BEFORE TH E ARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS

BEFORE TH E ARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS In the Matter of: TINA BAKALlS, LPC- 0 Licensed Professional Counselor and COMPLAINT NO. 0-00 L1SAC-1 01, Licensed Independent CONSENT AGREEMENT AND ORDER Substance Abuse Counselor, In the State of Arizona. Respondent 1 1 In the interest of a prompt and speedy settlement of the above captioned matter, consistent with the public interest, statutory requirements and responsibilities of the Arizon State Board of Behavioral Health Examiners ("Board"), and pursuant to A.R.S. - (H and 1-.0(F)(), Tina Bakalis ('Hespondent") and the Board enter into this Consen Agreement, Findings of Fact, Conclusions of Law and Order ("Consent Agreement") as a fina disposition of this matter. RECITALS Respondent understands and agn~es that 1. Any record prepared in this mauer, all investigative materials prepared or received b the Board concerning the allegations, and all related materials and exhibits may be retained i the Board's file pertaining to this matter.. Respondent has the right to a formal administrative hearing at which Responden can present evidence and cross examine' the State's witnesses. Respondent hereby irrevocabl waives her right to such formal hearing concerning these allegations and irrevocably waives he right to any rehearing or judicial review relating to the allegations contained in this Cansen Agreement, Findings of Fact, Conclusions of Law and Order. -1 H:\Patly\Consent Agreements\CA Bakalis 0-01 OO.doc

. Respondent has the right to consult with an attorney prior to entering into thi Consent Agreement.. Respondent acknowledges and agrees that upon signing this Consent Agreemen and returning it to the Board's Executive Director, Respondent may not revoke her acceptanc of this Consent Agreement or make any modifications to it. Any modification of this origina document is ineffective and void unless mutually approved by the parties in writing.. The findings contained in the Findings of Fact portion of this Consent Agreement ar conclusive evidence of the facts stated herein and may be used for purposes of determinin sanctions in any future disciplinary matter.. This Consent Agreement is subject to the Board's approval, and will be effective onl when the Board accepts it. In the event the Board in its discretion does not approve thi 1 1 Consent Agreement, this Consent Agreement is withdrawn and shall be of no evidentiary value, nor shall it be relied upon or introduced in any disciplinary action by any party hereto, excep that Respondent agrees that should the Board reject this Consent Agreement and this cas proceeds to hearing, Respondent shall assert no claim that the Board was prejudiced by it review and discussion of this document or of any records relating thereto.. Respondent further understands that once the Board approves and signs thi Consent Agreement, it shall constitute a. public record that may be disseminated as a forma action of the Board. The Board issues the following Findings of Fact, Conclusions of Law and Order: FINDINGS OF FACT 1. Respondent is the holder of License No. LPC- 0 for the practice of professional counseling and License No. L1SAC-'1 for the practice of independent substance abuse counseling in Arizona. - H:\Patty\Consent Agreements\CA Bakalis 0-01 OO.doG

. Beginning in 01/0 while in private practice, Respondent provided treatment to 1 1 Client for two years.. Client was seriously mentally ill with dissociative identity disorder, post traumatic stress disorder related to a history of sexual abuse as a minor and major depression that included frequent suicide ideation.. Respondent failed to obtain an informed consent for treatment from Client.. Respondent failed to maintain an annual written treatment plan for Client.. Client requested that her records be sent to another practitioner. Respondent failed to document the request, failed to provide the records, and failed to document her justification for not providing the records.. Respondent stated that she and Client had - weekly telephone discussions. Respondent failed to document a large rrajority of these telephone discussions.. Respondent stated that Clien t's sessions often lasted hours. Respondent fa iled to document the duration of Client's sessiors on the large majority of her progress notes.. The large majority of Client's progress notes were not signed by Respondent.. Respondent's progress note:, for Client's years of treatment were largely a verbatim recordation of Client's statements.. Respondent's progress note:, for Client's. years of treatment did not reflect Respondent's assessment of the status of Client's behavioral health issues or her treatment progress.. Respondent asserted that she monitored and assessed Client's suicide risk on more than 1 occasion. Respondent failed to document the sessions when these monitoringslassessments occurred or the!ir results.. Respondent asserted the fol lowing, but failed to document any of this information in the Client's records: - H:\Patty\Consenl Agreements\CA Bakalis 0-00.doc

