Britney Spears and “Dr. Phil:” breach of patient privacy?

By , January 6, 2008 1:46 pm

Let me start by saying that I do not follow all the news stories about Spears or other celebrities. But celebrity status should not negate a patient’s right to privacy and confidentiality. So what the hell was “Dr. Phil” doing and thinking? And why did Cedars-Sinai Medical Center give him access to Spears?

According to media reports, “Dr. Phil” (real name Phillip C. McGraw) was asked by Spears’ father to go see her. Her father has the right to ask him to do that, but “Dr. Phil” — if he is acting in his capacity as a psychologist — cannot just go push himself on a patient and certainly cannot talk about anything the patient said if he is any professional capacity as a psychologist. His statement to ETonline is troubling:

My meeting with Britney and some of her family members this morning in her room at Cedars leaves me convinced more than ever that she is in dire need of both medical and psychological intervention.

That sounds like a professional judgment in his professional capacity. And there is no way that a licensed psychologist should ever make such public statements about anyone whom they saw in an intended doctor-patient relationship unless the patient provides explicit informed consent for disclosure. [Correction: I found out later thanks to doc4nuts that “Dr. Phil” is no longer a psychologist.]

Sandy Cohen of the Associated Press adds:

McGraw planned to talk more about Spears on his daytime talk show this week, the press release said.

TMZ offers some additional information that also suggests highly questionable behavior on McGraw’s part:

People on the 7th floor at Cedars-Sinai Medical Center say the doctor arrived about 7:30 AM Saturday. We’re told Britney did not invite him in; she didn’t even know he was coming. Sources say it was Brit’s parents who told Dr. Phil to go to the hospital. When he walked into her room, we’re told, a blindsided Britney walked out — and eventually came back.

Sources say Phil tried speaking with Spears for about 15 minutes — not an hour as Dr. Phil’s press release states — but she wanted none of it.

[…]

Sources say Dr. Phil wants to do a television intervention, something that isn’t sitting well with some of the people who have known for a while that Britney has a very serious mental condition — likely a bipolar disorder that is now in the red zone.

TMZ contacted Cedars to find out why the hospital let a television doctor on a floor that has such fragile patients, particularly since Britney had no idea he was coming. It’s especially troublesome that Cedars let Dr. Phil go uninvited to Britney’s room, since she had already been discharged and presumably had a right to know if someone wanted to visit. A Cedars rep made it short and sweet, telling us, “No comment.”

Clearly, a lot of this is unconfirmed, but who is looking out for patient privacy and confidentiality here? Because the incident occurred in California and “Dr. Phil” is not licensed to practice psychology in California (as far as I can tell, anyway), he may or may not have violated their laws. Did he violate Texas’s laws for psychologists? [Clearly not, since he is no longer licensed in Texas]. And did Cedars-Sinai violate HIPAA?

This is not the first time that “Dr. Phil’s” ethics and conduct would be questioned. McGraw was brought up on ethics charges by the Texas State Board of Examiners of Psychologists [pdf] in the 1980’s for having a “dual relationship” with a patient. The Board did not strip him of his license, but required him to obtain supervision of his practice for 1 year, and to complete an ethics course as well as further examinations by the Board.

Perhaps “Dr. Phil” thinks that being a “TV psychologist” permits him to make a mockery of professional ethical standards for psychologists. Perhaps he thinks that everyone “knows” he’s not conducting himself like a “real psychologist” and so feels empowered to trample Ms. Spears’ privacy.

I hope this incident is investigated by appropriate licensing boards and hospital review boards.

Update of Jan. 20th: This thread is still “live” and open for comments. I seem to have been on the warpath about people diagnosing Spears when they are not even licensed as psychologists or psychiatrists, or otherwise turning a serious matter into a media circus for their own aggrandizement or commercial interests. For those interested in the topic, you may also wish to see my later posts on this blog about Dr. Phil and Dr. Lillian Glass and their conduct:

“Dr. Phil” catches some flak and dishes some out
A complaint filed about “Dr. Phil ” but is it well-founded?
People who live in Glass psychology houses shouldn’t throw stones. They should be stoned.
Dr. Lillian Glass backpedals, but is it too little, too late?

