Hearing TribunalGroup 5

Vicki PedersonCarli Newberry

Teresa SawatzkyWendy Reece-Wile

The Complaints Director wrote a letter to the complainant (Ted) dismissing the complaint with no reasons provided and the complainant has now appealed the decision to (us) the Complaint Review Committee (CRC)

Beginning Point

Within 60 days after receipt of the report against the psychologist under subsection (2) of the HPA, the complaint review committee would commence a review of the report and the decision to dismiss the complaint.

OUR MANDATE AS COMPLAINTS REVIEW COMMITTEE MEMBERS

Step 1

(a)refer the matter to the hearings director for a hearing,

(b) direct the complaints director to conduct or appoint an investigator to conduct a further investigation and to prepare a report on the further investigation and submit it to the complaint review committee for its consideration before acting under clause (a) or (c), or

(c) confirm that the complaint is dismissed if in the opinion of the complaint review committee(i) the complaint is trivial or vexatious, or(ii) there is insufficient or no evidence of unprofessionalconduct.

The Complaints Review Committee MustStep 2

One CRC Option

Dismiss the case

can interview witnesses and request alldocumentation (by court order if necessary)

would require identification of the individuals and groups potentially affected by the decision

they do not resolve or mediate but provide an objective report to the Hearing Director

APPOINT AN INVESTIGATOR

Another CRC Option

the hearing director reviews all relevant documentation and reports and will identify all ethically relevant issues and practices (Review of the Code of Ethics, Standards of Practice and Legislation relevant to the investigation).

provides written documentation of any decisions and actions to complainant and psychologist along with reasons for such actions.

REFER THE CASE TO THE HEARING DIRECTOR

Another CRC Option

If complainant or psychologist disagree with the decision of the hearing director (they have 30 days to appeal the decision) it goes to a hearing tribunal who will render the final decision.

Step 3

Hearing tribunal will determine if the conduct occurred and additionally determines whether the conduct does in fact constitute “unprofessional conduct”

dismiss the complaint against the psychologist orissue a penalty, orders/sanctions andThey will provide a copy of all factual findings and decisions and reasons for decisions in writing to the complainant and psychologist.

THE HEARING TRIBUNAL WILL

Step 4

IF THE COMPLAINT IS STILL NOT RESOLVED

IT MAY GO TO CRIMINAL OR CIVIL

COURT.

Step 5

1. She disclosed private information about Ted’s past to his daughter.

2. She was verbally abusive and called him a “control freak”.

3. She physically shoved him out of her office.

4. She refused to provide a copy of the notes when requested.

TED’S COMPLAINTS AGAINST DR. MEYER

I. Respect for the Dignity of Persons

II. Responsible Caring III. Integrity of Relationship

I.3 use respectful language in all written and oral communication

II.1 Protect the welfare of clients

III.11 be clear in communications, distinguish fact from opinion

I.9 Obtain informed consent from all

II.5 Ensure psychological knowledge is not used to harm others

III.14 Be clear about informed consent and get signatures

I.21 used signed consent forms that specify the dimensions of consent

II.19 Create and maintain records

III.16 Fully explain reasons for actions

I.44 clarify the boundaries of consent especially with families or groups

II.21 Strive to provide the best possible services

III.36 Abide by the rules of the profession unless they can cause harm

I.45 Share confidential information only with informed consent of those involved

II.30 Be discrete in record keeping: avoid conjecture and labeling

• Spoke about informed consent (I.9)

• Kept records for each session (II.19)

• Acted to protect and promote the welfare of clients (II.1)

• Was available and accessible to the family when they needed her (II.21)

• Acted to protect herself and clients from harm when Ted became aggressive (II.1)

WHAT DR. MEYER DID WELL

•Be clear about the limits of informed consent (I.45)

•Have signed consent indicating that all parties understand the limits of confidentiality (I.21)

•Keep adequate and appropriate records (II.30)

•Avoid using labeling terms that could be misunderstood (III.11)

•Refused to provide records to Ted (III.16)

•Did not respond to Ted’s written request (III.16)

WHAT DR. MEYER DID NOT DO WELL?

LegislationIn Alberta, the profession of psychology is

regulated in pursuant with Alberta’s Health Professions Act (HPA) and the Psychologists Profession Regulation. The HPA and Regulation are the primary legislation that applies to all members of the College of Alberta Psychologists. The legislation establishes the provisions relating to the discipline process.

LegislationHPA Complaint Process

Person makes a complaint to the Complaints DirectorComplaints Director

Investigator, Action or DismissalComplaint Review Committee

Investigator, Dismissal or ReferralHearings Director

Sets Hearing Tribunal DateHearing Tribunal

Witnesses, Dismissal or Action

Legislation“unprofessional conduct” is broadly defined in

the HPA, and includes:Displaying a lack of knowledge of or a lack of

skill or judgment in the provision of professional services

Violation of this Act, a code of ethics, or standards of practice; and

Conduct that harms the integrity of the profession

LegislationUnder the HPA, a psychologist may be found guilty of

unskilled practice for a number of reasons, including where the psychologist has breached the Code of Ethics. Although a psychologist who breaches the Code of Ethics may be found guilty of unskilled practice, the Code itself acknowledges that possibility of differences of opinion in some areas, such as the ethical decision-making process.

A psychologist who is the subject of a disciplinary proceeding may be asked to explain to what extent he or she considered the principles set out in the Code when faced with an ethical issue.