1 1 a. She made repeated attempts to refer Client to a higher level of care. b. Client terminated treatment with Respondent on occasions. c. Client had telephoned Respondent and was furious that Respondent had abandoned Client. d. Respondent released Client and offered to assist Client in finding another therapist. e. Another practitioner had forced Client to file the complaint against Respondent. f. Respondent encouraged Client on numerous occasions to seek treatment elsewhere because Respondent had never had DID training. g. Respondent had treatment goals for Client. h. Respondent took Client to Respondent's church because of Client's belief that Client was experiencing satanic possession in order to obtain relief for Client.. Respondent stated that she usually hugged Client on beginning and terminating a session. Respondent stated that she occasionally held Client's hand.. The International Society for the Study of Dissociation ("ISSD") Guidelines for the Treatment of Dissociative Identity Disorder ("DID") in adults generally do not recommend physical contact as a treatment technique with this type of client. They also warn that there is a significant potential for "client reenactments of boundary violations.". Respondent's choice to engege in physical contact with Client posed a reasonable possibility of physical or psychological ha rm to Client.. The ISSD Guidelines indicatn that DID patients are prone to eating disorder symptoms and clinicians treating DID patients are advised to vigorously address and manage these types of behaviors and to recognizh that these problems may require referral to specialized treatment programs. 1. Respondent asserted that Client would eat only foods and feared going to a hospital because of the food provided at a hospital. 1. Respondent did not document or collect sufficient information to accurately assess the scope and severity, monitor, refer, or otherwise therapeutically address Client's eating disorder. - H:\Patty\Consent Agreements\CA Bakalis 0-01 OO.do~

. Respondent failed to recognize or appreciate the need to maintain strict professional boundaries with Client when Respondent responded to - weekly telephone calls from Client, conducted a treatment session at a coffee shop because of Client's decompensation and limited ability to travel, conducted multiple treatment sessions at Client's home when Client had extreme emotioncll issues or was too ill to drive to Respondent's office, shared with Client Respondent's fleeting suicide ideation, told Client that Respondent loved her, hugged Client when saying hello or goodbye, held Client's hand in a calming manner, and took Client to Respondent's church.. Respondent showed Client's. drawing to the office receptionist without Client's written permission. '. permission. Respondent talked with Clie 1t'S daughter about Client without Client's written 1 1. Respondent talked with staff at the Social Security Administration about Client without Client's written permission.. Respondent asserted that during the years of treating Client in her private practice, Client became suicidal - times per year.. Respondent only recorded Client's suicidal-type statements times during 1 year of treatment.. Respondent completed suicide risk assessment training and had experience completing written suicide assessment forms.. The ISSD Guideline for DID treatment indicate that clients with DID are prone to suicide attempts and that a diagnosis of PTSD and/or Major Depressive Disorder increases the risk of a suicide attempt.. The APA Practice GuidelinHs for PTSD patients indicate that a complete, individualized assessment of suicide risk is important because individuals with PTSD are at an - H:\Patty\Consent Agreements\CA Bakalis 0-00.dIJC

increased risk for suicidal behavior and individuals with PTSD, depression and suicidal ideation 1 1 or behavior require particular attention both pharmacologically and psychotherapeutically. 0. Clinicians treating DID patiellts are advised to vigorously address and manage these types of behaviors and to recognize that these problems may require referral to specialized treatment programs. 1. Respondent failed to demor strate that she collected sufficient information to accurately assess the scope and severity of Client's depression, suicidal ideation or post traumatic stress disorder.. Respondent failed to docurrent the presence or absence, and duration of, any of Client's depressive symptoms.. Respondent failed to document how she monitored or otherwise therapeutically addressed Client's PTSD.. Respondent failed to document how she monitored or otherwise therapeutically addressed Client's history of physical, sexual or emotional abuse.. Respondent failed to document how she monitored or otherwise therapeutically addressed Client's major depression and/or suicidal ideation.. Respondent failed to compl,~te and document an assessment of Client's suicide risk.. Respondent was not compe!tent to treat clients with DID because of her lack of any training or education regarding DID treatment.. Despite recognition of her inability to provide an appropriate level of treatment to Client, Respondent treated Client for YI~ars in her private practice.. Respondent asserted she made multiple attempts to refer Client to another treatment provider more knowledgeable in treating people with DID. Respondent did not document these referral attempts. - H:\Patty\Consent Agreements\CA Bakalis 0-01 DO.doc