33 Responses to “Britney Spears and “Dr. Phil:” breach of patient privacy?”

  1. Annie says:

    There’s a victim here: Britney Spears. She also has a right to claim damages from McGraw and from Cedars-Sinai.

    I’m somewhat surprised because organizations that are familiar with treating celebrities and persons of public interest are usually pretty savvy about protecting their privacy and respecting their rights. The situation, coming during a usual change of shift time period, makes me wonder if one or more meployees took money in exchange for facilitaing or outright providing McGraw with access to Spears. Most inpatient adult psychiatric units are locked, and there is usually no way for a casual visitor to gain access without specific face to face contact with a staff member. All staff have written lists of people who are permitted to visit patients – even after they have discharge orders but have not yet left the unit.

  2. Drew says:

    When I read the story the first time, that immediately came to mind. Who asked the crackpot doc to publish his (patient unsolicited) diagnosis for all to consume?

  3. Annonymous says:

    Dr. Phil did not have an established patient doctor relationship with Britney and thus can disucss his interactions with her without technically being in violation of any ethical or legal law. She cannot be his patient unless she consents to be “treated” by him which it appears she did not. Simply having a conversation with someone just because you are a psychologist does not constitute treatment. Since Britney’s parents requested that Dr. Phil visit her he can claim he was simply a friend of the family. Cedars however should have obtained her consent before allowing any visitors to enter her room. Dr. Phil probably told everyone who worked there that the family had requested his visit however since Britney is over the age of 18 they should have obtained her permission first.

  4. Lori says:

    This is EXACTLY what I thought when I heard the press release. I am not a particular fan of either celebrity, but Brittney needs “psychological intervention” according to Dr. Phil, and she deserves the intervention and the privacy and professionalism that is her right. I usually don’t get my “panties in a bunch” over this type of stuff, but I am outraged. Even if she agreed to the press release (which I doubt), her desire for the publicity is a symptom of underlying conditions. Reinforcing that behavior will only continue to disintegrate her mental condition.

    The HIPPA Laws exist for a reason.

  5. dissent says:

    @Anonymous:

    I agree she was not his patient. But you don’t make “diagnostic-sounding” statements like “she needs treatment” when you know that your words will be given undue weight because people know you have a professional license in the field. And you don’t try to solicit a very vulnerable patient to come on your show to promote yourself.

    The ethics code also covers non-established relationships. Consider this provision from the APA ethics code:

    5.06 In-Person Solicitation
    Psychologists do not engage, directly or through agents, in uninvited in-person solicitation of business from actual or potential therapy clients/patients or other persons who because of their particular circumstances are vulnerable to undue influence. However, this prohibition does not preclude (1) attempting to implement appropriate collateral contacts for the purpose of benefiting an already engaged therapy client/patient or (2) providing disaster or community outreach services.

    Of course, the ethical standards only apply to psychologists when they are in their professional capacity and he will argue that he wasn’t. But I would argue that he was soliciting her for a counseling relationship, even if it was to be a televised one.

    McGraw’s show may be for “entertainment” purposes, but she didn’t come on his show — he went into her hospital room, unsolicited. There’s nothing entertaining about what he and the hospital have done. I think that California needs to crack down on using “entertainment” as an excuse for offering professional services without a license and without controls.

  6. I found this blog because I googled, “Dr. Phil breached patient confidentiality Britney Spears.” She has the right to sue him for violating her privacy in regard to patient confidentiality. I hope she doe! She’s already in trouble she doesn’t need this.

  7. will says:

    I am a Master’s student currently working on an adult psychiatry floor as an intern. Every day I get information release forms signed by the patients, usually only for family practice doctors and immediate family members. I am not sure what the laws are in California, but I know that in the state I am in NOBODY can visit the patient (other than staff and medical personal on the unit) without explict written consent from the patient. Futher, we cannot even disclose if a patient is in fact on the unit without explict written authorization. That McGraw was able to gain access in the way that the media is reporting is nothing short of major ethical and legal breaches of confidentiality. That he immediately reported information about her to the media is completely unprofessional in almost every manner. Spears is never going to get the help she really needs if every time she is hospitalized, her mental health workers speak directly to the press and plan to do television shows about her condition. It is absolutely absurd to think otherwise, and McGraw knows this. I think it is safe to say that he stopped being a professional a long time ago.

