Legislature(2001 - 2002)

04/24/2002 01:36 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
               HB 245-MARITAL & FAMILY THERAPISTS                                                                           
                                                                                                                                
                                                                                                                                
REPRESENTATIVE  PEGGY WILSON,  sponsor of  HB 245, explained  that                                                              
the measure  adds the  Board of Marital  and Family Therapists  to                                                              
the list  of professionals  that the  Department of Community  and                                                              
Economic Develop  (DCED) can contract  with to provide  assistance                                                              
and  treatment  to  persons  who abuse  alcohol,  drugs  or  other                                                              
substances.  It also  increases consumer  protection for  Alaskans                                                              
who  are seeking  professional counseling.   Section  2 gives  the                                                              
board  the  authority  to  order a  licensed  marital  and  family                                                              
therapist  to   submit  to  a   reasonable  physical   and  mental                                                              
examination  if  the board  has  credible evidence  sufficient  to                                                              
conclude  that the  therapist's physical  and  mental capacity  to                                                              
practice safely  is at issue.  Section 3 allows  individual client                                                              
contact  to  be  counted  as hours  toward  licensing.  Section  4                                                              
requires a  therapist to communicate  to law enforcement  officers                                                              
if a victim has  identified that the victim intends  to do serious                                                              
harm.                                                                                                                           
                                                                                                                                
CHAIRWOMAN GREEN asked where it says "must."                                                                                    
                                                                                                                                
REPRESENTATIVE WILSON referred to  Section 4 on page 3. Subsection                                                              
(a)  requires confidentiality  between  the  client and  therapist                                                              
except  when a  threat of  imminent  serious physical  harm to  an                                                              
identified victim has been made.                                                                                                
                                                                                                                                
CHAIRWOMAN GREEN asked if that is a requirement.                                                                                
                                                                                                                                
REPRESENTATIVE WILSON  replied, "No, it  is not a  requirement. It                                                              
is just a consumer protection because  without this, they wouldn't                                                              
be able  to do  that and yet  the therapist feels  that if  it's a                                                              
true risk, they need to be able to have that authority."                                                                        
                                                                                                                                
REPRESENTATIVE WILSON went on to  explain that the new language in                                                              
Section  5 (page  4, line  26) complies  with  the national  board                                                              
language   and   imposes   disciplinary   sanctions   for   sexual                                                              
misconduct.                                                                                                                     
                                                                                                                                
SENATOR  WARD asked  if Alaska  statute contains  sanctions for  a                                                              
case in which  a medical professional  and a client want  to marry                                                              
one year after the client/patient relationship is over.                                                                         
                                                                                                                                
REPRESENTATIVE WILSON did not know the answer.                                                                                  
                                                                                                                                
SENATOR WARD said someone brought  to his attention that this bill                                                              
will prevent  two consenting adults  from marrying for  two years.                                                              
He asked if medical doctors are similarly restricted by statute.                                                                
                                                                                                                                
REPRESENTATIVE  WILSON said  that  is not  the  case with  medical                                                              
doctors  and  that  this  only  applies   to  family  and  marital                                                              
therapists.                                                                                                                     
                                                                                                                                
SENATOR WARD  asked where the  prohibition against  marrying after                                                              
the client/patient relationship is over exists in statute.                                                                      
                                                                                                                                
TAPE 02-32, SIDE B                                                                                                              
                                                                                                                                
MS.  CAREN   ROBINSON,  representing   the  Marriage   and  Family                                                              
Therapists  Association,  said  to her  understanding,  a  similar                                                              
provision is in statute for social  workers and psychologists, and                                                              
it  is a  national standard  set  out by  the  Marital and  Family                                                              
Therapists' Association.  The reasoning behind the  restriction is                                                              
that a therapist has a power relationship  with a client so should                                                              
wait  two  years   after  the  therapist/client   relationship  is                                                              
terminated before having a sexual relationship.                                                                                 
                                                                                                                                
CHAIRWOMAN GREEN asked who that applies to now.                                                                                 
                                                                                                                                
MS.  ROBINSON repeated  it  applies  to psychologists  and  social                                                              
workers, and it might apply to professional counselors.                                                                         
                                                                                                                                
SENATOR  WARD asked  if a  provision is  in law  that prohibits  a                                                              
psychologist  from  marrying a  client  for  two years  after  the                                                              
professional relationship has been terminated.                                                                                  
                                                                                                                                
MS.  ROBINSON said  to  her understanding  yes,  but she  informed                                                              
members that  Larry Holman,  President of  the Marital  and Family                                                              
Therapists' Association, was available to answer questions.                                                                     
                                                                                                                                