0. Respondent asserted she continued to provide treatment to Client because of 1 1 Client's insistence that Respondent provide treatment to Client and Respondent's inability to find another treatment provider for Client. 1. Respondent's decision to co ntinue to provide treatment to Client for years despite her acknowledged lack of competence presented a risk of harm to Client. CONCLUSIONS OF LAW 1. The Board has jurisdiction ovar Respondent pursuant to AR.S. -1 et seq. and the rules promulgated by the Board relating to Respondent's professional practice as a licensed behavioral health professional.. The conduct and circumstances described in the Findings of Fact constitute a violation of A.R.S. -1 ()(p), failing to conform with minimum practice standards as developed by the Board, as it relates to P.. AC. R-- 01, consent for treatment.. The conduct and circumstances described in the Findings of Fact constitute a violation of A.R.S. -1 ()(p), failing to conform with minimum practice standards as developed by the Board, as it relates to AAC. R--0, treatment plan.. The conduct and circumstances described in the Findings of Fact constitute a violation of A.R.S. -1 ()(p), failing to conform with minimum practice standards as developed by the Board, as it relates to AAC. R--0, client record.. The conduct and circumstances described in the Findings of Fact constitute a violation of A.R.S. -1 ()(z), engaging in physical contact between a licensee and a client if there is a reasonable possibility of physical or psychological harm to the client as a result of that contact.. The conduct and circumstanees described in the Findings of Fact constitute a violation of A.R.S. -1 ()(p), failing to conform with minimum practice standards as - H:\Patty\Consent Agreements\CA Bakalis 0-01 OO.dc'c

developed by the Board, as it relates to A.A.C. R-- 0(B)(1 0), a licensee shall ensure that a 1 1 client record contains documentation of behavioral health services provided to a client.. The conduct and circumstances described in the Findings of Fact constitute a violation of A.R.S. -1 ()(k), any conduct or practice that is contrary to recognized standards of ethics in the behavioral heal':h profession, as it relates to the American Counseling Association ("ACA") Code of Ethics section A.1.b.. The conduct and circumstances described in the Findings of Fact constitute a violation of A.R.S. -1()(1), any concluet, practice or condition that impairs the ability of the licensee to safely and competently practice the licensee's profession.. The conduct and circumstances described in the Findings of Fact constitute a violation of A.R.S. -1 ()(p), failing to conform with minimum practice standards as developed by the Board, as it relates to A.A.C. R--0, a licensee shall only release or disclose information regarding a client with written authorization from the client.. The conduct and circumstances described in the Findings of Fact constitute a violation of A.R.S. -1 ()Uj), failing to make client records in the licensee's possession available in a timely manner to another health professional on receipt of proper authorization to do so from the client.. The conduct and circumstarces described in the Findings of Factconstitute a violation of A.R.S. -1 ()(k), any conduct or practice that constitutes a danger to the health, welfare or safety of a client.. The conduct and circumstar ces described in the Findings of Fact constitute a violation of A.R.S. -1 ()(k), any conduct or practice that is contrary to recognized standards of ethics in the behavioral health profession, as it relates to the ACA Code of Ethics C..a. and A..b. - H:\Patty\Consent Agreements\CA Bakalis 0-00.dOG