  8. dissent says:

    Nadine: as far as I know, she can’t sue him for violating patient confidentiality if she was not in a professional relationship with him. If there is a cause of action for him being a total sleazeball, then I think she would prevail.

    I don’t know if you all saw this story, but a number of psychiatrists also “slammed” the hospital for their role in this.

    And I was so ticked off that I submitted something to the California Board of Psychology, who probably has the power to sua sponte open an investigation or refer it to the appropriate agency for investigation (with respect to “Dr. Phil”). I suspect that this has come up before and that he will “walk.” As to the hospital personnel’s role, that should probably be a complaint to the HIPAA Compliance Officer for the hospital. As I recall the HIPAA regulations, you don’t need “standing” to file a complaint, if anyone is so inclined.

    FWIW, I have included this incident in the compilation of medical privacy breaches and incidents I tabulate for the Medical Privacy Project part of the PogoWasRight.org site because “Dr. Phil’s” role aside, I believe that the hospital violated HIPAA by even talking with him at all without her consent, much less admitting him to her room.

  9. doc4nuts says:

    He IS NOT licensed anywhere is the US. He was but is now practcing without a license-a felony in CA.

  10. Joanne MacPherson says:

    I too found your blog searching for answers on why Dr.Phil was permitted access to Britney Spears at Cedars hospital. It is sickening what he gets away with under the title of “Dr”. If he is a board certified psychologist he needs to be sanctioned now.

  11. dissent says:

    Update: “Dr. Phil” defends himself and the hospital in this report.

  12. dissent says:

    @doc4nuts: he let his license lapse in Texas? Sheesh.. I didn’t know that. Thanks for the info. You’re right: I don’t see him listed in current Texas licensees.

    Joanne: he can legally use the title “Dr.” in California because you don’t need a license to use the title — just a doctoral degree. Think of “Dr. Laura,” whose degree wasn’t even in psychology and who was giving advice with an inactive California Marriage Family and Child Counseling (MFCC) license.

    My money still says he walks on this… unless California really decides to make an example of him. If they really want to get him, can probably find a way. And I really wish they would.

  13. Jen says:

    It is interesting that we cannot leave messages on the Dr. Phil mesage boards about this.

    As someone who takes lithum every day for Bi-Polar illness one of the worst things a doctor can do it make my life, in any form, public. What is so sad is I know Dr. Phil knows this.
    He had no business going on TV to talk about Britney.

    Would be interested in knowing if he is , indeed her doctor or welcome in her room. SHE DOES HAVE RIGHTS.

    Thank God for my doctors. All I can say is take your medicine , get blood levels every three months and see your physician.

  14. dissent says:

    Another article about his conduct was published by the Associated Press today.

  15. Don Eisner says:

    As a psychologist and attorney in California(and Instructor in Law and Ethics in Mental Health), I have concerns about the role of “Dr Phil.” First, a check of the California Board of Psychology Website apparently confirms as noted in a prior post,that he is not licensed as a psychologist in California. Therefore, he may be practicing psychotherapy without a license when attempting an intervnetion. Since he is discussing diagnostic issues, this should be consdidered as clinical contact. He unilaterally established a “therapist”/patient relationship. As such,he would need a release from the patient to talk about the case or even state she was his patient.

    There may be a loophole in terms of Board of Psychology ethics violations for breach of confidentiality, but there could be an invasion of privacy issue. Dr.Phil provided the public with private information.

    If he were licensed, he would be in a dual relationship: psychotherapist/talk show host. The conflict of interest or exploitation is that he had a possible non-therapeutic agenda,which was to have a new patient appear on his show.

  16. Melanie says:

    I’m so glad this issue is being discussed! I’m a licensed psychotherapist in two different states, and all of the above-metioned issues crossed my mind when the news reports first appeared. Why was he allowed in her room without written consent from her? Why on earth is he blabbing about sensitive, confidential issues to the press? Why would he want to do a show about an obviously friagile girl?
    The answer is clear – self-promotion. Unethical doesn’t even begin to describe it. It’s disgusting and pathetic.