SENATOR LEMAN said  he reads it as a ban on  sexual misconduct but                                                              
not  a  ban on  marriage.  He  said  he cannot  imagine  that  the                                                              
regulations would define sexual activity  within marriage as being                                                              
sexual misconduct.                                                                                                              
                                                                                                                                
SENATOR  WARD  said the  person  who  contacted  him said  such  a                                                              
provision exists.                                                                                                               
                                                                                                                                
CHAIRWOMAN GREEN said she believes  it refers to the establishment                                                              
of a relationship between the time one is a patient and marries.                                                                
                                                                                                                                
SENATOR LEMAN  said his  point is  that the  language in  the bill                                                              
before the  committee does not say  that but he  acknowledged that                                                              
such a ban could exist in regulation.                                                                                           
                                                                                                                                
CHAIRWOMAN GREEN asked Representative  Wilson to finish her review                                                              
of the bill while the regulations are checked.                                                                                  
                                                                                                                                
REPRESENTATIVE  WILSON  explained  that Section  7  requires  that                                                              
before therapy begins,  a client be informed of all  of the facts,                                                              
including  the credentials  of the  therapist,  fee schedules  and                                                              
exceptions to the confidentiality rule.                                                                                         
                                                                                                                                
CHAIRWOMAN  GREEN asked what  happens if  that information  is not                                                              
furnished.                                                                                                                      
                                                                                                                                
MS. ROBINSON replied  that a client could report  such a violation                                                              
to the board who would decide whether to sanction the therapist.                                                                
                                                                                                                                
CHAIRWOMAN  GREEN said, according  to Sec.  087.63.230 on  page 5,                                                              
line 9,  the client may  not be charged  a fee for  those services                                                              
unless  the  client  was  furnished   a  copy  of  a  professional                                                              
disclosure  statement.  She  said  she  has  never  received  that                                                              
information  from  a medical  professional  prior  to "starting  a                                                              
conversation with them."                                                                                                        
                                                                                                                                
MS.  ROBINSON   said  that  provision   is  in  the   professional                                                              
counselors'  statute  and  is  the  direction  being  taken  on  a                                                              
national level  to provide for  consumer understanding.  She noted                                                              
the  information  could be  described  in  a small  brochure.  She                                                              
believes that  providing that  information will protect  consumers                                                              
who are often in crisis and vulnerable.                                                                                         
                                                                                                                                
REPRESENTATIVE WILSON added that  another reason for disclosure is                                                              
that marriage  and family  therapists are  being placed  under the                                                              
umbrella of many boards.                                                                                                        
                                                                                                                                
MS. CATHERINE  REARDON, Director  of the Division  of Occupational                                                              
Licensing in the Department of Community  and Economic Development                                                              
(DCED),  informed members  that the  provisions of  this bill  are                                                              
identical to provisions in other  occupational licensing statutes,                                                              
although  not  in  all  mental  health   provider  statutes.  This                                                              
particular disclosure  statement is identical to  a requirement in                                                              
the  professional   counselors'  statute.   She  noted   that  the                                                              
profession  itself  believes  it  is  a good  idea  to  require  a                                                              
disclosure statement,  which is the reason it was  included in the                                                              
bill. The public is, in general,  less familiar with the different                                                              
types of  mental health  professionals, what  they are  buying and                                                              
how the  billing systems work, therefore  she believes there  is a                                                              
higher need to educate patients.                                                                                                
                                                                                                                                
SENATOR WARD  asked Ms. Reardon if  she could answer  his question                                                              
about marriage being a violation of a professional's license.                                                                   
                                                                                                                                
MS. REARDON explained  that several professions  that are licensed                                                              
by  DCED, physicians,  professional  counselors  and marriage  and                                                              
family  therapists, have  the right  to adopt  codes of ethics  by                                                              
regulation.  Those codes  of ethics  include prohibitions  against                                                              
sexual  contact  with clients  for  a  certain time  period  after                                                              
therapy  is terminated.  The medical statute  (AS 08.64.326)  does                                                              
not specify  two years  but it  gives the  board the authority  to                                                              
define  a  time  limit.  The  physicians'  statute  prohibits  and                                                              
defines what sexual misconduct and  it explains the conditions for                                                              
terminating   a  professional  relationship   so  that   a  sexual                                                              
relationship  would be  acceptable. She  felt the  idea of  sexual                                                              
contact after a patient is no longer  seeing a physician is not as                                                              
big of a concern  because the patient's psychological  reliance on                                                              
the physician  is not  as great as  it can  be with mental  health                                                              
professionals.  Mental health professionals  believe there  should                                                              
be a period of time in which the  "influence can wear off and they                                                              
are  standing   on  their  own   two  feet  before   the  romantic                                                              
relationship begins." She repeated  that although the statutes may                                                              
not specify a two year waiting period,  they allow boards to adopt                                                              
codes of ethics that specify conditions.                                                                                        
                                                                                                                                