LegislationThe HPA authorizes the Council to adopt Standards of

Practice for the profession. Under the HPA, a breach of the Standards of Practice may constitute unprofessional conduct.

The Standards of Practice differ from the Code of Ethics in that the Standards are more definitive in nature.

The rules established in the Standards of Practice are often utilized in disciplinary hearings as a standard against which to judge a psychologist’s conduct, and violations of any of the individual rules may be the basis for a finding of unprofessional conduct.

Dr. Meyer Vignette

Standards of Practice that may

have been breached

Standards of PracticeThe HPA authorizes the Council to adopt Standards of

Practice for the profession. Under the HPA, a breach of the Standard of Practice may constitute unprofessional conduct.

The Standards of Practice differ from the Code of Ethics in that the Standards are more definitive in nature.

The rules established in the Standards of Practice are often utilized in disciplinary hearings as a standard against which to judge a psychologist’s conduct, and violations of any of the individual rules may be the basis for a finding of unprofessional conduct.

Informed Consent2(1) Psychologists shall obtain the informed consent of

all persons who are competent to give such consent for psychological services provided to them except in circumstances of urgent need (e.g., disaster or other crisis). In urgent circumstances, psychologists may proceed in accordance with the expressed preferences of such persons, and obtain informed consent as soon as possible.

Informed Consent2(3)Psychologists shall provide, in obtaining informed

consent, such information as a reasonable person would want to know to make a decision to consent to the service. The psychologist must relay this information in language that the persons understand (including providing translation into another language, if necessary) and will take whatever reasonable steps are needed to ensure that the information is understood

Informed Consent2(6)Psychologists shall document the discussion held

with their clients and whether informed consent was obtained.

Multiple Clients21When professional services are rendered to more

than one client during a joint session (for example, to a family, a couple, a parent and child or a group), psychologists shall at the beginning of the professional relationship clarify for all parties the manner in which confidentiality will be handled and all parties must be given an opportunity to discuss and accept whatever limitations to confidentiality apply.

Release of Information to Client

27 (1)When a Psychologist has control of a client's file,

he/she shall provide access to, and shall, within 30 days of a request, permit the reproduction and release of confidential information about a client to the client unless there is a significant likelihood that disclosure of the information would cause

(a) a substantial adverse effect on the client’s physical, mental or emotional health, or

(b) harm to a third party.

Where files contain information about several persons obtained in the context of a professional relationship (for example, in couples or family therapy), the psychologist must secure the consent of all such persons before releasing the information. Psychologists may release file information without the consent of the third parties in this circumstance if it is possible to obscure information about third parties identified in the file or sever third party information from the file.

Professional Guidelines for Psychologists Release of Confidential Information:Special Issues in Client and Third Party Requests Adopted by CAP 1998 Revised November 2001 Revised May 2002 Revised September 2005

Professional Guidelines for Psychologists

What to do?CRC Options

Dismissal Appoint an Investigator

Refer to the Hearings Director for a

Hearing

To dismiss or not to dismiss…

Possible Outcomes of the Hearing Tribunal

Recommend the psychologist practice under increased supervision for a specified time

Recommend the psychologist practice with one or more other regulated members

Suspend the practice permit of the psychologist

Dismiss the complaint

What We Predict…

If No Additional Evidence is Found…

ComplaintsDr. Meyer was physically abusiveDr. Meyer was verbally abusiveDr. Meyer refused to release her notes

will be dismissed on grounds that the complaints:

Are trivial and vexatious in natureYield insufficient evidence of professional misconduct

If No Additional Evidence is Found…

Complaint regarding confidentiality will be addressed with a cautionary letter citing: Alberta College of Psychologists Standard 2(6):Psychologists shall document the discussion held with their clients and whether informed consent was obtained

CPA Code I.21 Establish and use signed consent forms that specify the

dimensions of informed consent or that acknowledge that such dimensions have been explained and are understood, if such forms are required by law or if such forms are desired by the psychologist, the person(s) giving consent, or the organization for whom the psychologist works.

Included in the Letter…Psychologist will receive a written reminder of

her obligation to use discretion in written notes (as per standard II.30)

Psychologist may be required to attend professional development workshops

Included in Letter to Ted:Dismissal of first three complaints citing

vexatious nature and insufficient evidence of an ethical breach

Acknowledgement of a possible nondisclosure of informed group confidentiality, and assure him she will be advised to change this practice

The Bigger Picture

From the CPA Code: In determining corrective action for an individual

psychologist, one of the judgments the adjudicating body needs to make is whether an individual conscientiously engaged in an ethical decision-making process and acted in good faith, or whether there was a negligent or willful disregard of ethical principles. (Preamble)

If the psychologist can demonstrate that every reasonable effort was made to apply the ethical principles of this Code and resolution of the conflict has had to depend on the personal conscience of the psychologist, such a psychologist would be deemed to have followed this Code. (Preamble)

References Alberta Heath and Wellness (2002). Health professions act: A

new law for regulated health care professionals. Edmonton: Author.

Canadian Psychological Association. (2000). Canadian code of ethics for psychologists (3rd ed.). Professional Guidelines for Psychologists Release of Confidential Information:Special Issues in Client and Third Party Requests Adopted by CAP 1998 Revised November 2001 Revised May 2002 Revised September 2005

College of Alberta Psychologist (2005). Professional guidelines for psychologists: The status of regulatory documents in the regulation of the psychology profession in Alberta. Edmonton: Author.

Province of Alberta (2000). Health professions act. Edmonton: Author.