Eye on Ethics
One Simple Mistake — Ethics Catastrophes
By Frederic G. Reamer, PhD
Several troubling cases crossed my path recently, and they have a common theme: Talented and principled social workers can find themselves in ethical hot water as a result of the simplest of errors. In one case, a dedicated clinical social worker employed by a prominent mental health center was housebound because of a blizzard. The agency director asked professional staffers, all of whom were able to access their encrypted clinical records from home by logging into the agency's database, to do as much work from home as possible. The social worker used this opportunity to bring his clinical notes up to date. He logged in to the records of clients he had seen the day before and completed his notes. The social worker took a selfie as he worked from home, sitting at his computer, and posted the photo on his Facebook page with the following caption: "We're completely snowed in today, but I'm so dedicated I'm working from home. See?!"
What the social worker failed to realize was that the photo he posted included considerable identifying information from his client's electronic record that was on the social worker's computer screen when he took the photo. The social worker's supervisor, who was the social worker's Facebook friend, saw the photo, enlarged the image on her computer screen, and was able to read detailed identifying information, including the client's clinical diagnoses. Clearly, this was a violation of the client's privacy and confidentiality rights as defined in the NASW Code of Ethicsand various federal and state laws.
The supervisor shared her concern with the social worker, who was horrified by his error in judgment, then informed the agency's director of human resources. The social worker was fired from his job because of this egregious ethics violation.
In another case, a social worker who served as a supervisor in a major health care system sent an e-mail to colleagues that appeared to mock people who committed suicide. The e-mail, which was sent shortly before the Christmas holiday, included a photograph of a toy elf pleading for anxiety medication and hanging itself with an electrical cord. The social worker resigned from her position after the story went viral on social media and generated widespread outrage. The state licensing board suspended her social work license.
In a third case, a social worker was formally sanctioned after she posted comments on Facebook about a child protection case. One post was accompanied by a small map that pinpointed the location of the court that handled the matter. At a disciplinary hearing, the social worker testified that she thought her Facebook post was available only to her friends. However, the mother of the children in the protective custody case discovered the Facebook posting when she conducted a Google search for information about the social worker. Also, the social worker's supervisor was able to access the posting by conducting a simple Google search of the social worker's name. The social worker acknowledged confusion about her Facebook privacy settings.
The Moral of the Stories
The social workers involved in these three cases presumably meant no harm. They made simple mistakes that had enormous consequences. So, what's to be learned from these missteps?
Ethical challenges in social work come in all kinds of shapes and sizes. In my experience, they tend to fall into three broad groups. First, some ethical challenges arise when social workers find themselves on the horns of a genuine dilemma. These are instances where social workers must make difficult decisions in the face of conflicting duties and obligations. For example, in one case a social work supervisor at a mental health agency discovered that a former client of hers had been hired to work in a program that falls under the social worker's administrative duties. The social worker was not aware that her former client had applied for a job at the agency and was not involved in the hiring decision. The social worker realized that she faced an ethical dilemma. She had to decide how to handle this conflict of interest and boundaries issue; the social worker understood that it would not be ethical for her to serve as a job supervisor for someone who had once been a clinical client. The social worker knew she needed to consult with an agency administrator about how to handle this ethical dilemma, but was unsure about whether she should or could share confidential information about the client's clinical challenges during the consultation.
In another case, a clinical social worker in an addictions program in a suburban community provided services to a young man who struggled with alcoholism. The client attended Alcoholics Anonymous meetings as part of his recovery. It happens that the social worker was also in recovery. One evening, the social worker attended her own AA meeting, which was located quite some distance from the social worker's home and worksite, and discovered that, coincidentally, her client had shown up for the same meeting. The social worker had to make an ethical decision about how to handle this dilemma in order to maintain solid professional and personal boundaries.
A second type of case involves ethical misconduct. Sadly, a very small percentage of social workers do engage in severe misconduct. In one case on which I consulted, a seasoned clinical social worker who worked at a large medical center provided services to clients with significant trauma histories. It turns out that this social worker engaged in sexual relations with several clients. One of the clients filed a complaint, which led to a sweeping investigation. Media publicity about the investigation led to other victims disclosing how the social worker abused them sexually. The social worker was fired, sued by his victims, lost his professional license, and sentenced to prison.
In another ethical misconduct case, a clinical social worker in private practice billed a prominent health insurance company more than $100,000 for services she never provided. She was indicted, convicted, and is now serving a 30-month sentence in federal prison.
And then there is the third category of cases. These involve good social workers who had a very bad moment and made a serious ethical mistake. Typically these are social workers who have led stellar professional lives and had a momentary, albeit serious, lapse in judgment.
The moral of the story is that social workers must always be on their ethics toes. No one can afford to let down their guard. Being ethical requires constant vigilance.
— Frederic G. Reamer, PhD, is a professor in the graduate program of the School of Social Work at Rhode Island College. He's the author of many books and articles, and his research has addressed mental health, health care, criminal justice, and professional ethics.