Author Archives: Admin4

https://www5.fsco.gov.on.ca/AD/4558

Dr. Platnick carried out a paper review and on the basis of Dr. Platnick’s assessment, the Insurer determined, on February 4, 2013, in a letter to the Claimant, the OCF-18 was not reasonable and necessary to treat the impairment arising out of the March 5, 2008 motor vehicle accident. For specific details of the denial, the Applicant was referred to “a report of examination under Section 44 dated January 15, 2013, and completed by Dr. Howard Platnick, Physician”.

Before I proceed to my analysis, I have to comment on the assignment of a general practitioner by Primmum to conduct this Section 44 Assessment. The Insurer’s denial, and the origin of this dispute, was based on Dr. Platnick’s conclusions that the cost of the private school funding was not reasonable and necessary.  Dr. Platnick’s reports are found in the Joint Brief at Tab 31(e) and 31(f). The reports in the Joint Brief are described, incorrectly, as “Physiatry” Paper File Review Report of Dr. Platnick, MD.

Dr. Platnick’s reported expertise, as set out in the preamble of his report, has no relation to the expertise required to assess the Applicant’s OCF-18. His expertise, as a family physician, as stated in his “Assessor Qualifications”, is described as having a special interest in neuromusculoskeletal disorders, disability management and rehabilitation. He treats adult, pediatric, and geriatric populations and is involved in the treatment of chronic pain (chronic non-malignant pain – musculoskeletal and neuropathic) and headache patients including narcotic and adjunct medication prescribing/monitoring.

By the time of Dr. Platnick’s report in January 2013, almost five years had elapsed since the motor vehicle accident in 2008. The medical reporting, the exchange of letters between the Applicant’s counsel and Primmum, and prior Section 44 assessments during this timeframe indicated that the impairment symptoms in this very young Applicant were related to anxiety and its interaction with her learning disability, socialization and mood related issues and sleep disturbances. The school records at the time of his assessment reported early learning and fine motor skills development delays as well as below grade level academic performance.

With the exception of a more recent report from a treating psychologist, the Joint Brief indicates that the Insurer had access to most of the medical and school records as I have before me at the time Dr. Platnick completed his assessment.

By contrast, all prior Section 44 assessments – six are listed in the Joint Brief – were conducted by Dr. Amena Syed, an assessor with more relevant expertise. Dr. Syed states her qualifications in the preamble, as a registered psychologist with areas of competence in clinical, rehabilitation and neuropsychology. Her resume states she is qualified to provide these services to children, adolescents and adults. She has experience working with genetic, neurological, developmental and psychiatric/psychological illnesses providing consulting, assessment and treatment services.

The Insurer had to be aware of the required Section 44 assessment expertise when the OCF-18 Treatment Plan of August 2012 was submitted to the Insurer by Dr. Bremermann. The doctor made it clear in the Form that her patient:

is having learning difficulties and anxiety arising from the motor vehicle collision on March 5, 2008 which is affecting her studies at school. She is requiring private school funding to support her learning needs.

From the statements made by Dr. Bremermann on the submitted OCF-18 and the prior reporting history, showing the nature of the impairment and the numerous assessments of Dr. Syed, (seven are listed as having been reviewed by Dr. Platnick) it had to be evident to Primmum what the required Section 44 assessment expertise was to be. But for some reason, the Insurer selected a family physician.

Dr. Platnick concluded from the paper review that the treatment plan was not reasonable and necessary. The medical documentation in his view did not support a “head-trauma-acquired brain injury as a result of the MVA”, consequently, there was no organic-based, cognitive, accident-related impairment that would require the proposed “goods and services”, i.e., the tuition fees for Tall Pines School. Included in this conclusion, Dr. Platnick reviewed a neuropsychological assessment report prepared by Dr. Janine Hay, C. Psych., Clinical Neuropsychologist.

Dr. Hay’s report was not an assessment of a neuromusculoskeletal disorder. Prior to Dr. Platnick’s assignment in January 2013, the Insurer agreed to fund a neuropsychological assessment on the Applicant and her report was not available to Dr. Platnick at the time so his conclusions were delayed until he completed his review of  Dr. Hay’s report.

Again, as with Dr. Syed, Dr. Hay’s expertise is more in keeping with the assessment requirements. Dr. Hay works at Holland Bloorview Kids Rehabilitation. Her expertise, as stated in her testimony at this Hearing, is carrying out neurological assessments to assess cognitive functioning with respect to brain behaviour relationships and to understand the cognitive profiles, learning profiles and make recommendations for academic planning and rehabilitation.

