Sexual misconduct, failure to refer, practicing psychology without a license, improper employee compensation — see how a doctor's bad decisions affect a malpractice case.
Posted in Case Studies on Friday, May 5, 2023
Sue Green started treating with Joe Blackett, DC, in 2008 at the recommendation of her father. From 2008 through 2015, Dr. Blackett treated Sue on a periodic basis for minor back and neck symptoms.
While receiving chiropractic treatments, Sue sometimes talked to Dr. Blackett about her personal life. Later, during a deposition, Sue would describe her early interactions with Dr. Blackett as follows:
“In early 2013, I was going through a rough patch and feeling depressed. I didn’t know who I could talk to and one day, during one of my appointments with Dr. Blackett, I broke down. I felt I could trust him, and I told him about my problems. He said I should see my family physician and possibly get started on an antidepressant. I followed his advice.
Later that year, after my second child was born, I was experiencing postpartum depression and also had concerns about my personal appearance, including my breast size. I shared my concerns with Dr. Blackett and he mentioned that there were many possible solutions to my problems, such as different bras, prosthetics and implants.
In 2014, I underwent breast implant surgery. My surgeon said to let my chiropractor know about the surgery because it might affect the way he adjusts me. After that, the implants seemed to be the topic of conversation every time I went in for an adjustment with Dr. Blackett. He even asked to see my scars one time, which I didn’t find unusual because he was the physician.”
Doctor Hires Patient
In April 2016, Sue learned that Dr. Blackett was looking to hire a part-time receptionist in his chiropractic office. At that time, Sue was looking for part-time work to generate some extra income for her family, so she applied for the job.
Around this time, Sue began to have flashbacks of sexual molestation incidents that occurred when she was 8 years old. Sue started seeing a psychologist as a result of these memories and was diagnosed with post-traumatic stress disorder (PTSD).
Since Sue knew that the perpetrator of her childhood sexual molestation was a patient at Dr. Blackett’s clinic, she disclosed her history of sexual abuse to Dr. Blackett when she interviewed for the position. Despite this, he hired her anyway.
Over the next few months, Sue began confiding in Dr. Blackett even more than she already had. Though Dr. Blackett was aware Sue was seeing a psychologist, he repeatedly encouraged her to divulge details about the sexual abuse she experienced as a child.
In July 2016, Sue was involved in a motor vehicle collision that caused back and neck injuries. She went to the local hospital, was examined and discharged home with a prescription for Flexeril and was advised to follow up with her treating doctor if she experienced further problems. The day she was discharged from the hospital, Sue reported for work at Dr. Blackett’s office. Later that same day, Dr. Blackett provided chiropractic adjustments for her injuries.
No Significant Improvement
Over the course of the next several months, Dr. Blackett was the sole treating doctor for Sue’s collision injuries. Initially, the treatments provided her with some temporary relief of her symptoms. But there was no significant overall improvement of Sue’s symptoms, despite numerous and repeated treatments by Dr. Blackett. Sue asked Dr. Blackett to refer her to another doctor, but Dr. Blackett assured Sue that this wasn’t necessary.
As Dr. Blackett continued to treat Sue, her emotional dependence on Dr. Blackett grew. In addition, Dr. Blackett routinely encouraged Sue to stay at work after hours to discuss her problems.
Sue looked up to Dr. Blackett as someone she could trust and confide in, and in essence, Dr. Blackett took on the unofficial role of being Sue’s therapist. By this point, Sue was thoroughly confused about the nature of her relationship with Dr. Blackett—he was playing the role of her friend, counselor, confidant, doctor and employer all at the same time.
In October 2016, Dr. Blackett jokingly offered a “challenge” to his office staff. If they collected more cash than charges for three consecutive days, he would give them all a big kiss. When the staff was successful in meeting the challenge a few days later, Sue reminded Dr. Blackett about the kiss he had promised. That evening, as Sue was getting ready to leave for the day, Dr. Blackett came up to her and kissed her for the first time. He told her he had never done anything like that before.