SENATOR WARD  noted the  person who contacted  him said  there was                                                              
nothing  in law  that  prohibits  any licensed  professional  from                                                              
getting   married  to   a   client  after   the   therapist/client                                                              
relationship is terminated.  He asked if that is true.                                                                          
                                                                                                                                
MS. REARDON said she does not think  that statement is not correct                                                              
for all of the mental health professions.  The codes of ethics for                                                              
professional  counselors and  marital and  family therapists  that                                                              
were adopted by regulation require "cooling off" periods.                                                                       
                                                                                                                                
MR. LARRY  HOMAN (ph), President  of the Association  for Marriage                                                              
and  Family Therapy,  told  members  that the  ethical  guidelines                                                              
written   by    the   psychological   association,    professional                                                              
counselors,  marriage  and family  therapists  and social  workers                                                              
require   a   two-year   waiting  period.   Most   likely,   those                                                              
professionals would not go to jail  for a violation but would lose                                                              
their licenses  if they  engaged  in sexual conduct  while  in the                                                              
therapist/client  relationship. However,  after that  relationship                                                              
is terminated,  the guidelines are  gray. He noted  the guidelines                                                              
were  designed  to   protect  the  client.  He   agreed  that  the                                                              
therapist/client   relationship   is   quite  different   than   a                                                              
physician/client relationship.                                                                                                  
                                                                                                                                
2:40 p.m.                                                                                                                       
                                                                                                                                
CHAIRWOMAN GREEN  asked what professions  Mr. Homan  was referring                                                              
to.                                                                                                                             
                                                                                                                                
MR.  HOMAN   replied  psychologists,   clinical  social   workers,                                                              
professional counselors, and marriage and family therapists.                                                                    
                                                                                                                                
SENATOR  WARD asked  if the first  three have  a two-year  waiting                                                              
period and whether that includes a ban on marriage.                                                                             
                                                                                                                                
MR. HOMAN  said they do  have a two-year  waiting period,  but the                                                              
guidelines do  not specify a ban  on marriage. He said  the intent                                                              
of  the guidelines  is  to prevent  a dual  relationship,  meaning                                                              
personal and professional, so he  does not believe, "you could get                                                              
around the  marriage thing  because obviously  that is  a personal                                                              
relationship so  it would be  interpreted as a  personal, romantic                                                              
kind of relationship which obviously would include marriage."                                                                   
                                                                                                                                
SENATOR WARD asked if, by regulation,  the first three professions                                                              
cannot marry a patient for two years without being in violation.                                                                
                                                                                                                                
MR.  HOMAN said  the  regulation does  not  specifically say  they                                                              
cannot  marry  but  he  believes  that is  how  the  boards  would                                                              
interpret the  regulation because  of the  personal nature  of the                                                              
relationship.                                                                                                                   
                                                                                                                                
SENATOR  WARD asked  if  the  national professional  boards  allow                                                              
marriage.                                                                                                                       
                                                                                                                                
MR. HOMAN said they [the codes of  ethics] do not address marriage                                                              
specifically in  those words. They address the  personal, romantic                                                              
relationship that  comes with a dual relationship,  and he guesses                                                              
that  would include  marriage. He  noted the  marriage and  family                                                              
therapist  guidelines put  forth  by the  American Association  of                                                              
Marriage  and   Family  Therapy,  do  not   specifically  prohibit                                                              
marriage but  they do prohibit  sexual relationship for  two years                                                              
after the professional relationship has been terminated.                                                                        
                                                                                                                                
CHAIRWOMAN GREEN  asked Ms. Reardon  if the language  she referred                                                              
to was in regulation.                                                                                                           
                                                                                                                                
MS.  REARDON  explained that  the  statute  gives the  boards  the                                                              
authority  to adopt codes  of professional  conduct. She  believes                                                              
the boards adopted those codes by regulation.                                                                                   
                                                                                                                                
CHAIRWOMAN GREEN asked  Ms. Reardon to describe what  she means by                                                              
a code of ethics.                                                                                                               
                                                                                                                                
