http://www.canlii.org/en/on/onhparb/doc/2014/2014canlii30272/2014canlii30272.html
32. In her complaint letter dated September 1, 2011, the Respondent indicated, “[the Applicant’s] medical opinion as set out in the report contained inappropriate personal opinions as to her character. … [The Applicant] improperly permitted these personal opinions to inform his medical opinion as evidenced by the report itself.” The Respondent stated that the Applicant’s ill-informed and personal opinions as to her “personality style” were not relevant or proper in discussing her medical diagnosis.
33. The Committee indicated it had an opportunity to review the IME report that the Applicant produced following the Applicant’s assessment of the Respondent. The Committee stated that it “found [the report] skimpy, almost casual, and simply unacceptable as a serious and credible psychiatric evaluation.” In the Committee’s view, “it showed many deficiencies of diagnosis and formulation.” The Committee stated that its concerns about the Applicant’s approach in this case was compounded by the fact that it was aware that the Applicant had, in the past, been the subject of complaints to the College regarding his approach to psychiatric IMEs, and that the Committee had sanctioned him in the past regarding aspects of his practice. The Committee also stated that the Applicant’s “approach betrays deficiencies in his management of patients who may have PTSD. He needs to be aware of all criteria for PTSD so he can screen for it, and manage it, if found.”
34. In reaching its decision, the Committee noted that the Applicant’s comments in his report about the Respondent’s personality style were odd in that the Applicant focussed on the fact that the Respondent went on holiday with a colleague and did not address questions relevant to assessing the Respondent’s premorbid personality. The Committee noted that the Applicant did not document anything about premorbid personality in his report. The Committee also noted:
Personality is relevant to a psychiatric consultation or assessment. [The Applicant], however, did not explain it in the context of a proper diagnostic grid. Axis II refers to personality disorders and traits and [the Applicant] did not present a formal and detailed diagnosis. Under “Axis II” in [the Applicant’s] report, he marked nil. [The Respondent’s] psychologist and psychiatrist did not document anything about personality. Her psychiatrist also put “nil” for Axis II.
35. Given the totality of this information, the Committee decided to caution the Applicant in person regarding the thoroughness of his IME assessment and report and further required that the Applicant provide a written report with respect to assessment and management of PTSD and the components of a psychiatric assessment.
36. At the Review, the Applicant submitted that the Committee’s conclusion regarding the Applicant’s practice management of patients with PTSD was outside the scope of this complaint. The Applicant argued that the Committee’s conclusion was too broad given that it limited the investigation to the Respondent’s IME. Furthermore, the Applicant submitted that if the Committee had concerns about his practice management of patients with PTSD, it should have given him the opportunity to respond to this aspect of the Committee’s concerns. He commented that this aspect of the Committee’s decision should be further investigated and reconsidered. The Applicant noted that his comments in the IME report regarding the Respondent’s personality style may have been clearer under another section of the report rather than under the DSM IV and diagnosis section.
37. As indicated earlier, the Board finds that the scope of the Respondent’s complaint involved the accuracy and appropriateness of the IME report, including her concerns about the inclusion of comments about her character and her personality style. In examining the Committee’s decision, the Board observes that the Committee examined the IME report and other information in the Record and found it had concerns about the Applicant’s approach, stating more specifically that his “approach betrays deficiencies in his management of patients who may have PTSD” and the criteria for PTSD. The Committee commented that the Applicant “referred to personality disorders and traits and [the Applicant] did not present a formal and detailed diagnosis.” The Committee noted that under Axis II (personality disorders and traits), the Applicant marked “nil”. The Committee further noted that the Respondent’s psychologist and her psychiatrist did not document anything about personality and also put “nil” under Axis II.
41. The Committee noted that the Applicant’s approach betrayed deficiencies in his management of patients who may have PTSD. The Committee indicated that the Applicant needed to be aware of all criteria for PTSD so he can screen for it, and manage it, if found. The Board does not agree with the Applicant’s submission that this conclusion falls outside the scope of the Respondent’s complaint or that it required additional records to arrive at this conclusion. The Committee reviewed the Applicant’s approach to the IME in this case, considered his conduct history and identified areas where he could improve his future practice regarding patients who may have PTSD. Given the College’s legislated public interest mandate and its duty to maintain professional standards, the Board finds reasonable the Committee’s request that the Applicant provide the Committee with a written report with respect to assessment and management of PTSD and the components of a psychiatric assessment.
45. Pursuant to section 35(1) of the Code, the Board confirms the Committee’s decision to:
i) require that the Applicant attend the College to be cautioned in person with respect to the requirement of maintaining confidentiality of personal health information, and with respect to the thoroughness of his IME assessment and report; and
ii) request that the Applicant provide the Committee with a written report, approximately 2-4 pages in length, with respect to assessment and management of PTSD, and the components of a psychiatric assessment, and with respect to law and policy regarding privacy of personal health information.