Health Professions Board Provides Guidance on Requirements for Adequate Investigation
Ontario's Health Professions Appeal & Review Board (HPARB) provided guidance as to what is required for a College investigation to be deemed adequate.
This guidance is found in a recent decision by HPARB regarding its review of a decision by the Inquiries, Complaints and Rerports Committee (ICRC) of the College of Physicians and Surgeons of Ontario (CPSO) in respect of a complaint by a patient about the fees charged by his ophthalmologist in connection wiht cataract surgery. After the ophthalmologist diagnosed the patient with cataracts, the patient decided to proceed with cataract surgery. Although the surgery was covered by OHIP, the patient was told he would have to undergo additional non-insured treatment, tests and procedures, for which he paid $1000. The patient underwent these tests, but subsequently decided not to proceed with the cataract surgery. He the requested his money back, and the ophthalmologist reimbursed $500 but retained $500 to cover the costs of the non-insured preoperative testing, which the patient underwent.
The patient complained to the CPSO, and the complaint was investigated by its ICRC. The ICRC ultimately decided to advise the doctor "to take greater care and ensure he provides full information when selecting patients for non-insured refractive procedures."
The patient asked HPARB to review the decision of the ICRC. HPARB was required to consider either the adequacy of the Committee’s investigation, the reasonableness of its decision, or both.
HPARB found the investigation to be inadequate for two reasons:
First, the ICRC was required to consider the member's complaints history, including all prior decisions relating to him. However, the ICRC was only provided with summaries of such decisions.
Second, the ICRC had before it the College policy statement #3-10 on uninsured services, which states that physicians “must ensure that the fees charged for uninsured services are reasonable”. The policy states that physicians “should refer” to an Ontario Medical Association (OMA) document entitled “Physician’s Guide to Third-Party & Other Uninsured Services” (the "Guide") for the recommended schedule of fees. However, the ICRC did not have the Guide before it when considering the complaint. Since the complaint related to fees charged and there is no document in the Record which breaks down the fee paid, HPARB found that the failure to obtain and reference the OMA fees guidelines for uninsured services renders the investigation inadequate.
HPARB remitted the matter back to the ICRC and and required it to conduct a further investigation after obtaining and considering: (a) all prior decisions pertaining to the member; and (b) the Guide, as well as the Member's submissions with respect to same.
