1. It is the decision of the Health Professions Appeal and Review Board to confirm the decision of the Inquiries, Complaints and Reports Committee of the College of Occupational Therapists of Ontario to:
(i) issue a caution to D.H., OT, to attend before a panel of the Inquiries, Complaints and Reports Committee for a verbal caution regarding his obligations as a regulated health care professional to accurately report on a client’s functional presentation, to adequately inquire about, review and consider the impact of a client’s cognitive deficits in his assessment, and to use appropriate language and tone in his reports;
(ii) to provide guidance to D.H., OT by:
(a) recommending that he try to strike a better balance, and to ensure that he thoroughly reviews and analyzes the reports of his client’s practitioners which relate to psychological and cognitive health, and not merely physical health and;
(b) encouraging him to carefully review, and where appropriate, to cite healthcare practitioners reports that raise salient points which do not support his point of view.
2. This decision arises from a request made to the Health Professions Appeal and Review Board (the Board) by D.H., OT (the Applicant and Respondent by cross-review) to review a decision of the Inquiries, Complaints and Reports Committee (the Committee) of the College of Occupational Therapists of Ontario (the College). The decision concerned a complaint made by S.H., (the Respondent and Applicant by cross-review) regarding the conduct and actions of the Applicant.
8. The Respondent complained that the Applicant:
• made false claims and inaccurate statements in his assessment report
about the patient;
• misused the reports of other healthcare professionals;
• is incompetent because he failed to ask appropriate questions during
the assessment and has poor observational skills; and
• is biased in his report in favour of the insurance company that hired him
The Committee’s Decision
13. The Committee investigated the complaint and decided to:
(i) issue a caution to the Applicant to attend before a panel of the Committee for a verbal caution regarding his obligations as a regulated health care professional to accurately report on a client’s functional presentation, to adequately inquire about, review and consider the impact of a client’s cognitive deficits in his assessment, and to use appropriate language and tone in his reports;
(ii) to provide guidance to the Applicant by:
(a) recommending that he try to strike a better balance, and to ensure that he thoroughly reviews and analyzes the reports of his client’s practitioners which relate to psychological and cognitive health, and not merely physical health and;
(b) encouraging the Applicant to carefully review, and where appropriate, to cite healthcare practitioner’s reports that raise salient points which do not support his point of view.
38. The Committee noted the Applicant’s conduct history before this Committee and that it has previously offered him guidance with respect to the fact that tone and overall presentation of findings can affect interpretation of such findings and to be mindful of verbal and non-verbal communication. It stated that the similarity between the current complaint and prior matters before the Committee was of concern and it decided to issue a verbal caution to the Applicant about the use of appropriate language and tone in his reports.
45. In addition, the Board finds reasonable the Committee’s decision to caution the Applicant due to its concerns. Among the array of educative or remedial dispositions available to the Committee, the decision to caution is one of the available dispositions. A caution is advisory and intended to be remedial; it is not a sanction. The Code requires the Committee to consider the Applicant’s conduct history and, as noted by the Committee, it had previously offered him guidance with respect to the fact that tone and overall presentation of findings can affect interpretation of such findings and to be mindful of verbal and nonverbal communication. The Committee reasonably took this fact into consideration in determining to issue a verbal caution.
Declining to partake in tests and Cognitive Assessment
46. The Committee considered that the Respondent asserted that the patient did not decline to partake in tests but simply sought rests, whereas the Applicant disagreed.
47. The Committee considered the information contained in the report of the patient’s treating occupational therapist, who was present for the Applicant’s assessment and who disagrees with the Applicant’s position in this regard.
48. The Committee concluded that the patient did not decline to participate in all range of motion testing as reported by the Applicant, based on the information before it from the patient, the Respondent and the patient’s treating occupational therapist.
49. The Committee thus found that there was evidence before it that the Applicant’s report contained inaccuracies with regard to the issue of declining to partake in tests.
50. The Committee then considered the issue of cognitive assessment and concluded that the patient demonstrated significant cognitive deficits on the Montréal Cognitive Assessment test (MOCA) related to visual spatial and executive function, naming, memory, attention, language, orientation and delayed recall. The Committee concluded these are serious concerns which appear to have been heavily discounted by the Applicant.
51. The Committee further found that the Applicant appeared to have ignored the emotional social sequelae that the patient seems to have experienced as a consequence of her motor vehicle accident. In particular, the Committee noted that the Applicant made little reference to the patient’s diagnosis of post-traumatic stress disorder as well as the grief she experienced as a consequence of the loss of her husband in the accident.
52. The Committee concluded that it had significant concerns about the Applicant’s assessment of the patient as it related to her cognitive presentation and the consequence to her function.
53. In the Committee’s opinion, there was sufficient information before the Committee demonstrating the presence of inaccurate statements in the Applicant’s report.
54. For these reasons, the Committee decided to issue a verbal caution to the Applicant about the importance of accurately and completely reporting on the patient’s functional presentation, as well as his obligation to adequately inquire about, review and consider the impact of the patient’s cognitive deficits in his assessment.