  17. dissent says:

    I’ve provided a bit of an update in a later blog entry, for those who want to see an interview with a Spears family spokesperson on The Today Show.

  18. Anonymous says:

    I can not stand that Dr. Phil. I feel he should lose his foolish television show just as that Dr Laura did. Show businness is not a medical practice and there needs to be a clear distinction and lets use Dr. Phil as an example by cancelling his show. .

  19. anonymous says:

    This (Dr.) Phil – and I use this term lightly because he is not a medical doctor, he is not even licensed right now to practice psychology. He has always had a problem with ethics as he previously hired a former patient in Texas and that 19 year old woman said they had a sexual relationship. Of course, he did not even finish the ‘required’ sanctions that Texas required him to complete.

    The Spears family has since come out stating that they are very angry w/ Dr. Phil right now because they had asked him, in a position of ‘trust’, to pay a visit to Britney. His publicist has since made a statement from Dr. Phil, saying that he stands by his position. This guy knows he was wrong, but will not admit it. I hope some medical professionals take this beyond where it stands right now and petition that Dr. Phil be taken off the air and/or be sanctioned somehow. However, how do you get sanctioned when you are not even licensed? Please go after this creep!

  20. Robert Gore, Ph.D. says:

    For quite some time, Dr. Phil McGraw has been making a mockery of psychotherapy through his television show. What kind of therapist has to pay people to undergo his treatment? He is another in a sad line of media hounds who have highly questionable credentials and/or misuse and misrepresent psychological knowledge and practice. Other notorious examples include “Dr.” Laura (who has no doctorate in psychology or psychiatry, but instead in physiology – not the brain kind even) and childrearing “expert” Dr. James Dobson. One commentator on these sad events has a Psy.D. from an online university of highly dubious repute (the Southern California University of Professional Studies, which advertises that you can get your degree while playing with your family). Dr. Drew Pinsky is engaging in seriously questionable behavior with his new celebrity rehab show and is justifying his actions on the strange ground that his minor celebrities couldn’t afford treatment otherwise.

    When will the public wise up and stop watching quacks?

    Robert Gore, Ph.D.
    Associate Director of Clinical Training
    Clinical Assistant Professor of Psychology
    Ph.D. Program in Clinical Psychology
    Department of Psychology
    University of Southern California

  21. dissent says:

    The professional organizations need to do a better job of educating the public that these “Drs.” are not licensed professionals and are not bound by professional standards or ethics.

    In large part, I think that this is also a scope of practice issue, but if we try to address it, we’ll be accused of just trying to protect our own interests/guild, etc. But as long as certain types of activities are not restricted to licensed professionals, we’ll continue to see sleaze like these folks raking in big bucks while possibly doing harm to individuals.

    At the very least, each and every show should have a huge disclaimer at the beginning that says, “This show is for entertainment purposes only. The “Dr.” is not a licensed mental health professional, does not necessarily adhere to ethical standards for any recognized mental health profession, and would rather chew nails than actually engage in research-validated therapeutic approaches.”

    I do not see why California consumer protection or some board can’t require such disclosure or better protections for the public.

  22. dissent says:

    Update: The NY Times has a piece on this controversy. In it, the author suggests that I questioned whether Cedars-Sinai violated HIPAA “by allowing Ms. Spears’s parents to invite Dr. Phil to her room.”

    To be clear: I did not question whether Cedars-Sinai violated HIPAA by allowing the parents to invite him. The issue is that as an adult, Ms. Spears has rights, irrespective of her parents’ wishes. I questioned whether the hospital violated HIPAA by not obtaining Ms. Spears’ consent to let him enter her room. As a patient, she has a right to privacy, doesn’t she?

    The NY Times piece includes something that I had not read elsewhere. A CBS spokesperson said, “He was escorted to her room by family members, and she greeted him. There was no drama of any kind.’’ (Corrected to read CBS, Jan. 11, 2008)

    Interesting that none of the media stories I read mentioned that her family was present at the time.

    I’d still like to see some serious discussion of the hospital’s responsibility to a patient who was admitted involuntarily with respect to protecting their privacy.