Around this same time, Sue’s husband became increasingly suspicious about the late hours she was spending at Dr. Blackett’s office and the frequency of her chiropractic treatments. He couldn’t understand why Sue’s life suddenly revolved around her employer/chiropractor.
After several weeks of heated arguments about the nature of the relationship, Sue’s husband flew into a jealous rage and physically attacked her. Fortunately, Sue wasn’t injured in the assault, but her husband was arrested for domestic abuse, and he moved out of the house.
After Sue’s husband moved out, she and Dr. Blackett’s relationship became more personal and intense in nature. They spoke on the phone frequently, and they were intimate virtually every day.
On the Clock for After-Hours Activities
At Dr. Blackett’s request, Sue would often stay on after her shift to engage in sexual activity. Dr. Blackett insisted Sue remain “on the clock” during these encounters to avoid raising suspicion with his wife. As a result of these interactions, Sue became emotionally dependent on Dr. Blackett.
During the months of December and January, Dr. Blackett bought Sue a Christmas gift, called her several times a day and continued to advise her about her worsening emotional and marital difficulties. Dr. Blackett also kept providing chiropractic care to Sue, despite the fact that she didn’t receive any long-term relief from her symptoms.
In addition, Dr. Blackett sent Sue mixed signals about his intentions. At times, Dr. Blackett would tell Sue he loved his wife and children and would never leave his family. At other times, he would say he was falling in love with Sue and wanted her to be the mother of his children.
In early February, Dr. Blackett’s wife discovered the relationship between Sue and Dr. Blackett when his cell phone bill revealed countless calls between the two over several months. Dr. Blackett’s wife confronted him, and he admitted to the affair.
When Sue reported to work the next day, Dr. Blackett met her at the door and told her to go home. Sue expressed concern about losing her job, but Dr. Blackett reassured her she was not being fired. The following day, Dr. Blackett called Sue to inform her that she didn’t need to report for work as normal that day, but she needed to attend a meeting at his office that evening to discuss her “new job responsibilities.”
When Sue arrived at the chiropractic office that evening, Dr. Blackett handed her an envelope containing a letter that immediately terminated her employment. The letter stated Sue’s position was being eliminated due to the changing business needs of the clinic. Dr. Blackett also informed Sue he could no longer treat her as a patient and was transferring her care to another chiropractor.
Sue chose to see her family physician for her motor vehicle accident injuries instead of going to the chiropractor Dr. Blackett had recommended. Her family doctor shared with Sue that he thought her cervical spine complaints were aggravated by the chiropractic manipulations. He then referred Sue to a neurologist for a consultation. This neurologist advised Sue to undergo physical therapy, and after a couple of months of receiving this treatment, her injuries were resolved.
Holding the Doctor Accountable
Once Sue’s physical injuries were asymptomatic, she and her husband agreed to try to reconcile their marriage. At their first session with a marital and family therapist, Sue revealed her affair with Dr. Blackett.
Sue’s husband was outraged when he learned his suspicions were right about his wife’s affair with the DC and he nearly stormed out of the therapist’s office. However, he was convinced to stay to deal with the issue.
As the therapy sessions progressed, the therapist explained that Dr. Blackett should be held to a higher standard of responsibility for the affair than Sue. The ethical codes of all health care providers warn about the imbalance of power when a patient becomes dependent on a provider of care.
The therapist stated that he believed Dr. Blackett’s efforts to make Sue dependent on him was consistent with a pattern found in sex abusers—they isolate their potential victims and attempt to foster their trust.
As part of the process to regain trust in their marriage, both Sue and her husband felt it was important that Dr. Blackett be held accountable for his actions. As a result, they filed a complaint about Dr. Blackett with the state’s Board of Chiropractic Examiners.
The investigation led to Dr. Blackett being charged with unethical conduct for engaging in a sexual relationship with an employee who was also a patient. Dr. Blackett admitted to the unethical conduct, and he agreed with the state’s proposed consent agreement.
