Is it ethical for a lawyer to be a puppeteer?

Assume a lawyer gives a medical provider a letter of protection.  The value of medical services rendered is significant.  Once the case settles, counsel for the medical provider writes to plaintiff’s counsel several times but receives no response.  Counsel for the medical provider then brings suit against the patient / plaintiff, who appears pro se and files an answer and counterclaim both appearing to have been drafted by a lawyer.

What should counsel for the medical provider do?  The cost of the collection action plus defending against the counterclaim will be significant.  At no time prior to the start of the collection action had the plaintiff/patient complained about the quality of care.  Plaintiff’s counsel used the cost of medical care as one of the bases for negotiating settlement of the patient / plaintiff’s claim.

Is it ethical for plaintiff’s counsel to fail to respond to the letter from counsel for the medical provider?

If counsel for the patient / plaintiff is directing his client’s responses to the collection action and ghostwriting the pleadings, is her conduct ethical under the reasoning of Informal Opinion 2010-4, Lawyer Assisting Pro Se Litigant Not Obligated Under the RPC To Disclose Such Assistance To The Court?  To read Informal Opinion 2010-4 click here..