patients

Never Date Your Patient

Harm & Safety
Psych Team

-Sincerely, The General Population and Your Sanity

Soo many problems with this story and warning this can be triggering. I actually remember Stevie Ryan because she did a funny video years ago. She was talented, eccentric, and had a lot of potential (look how awesome her name was). She had some mental health issues and took a break to get some professional help.  

People who persistently use social media, usually make me worry because even when they’re having a good day, one bad comment can easily destroy a person’s mental health. I got several patients who have a social media career and I just try to remain neutral but caution about the risks. The last thing I’ll ever do or advise is to date the patient or any patient in my care. 

The Psych NP, Gerald Baltz was aware of all these risks, the vulnerability, and unfortunately, Stevie ended her life in 2017 shortly after he broke up with her. More details have emerged due to new legal proceedings that seek to revoke or suspend his licenses. Here’s a quick article:

An NP Accused of Misconduct

A nurse practitioner who treated YouTube star, Stevie Ryan, before she killed herself has been accused of having a sexual relationship with her and telling her not to go to the hospital when she was suicidal. Ryan, an actress, and comedian who gained fame on YouTube with impersonations of celebrities committed suicide in her Los Angeles home in 2017 at the age of 33. New details have now emerged about Ryan’s final few months due to legal proceedings being brought against the nursing practitioner, Gerald Baltz, that seek to revoke or suspend his licenses.

The California Board of Registered Nursing is behind the legal action against Baltz after accusing him of misconduct, gross negligence, and incompetence in relation to his treatment of Ryan. The nursing board filing, obtained by the LA Times, accuses Baltz of engaging in an improper relationship with Ryan while she was his patient for two years.

He has also been accused of engaging in a sexual relationship with her three months before her suicide when she was being treated by someone else but at the same facility where he worked. Ryan had started seeing Baltz for treatment in 2015 about a year after her sketch comedy TV show on VH1, ‘Stevie TV,’ was abruptly canceled.

In the two years that Baltz treated Ryan, he prescribed her a range of medications for depression, schizophrenia, and bipolar disorder, according to the filing. During that time, he is accused of failing to get supervision for Ryan despite her being suicidal. The filing includes texts that Ryan had sent her friends about Baltz, included one message where she said Baltz had told her not to go to the hospital.

‘Saw my doc. He said DO NOT go to the hospital,’ Ryan texted a friend. ‘He’s putting me on new meds AGAIN… But he is so hot… like FINE… I think I’m dating my doctor now.’ The filing suggests Baltz ended their practitioner-patient relationship after two years so they could start a relationship. According to text messages, that relationship appeared to last a few weeks.

Ryan had sent a text to a friend in April 2017 saying she had asked her ‘doc’ out and that he had agreed but he couldn’t treat her anymore. He referred her to another doctor at the facility, Insight Choices, where he worked as a contractor, according to the filing.

In texts allegedly exchanged between the pair about the ethics of the relationship, Baltz wrote: ‘I’m a healer, it would be unethical for me… not you… I took an oath!!’ Another text read: ‘If I did anything to harm you it would not only be a d**k move but cause 10 years of school and work to disappear for me.’ Baltz denied sending the messages when questioned by a nursing board investigator. He also allegedly told Ryan to delete some of their exchanges.

As the relationship began to deteriorate in late April, Baltz allegedly texted Ryan: ‘I made a horrible error in judgment. You needed help and I worsened the situation.’ In a breakup text exchange that Ryan allegedly had with Baltz, of which she shared screenshots with a friend, he told her: ‘So you don’t want to date anymore? It’s okay I figured you might not be thinking clearly. That sucks I like you but if that’s what you’re saying I’ll leave you alone.’

A few days later, he allegedly wrote to her: ‘Listen I feel terrible about this whole thing. Most important thing is your mental health. This is exactly why I’m an idiot.’ Ryan continued undergoing treatment at the facility but eventually stopped because Baltz worked there, the filing says.

In an interview with the nursing board investigator after her death, Baltz acknowledged that he knew Ryan had been having suicidal thoughts. The claims made in the filing are similar to ones made in a wrongful-death lawsuit that Ryan’s parents brought against Baltz in 2018. That lawsuit included allegations they had engaged in a sexual relationship. He settled the lawsuit for $200,000.

Baltz has four active nursing licenses in California, which permit him to provide psychiatric-mental health care. As a nursing practitioner, he is allowed to prescribe medicine. He has multiple nursing degrees from Saint Louis University. Baltz is still working as a psychiatric nursing practitioner, according to his LinkedIn profile.

–Daily Mail

How to Maintain a Healthy Patient-Provider Relationship

  • Have CLEAR professional boundaries: if things get blurred or awkward, consider a mediator or refer. I’m getting more female patients who expressed the male psychiatrist/therapist made them feel uncomfortable. Men -don’t take it too personally, think about how some women prefer female OB/GYNs, or kids wanting a parent around… just consider how involving a third person can make things run smoother.    
  • Remain a Strong Advocate: when you advocate for your patients, you’re not just focused on their mental health, you are treating the person as a whole. You’re making sure they’re doing okay economically, socially, and in general. In other words, have a habit of being too busy to think about having any inappropriate activities or get HELP.
  • Clearly Communicate Goals: almost with all my patients, I try to communicate goals. Be careful NOT to develop a co-dependency relationship. I sometimes ask my patients, what if something happens to me or with the clinic because when a therapist or somebody would leave, they would get sad, anxious, angry… My goals are simple; obtain a functional long-term independent life. Communicate the importance of having independence so things won’t get too personal. 
  • Seek a 2nd Opinion: I had a parent emailing me articles, teacher’s notes, and all types of stuff, I spoke with my collaborative physicians and they were concerned because it was getting overbearing and intrusive. They gave me the BEST advice ever, time to bring the person in for every visit. Now due to COVID, I was trying to be considerate but I reminded the parent again, I can’t give advice electronically and just reserved everything for the med review. So now if a situation is getting more complex/difficult, regardless of the inconvenience, make the visits MORE formal and once again reiterate clear boundaries and goals. Thus, if a situation is getting shaky, seek professional counsel, get support, and maintain reasonable decisions. 

If boundaries are still blurred or there’s a conflict of interest; try to reestablish goals/plan of care or refer. Keep yourself (professionally) safe. I would also caution following patients on social media, friending them on Facebook, etc. Try to keep your social media private, work and personal life separated, and use caution expressing extreme personal views. 

Red Flags or How Things Get Out of Control

  • Meeting with the patient outside work/clinic/after hours.
  • Exchanging private text messages: I do give clients my work email but do not use personal phone exchanges unless for serious emergencies.
  • Not keeping the boundaries clear: I do NOT recommend treating friends, family, peers, co-workers, neighbors…
  • Additional: accepting gifts, bribes, extra affection, foul/inappropriate body language, and conversations, revealing too much of your personal life, more undocumented time or activities, offering free services ..etc. stuff you normally wouldn’t do for most patients, doing things, not in the scope of practice will ALWAYS be a red flag.

If you do cross the boundaries, there are consequences; including jail, lives being put at risk, death, etc. It’s NOT worth it. EVER. I have a patient that said the psychiatrist dated her and then started to do drugs with her so I’ve almost never heard a good story with people dating their patients and even if it was, it’s still questionable.

This is honestly embarrassing for our profession, most articles referred to the NP as a nurse and we already have people questioning our credibility. Yes, a bad apple spoils the whole bunch. And if all else fails or gets disregarded, at least think about how you would want someone to treat your child or loved ones. This post may have been triggering, additional resources:

    

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