It has to be questioned then, why the Insurer assigned a family doctor, with an interest in neuromusculoskeletal disorders, to review, comment, and making findings on a neuropsychological assessment report. It also has to be noted that the history of the claim in this case did not centre on a neuromusculoskeletal disorder but rather the interaction of anxiety and behavioural concerns with developmental learning skills.

Other documents in the Joint Brief show that the Insurer was aware that the Applicant’s anxiety and related issues were interrelated with the Applicant’s learning and educational development.

On August 9, 2012, five months prior to Dr. Platnick’s assessment, Ms. Edmonds wrote that in her view, the force of the impact “were sufficient to cause brain injury whether or not Kristen exhibited any signs of it immediately after the collision”. She goes on to write: “Your Neuropsychologist has already commented that there is evidence of symptoms of post-traumatic stress disorder and anxiety as well as developmental and cogitative impairments”.  Again, in a letter to Primmum, dated October 9, 2012, Ms. Edmonds wrote: “The purpose of Dr. Hay’s Assessment is to determine the nature and etiology of Kristen’s cognitive impairment, learning difficulties and anxiety”. In explaining the hoped for outcome of Dr. Hay’s assessment Ms. Edmonds stated:

I must determine whether her assessment, which is directed to cognitive problems and learning disabilities, will focus sufficiently on emotional and anxiety issues, as it is my understanding that the purpose of the  Psychological assessment was not only to assess Kristen’s difficulties and determine their relationship of them to the collision, but to formulate a treatment plan.

On October 22, 2012, the prior Section 44 assessor, Dr. Syed, wrote Primmum a clarification letter to show the difference between Neuropsychological assessment and a Psychoeducational assessment. Writing about the investigation of Kristen’s symptom aetiology, she stated: “The aetiology of her symptoms need to be understood from a brain behaviour perspective and investigated as such”.

From the history of the Applicant’s symptoms in the intervening almost 5 years, as documented in the Joint Brief; the medical reporting; and the investigations and assessments by the Insured, it is reasonable to infer that the Insurer was in error by assigning Dr. Platnick and accordingly, his conclusions can not to be relied upon. Dr. Platnick has neither the qualifications to review the submitted OCF-18, dated August 27, 2012, nor the qualifications to review Dr. Hay’s Neuropsychological Assessment Report. The reasons Primmum relied on in denying the Applicant’s claim have to be removed from consideration.

http://www.canlii.org/en/on/onhparb/doc/2015/2015canlii46/2015canlii46.html

51.              The Committee considered the information in the Record and concluded that it remained extremely troubled by the Applicant’s apparent lack of understanding of his role as independent medical examiner or third party assessor.

52.              The Committee noted that the Applicant conducted the appointments with the Respondent without obtaining the express consent and clarifying the purposes of the assessments; he communicated certain aspects of the Respondent’s health information directly to the Respondent’s employer also without the express consent of the Respondent; he provided medical treatment over several appointments to an individual whom he had been hired to assess by that individual’s employer, creating a conflict of interest between his role as third party assessor and treating physician to the individual; and he did not document the treatment provided to the Respondent nor the rationale for such treatment.

53.              The Committee determined to issue a caution in person to the Applicant as he acted far beyond the scope of what is appropriate for an examiner or assessor, and appeared not to have an adequate understanding of the role of such a physician.

54.              The Committee required the Applicant to attend the College to be cautioned regarding his obligations as an independent medical examiner or third party assessor and particularly with respect to:

•           assessing a patient without adequate, informed consent;

•           treating an individual who was not a patient;

•           failing to obtain written consent to discuss his findings with the employer of the individual being assessed; and

•           failing to document the treatment provided.

55.              The Applicant and his Counsel made strong objections to the Committee’s analysis of the Applicant’s actions and submitted that he should not be judged by the Third Party Policy as he is a “company doctor” and practices in the Occupational Health and Safety Field and does not view himself as being subject to that policy.

56.              The Board notes that this issue was addressed previously in this decision under ‘Adequacy of the Investigation,’ wherein the Board found that the Committee had retained an IOP practising in the occupational health field in order to have sufficient expertise to address the issues involved in this complaint.

57.              As stated, the Committee, after considering the independent opinion, found that the Applicant is subject to the standards as set out in the Third Party Policy.

58.              The Committee has considered the Applicant’s conduct and actions with the lens of the Third Party Policy and the assistance of an IOP practising in the Occupational Health and Safety field.

