Remedial Agreement Appropriate Where Concerns are Acknowledged

This case involved a complaint about the care provided by a psychiatrist to the applicant’s son over the course of eight years.  The Inquiries, Complaints and Reports Committee of the College of Physicians and Surgeons of Ontario investigated the complaint and decided to state its expectations that the psychiatrist complete a Remedial Agreement acknowledging the concerns raised and measures to be taken to improve his practice.   While the applicant wanted a “harsher penalty”, the Health Professions Appeal and Review Board confirmed the Committee’s decision.

Background

The applicant’s son was a psychiatric patient of the respondent between 2008 and 2015.  The applicant complained that during the course of eight years, the psychiatrist never provided a diagnosis while continuing to prescribe medication that was not helpful.  The applicant also complained that the psychiatrist was dismissive of her and her family.  He refused to allow family members to be present during discussions, despite the patient’s consent.  He also failed to complete the patient’s disability tax credit forms.

The Committee’s Decision:

The Committee investigated the complaint and decided to accept the psychiatrist’s “Remedial Agreement” wherein he acknowledged that he needed to improve the following skills:

  1. Communication with patients and family members;
  2. Record keeping, specifically relating to the inclusion of a clear diagnosis and treatment plan; and
  3. Knowledge of the College’s Third-Party Policy.

The agreement required the psychiatrist to participate in self-directed educational efforts to address these concerns, and to follow up by submitting a self-study report to the College, outlining his efforts, together with references to any materials reviewed. The report would include a description of the educational activities that he undertook, a summary of his learnings, and an indication of how he has changed or plans to change his practice.

Any ongoing concerns by the College, after reviewing this report, would lead to the file being sent back to the Committee for consideration.

The Review

The applicant did not find the Committee’s decision acceptable, suggested a “harsher penalty” was in order, and requested a review by the Board.

After completing its review, the Board found that the Committee’s decision was reasonable. The Remedial Agreement addressed the identified areas of practice in which the psychiatrist would benefit from further education.  The Committee’s concerns broadly reflected those of the applicant’s.  The requirement that the psychiatrist engage in self-study in the specific areas listed was a remedial disposition that protected the public interest.  Furthermore, there were provisions for the review of his self-study and possible referral to the Committee in the event of ongoing concerns.  The Committee also reserved the right to take further action if the he failed to comply with the terms of the agreement.

Of significance was also the fact that the Remedial Agreement would remain on the psychiatrist’s permanent record, which, although private, may be considered in the event of a further complaint.

Takeaway

In our view, this was a reasonable outcome in the circumstances given that the concerns raised by the applicant were warranted.  Although there would be no publication, the public was protected, in that the professional was required to take remedial measures.

Significantly, the psychiatrist avoided further action such as a caution or a Specified Continuing Education and Remediation Program (“SCERP”) because of his willingness to address concerns by undertaking remedial efforts of his own volition. Proposals such as this go a long way in reducing the risk to the public in the eyes of the Committee, and warrant less onerous outcomes for health professionals.

Please contact us if you have questions about this case or health professionals’ regulatory proceedings.

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