Concern two
The Applicant misused the reports of other healthcare providers
61. The Committee concluded that it does not believe the Applicant is in a position to make an assessment as to the honesty of the other healthcare provider reports. It noted that, as required by standard 2B of the Standards for Occupational Therapy Assessments, he can review the reports, compare them to the information he obtained during the assessment, and make a reasonable effort to ensure currency and accuracy of information collected from other sources. It further noted that he is not obliged to determine if the report of another health practitioner has false information. Accordingly, the Committee determined it would take no further action in response to this concern.
62. However, the Committee was concerned that the Applicant quoted largely from the practitioners whose opinions coincided with his own. The Committee noted that it appears that the Applicant sought evidentiary support from a select few practitioners to reinforce his decision and disregarded evidence from practitioners whose opinions he did not share. The Committee decided to recommend to the Applicant that he try to strike a better balance, and to ensure that he thoroughly reviews and analyzes the reports of his client’s practitioners which relate to psychological and cognitive health, not merely physical health. Moreover, the Committee encouraged the Applicant to carefully review, and where appropriate, to cite other health care practitioners’ reports that raise salient points which do not support his point of view. Other than offering this guidance to the Applicant, the Committee determined it would take no further action in response to this concern.
63. The Board finds these determinations by the Committee to be reasonable. They were within the realm of the Committee’s expertise. There is no persuasive information in the Record or advanced at the Review to demonstrate that the Committee’s opinions on these points are inappropriately applied or that the rationale was unsupported.
Concern Three
The Applicant is incompetent because he failed to ask appropriate questions during the assessment and has poor observational skills.
64. The Committee agreed with the Applicant’s statement that the patient’s shower bars are not assistive devices and that there is no information before it that the Applicant’s observations and reporting of the patient sitting tolerances were due to a lack of observational skills.
65. Accordingly, the Committee made no finding that the Applicant lacks observational skills.
66. Regarding the Respondent’s submission that the Applicant failed to make adequate inquiries about the patient’s ability to take public transit, the Committee was of the opinion that the Applicant did not sufficiently probe into the patient’s transportation and travel concerns. The Committee found that he did not inquire about her ability or inability to take public transit but relied instead on the information in the physician’s report to draw the conclusion that public transit was an option for the patient.
67. The Committee determined that this fact, combined with the Applicant’s failure to make further inquiries about the patient’s cognitive impairments (as discussed previously), led the Committee to agree that the Applicant failed to ask appropriate questions of the patient during the assessment.
68. The Committee noted that occupational therapists are required to use safe tools and assessment methods together with adequate information for the analysis of the patient’s occupational performance issues in relation to the request for service.
69. The Committee stressed the importance of gathering adequate subjective and objective information from the client as accurately as possible. For the reasons as stated, the Committee determined to issue a verbal caution to the Applicant in response to this concern.
70. In addition, the Board finds these determinations by the Committee to be reasonable. They were within the realm of the Committee’s expertise. There is no persuasive information in the Record or advanced at the Review to demonstrate that the Committee’s opinions on these points are inappropriately applied or that the rationale was unsupported.
71. The Board finds the Committee’s decision to issue a verbal caution as a result of its concerns to be reasonable as the decision to issue a verbal caution is one of the dispositions available to the Committee amongst its array of dispositions. It is advisory and intended to be remedial; it is not a sanction.
Concern Four
The Applicant’s report is biased in favour of the insurance company that hired him.
72. The Committee determined that there was no information before the Committee that indicated that the Applicant was biased in favor of the referral source, the insurer. It noted that inaccuracies in the report are not evidence of bias, nor are differences of opinion between occupational therapists.
73. For this reason, the Committee took no further action with respect to this concern.
74. The Board finds the Committee’s conclusion regarding this issue to be reasonable as it is based on information in the Record and the Committee’s expertise. There was no persuasive information in the Record or advanced at the Review to demonstrate that the Committee’s opinion on this point was inappropriately applied or that its rationale was unsupported.
Conclusion
75. For the reasons as stated, the Board finds the Committee’s investigation to be adequate and its decision to be reasonable.
VI. DECISION
76. Pursuant to section 35(1) of the Code, the Board confirms the Committee’s decision to:
(i) issue a caution to the Applicant to attend before a panel of the Committee for a verbal caution regarding his obligations as a regulated health care professional to accurately report on a client’s functional presentation, to adequately inquire about, review and consider the impact of a client’s cognitive deficits in his assessment, and to use appropriate language and tone in his reports;
(ii) to provide guidance to the Applicant by:
(a) recommending that he try to strike a better balance, and to ensure that he thoroughly reviews and analyzes the reports of his client’s practitioners which relate to psychological and cognitive health, and not merely physical health and;
(b) encouraging the Applicant to carefully review, and where appropriate, to cite healthcare practitioners reports that raise salient points which do not support his point of view.