As required by the state, Dr. Blackett underwent a professional sexual misconduct evaluation.
Although the evaluation recommended Dr. Blackett be allowed to continue to practice as a DC, it also included five years of probation on his license. Dr. Blackett would only be released from probation when he complied with the following steps:
- Taking a total of 30 hours of continuing education over three years on the topic of professional boundaries at his own expense, in addition to the standard continuing education requirements for renewal of his license,
- Receiving mental health counseling with a therapist approved by the board, as well as undergoing several evaluations at an out-of-state sex offender at his own expense,
- Notifying his staff about the state’s order, and the board receiving verification from all employees that they are aware of the state’s order,
- Being required to have a female chaperone present in the examination room every time he treats a female patient who is also an employee,
- Providing a copy of this order to both current and new female employees,
- Documenting the identity of the chaperone in each patient’s record,
- Implementing a patient satisfaction survey in his practice and providing the results to his therapist, and
- Making an appearance before the board annually or upon request.
In a related matter, Sue and her husband filed a lawsuit against Dr. Blackett alleging he engaged in an improper sexual relationship, violated state laws and improperly provided marital counseling and advice to Sue. The Greens later added allegations that Dr. Blackett failed to refer Sue to another provider for timely diagnosis and treatment and that he provided excessive chiropractic services and treatment.
Dr. Blackett tendered Sue’s lawsuit to NCMIC for coverage. Because some of the alleged acts were covered under his policy, NCMIC provided a defense for all the allegations. However, compensation for damages, losses or injuries suffered due to Dr. Blackett’s sexual improprieties, violation of certain laws and providing marital counseling and advice to Sue without a license would likely, not be covered by the policy.
Early in the litigation, the court ordered the parties to mediate this case. Dr. Blackett promptly gave his written consent to settle and NCMIC paid $75,000 to settle the case.
Dr. Blackett’s poor judgment further cost him when he re-credentialed with the HMOs, PPOs and health insurance plans he contracted with. After disclosing he was on probation from his state’s licensing board, several of them revoked his preferred provider status.
Compounding Dr. Blackett’s problems was the fact that when his NCMIC policy came up for renewal, his policy was not renewed because his license was on probation. As a result, Dr. Blackett purchased malpractice insurance from a high-risk insurer for a significantly higher premium.
Dr. Blackett continues to work on rebuilding his credibility, reputation and practice. NCMIC spent nearly $40,000 to defend Dr. Blackett in this matter.
What Can We Learn?
The personal information issue. A little red flag should go up in a doctor’s mind when the discussion turns from clinical information to the sharing of too much personal information. In hindsight, just the fact that Sue was seeing a psychologist and was diagnosed with post-traumatic stress disorder should have caused the doctor to pause. Situations where the professional and personal lines are blurred can lead to patient transference of their emotional issues onto professionals untrained in mental health such as Dr. Blackett.
The downhill slope. Dr. Blackett had no clinical reason to look at Sue’s breasts and scars—this kind of activity can only lead to allegations of sexual impropriety and other potential bad decisions. Another inappropriate decision was to offer his staff “a big kiss” for meeting certain goals. Even worse, Dr. Blackett went beyond this by questioning Sue about her sexual abuse as a child, hiring her as an employee, providing counseling on her emotional issues, engaging in sexual relations with her and paying her inappropriately.
Pay attention to disclosure. Sue clearly informed Dr. Blackett of her childhood sexual molestation and even identified one of Dr. Blackett’s patients as the perpetrator. Ignoring Sue’s trauma, Dr. Blackett hired her for a position that was detrimental to her psychological health. In addition, he fostered that unhealthy atmosphere by attempting to enthrall her with his position of power and influence.
Too much involvement is blinding. In this case, Dr. Blackett’s judgment was completely compromised. He should have recognized that months of treatment with no improvement is a red flag suggesting re-evaluation and/or referral. Compounding this therapeutic blindness was the fact that the patient requested a referral, and he failed to give her one.