Retired Military Patriot
Although given the forensic situation, technically there may have been no violation of confidentiality, Ms. Duley's behavior from a clinical and ethical perspective is certainly open to question. One of the reasons that confidence is so zealously protected is that patients in treatment frequently say things that could prove harmful or, at least, embarrassing if they were to became public. Furthermore, statements made in treatment reflect the patients perceptions, emotional status, and environmental pressures. They don't necessary reflect reality as others might see it. One of the tasks of the therapist is to help the patient sort out facts from often distorted perceptions. Thus, one tries to avoid damage to a patient by sharing the contents of sessions. This case raises some serious questions about the actions that Ms. Duley took and why they were even necessary. To some extent, her actions may have been the result of inexperience or lack of training. Although you refer to Ms. Duley as a "social worker" and she has been called that in some reports, as I mentioned in a prior post http://letters.salon.com/opinion/greenwald/2008/08/01/anthrax/permalink/a2a0481d5358c6907de2af42aa6e5594.html, I have found no documentation that she is, indeed, a social worker and she may have only undergraduate and some chemical dependency training.
These are some of the questions that I have:
1. Why was a restraining order/peace order on Dr. Ivins required? According to numerous reports, Dr. Ivins was under heavy surveillance and Ms. Duley was working closely and cooperatively with the FBI according to her own report. Given that level of federal protection, what was the purpose of seeking a PO with local police? Certainly they could have been alerted (and I hope were) but what was the specific need satisfied by a PO?
2. Given that she did go that route and her testimony contained substantial information that could be prejudicial in a trial, why did the judge not seal her testimony and associated documents? Why were copies of her request and audio recording given (or leaked) to the press? I won't even ask why the press released this information.
3. If she was working closely with the FBI, and supervised by an independent professional, why did they not warn her or the judge about the risks inherent in filing a PO. Note that although there are references to Ivins' "psychiatrist" lurking in the background, no such person has come forth with an independent professional evaluation.
Unfortunately, this disrespect for patient rights (whether inadvertent of deliberate) has left us with the press and cable channels spewing her complaints without caution or explanation and giving her credibility as his "therapist." This is trial in the Court of Public Opinion. The government has not yet made a convincing case for Dr. Ivins' guilt and Ms. Delay's testimony has not been challenged on cross examination. Dr. Ivins' suicide (if that is what it was) conveniently avoids the accountability of a court trail. That provides a compelling argument for a congressional hearing to determine the facts in this case and, if he was innocent as many people believe, to provide a means to clear his name and give some comfort to his family.
[Read lcr's other letters]
I would add that I question why live testimony was necessary to get a temporary restraining order. It seems like overkill and smacks of orchestration.
I agree that the first hearing could have been sealed, and the public interest in open courts could have been met by opening the hearing on a permanent restraining order when Ivins was expected to be present.
Another good comment from the same person:
I'm not sure about the reason for your comment but suspect you've not read my prior posts or you wouldn't have made assumptions about the quote that you use. As a psychologist, I'm well aware of confidentiality issues -- and the limits on confidentiality. As Annie W discovered, clients are (or should be) routinely informed on the limits of confidentiality. We do have a duty to report and, if subpoenaed, must provide requested records. That is not the issue here. If Duley honestly believed that Dr. Ivins was a threat to himself or others, she had a duty to report and apparently did -- leading to his brief hospitalization. That's appropriate and, except for whatever additional stress was imposed on the patient by the hospitalization, would have been the end of that story. What was not required was for her to to initiate a restraining order or for it to be handled in the way it was. What that filing accomplished was not only an egregious violation of patient privacy but has provided the media with talking points that they are gleefully repeating, that smear Dr. Ivins' record and name and that provide cover for the FBI's desire to close the case -- nothing here, the guy was crazy, move on.
If you're interested in my concerns about the restraining/peace order (as opposed to the duty to warn), please see here:
[Read lcr's other letters]
Permalink Sunday, August 3, 2008 05:30 PM