent form say in the ‘expectations to confidentiality’?
C: “The counseling staff works as a team. Your therapist may consult with other counseling
staff to provide the best possible care. These consultations are for professional and training
purposes.
A court order, issued by a judge, may require the Counseling Services staff to release
information contained in records and/or require a therapist to testify in a court hearing.”
P: If there is evidence of clear and imminent danger of harm to self and/or others, a
therapist is legally required to report this information to the authorities responsible for
ensuring safety (Walz, Bleuler 2015). Your knowledge of Amanda’s threat were neither
fully documented nor reported.
Thank you for your time.
Case of Counselor Cammie 21
H: Since Amanda’s admission to The Forks, she has instigated fights with her peers and has
on several occasions made threats of self-harm. Staff has discussed this with Amanda
regularly and continue to process why she may be doing this and how this can be very
alarming to staff and peers. One of the factors for Cammie would have been Amanda’s prior
statements and behaviors. I don’t want to generalize, but Amanda’s statements have
become the “status quo,” or baseline, for her. You can check the staff logs. Another factor is
that Cammie heard this from another client. Rumors spread like wildfire around here, and
most often it isn’t true. For all Cammie knew, Sophia’s encounter with Amanda wasn’t even
real, and was just meant to stir the pot with the other residents. On top of that,
confidentiality restricted Cammie from acknowledging that she even sees Amanda for
therapy. In this situation, it could be very reasonable to just quickly ask Amanda how she is
doing, as to not instigate any further rumors if Sophia’s original comment was a rumor. Life
here at The Forks is definitely interesting when it comes to rumors.
L: You’ve made it clear, Hannah, that there are a variety of factors as to why Cammie did
what she did. In this particular case, did Ms. Peterson take steps to protect her client,
Amanda, by setting up an appointment with her at her earliest time?
H: Yes. Cammie’s hours in the office are at set times. After Sophie’s session, Cammie sought
out Amanda to schedule the earliest time available to meet with Amanda after the holiday
weekend. I’m sure Cammie briefly followed up with Amanda to do a quick risk assessment
to see if she was doing okay and to ask if she wanted to talk briefly. Like I said, Cammie
upholds her ethical and legal obligations; she wouldn’t just walk away if she felt like
Amanda was at risk of harming herself.
L: Thank you for your time, no further questions.
Case of Counselor Cammie 23
H: I’m not a counselor.
P: No further questions.
Case of Counselor Cammie 25
Closing Remarks
P: Today reviewed two sides of the same story, resulting in the injury of a client, Amanda. A
client whom the counselor held a duty to protect. Individuals took the stand who all hold
high standards of services and have good reputations in our community yet the
circumstances surrounding these charges brought us here today. It is at this time I ask you,
the board, to take the time to review the facts, keeping in mind the reality of care that these
clients, and all individuals in our state deserve, and the number one care is to ensure safety
for the client which is what Ms. Peterson failed to do. In the end, it is a conflict between Ms.
Peterson’s thoughts surrounding the ethical dilemma which resulted in the lack of action.
According to Smith, 2016, the concept of “I thought” statements inherently include
application of past expectations. In the application of past expectations onto the risk of
suicide, risk must be assessed. Because risk was not assessed and Ms. Peterson did not did
not take immediate actions nor consult with her supervisor, she violated her ethical
demands, her duty, and her responsibility.
L: I do agree with one statement my colleague just said, asking you to review the facts.
Along with this review, take into consideration the nature of human behavior and the
limitations of the Code of Ethics. As any action taken by my client would have resulted in an
ethical violation, she decided that the best answer to protect her client was to set up an
appointment with her immediately. According to Duty to Warn from the National
Conference of State Legislatures, “Although ethical codes are written to provide ethical
guidelines for professionals, they are not meant to provide absolute rules”. It is unfortunate
that Amanda’s actions resulted in her own harm, but in this case brought to the Board of
Behavioral Sciences my client believes she did everything in her power to do no harm to
her client by setting up an appointment with Amanda, and protecting her confidentially in
her sessions with Sophia and Amanda.
Case of Counselor Cammie 26
References
Case of Counselor Cammie 27
References
Griffith, E. & Griffith, E. 1978. “Duty to Third Parties, Dangerousness, and the Right to
Refuse Treatment: Problematic Concepts for Psychiatrist and Lawyer.” 14 Cal. West
L. Rv 241-47.
Mullen, P., Morris, C., & Lord, M. ( 2017). The Experience of Ethical Dilemmas, Burnout, and
National Conference of State Legislatures. (2015). Mental health professionals’ duty to warn.
professionals-duty-to-warn.aspx
Pompeo, A., & Levitt, D. H. (2014). A Path of Counselor Self-Awareness. Counseling and
Values, 80-94.
Toriello, P. J., & Benshoff, J. J. (2003). Substance abuse counselors and ethical dilemmas:
The influence of recovery and education level. Journal of Addictions & Offender
http://www.psychologytoday.com/blog/media-spotlight/201407/revisiting-
tarasoff.
Werth, J. L., & Rogers, J. R. (2005). Assessing for impaired judgments as a means of meeting
10.1080/13576270500030966