  23. Dr. Johnson (Psychologist in Texas) says:

    Money trumps ethics. Not as it should be, but as it is.
    The budgets of State Licensing Boards are limited. Dr. Phil is rich. He would drain the legal budgets the board and so limit the board’s capacity to deal with other issues. I expect that is why they leave him alone.

    In the meantime his acts reflect very badly on our profession and erode public trust.

  24. Simon says:

    Shame on Oprah, and as for Brit – sue.

  25. Sorry folks.

    The Health Insurance Portability and Accountability Act of 1996 (HIPAA) does not provide for a private right of action. So Ms. Spears could not sue Dr. Phil under HIPAA if she wanted to. She can only file an administrative complaint with the Office of Civil Rights headed by Winston Wilkinson at the U.S. Department of Health and Human Services (with the other 25,000 pending complaints).

    See my web-site oif you desire more information.

    http://www.BarbClark.org

  26. dissent says:

    Yep. I pointed out that HIPAA would apply to the hospital’s actions, not his. I still would like a complete disclosure and review of the hospital’s actions with respect to patient privacy and whether anyone who shows up to visit anyone is just admitted.

    Your site looks interesting. I’ll check it out. Re private cause of action: Acosta v. Faber, discussed in this post, has an interesting workaround for using HIPAA as a basis for private cause of action.

  27. Jeff says:

    I’m a student of psychology and, since the first time I saw him, have wondered how this clown who calls himself a doctor can do what he does. Like has already been said many times, he is ruining peoples perception of psychology
    and scaring away those who would otherwise seek help from a true professional. At least those of us who know better can, if we allow ourselves to see past our anger, get a good laugh at this guy. Just makes you wonder how much damage this Bozo has already done.

  28. HOPEFORALL2006 says:

    GET OFF IT PEOPLE.HE’S A GREAT GUY.DONT LISTEN
    TO EVERYTHING YOU HERE.THE MEDIA WILL KILL
    BRIT BEFORE ANYTHING ELSE LIKE PRINCESS
    DIANA!I GUESS WE ALL FORGOT THAT TRADIDY.
    DR.PHIL IS NOT A BAD PERSON IF YOU KNOW
    ANYTHING ABOUT HIM AT ALL WHICH I CAN SEE THAT.
    IF THAT WHERE MY KID I WOULD ASK FOR HIM TOO.
    THERE’S A ARTICAL AWHILE BACK BEFORE ALL THIS
    THAT THE PARENTS ASKED FOR HIS HELP.HE DIDNT
    DISCUSS ANYTHING ABOUT ANTHING THAT HAPPENED!
    SO GET OFF OF IT ALREADY AND PUT THE BLAME
    WHERE IT BELONGS!!!!!! [HOPE]

  29. Wendy says:

    What Phil McGraw did by discussing his visit to Spears and her parent’s request that he visit her has nothing to do with whether he is legally liable or not.
    It has to do with common decency and professional ethics. He simply used his celebrity status ….to boost his celebrity status! But that is just the tip of the iceberg.
    The whole phenomenon surrounding this young woman and the cult of celebrity in this country should raise red flags about who and what we are as a society. The photographers and publishers of the rags and the people who crave this information should be doing as much soul searching as Dr. Phil.

  30. Rachel says:

    How do we stop this man? He is a fraud (not a doctor) and leaves a skewed view on professional mental health.

  31. dissent says:

    I think the recent bad press he got has made him a bit more cautious. In a recent TV appearance, he was very careful to be clear that he is not a psychologist, etc. And that’s progress as far as I’m concerned. Then, too, Dr. Glass (see my blog entries about her) has also suddenly showed more restraint. So maybe the blogosphere had some impact of a positive nature, as a number of bloggers went up in arms over this matter.

  32. I am not defending Dr. Phil’s actions, goodness knows…but when you see a sign that says “beware of the dog” and you enter the yard anyway, is it the dog’s fault? The Spears family surely knew with whom they were dealing when they invited Dr. McGraw to meet with their daughter, whether as a private citizen or not.

  33. For those concerned about the Dr. Phil / Britney “mishaps!” please join in National “Guru-Free” Week beginning April 1st (Fool’s Day)!

    Be well

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