59.              The Committee has based its findings on information in the Record.

60.              Notwithstanding the Applicant’s strong objections, the Committee’s decision is a decision that falls within a range of possible, acceptable outcomes that are defensible in respect of the facts and the law and is thus reasonable.

https://www.canlii.org/en/on/onsc/doc/2015/2015onsc1928/2015onsc1928.html

[34]      Further, the plaintiff asserts that the defendant’s witness, Dr. Clark, repeatedly and in the face of my clear instructions gave improper evidence, which resulted in considerable delay and expense. Further, defence counsel was aware, at least partly, of the change in Dr. Clark’s evidence before he testified; however, the Court was not made aware of it prior to Dr. Clark testifying. As a result, the plaintiff submits that Dr. Clark’s disbursements, totaling $11,450.04, should be eliminated or reduced.

[35]      I qualified Dr. Clark to give expert evidence. He testified that previously he has been qualified to give expert evidence in Superior Court. He either knows, or should know, the rules governing the nature of his testimony. His breaches of those rules resulted in a motion to strike the jury. His breaches caused considerable cost and delay to the trial.

https://www5.fsco.gov.on.ca/AD/4330

http://canlii.ca/t/gfnxd

3.  Is the impairment serious?

[18]           The court heard from the defence expert medical witness, Dr. Michael Ford, a spine and trauma surgeon at Sunnybrook dealing with serious fracture cases. He is still active as a surgeon and does a significant amount of medico-legal assessments. He does not practice in the area of chronic pain but he is experienced in assessing it as an orthopedic surgeon. He categorically dismisses chronic pain complaints unless, as he said, he can see or understand the mechanism causing the complaint. He dismissed Dr. Alpert’s opinion as supposition.

[19]           Dr. Ford gave this plaintiff a very cursory examination. It was his last appointment of the day. He took Ms. Maxwell’s history in ten to fifteen minutes and the physical examination consisted of Dr. Ford watching her walk, do a neck extension and neck rotation. He never palpated her so he could not have found what Dr. Alpert says he found as his own objective findings during his examination.  He found that:

•         she had a decreased range of motion doing different movements -he saw these as significant and in the 40% to 70% range;

•         she had muscle tightness and tenderness to the touch in the cervical area from C2 to C6 – he could feel the tautness and ropiness in the muscles and ligaments there;

•         she had tenderness to palpation over the occipital nerves.

[20]           These findings were dismissed by Dr. Ford. He saw this case as simple and uncomplicated, where there were no objective mechanisms causing pain, therefore there could be no valid complaint. He understood that she had stopped working because of her pregnancy and that her complaints from the car accident in 2007 had long since resolved.

[21]           If he had asked a few questions about these answers, he probably would have learned that she could not do the strenuous dances that success at her job demanded, being very dependent on tips; she could no longer do the one recreational activity she loved, horse-riding, though she did try and was hit in the head once and fell off a second time. Dr. Ford simply dismissed Ms. Maxwell and wrote a report concluding without even a full examination of the patient, that any complaints she had now must come from her prior or other medical history without any analysis as to what exactly in her past would have caused them but the 2007 collision; all other previous traumas were reported and the treating doctor or chiropractor could see no reason to follow up other than to suggest some rest. I do not accept Dr. Ford’s opinion nor do I sense that Dr. Ford has an understanding of the fundamental aspect of those chronic pain cases, which lack objective proof. Nevertheless they are very real to the patient.  In finding as I do, I am not to be taken to take away from Dr. Ford as an excellent spinal surgeon who works with serious trauma patients often derived from serious fractures, and displacement and other severe physical trauma. But I question his expertise in the area of chronic pain due to his offhand examination, his failure to test by palpation or to observe a variety of movements, and his very brief approach to her medical history which is by no means a simple one to understand, both orally and through the many records from the treating practitioners.

Speaker’s Corner: An expert witness’ friendly advice on information he needs from lawyers

https://www.canlii.org/en/on/onsc/doc/2014/2014onsc6828/2014onsc6828.html

[6]               Cira is not a party to this litigation. It is a national company in the business of providing medical assessments and health services for several corporate, insurance and medical legal communities through a network of independent health professionals. Cira was created in June 2012 and is a combination of two companies, namely, Riverfront Medical Services (“Riverfront”) and Medisys IMA.

[7]               The Defendants retained Cira to co-ordinate defence medical examinations of Ms. Burwash conducted pursuant to s. 105 of the Courts of Justice Act, R.S.O. 1990, c. C.43.

[8]               The Defendants do not object to the production of the files.

[9]               The Defendants have requested disclosure of Cira’s complete files.  The Plaintiffs allege that only partial production of the files has been made to date.