MS. REARDON  said a code  of ethics is a  written set of  rules on                                                              
professional  behavior. They  are actually  incorporated into  the                                                              
regulations  by  reference, so  although  the  code might  not  be                                                              
printed in the regulations, a document can be provided.                                                                         
                                                                                                                                
SENATOR WARD asked for a copy of  the codes of ethics of the three                                                              
professions.                                                                                                                    
                                                                                                                                
MS. REARDON offered to provide them.                                                                                            
                                                                                                                                
SENATOR  LEMAN   commented  that   he  believes  marriage   should                                                              
terminate the ban on sexual activity  and that would be consistent                                                              
with  the   intent  of   regulating  the   profession.  He   asked                                                              
Representative  Wilson  for  feedback  on  that  position  in  the                                                              
future.                                                                                                                         
                                                                                                                                
MR. HOMAN  said the  intent is  to limit  a romantic  relationship                                                              
between a  therapist and  a client  and sex is  just one  part. He                                                              
said one has  to look at what kind of relationship  is acceptable.                                                              
It has  been argued that the  professional should honor  the power                                                              
difference in the  relationship and that the rule  was designed so                                                              
that   a  client   would   not  be   taken   advantage  of   while                                                              
psychologically fragile and unable to use good judgment.                                                                        
                                                                                                                                
CHAIRWOMAN GREEN referred  to lines 24 and 25 on  page 4 and asked                                                              
what  "engaged  in  unethical  conduct   in  connection  with  the                                                              
delivery of professional services to clients" encompasses.                                                                      
                                                                                                                                
MR. HOMAN  said that  itemizing misconduct in  the bill  spells it                                                              
out more  clearly, although  it is also  contained in  the ethical                                                              
guidelines.  He  noted  sexual misconduct  is  considered  a  very                                                              
serious breach of ethics.                                                                                                       
                                                                                                                                
MS. REARDON  said professional  misconduct is  not limited  to the                                                              
seven grounds  for disciplinary sanctions  listed in the  bill. AS                                                              
08.63.050 says  the board shall adopt  a code of  ethical practice                                                              
for  marital  and  family  therapy.    That  is  most  likely  the                                                              
statutory authority  the board would have used to  adopt a code of                                                              
ethics. If a member  violated the code of ethics,  he or she would                                                              
be disciplined  under subsection  (5) on  page 4,  line 18  of the                                                              
bill.                                                                                                                           
                                                                                                                                
SENATOR  WARD said  he agrees  that  a person  is vulnerable  when                                                              
under a  therapist's care  and should not  be taken advantage  of.                                                              
However,  he did not  know there  was a  law prohibiting  marriage                                                              
after  the  professional   relationship  was  terminated   and  is                                                              
surprised  to find  such  an interpretation  because  he does  not                                                              
consider sexual activity within marriage  to be sexual misconduct.                                                              
He repeated his  request for copies of the codes  of ethics of the                                                              
three boards.                                                                                                                   
                                                                                                                                
CHAIRWOMAN GREEN asked Ms. Reardon  to supply the committee with a                                                              
rundown of the wording in statute  regarding what the authority is                                                              
for the  comparable professions.  She said she  does not  see such                                                              
language in statute.                                                                                                            
                                                                                                                                
SENATOR WARD  asked if the  sponsor researched the  question about                                                              
marriage or whether it has been asked by anyone else.                                                                           
                                                                                                                                
REPRESENTATIVE WILSON said that question  was never raised to her.                                                              
She said  the intent of  the bill is  to protect the  consumer and                                                              
that the only time a charge would  be filed is if the consumer was                                                              
hurt or violated in some way. She  assumed if the relationship led                                                              
to marriage, no charge would be filed with the board.                                                                           
                                                                                                                                
SENATOR WARD said  anyone could bring the charge  to the board. He                                                              
said he does not want to sanction  an improper relationship but he                                                              
is amazed to find that marriage would be illegal.                                                                               
                                                                                                                                
SENATOR WILKEN said  he has three questions. The  first relates to                                                              
Section 2  (page 2,  line 6), which  allows the  board to  order a                                                              
therapist  to submit  to  a physical  or  mental examination  with                                                              
cause and, according to page 5, line  2, if the therapist does not                                                              
submit, his or her  license can be pulled. He said  his concern is                                                              
that the words  "reasonable" and "credible" invite  litigation. He                                                              
asked if that is new language or similar to other statutes.                                                                     
                                                                                                                                
