Worker with disorder can work from home after Saratoga County reverses policy

BALLSTON SPA – After six weeks of begging to work from home, Saratoga County officials finally granted a mental health clinician with anxiety disorder the ability to counsel her clients virtually.

But the accommodation did not come until after the Times Union called county officials this week asking about the licensed clinical social worker’s disability, which is recognized by the Americans with Disabilities Act, and whose symptoms rekindled when she was forced to return to the office on July 20.

Mental Health Director Dr. Michael Presioso and Human Resource Deputy Director Adam Kinowski, in an Aug. 20 meeting of which the Times Union obtained a recording, told the LCSW they couldn’t allow her to work at home, despite her frequent panic attacks in the office, because the county has no work from home policy and the Board of Supervisors had “no appetite” to create one.

“I empathize,” Kinowski told her in the meeting. “I truly do. I wish, I wish we had a work from home policy … We just don’t have one. I mean, I want to be able to make a reasonable accommodation that works within what we have currently. But I, there’s no policy to work from home. I mean, that’s, that’s just where we are.”

The mental health clinician, who wants to remain anonymous for fear clients will learn of her disability and use their time to focus on her instead of themselves, had counseled patients virtually from home for 126 days, from March to July, the period after the start of the coronavirus pandemic. Prior to the meeting, Presioso, in a letter to the clinician, praised her at-home work, calling it “exemplary” and her a “consummate professional.”

Still, her request hit a wall, even though she explained, she would work from home “only as long as it won’t compromise patient care.” She also said,  “if patients are expected to or prefer to have therapy in person I will be there. I will never compromise the care of my patients.”

All this takes place at a time when telehealth is growing ever more popular. Since the start of the pandemic, countless numbers of counselors and therapists have used telemedicine to stay in touch with their clients remotely. The American Counseling Association, in an article on its website, noted that telehealth “is a great addition to their practice and their work with clients, including the ability to reach clients while obstacles may limit or prevent clients from in-person counseling.”

The American Mental Health Counselors Association concurs, saying that “we are meeting telehealth with enthusiasm and excitement.”

In addition, federal guidelines encourage remote work during the pandemic. The Centers for Disease Control “supports and encourages options for telework” and also recommends maintaining “flexible policies,” “flexible workspaces” and “flexible work hours.”

The county instead offered to move the clinician’s office, with a window that does not open, closer to an outside door; put up a shower curtain to separate her from her clients; reduce her caseload or give her unpaid family leave. None of these options, she said, work because they don’t consider optimal care of her clients.

“I told them it was irresponsible and unsafe. … I didn’t get very far,” she said.

The clinician’s disorder was verified in a letter to the county from her psychiatric nurse practitioner Susan Decker, who has been treating the woman for five years. Decker recommended that “telehealth from her client’s home would allow her to continue meeting expectations of her job without compromising patient care.”

In the meeting, the clinician also explained to Presioso and Kinowski that she hadn’t had a panic attack for more than a year. But now, she is “sick every morning.”

“This is very simple. It’s hard to breathe,” she said as she hyperventilated through the 51-minute meeting. “So since returning I have experienced increase symptoms, which I found difficult to manage in the office.” After the meeting, she could be heard on the recording throwing up.

During the meeting, Kinowski offered her tissues and told her everyone was nervous about returning to the office.

“There are a lot of anxious people,” Kinowski said. “There were people kind of looking over their shoulders … I got really used to being at home. The rhythm was off. … So you got comfortable doing something. You found a different rhythm … and beat. And then now you’re being asked back. That’s a hard undertaking and nobody, and especially from this office, has been playing (it) down to anyone. We understand that this would be difficult for folks.”

Kinowski on Wednesday said he could not comment, saying that his office cannot discuss personnel matters, but he granted the woman’s request the next morning. Presioso did not return a Times Union phone call seeking comment.

The clinician called the initial county response despicable.

“They could see I was really struggling,” she said on Thursday after learning that her accommodation was granted. “I feel like the process itself made everything so much worse. If I was not stubborn and had not invested so much energy into patient care, I don’t know. … It shouldn’t have been such a battle and require a call from (the Times Union) to make it happen.”

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