Timing of the Motion

[10]           The Plaintiffs assert that they had no reason to suspect that Cira was involved in the review, revision and editing of draft expert reports until the examination for discovery of Dr. St. Pierre when answers and subsequent productions indicated that Cira may be using third parties to review and revise the Defendants’ expert reports.

[11]           I am satisfied that the Plaintiffs have brought this motion at the earliest opportunity and that they could not have reasonably discovered that the issue existed any earlier.

[28]             Rule 53.03 of the Rules of Civil Procedure is designed to ensure the independence and integrity of the expert witness. The duty of the expert witness is to be of assistance to the court. Each expert witness is required to sign an acknowledgement that they are providing an independent and unbiased opinion. If there is reason to believe that the expert’s report or opinion has been influenced by unknown third parties and is therefore not entirely the expert’s opinion, the fundamental rationale for accepting expert opinion evidence is no longer present and hence the report is not only not helpful to the court but may become misleading. This is an issue that is directly related to trial fairness.

https://www5.fsco.gov.on.ca/AD/4290

AXA’s medical evidence

AXA relies on two Insurer Examination (IE) reports: one by Dr. Urovitz dated August 25, 2010[16] and the other by Dr. Waisman dated August 23, 2010[17], which state that Mrs. Shokat does not suffer a substantial inability to engage in her pre-accident housekeeping duties.

Dr. E. Urovitz

Dr. Urovitz, an orthopaedic surgeon, who assessed Mrs. Shokat on behalf of AXA, stated in his report dated August 25, 2010[18] that Mrs. Shokat’s complains at the time of her visit were constant daily pain in her right wrist, right ankle, right fifth finger, central neck and central lower back. He diagnosed her with a “soft tissue injury to the right wrist and right ankle, contusional injury to the right lower extremity, neck strain … and lower back strain” … as a result of the motor vehicle accident.

He opined that Mrs. Shokat had suffered a soft tissue injury to her right wrist and that, from an orthopaedic perspective, Mrs. Shokat did not suffer a substantial inability to engage in her pre-accident housekeeping duties.

He however recommended an MRI of the right wrist because of the ongoing complaints to her wrist to rule out the possibility of an internal derangement particularly meniscal damage.

Dr. Waisman

Dr. Waisman, a psychiatrist, assessed Mrs. Shokat on behalf of AXA on July 30, 2010. In his report dated August 23, 2010[19], Dr. Waisman stated that Mrs. Shokat reported having mood fluctuations based on the degree of pain felt. She further reported having poor concentration and memory since the accident. He opined that Mrs. Shokat was not substantially unable to perform her pre-accident housekeeping tasks from a psychiatric perspective.

Findings on Disability

There is no evidence that Dr. Urovitz or any of AXA’s assessors reviewed the results of the MRI of December 2010 which revealed a triangular fibrocartilage tear to Mrs. Shokat’s right wrist.[20] I find it pertinent that the only assessors who had the benefit of reviewing the MRI of her wrist before forming an opinion on Mrs. Shokat’s physical injuries were her assessors.

Albeit, Dr. Schofield, who assessed Mrs. Shokat in October of 2011, seemed to have a different opinion from Dr. Tuli in that he did not think that surgery would be beneficial to Mrs. Shokat’s hand and instead recommended ongoing exercise to gradually improve her grip strength, I note that his report is indicative of the fact that her symptoms continued to persist at the time of her visit. Therefore, I find it reasonable to infer that resuming her pre-accident housekeeping tasks at that time would result in an exacerbation of her symptoms.

I find on a balance that the objective medical evidence does not support AXA’s evidence on Mrs. Shokat’s inability to perform her pre-accident housekeeping tasks, particularly Dr. Urovitz’s opinion. I find that the objective medical evidence supports the disability certificate − therefore, I prefer this evidence.

https://www5.fsco.gov.on.ca/AD/4291

Mrs. Nguyen submits that Dr. Monte Bail, the psychiatrist at Lorak, wrote a report that “purposely contained errors, changed and edited information from Ms. Nguyen’s previous insurer’s examination reports to ultimately fit his opinion that Ms. Nguyen’s caregiver benefits should be terminated.” However, as noted above, the Arbitrator did not assign great weight to Dr. Bail’s report. He found that Dr. Bail “did not fairly assess Mrs. Nguyen. His report was profoundly impacted by his belief that Mrs. Nguyen was not truthful about taking medications prior to the motor vehicle accident. In fact, Mrs. Nguyen’s family doctor had made an error which led Dr. Bail to reach the conclusion that he did.”

http://canlii.ca/t/g8gcq

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.