I have an interesting dilemma. About a month ago, I saw a man for an independent evaluation. He claimed a TBI from an auto accident in the past year. Within the context of obtaining a history, I found out that he was in a prior accident. He did not claim a brain injury in that prior accident, but he did tell me that his wife (now his ex-wife) sustained a brief loss of consciousness in the accident.

I just discovered that I am scheduled to see this man's ex-wife for an independent examination. She is suing her ex-husband for the earlier accident.

My question is regarding what seems to be a conflict of interest. My first examination (male) was at the request of the defendent in his more recent suit. This new examination (female) would be at the request of the defendent, technically the ex-husband. Doesn't this create a conflict of interest. How can the attorney for a defendant hire an expert who was hired by a defendant to examine the then plaintiff who is not the defendant? Keeping in mind that these are two different suits, I must still consider that this is one person. Right? Before offering advice, do not address the issue of remaining impartial or objective. This is not an issue for me, as I am confident that I can do so.

Reply 1
My immediate reaction is "just don't do it." We are ethically obligated to avoid dual relationships. It seems that this situation would be quite messy. You couldn't report that the husband previously acknowledged that she lost consciousness (he might deny it now that she is sueing him!), you already have a relationship established with the husband, who, under other circumstances, you might want to interview... Better to refer to another neuropsychologist.
Reply 2
That was my initial reaction, and I probably would follow it, but I don't think it is that simple from the ethical standpoint. The patients in this case are not the clients- the attorney's are. It is obviously messy, but in this case, as opposed to a clinical case, the relationships being established are with the attorneys, not with the people undergoing testing. My brain hurts from thinking about it, but this does seem to make a difference to me. The question I have is would the information gained in evaluating the husband have any bearing on the decision regarding the wife. I know that Dr. Baker would be able to refrain from bias, but I think that the situation would lend itself to bias and therefore best be avoided, though again since the attorney's are the clients I am not sure that the dual relationship principle would apply.
Reply 3
I don't agree that attorneys are ever clients. Our duty is always to our patients. What about an evaluation, in which there is no treating relationship? Our duty is still to the evaluee, not the attorney.

I don't care who pays me (HMO, BC/BS, attorney, Work Comp, etc.), I am going to look only at the patient or evaluee, with a duty to provide the most accurate evaluation data and conclusions.

Reply 4
This is one of those "If you have to ask . . ." situations. It's murky enough that even if you could convince yourself of impartiality, it'd be even odds that I could convince someone else that this was debatable -- nothing personal, it's just that you're stuck with this human cognition thing. Gooey enough that I wouldn't even torture myself with the "does this meet APA ethical guidelines?"
Reply 5
Regardless of who is determined to be the legal "client," we still are obligated to maintain professional ethics in the delivery of our services (we could entertain other types of dual relationships to make a point - e.g., if the patient is not the "client," would it then be OK to hire the patient to be your housekeeper, to ask the patient's sister out on a date, to have sex with the patient, etc., but not any of these options with the attorney !"). We still have ethical obligations to the patient, despite that we are hired by the attorney. According to the Specialty Guidelines for Forensic Psychologists, part IV-D reads: "Forensic psychologists recognize potential conflicts of interest in dual relationships with parties to a legal proceeding, and they seek to minimize their effects." The way I read this, the relationship may be with the patient or the attorney. In this case, the wife may perceive she is being sent to "her husband's neuropsychologist," rather than to an independent party. My vote is still to refer.