A sexual relationship with your mental health patient is an absolute violation of professional and ethical standards. It is also a crime in many states. As an educator, this is one of the first things we teach students. Obviously the practitioner is at fault, but was he adequately supervised and were proper screening procedures used when he was hired and again when (if) he was re-credentialed? Criminal background checks are a standard part of hiring and credentialing any independently licensed mental health provider so his prior conviction for voyeurism should have been discovered. He should also have disclosed his conviction on his credentialing application. Many employment contracts also require the employee to notify the employer of any change in status, such as a felony conviction. Furthermore, his felony conviction of voyeurism may have also tagged him as a sex offender depending on the state he was convicted in. Sex offender status should have caused the hospital to decline to hire him or at least resulted in a heightened level of supervision. His felony conviction may have also prevented him from having an independent practice license, again depending on the state. So it is possible, the hospital was allowing him to practice without a valid license. Ultimately, it comes down to whether the hospital’s hiring and credentialing policies and procedures met the generally accepted standard and if the hospital actually followed their own policies and procedures. The only way a sexual relationship like this could happen would be if the therapist went to great lengths to conceal his illegal activity from the hospital because this is exactly what strong hiring and credentialing procedures are designed to prevent. As former chairman of the professionalism and disciplinary board for medical students at a public medical school, I am quite familiar with these policies and procedures. I have not functioned as an expert witness in such a case, but as the chair of the internal board that investigates and adjudicates allegations of unprofessional conduct.