From Board Insights, Episode 1, featuring Catrice Opichka, Director of CARE Programs, CRDTS
When a licensee comes before a regulatory board for a clinical violation, the case tends to get classified by the clinical act itself. The record describes what went wrong at the point of care. The remediation plan addresses what looks like the gap that produced it – training, supervised practice, a refresher on the relevant standard.
That is how enforcement has worked for decades, and there are reasons for it. Clinical acts are visible and documentable. They map cleanly to remediation pathways boards already have in place.
But practitioners working across high volumes of enforcement cases notice that the clinical act is usually the last step in a chain that started somewhere upstream.
The Pattern Behind Clinical Cases
Catrice Opichka directs the CARE programs at CRDTS, which works with licensees remediating through board-ordered programs across multiple professions. Her observation from that vantage point is direct:
“Every case that is a clinical case has an ethical component that stems from probably initial decision making that leads to shortcuts, that leads to the clinical components.”
The word she returns to is shortcuts. Not technical skill failures, but judgment calls made earlier in the sequence. The documentation gets abbreviated because the day is running long. A procedural step gets skipped because it has been skipped before without consequence. By the time the clinical violation is visible on the record, the ethical decision that enabled it has already happened, often repeatedly, often long before the case reached the board.
This is not a claim that clinical skill is irrelevant. Some cases are genuine skill failures. But in Opichka’s experience building programs around disciplinary cases, the cases that look purely clinical rarely are.
Why the Reframe Matters for Boards
If the ethical decision precedes the clinical error, then remediation that only addresses the clinical act leaves the upstream judgment pattern untouched. The licensee returns to practice technically refreshed but with the same decision habits intact.
The recurrence risk is the more direct concern. A licensee who took a documentation shortcut once has a judgment pattern that tolerates documentation shortcuts. If remediation retrains the documentation procedure without examining why the shortcut felt acceptable in the first place, the conditions for the next violation are still in place. The board sees a completed remediation. The public protection question is less settled than it looks.
There is a second-order issue around consistency. When cases get classified by their downstream clinical features rather than their underlying judgment patterns, boards can end up routing similar root-cause issues to very different remediation pathways – one surfaced as a documentation issue, another surfaced as a boundary issue, both produced by the same kind of shortcut. This is not a failure of any individual board decision. It is a byproduct of classifying cases at the wrong layer.
Both concerns show up in the patterns remediation programs see across cases.
What Sequencing Changes
If judgment is upstream of skill, measuring judgment first tells a board something that a clinical review cannot – whether the ethical reasoning that produced the case has actually changed, and what the remediation should focus on.
Opichka describes how CRDTS structures this in practice:
“We do build ethics into the core structure of what we do with licensees. And it’s often one of the first things that we do with them before we even touch on the clinical component. We do the assessments with EBAS to gauge where they are in their ethical decision making because it helps guide us build those clinical components of our program.”
Ethical reasoning is assessed early. The assessment result shapes what the clinical remediation looks like – which components to emphasize, where the licensee’s reasoning already holds up, and where the gaps are. The clinical work is designed around what the assessment surfaced, rather than running on a parallel track.
For boards, the practical handle here is smaller than it might sound. Placing the assessment earlier in the remediation sequence is a language change in the consent order, not a budget change or a new tool. The assessment itself is the same assessment. What changes is where its output lands in the decision chain and what it gets used to inform.
The Role of Measurement
An ethics assessment surfaces what a licensee’s ethical reasoning looks like when tested against scenarios relevant to their profession and the violation in front of the board. It produces a structured, documented input that a remediation plan can be built around.
For boards, that input does two things. It gives the remediation plan a defensible basis – a validated measurement on the record rather than inference from the clinical file. And it gives the plan direction, identifying the reasoning gaps that actually need to be addressed rather than leaving that to inference.
Teaching, counseling, and clinically remediating sit with education and remediation partners. Measuring where a licensee stands sits with assessment. CRDTS runs its CARE program on that division of labor, and Opichka’s experience with it is what makes the upstream argument concrete. The sequence is not theoretical for her program. It is how the work gets done.
About Board Insights
Board Insights is a recurring conversation series from EBAS featuring practitioners working in regulatory enforcement, remediation, and licensee oversight. Each episode explores practical questions boards face and the patterns that experienced professionals see across cases.
Watch the full episode with Catrice Opichka
