Ethics for Psychologists _______________________________________________________________________
Colello had dinner with his parents on June 21. He was extremely depressed. Colello talked to his father about how he had lost the desire to live and about his building resentment toward Williams’ new boy- friend. He told his father “he couldn’t handle the fact that [Williams] was going with someone else,” and said he “was considering causing harm to the young man that [Williams] was seeing.” Colello’s father contacted Goldstein and told him what Colello had said. Goldstein urged Colello’s father to take Colello to Northridge Hospital Medical Center, where Goldstein arranged for him to receive psychiatric care. Colello was voluntarily admitted the evening of June 21, under the care of Dr. Gary Levinson, a staff psychiatrist. On June 22, Levinson told Colello’s father he planned to discharge Colello. Concerned that his son was being released prematurely, Colello’s father called Goldstein. Goldstein contacted Levinson, with whom he had not yet spoken and explained why Colello should remain hospitalized. Levinson told Goldstein that Colello was not suicidal and would be discharged. Goldstein urged Levinson to re-evaluate Colello and keep him hospitalized through the weekend. He did not do so. Colello was discharged on June 22. Goldstein had no further contact with his patient. On June 23, Colello murdered Williams’ new boyfriend, Keith Ewing, and then committed suicide. Keith’s parents, Cal and Janet Ewing, sued Gold- stein for wrongful death based on professional negligence. The Ewings alleged Colello posed a foreseeable danger to their son and had directly or indirectly through third persons communicated to Goldstein his intention to kill or cause serious physical harm to him. They alleged Goldstein failed to discharge his duty to warn their son or a law enforcement agency of the risk of harm his patient posed to their son’s safety. What is often omitted in discussions about this case is the fact that Geno Colello was a police officer and had access to weap- ons and substantial knowledge and training in using them. Complicating the clinical treatment decision making was the fact that June 22, when Geno Colello was released from the hospital, was a Friday and Geno Colello was not scheduled to be seen by Dr. Goldstein until the next week. Dr. Goldstein appropriately questioned the validity of Dr. Levinson’s assess- ment in light of contradictory information from the family but failed to do anything to make his own assessment of the patient and failed to notify law enforcement or the potential victim or family members of the potential threat. Had Dr. Goldstein gone to the hospital and independently evaluated
• Good record keeping is paramount. The model risk- benefit progress note should include: (a) an assessment of suicide risk; (b) the information alerting the clinician to that risk; (c) which high-risk factors were present in that situation and in the patient’s background; (d) what low-risk factors were present; (e) what information, namely the patient’s history and the clinician’s profes- sional judgment, led to actions taken and rejected. • Routinely seek consultations from professional col- leagues who have expertise in treating suicidal patients. • Consult with legal counsel to determine if the insur- ance carrier needs to be notified of a serious suicide attempt or completed suicide. Harm of Others The same types of issues arise with concerns that a patient will harm others. Following legal landmark cases (e.g., 1976 California Supreme Court decision on Tarasoff v. Regents of the University of California; 1983 Hedlund v. Superior Court; and 2004 Ewing v. Goldstein), states have enacted laws to require psychologists to warn those at risk and persons in close relationship to the object of the person’s threat and to include information from family members, not just the patient directly. In the Ewing case, the APA dissented from the ruling, stating that “requiring a therapist to warn intended victims when notified by a family member would have a ‘chilling effect’ on patients” [1]. The facts of the case document some informa- tion that is often omitted from discussion regarding the ethical issues involved in the case. The following is from Ewing v. Goldstein, 15 Cal. Rptr. 3d 864 - Cal: Court of Appeals, 2nd Appellate Dist., 8th Div. 2004 [22]: Respondent Dr. David Goldstein is a marriage and family therapist. Between 1997 and June 2001, Goldstein provided personal therapeutic services to Geno Colello, a former member of the Los Angeles Police Department. Goldstein treated Colello for work-related emotional problems and problems con- cerning his former girlfriend, Diana Williams. Beginning in early 2001, Colello became increas- ingly depressed and despondent over the termina- tion of his relationship with Williams. Colello’s feelings of depression significantly increased in mid- June, after learning of her romantic involvement with another man. Goldstein last met with Colello at his office on June 19, 2001. Goldstein spoke with Colello on the telephone on June 20 and again on June 21, when he asked Colello if he was feeling suicidal. Colello “was not blatantly suicidal, but did admit to think- ing about it.” Goldstein asked Colello to consider checking himself into a psychiatric hospital and also sought and obtained Colello’s permission to speak with his father, Victor Colello.
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