ORDER 1 1 Based upon the foregoing Findings of Fact and Conclusions of Law, the parties agree t the provisions and penalties imposed as follows: Suspension 1. Respondent's licenses, LPC-1 ' and L1SAC-1 01, will be suspended until the completion of the following: Continuing Education. In addition to the continuing education requirements of AR.S. - and upon the effective date of this Consent Agreerrent, Respondent shall take and pass a three semester credit hour graduate level professional counseling ethics course from an accredited college or university, pre-approved by the Counseling Credentialir1 Committee Chair or designee. Upon completion, Respondent shall submit to the Board an official transcript establishing completion of the required course.. In addition to the continuing education requirements of AR.S. - and upon the effective date of this Consent Agreement, Respondent shall take and pass a three semester credit hour graduate level basic counseling skills in the helping relationship course from an accredited college or university, pre-approved by the Counseling Credentialing Committee Chai or designee. Upon completion, Respondent shall submit to the Board an official transcript establishing completion of the required course.. In addition to the continuing ed ucation requirements of AR.S. - and upon the effective date of this Consent Agreement, Respondent shall take and pass a three semester credit hour graduate level counseling diabnosis, assessment and treatment planning course from an accredited college or university, pre-approved by the Counseling Credentialing Committee Chair or designee. Upon completion, Respondent shall submit to the Board an official transcript establishing completion of the required course. - H:\Patty\Consenl Agreements\CA Bakalis 0-01 OO.do:

. In addition to the continuing ec ucation requirements of A.R.S. - and upon the effective date of this Consent Agreement, Respondent shall take a -c1ock hour seminar in clinical documentation and recordkeepin~l. The required seminar shall be pre-approved by the 1 1 Counseling Credentialing Committee Chair or designee. Upon completion, Respondent shall submit a certificate of completion of the mquired seminar. Probation. Following the period of suspension and completion of the required coursework and seminar and upon the Counseling Credentialing Committee Chair or designee's approval, Respondent may request release from slispension of her licenses upon providing evidence of her employment in an OBHL licensed facility. Upon approval of her request for release from suspension, Respondent's licenses, LPC- 0 and L1SAC-1 01, will be placed on probation for a minimum of months. Practice Restriction. While on probation, Respondent shall not engage in private practice and shall only work at an OBHL licensed agency consisting of or more clinicians. Clinical Supervision. While on probation, Respondent shall submit to clinical supervision for a minimum period of months by a masters or higher level behavioral health professional licensed at the independent level. Within 0 days of the date Respondent commences probation, Respondent shall submit the name of a clinical supel"'ll'isor for pre-approval by the Counseling Committee Chair or designee. Also within 0 days of the date Respondent commences probation, the clinical supervisor shall submit a letter disclosing his/her prior relationship to Respondent. In tha letter, the supervisor must address why he/she should be approved, acknowledge that he/she has reviewed the Consent Agreement and include the results of an initial assessment and a - H:\Patty\Consenl Agreements\CA Bakalis 0-01 OO.do:

supervision plan regarding the proposed :,upervision of Respondent. The letter from the 1 1 supervisor shall be submitted to the Board. Focus and Frequency of Clinical Supervision. The focus of the supervision shall relate to professional counseling ethics, basic counseling skills in the helping relationship and diagnosis, assessment and treatment planning, and clinical recordkeeping and documentation. Respondent shall meet in person with the supervisor at least weekly. Quarterly Reports. Once approved, the supervisor shall submit quarterly reports for review and approval by the Counseling Credentialing Committee Chair or designee. The quarterly reports shall include issues presented in this consent agreement that need to be reported and the supervisor shall notify the Board if more frequent supervision is needed. After months, the supervisor shall submit a final summary report for review and approval by the Counseling Credentialing Committee Chair or designge. Change of Clinical Supervisor During Probation. If, during the period of Respondent's probation, the clinical supervisor determines that he/she cannot continue as the clinicell supervisor, he/she shall notify the Board within days of the end of supervision and provide the Board with an interim final report. Respondent shall advise the Counseling Committee chair or designee within 0 days of cessation of clinical supervision by the approved clinical supe'rvisor of the name of a new proposed clinical supervisor. The proposed clinical supervisor shall provide the same documentation to the Board as was required of the initial clinical supervisor. - H:\Patty\Consent Agreements\CA Bakalis 0-00.dcc

