Mary Alice Fisher, PhD, has heard many horror stories about what happens when a practicing psychologist dies without a professional will. “I got a call from a private practitioner’s secretary, who said, ‘The person I work for just died, and I don’t know what to do,’” says Fisher. The practitioner’s secretary couldn’t access patients’ records. She didn’t know which clinicians to refer patients to. And because she wasn’t a clinician, she didn’t have the training to handle patients’ reactions when she called to tell them their psychologist had died. Says Fisher, “It was a mess.”
Unfortunately, this kind of scenario is not unusual, says Fisher, who is the executive director of a Charlottesville-based organization called the Center for Ethical Practice, which provides continuing education workshops and additional resources to psychologists and other mental health professionals. To avoid any potential problems, it’s essential to have a professional will, which lays out what happens with your practice if you die or become incapacitated. (If you work for an organization, your employer will have its own policies.) Similar to a personal will, a professional will names a trusted colleague as your professional executor and provides the information that person will need to close down your practice.
Your professional executor has many jobs, explains private practitioner Denise Davis, PhD, of Nashville, author of “Terminating Therapy: A Professional Guide to Ending on a Positive Note.” An executor will protect and manage access to your current and past patient records; notify your patients and make referrals to other mental health professionals if continued treatment is necessary; and complete any tasks involved with closing down your business (such as terminating your lease or collecting outstanding payments).
Here are some steps to take to protect your patients and make it easier for your colleagues and family members to tie up loose ends with your practice:
- Don’t delay in writing a will. Disaster can strike any time. “A professional will is an important thing to have long before you retire,” says Fisher. “It’s an ethical issue: Without it, your patients, clients and ex-clients are unprotected.” APA’s Ethics Code (PDF, 273KB) requires private practitioners to “make plans in advance to facilitate the appropriate transfer and to protect the confidentiality of records and data in the event of psychologists’ withdrawal from positions or practice” and to “make reasonable efforts to plan for facilitating services in the event that psychological services are interrupted….” APA Services has a sample professional will (PDF, 254KB) you can use as a template.
- Know your state laws. “In some states, confidentiality follows you to the grave,” says Jeffrey Zimmerman, PhD, co-founder of the Practice Institute, a consulting firm that helps behavioral health practices thrive. Of particular concern is access to patient records. “If a patient dies and your executor requests that [patient] information for some reason, legally they can’t get it in some states unless there’s a court order.” Make sure your professional executor also understands the rules and regulations of your state, adds Zimmerman, who explains that being attuned to confidentiality issues is another reason a fellow psychologist is the best professional executor. “You can’t just have your cousin do it,” he says.
- Orient your executor and your clients. Serving as an executor involves a lot of responsibility, so make sure the person you tap for the job understands the scope of their work, recommends Christine Courtois, PhD, of Washington, D.C., who had to step in when a colleague unexpectedly died. You’ll also need to give your professional executor all the information he or she will need to act on your behalf, such as patient contact information, how to access your current and past client records, passwords to your email and voicemail accounts, even where the keys to your office are. Use APA Services’ template of information for a professional executor (PDF, 237KB) to gather that information in one document and update it regularly. Include a copy in your personal will and give copies to your professional executor, attorney and liability insurance carrier.
- Inform your clients. APA Services advises adding a section to your informed consent document alerting patients that the person you’ve named will be in charge of their records if something happens to you.
- Appoint a representative for short-term absences, too. It’s not just death or disability you need to prepare for. “Let’s say you close your practice temporarily because you’re going to India and are going to be unreachable for six months,” says Zimmerman. “You’re still going to need someone to handle questions that come up or act on your behalf if something is needed.” In such cases, he says, you should appoint someone who will be available and can make appropriate decisions on your behalf. “It’s like a professional will, but it could be very short-term,” Zimmerman says.