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Dr. McGee: Wow. How did that turn out?

Dr. Firestone: The medical board interviewed him, and she also reported it to his employer and the
employer asked for his resignation and the medical board was about to take action against him and he
decided to surrender his license. I'd felt that he was premature in doing that, but he decided that, "I might
as well retire, I don't want to be on probation." So, both of those I guess address various kinds of
boundary violations.

About 20 years ago I represented a psychiatrist from Orange County who contacted me because Orange
County had essentially sanctioned him by suspending him from Orange County and of course that was a
suspension to the American Psychiatric Association which would have gone to the medical board for some
kind of investigation. Apparently, what occurred is he had a patient a few years earlier, having treated her
successfully, they terminated care amicably and about a year or two later they are both at a coffee shop
and met each other having a cup of coffee and they struck up a conversation and that ultimately led to the
two of them developing a romance and getting married. The Orange County Psychiatric Society felt that
that was a boundary violation even though they were married.

He asked me if I would appeal this to the American Psychiatric Association, because of course, ultimately
the APA is the entity that makes the final decision, and the Orange County Psychiatric Society can only
make recommendations. So, we appealed it, went to Washington DC, and I presented the arguments. He
had two outstanding forensic psychiatrists, one of which was a past APA president, who was also on the
APA appeal board, but he recused himself. I quoted some of their writings and argued, and ultimately the
appeal board decided that this was unfair in some ways and reversed the decision by the Orange County
Psychiatric Society.

Those are three that come off the top of my head. I mean, I could think about probably another half dozen
of other cases, but I think that those somehow drive the point about boundary violations and boundary
crossings. A boundary crossing is essentially something that is benign, but not a good idea so it's
considered a minor ethical violation. A boundary violation is considered a major ethical violation. I wrote
about the boundary crossings and boundary violations about two years ago in the newsletter, if anyone
wants to look up those two articles. I think I did a series of three, actually.

Dr. McGee: Thank you for sharing these stories. As we come to a close on this, I guess I'll reflect that our
jobs are difficult enough and stressful enough without adding the unbelievable stress of going through a
board hearing or litigation, which many of us have come through a malpractice litigation, which is
incredibly stressful and very difficult. So, it's very good to be mindful about these boundary crossings and
violations because it's just one extra source of adversity and stress that we can avoid.

Dr. Firestone: What I have found in representing physicians, and previously I have represented other
people besides physicians. But what I have found is of all the professions, physicians and especially
psychiatrists, identify very closely with being a physician. And whenever there is any kind of complaint
allegation or accusation of the physician's competence or the physician's ethics, it really hits them right in
the heart because the physician is who they are. And I don't know of any other profession that identifies
so closely with their profession. So, I think whenever there is this kind of litigation, whether it be in an

ethics forum or an accusation or a medical malpractice, you're right, it's very stressful. And I believe it's
stressful specifically for a position because of how closely one identifies with the profession that one is a
member of. I even wrote a chapter in a medical malpractice handbook about five years ago and the
chapter was on malpractice stress syndrome, and I equated it to something similar to a post-traumatic
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NORTHERN CALIFORNIA PSYCHIATRIC SOCIETY Page 11 JANUARY/FEBRUARY 2022