HPARB confirms advice to owner of Psychotherapy practice in workplace dispute

By Clancy Catelin

In a recent decision, the Health Professions Appeal and Review Board (the “Board”), confirmed reminders and advice issued to the owner of a psychotherapy practice following a contentious workplace dispute. The advice and reminders issued by the Inquiries, Complaints and Reports Committee (the “Committee”) of the College of Registered Psychotherapists and Registered Mental Health Therapists of Ontario (the “College”) in this matter offer helpful guidance regarding the professional responsibilities of regulated health professionals who run a business.

 

This blog includes the following sections:

  1. Background
  2. Reminders and Advice
    1. Business Practices
    2. Accountability for the Behaviour of Staff
    3. Financial Settlements
  3. Conclusion

A. Background

The matter before the College was a complaint against a registered psychotherapist (the “Owner”) who owns a practice which provides psychotherapy, counselling, psychology, and assessment services by multiple practitioners (the “Practice”). The complainant (and Applicant before the Board) was a counsellor (the “Counselor”) who had entered an arrangement with the Owner to rent office space at the Practice and possibly receive referrals through the Practice.

Shortly thereafter, the Counselor engaged two members of the College of Psychologists of Ontario (“CPO”) who were associates of the Practice in a paid arrangement for clinical supervision. The Counselor alleged that clinical supervision was a requirement of her employment with the Practice, and she went on to provide clinically supervised services to patients of the Practice under this arrangement.

After a little over two years of working in this fashion, the Counselor voiced concerns that her supervisors were not meeting the CPO requirements for supervision and that the Practice was therefore fraudulently billing for clinically supervised treatments in a scheme to maximize the use of client’s insurance benefits while providing them with substandard care.

The Counselor further alleged that when she expressed concerns about this arrangement to the Owner and other associates of the Practice, they forced her out of the Practice abruptly, causing her financial and emotional hardship. She further alleged that the Owner had attempted to prevent her from making a complaint through a financial settlement.

The events that surrounded this dispute included numerous other allegations and legal proceedings which are not included in this article. Suffice it to say that there was significant disagreement on the facts and that the relationship between the Owner and Counselor was acrimonious.

The Owner denied the Counselor’s allegations, including that the Counselor was an employee of the Practice or that supervised practice was mandatory. The Owner explained that supervised practice was presented to the Counselor as an avenue to grow her practice, as some insurance carriers authorize payment for psychotherapy services under the supervision of a psychologist where they would not for unsupervised services. The Owner further clarified that she was not involved in the supervision arrangement that the Counselor had with her associates and had no knowledge of whether it was compliant with CPO standards or not.

The Committee found that there was no evidence of fraud, but nevertheless identified several concerns with regards to the Practice and issued reminders and advice to the Owner regarding her business practices.

The Counselor appealed the Committee’s decision, submitting that the disposition failed to address the magnitude of the Owner’s actions or to protect the public. After considering the parties’ submissions, the information in the record, and the Committee’s decision, the Board confirmed the Committee’s decision to issue reminders and advice to the Owner regarding her business practices, accountability for the behaviour of staff, and settlements. 

B. Reminders and Advice

The reminders and advice issued by the Committee and confirmed by the Board provide simple and practical guidance that applies to a range of regulated health professionals and types of practices. The following sections will break these down and identify key takeaways.

1. Business Practices

It may come as a surprise to some regulated health professionals who run a business that they are professionally responsible for several aspects of the services provided through their practice, even when they are provided by other regulated health professionals.

In this case, the Committee commented that it is a psychologist’s professional responsibility if they run a practice to ensure that:

  • services are accurately represented on invoices and receipts;
  • fees are clearly defined and that clients are not charged a referral fee;
  • services and clinical supervision are provided by qualified regulated health professionals;
  • clinical supervision occurs at a level that supports services being billed and represented as “clinically supervised services”; and
  • they always conduct business in a professional manner that fosters public confidence in the profession.

To fulfill these goals, the Committee recommended implementing written contracts and vetting all therapists and clinical supervisors providing contracted services through the Practice.

Some knowledge of the requirements that apply to different types of regulated health professionals may be required to effectively vet candidates. Several colleges provide advice on this issue specifically geared toward employers. Legal advice may also be required.

2. Accountability for the Behaviour of Staff

The Committee also provided guidance regarding the professional responsibility of regulated health professionals when addressing workplace issues in their practice. The Committee stated that regulated health professionals have a professional obligation to address any issues or concerns reported by colleagues and staff working within their practice, including those related to contractors. This includes concerns related to harassing and disrespectful behavior in the workplace.

To fulfill this responsibility, the Committee recommended that when workplace disputes arise, even among contractors, the Owner should act as the point of escalation to help resolve these concerns and prevent similar incidents in the future. It stands to reason that having a practice policy or procedure for addressing workplace disputes or problematic behaviour will help ensure that staff and contractors know how to escalate that issue to the practice owner.

3. Financial Settlements

In some circumstances, it may be possible to resolve or settle a complaint before it is taken to a College. It is generally permitted for these settlements to include a financial element, such as a refund or payment for a corrective treatment, and for a complainant to agree that their complaint is resolved and that they will not make a College complaint. However, as the Committee reminded the Owner in this case, a payment should not be offered in exchange for a person’s right to make a complaint or as a “bribe” to ensure their silence.

The Committee highlights that public protection is always paramount and a member of the public should never feel blocked from making a complaint to the College in good faith. Not only would such an agreement likely be ignored by a college, but the attempt to silence the complainant would likely be considered an aggravating factor when the complaint is considered.

The Committee recommended that, in order to avoid the perception that an offer of settlement was at least in part a “bribe”, any monetary settlement reached should include a description of the payment’s purpose (e.g. payment of monies owed, to offset legal fees, refund of services, etc.). We interpret this as meaning that the amount provided should also be justified in light of the purpose described.

C. Conclusion

This case is an excellent reminder for all regulated health professionals of how their role as a professional and a business owner intertwine. It is also an illustration of how workplace disputes can lead to professional consequences.

In summary, here are our top takeaways from the Committee’s reminders and advice in this matter:

  • Vet all staff credentials and implement written contracts with employees and contractors.
  • When workplace disputes arise, even among contractors, the Owner should act as the point of escalation for dispute resolution.
  • Any monetary settlement should include a description of the payment’s purpose. This purpose must not include negating an individual’s right to make a complaint to a regulator.

If you require advice regarding your health care business or professional responsibilities, please contact us.

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