Case library / Records, confidentiality and the file
The letter written for the ex-spouse
In short
Stayed revocation with probation in September 2023, then license surrendered in September 2025 under a condition of that
$12,242Confidentiality, altered records and a missed child abuse report, in one case. License surrendered, $12,242.
Three separate rules break in one case, and each of them is a rule ordinary therapists get asked to break every year.
What happened
The therapist treated a client twice weekly for anxiety, depression and suicidality. The client's spouse later joined for couples work.
After termination, the ex-spouse contacted the therapist and asked her to diagnose the client for her own files. She said he was drinking heavily, had a gun, might attempt suicide again, and that she was afraid he might kill the children first.
The therapist wrote a “To Whom It May Concern” letter setting out the client's diagnosis, suicide attempts and treatment, and gave it to the ex-spouse. She had no consent from the client, was not appointed by any court, and had not been asked for it by the family court. It was presented at the custody hearing along with his records.
When the Board investigated, the copies of the intake form, Notice of Privacy Practices, depression checklist and EMDR worksheet that the therapist produced differed from the client's copies: different handwriting, marks on different pages, different checklist entries bearing the same date.
And on being told that the ex-spouse feared he would kill the children, no child abuse report was made.
What it was charged as
Gross negligence.
Failure to maintain confidentiality of information received in confidence during treatment.
A dishonest, corrupt or fraudulent act — the record discrepancies.
Failure to comply with the child abuse reporting requirements.
The outcome
Stayed revocation with probation in September 2023, then license surrendered in September 2025 under a condition of that order. Cannot reapply for three years; all charges deemed true and admitted for any future application; the surrender forecloses any petition for reinstatement.
OAH No. 2023020686
$12,242ordered in cost recovery under B&P §125.3What the rule actually says
Three separate rules collide here and each is worth stating on its own. A former client's confidentiality survives termination and survives the other spouse asking nicely. A record is a contemporaneous document; a later version that differs from the client's copy is evidence of a dishonest act under §4982(j), not a correction. And a mandated report is triggered by a reasonable suspicion arising from information received in a professional capacity — including from a third party, and including about a former client's household.
Discussion
Analysis, not part of the decision
The request will sound familiar to anyone who has treated a couple. An ex-spouse calls after termination, describes a frightening situation, and asks for something in writing. Everything about the framing invites help. The therapist wrote a To Whom It May Concern letter setting out the former client's diagnosis, suicide attempts and treatment, with no consent, no court appointment and no request from the family court. Confidentiality survives termination, and it survives the other spouse asking nicely.
The second rule is about records. When the Board investigated, the documents the therapist produced differed from the client's copies — different handwriting, marks on different pages, checklist entries bearing the same date. A record is a contemporaneous document. A later version that does not match the copy the client already holds is evidence of a dishonest act under §4982(j), not a correction. If a record genuinely needs amending, the amendment is dated and additive.
The third is the one most likely to be missed on a first reading. Told that the ex-spouse feared he might kill the children, the therapist made no child abuse report. The mandated reporting duty is triggered by a reasonable suspicion arising from information received in a professional capacity — including information from a third party, and including about the household of a former client. The duty did not end with the therapy.
Where insurance reaches, and where it does not
This is the case that best justifies the privacy sublimit on a policy. An unauthorized disclosure to a third party who then uses it in litigation is the paradigm HIPAA-defense claim, and those sublimits run $25,000 to $50,000. The record discrepancies are not insurable at all — the moment the allegation is alteration rather than error, the intentional-acts exclusion is in play.
What would have changed it
- Never write a letter about a client for anyone who is not the client, without the client's written authorization, and preferably not at all in a custody matter unless a court has appointed you.
- If you amend a record, amend it visibly: date the amendment, mark it as an amendment, and keep the original. A clean second version is the worst possible artifact to hand an investigator.
- Write the mandated report even when the source is a hostile ex-spouse and you doubt her. The reporting duty is a low bar by design and the assessment is not yours to make.
Questions
For a law and ethics seminar, or for yourself
- Draft the response you would send to the ex-spouse. What can you say, and to whom?
- The therapist arguably believed she was protecting children. Reconcile that belief with the outcome: what should a clinician who genuinely fears for a child do instead?
- Distinguish a lawful late entry in a clinical record from an alteration. What does the lawful version look like on the page?
Source. This write-up is drawn from the signed public decision in the case number above. Names, cities and employers have been removed — why. To pull the original, open the Board's quarterly newsletter archive, find the issue covering September 25, 2025, and match the case number in the Formal Disciplinary Actions section. Not legal advice.
