Currently, Dr. Welch has a national law firm practice specializing in managed care malpractice and related cases. He is co-founder and CEO of the Legal Center for Patient Protection, a non-profit advocacy organization devoted to the protectrion of patients from managed care abuse, and he is a leading mental health spokesperson seeking regulation of managed care mental health. He is also an assistant professor of psychology at the George Washington University, Washington, DC, where he teaches law and psychology courses and professional issues to doctoral students in clinical psychology. Dr. Welch is a member of the American Psychological Association (APA) and has been awarded several distinguished contribution awards from the APA. He has also received several awards from various state psychological associations.

Dr. Welch received his Bachelor of Arts from Harvard College, his Juris Doctor from Harvard Law School and his Ph.D. in clinical psychology from the University of North Carolina. Questions submitted to Dr. Welch MAY appear on this web site in edited form and will be masked for confidentiality, where appropriate. 

Q. How will online counseling and medical advice services be covered in the future? With HMOs now approving online advice services, how will liability be covered? 

A. This is a fascinating question! With the growth of communications technology, there will be enormous implications for health care. On the positive side, highly specialized expertise will be available to rural populations who have had only primary care treatment in the past. In addition, the cost of such care will be greatly reduced because of the more efficient use of the professionals time, and the ability of computer technology to assist in the assessment and treatment of many illnesses. On the negative side, it will almost certainly be abused by the managed health care industry leading to more depersonalized and superficial health care. Mental health is one area that, because of its unique reliance on interpersonal relationships, will be especially vulnerable. 

While the legal basis for liability in this area is untested at present, a few things seem predictable. Some mental health professionals believe it is inherently bad practice to engage in telephone therapy with patients and presumably will have similar objections to the use of online services. One can certainly argue online services provide even less clinical data on which to make clinical interventions than phone treatment. However, it is very unlikely that the courts will hold that the use of online counseling and health care is in and of itself negligent treatment. Instead, I believe courts will look, on a case-by-case basis, to the quality of information provided, the reasonableness of the patient's reliance on it, and the degree of predictable harm it causes. These are traditional malpractice concepts that will quite simply be applied to the new technology. Efforts by mental health professionals to attack the per se use of the new technological systems, like online services, as inherently inappropriate, rightly or wrongly, will be attacked as self-serving guild efforts to restrain trade. This is especially likely if the public wants to use the new services. The new communication systems, especially videoconferencing, raise fascinating questions from a psychological point of view. Given the prevalence of schizoid defenses in our culture, it is entirely possible we could conclude that videoconferencing is the same as being in the same room with the patient and inadvertently throw the baby out with the bath in our "futuristic therapeutic paradigm". We will become more and more accepting of "part-object" relatedness and more and more fragmented both individually and culturally.