MS.  REARDON  said  that  language  exists  in  several  statutes,                                                              
although not  all. She believes those  words are important  to act                                                              
as  checks on  the  board. If  the  division was  investigating  a                                                              
therapist, it would ask the board  to order an examination. If the                                                              
therapist objected,  he or she  could be summarily  suspended. The                                                              
summary  suspension  statute  says  the division  must  provide  a                                                              
hearing within 7 days because the  person loses his or her license                                                              
immediately and cannot  wait for a decision. At  that hearing, the                                                              
division   must  provide   credible   evidence   upon  which   the                                                              
examination  was  requested.  She  said  she  understands  Senator                                                              
Wilken's concern but,  on the other hand, when  a practitioner has                                                              
developed a serious substance abuse  problem or has a relapse, the                                                              
division cannot wait several months  to stop the practice. Another                                                              
problem that could  occur is mental illness or  dementia, in which                                                              
the practitioner  does not  believe he  or she  has a problem  but                                                              
outside  observers  believe  a  problem   exists.  A  professional                                                              
assessment  needs to  be  done to  get an  answer  to protect  the                                                              
public. She noted that provision has rarely been invoked.                                                                       
                                                                                                                                
SENATOR   WILKEN  said   his  second  question   relates   to  the                                                              
qualifications  on  page  3,  line  4,  and  asked  why  the  word                                                              
"individuals" was added.                                                                                                        
                                                                                                                                
MS. ROBINSON  said it was added  because in family  situations, it                                                              
might be  in the best  interest of the  family to have  individual                                                              
sessions with  each member.  Those hours  would be counted  toward                                                              
the required 1500 hours for certification.                                                                                      
                                                                                                                                
SENATOR  WILKEN   asked  if  therapists   were  able   to  counsel                                                              
individuals before.                                                                                                             
                                                                                                                                
MS.  ROBINSON  said  they  could  not  count  those  hours  toward                                                              
licensure.                                                                                                                      
                                                                                                                                
SENATOR WILKEN referred to the new  language on the bottom of page                                                              
3 and asked if  a therapist would be liable if he  or she does not                                                              
communicate  with  a  law  enforcement  officer when  there  is  a                                                              
threat. He asked  if that paragraph obligates  the practitioner to                                                              
report.                                                                                                                         
                                                                                                                                
MS. ROBINSON said she assumes it  does not and that the idea is to                                                              
encourage the  therapist when they  have knowledge of a  danger to                                                              
report  it. That  provision  grants  immunity from  liability  for                                                              
reporting.  She then  asked  members to  keep  in mind,  regarding                                                              
Senator  Leman's position,  that  the job  of  family and  marital                                                              
therapists is to  work with married couples so she  believes it is                                                              
in everyone's  best interest that  the therapist not  get involved                                                              
in a sexual relationship with a family  member. The goal should be                                                              
to keep the family intact and help  members work through a crisis.                                                              
She said she is  aware of situations where a couple  got a divorce                                                              
during therapy because of sexual  misconduct by the therapist. She                                                              
added that people  who go to a therapist are usually  in some kind                                                              
of  a vulnerable  situation. The  therapist  is in  a position  of                                                              
power as the family expects to get good advice.                                                                                 
                                                                                                                                
SENATOR  WARD said no  one disagrees  with that  position but  the                                                              
scenario brought  to him flies in  the face of common sense  as it                                                              
is between two adults  who were not married and who  want to marry                                                              
two years after the professional relationship terminated.                                                                       
                                                                                                                                
MS. REARDON said the time the professional  relationship no longer                                                              
exists  is  not  black  and white.  Although  a  person  may  have                                                              
terminated  sessions, the  professional  relationship may  persist                                                              
for some time.                                                                                                                  
                                                                                                                                
CHAIRWOMAN  GREEN  said  looking  at comparable  language  in  the                                                              
social  worker statutes  regarding  the reporting  of a  potential                                                              
danger in  relationship to  children says  "shall." She  asked Ms.                                                              
Reardon to provide  her with information about  whether family and                                                              
marriage therapists  are required to  report child or  elder abuse                                                              
or threats of abuse.                                                                                                            
                                                                                                                                
SENATOR LEMAN  said, in response  to Ms. Robinson's  comment, that                                                              
he agrees  with the  restriction  for the reasons  she stated  but                                                              
that his  earlier comment was  an attempt to  get to the  issue of                                                              
whether  or not marriage  should  terminate that  ban. He said  he                                                              
understands that  marriage does not  happen without  courtship and                                                              
that could be interpreted to be in  violation of that professional                                                              
standard.                                                                                                                       
                                                                                                                                
CHAIRWOMAN GREEN asked members to  get any additional questions to                                                              
her or the sponsor.                                                                                                             

Document Name Date/Time Subjects