!:arly Release 1 1. After months and upon the supervisor's recommendation, Respondent may request early release from the Consent Aqreement and Order if all other terms of the Consent Agreement and Order have been met. Licensee Name. Respondent shall practice counseling using the name under which she is licensed. I Respondent changes her name, she shall advise the Board of the name change as prescribed under the Board's regulations and rules. General Provisions. Within days of returning to clinical practice, Respondent shall provide the Counseling Credentialing Committee Chair or designee with a signed statement from Respondent's employer confirming Respondent provided the employer with a copy of this Consent Agreement and Order. If Respondent does not provide the employer's statement to the Board within days of the effective date, the Board will provide Respondent's employer with a copy of the Consent Agreement and Order.. If, during the period of Respol1dent's probation, Respondent changes employment, Respondent shall immediately inform the Board of the new employment and shall within days of starting each new employment, provide the Counseling Credentialing Committee Chair or designee with a signed statement from RI~spondent's new employer confirming Respondent provided the employer with a copy of this Consent Agreement and Order. If Respondent does not provide the employer's statement to the Board within days of the effective date, the Board will provide Respondent's employer with a copy of the Consent Agreement and Order.. Prior to the release of Respondent from probation, Respondent must submit a written request to the Board for release from the terms of this Consent Agreement and Order at least 0 days prior to the date she would like to have this matter appear before the Board. - H:\Patty\Consent Agreements\CA Bakalis 0-01 OO.doG

Respondent may appear before the Boar::!, either in person or telephonically. Respondent must 1 1 provide evidence that she has successfully satisfied all terms and conditions in this Consent Agreement. The Board has the sole discretion to determine whether all terms and conditions of this Consent Agreement and Order have been met and whether Respondent has adequately demonstrated that she has addressed the issues contained in this Consent Agreement and Order. In the event that the Board determines that any or all terms and conditions of this Consent Agreement and Order have not been met, the Board may conduct such further proceedings as it determines are appropriate to address those matters.. Respondent shall not provide clinical supervision while under probation. 1. Respondent shall bear all cm;ts relating to probation terms required in this Consent Agreement and Order. 1. Respondent shall be responsible for ensuring that all documentation required in this Consent Agreement and Order is provide!d to the Board in a timely manner.. This Consent Agreement ancl Order shall be effective on the date of entry below.. This Consent Agreement ancl Order is conclusive evidence of the matters described herein and may be considered by the Board in determining appropriate sanctions in the event a subsequent violation occurs. PROFESSIONAL ACCEPTS, SIGNS AND DATES THIS CONSENTAGREEMENT "::tg~.~ TINA BAKALIS ~~ Dat BOARD ACCEPTS, SIGNS AND DATES THIS CONSENT AGREEMENT Dated this J-f!= day of _'---'------,~'-""''------_'0. By: DEBRA RINAUDO, Executive irector Arina Board of Behavioral Health Examiners G~'~::::::lC::=:::---1-L~~~ - H:\Patty\Consent Agreements\CA Bakalis 0-01 OO.dclc

O~lql~~L of the foregt1~:.~a- ThIs ~ day of ~... _<EC-= Arizona Board of Behavioral Health Examiner:; N. Central Ave., Suite 00 Phoenix, AZ 0 Tina Bakalis Address of Record Respondent ' 0, with: -L..r~:\A,;.~-----'0, to: Gregory C. Michael Law Offices of Gregory C. Michael North Tatum Boulevard Suite 01 Phoenix, Arizona 0 Attorney for Respondent C~PI t,>fl!l'e foregoing m~ This ~ day of ~.. Marc H. Harris, Assistant Attorney General W. Washington, CIVILES Phoenix, AZ 00 Attorney for the Board r ~I<'.."...L\ ' 0, to: 1 1 - H:\Patty\Consenl Agreements\CA Bakalis 0-01 OO.doc