ABSTRACT
Imagine yourself in this nightmare: You are a successful psychotherapist in a busy solo private practice and are taking a muchneeded ski vacation with your husband and children in Utah. On the second day, you decide to try skiing down a more difficult slope. Suddenly, unexpectedly, you hit a tree. The accident leaves you seriously injured, without speech. Your career as a psychotherapist is abruptly interrupted. You cannot contact your patients yourself, and no one else knows their names, nor where you keep the keys to your files, nor the password for your computer in order to access your patients’ records. You cannot help your patients deal with this tragedy and sudden loss of your services, nor can you help them consider alternative solutions to meet their needs for ongoing treatment. You are especially concerned about those who have experienced deaths of parents when they were very young For them, losing you without preparation or discussion with you will likely feel like another abandonment. You always take care to prepare your clients for your vacations. You had planned to prepare them in advance of your retirement, too. Now what will happen? How will your patients have access to their records so other professionals can take over their care? Your husband and adult children are helping you get the urgent medical care you need. But it has always been inappropriate for them to know your patients’ names and see their confidential records. They cannot help with your professional emergency. What do you do? Practitioners are clinically, ethically, and legally compelled to take reasonable steps to assure continuity of care for patients when their practices are temporarily suspended or permanently closed. Nevertheless, many practitioners in independent practice and other settings are unaware of how to carry out this critical responsibility in advance of an interruption in services, such as in the tragic circumstances above. Often they have not developed policies and procedures to ensure the ongoing clinical care of their clients, adequate protection for the confidentiality of client records, or access to those client records by appropriate agents after clinicians’ retirement, incapacitation, or death. Professional organizations have only recently begun to give attention to the urgent need for policies and procedures in this area (North Carolina Society for Clinical Social Work, 2000; Salomon et al., 1997). Establishing proactive procedures for management of tasks involved in suspensions or closures of practices is essential, as it protects and comforts everyone who is directly and indirectly involved with the clinician’s practice.
