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[2017] VCAT 378
Victorian Civil and Administrative Tribunal
2017-03-16
Original judgment source is linked above.
Health Practitioner Regulation National Law (Victoria) Act 2009 - whether conduct of registered psychologist in refusing to permit on-site audit at his practice and to undergo a performance assessment constituted professional misconduct or unprofessional conduct under the National Law
Senior Member I. Proctor & Members C Manning and M. Power
Psychology Board of Australia v Wilkinson (Review and Regulation) [2017] 378
Orders under section 17 of the Open Courts Act 2013
On 28 November 2016 the Tribunal made the following orders which remain in force:
(a) The publication of a report of this proceeding to the extent that it would disclose the name and address of the notifier whose notification indirectly gave rise to this proceeding, the registered psychologist who was the subject of that notification and/or any patient of any registered psychologist and the publication of any information derived from this proceeding which could reasonably be expected to enable such identification, is prohibited.
(b) These orders apply throughout Australia. VCAT's reasons for decisions are published on the AustLII website, which is accessible throughout Australia.
(c) This order operates until further order of the tribunal or until the death of the last surviving of the notifier or the registered psychologist referred to in Order 1 above.
In this case, [Mr Wilkinson] maintains he will continue to act as he does, unless the tribunal rules a different practice is required. By these findings, the tribunal intends to send a strong message to [Mr Wilkinson] and others who may be minded to engage in a similar mode of practice that it is unacceptable practice. Simply put, all psychologists must keep adequate, current, up-to-date records of treatment of clients.
The tribunal is of the opinion that [Mr Wilkinson] knows what his professional obligations in this regard are and what he must do to comply with them. ... In those circumstances, the tribunal is of the view that a course in trying to re-educate [Mr Wilkinson] would not protect the public and would not sufficiently reflect general deterrence. The penalty the tribunal has imposed is designed to address these specific issues. In arriving at the penalty imposed the tribunal is conscious of the fact that in the future the [Board] may periodically check that [Mr Wilkinson] in fact complies with his continuing obligation to keep proper records of the psychological services he provides to clients. If that is done the public will have further protection. The tribunal notes the [Board] has the necessary power to check the performance of [Mr Wilkinson] as a registered health practitioner pursuant to s 118(1)(e) of the HPRA.
That, between on or about 23 November 2012 and on or about 16 May 2013, Mr Wilkinson engaged in professional misconduct within the meaning of paragraph (a) of the definition of professional misconduct in section 5 of the National Law and/or engaged in unprofessional conduct within the meaning of the definition of unprofessional conduct in section 5 of the National Law, in that:
(a) by not permitting an auditor nominated by the Board to conduct a practice site visit and an audit of random files selected by the auditor, he did not comply with a condition on his registration requiring audits of his clinical files (Condition) in circumstances where he knew or ought to have known that the audits that were the subject of the Condition were to be conducted by way of a practice site visit and an audit of random files selected by the auditor; or
(b) in the alternative, he refused to permit an audit of his clinical records in the manner required by the Board and/or as the auditor saw fit, involving a practice site visit and an audit of random files selected by the auditor.
That, on 10 October 2013, Mr Wilkinson engaged in professional misconduct within the meaning of paragraph (a) of the definition of professional misconduct in section 5 of the National Law and/or engaged in unprofessional conduct within the meaning of the definition of unprofessional conduct in section 5 of the National Law, in that he refused to undergo a performance assessment as required by the Board.
Allegation 1 - failure to comply with audit condition
Mr Wilkinson's clinical records are to be audited by a psychologist approved by the Board within 3 months of the Board approving the auditor, and at 6 and 12 months thereafter.
Although I am not obliged to even meet with [the auditor], if she 'audits' the case files and wants to ask a few questions I will allow this. This could easily be by telephone or in person at my office, I consider this a considerable concession, but I do not intend to spend any more than one hour on any such process. The case files will be made available by 18 January.[8]
Best practice surrounding documentation audit process would entail visiting the practice rooms of the psychologist to conduct a random audit. This procedure allows the auditor to review the security arrangements for storage of confidential records, to match files and entries against client booked appointments to review the consistency of documentation practice, and to randomly select files for audit.
The current audit was not conducted at the practitioner's office at his request. Alternatively, a pdf containing records selected by the practitioner was provided to the auditor electronically.
As with the initial order, the outcome of the current audit is significantly limited by the procedure as the records were self-selected by the practitioner, rather than randomly selected by the auditor.
The current audit was not conducted at the practitioner's office at his request.
Based on the information provided in this report, it is my opinion that Mr. Wilkinson's conduct fell below the standard reasonably expected by a registered psychologists of an equivalent level of training or experience by failing to allow the Board appointed auditor to conduct her audits as she determined necessary under the circumstances. Mr Wilkinson had an ethical and legal obligation to ensure that his records were maintained in an accurate and complete manner. Based on the ethical standards and Ethical Guidelines on Record Keeping Mr. Wilkinson should have known that an audit of his records would necessitate a visit to the location where the files are maintained, followed by a review of the record keeping system, the manner in which the files are stored, and a review of a selection of files drawn by the auditor.
The argument that Mr Wilkinson proffered that a visit to his professional premises and a review of the files was an invasion of his client's privacy and his personal and professional space is spurious since his obligation is to make the records, including his record keeping system, available for review by the auditor irrespective of where the records are maintained. It is his choice to locate his practice in his home and this choice does not obviate in any way his ethical or legal obligations.[13]
Finally, the ethical principles and standards, as well as the Guidelines, make clear that neither Mr Wilkinson, nor his clients, have an absolute right of confidentiality to the records. File audits are routinely required in psychologists' and other health professionals' practices and the auditors have ethical and legal obligations to maintain confidentiality of the content of the files reviewed. Indeed, as specified by the Board, the auditor appointed was a psychologist who would therefore be required to comply with the Code, including provisions regarding confidentiality.
In my opinion, Mr. Wilkinson's conduct, by failing to subject his records to audit, constitutes unprofessional conduct as specified in the National Law insofar as it was of a lesser standard than that which might reasonably be expected of the health practitioner.
As specified in this report, Ethical Standard C.7 requires that psychologists cooperate with ethics investigations by statutory bodies charged with the responsibility to investigate complaints against psychologists. In addition, Ethical standard B.1.2 requires that psychologists provide services within the boundaries of their professional competence, which includes complying with the law of the jurisdiction in which they practice including, in this instance, the National Law.
It is my view that Mr Wilkinson's argument that no rulings existed to enable the auditor to conduct an on site inspection of his records is spurious. He should have reasonably expected that the condition imposed by the Board that his 'clinical records are to be audited by a psychologist' would involve a review of his record keeping system, storage, and actual files selected by the auditor, which would require a visit to his professional premises. This interpretation of the condition is consistent with the Code and Ethical Guidelines on Record Keeping.
In my opinion, Mr. Wilkinson's conduct, by failing to comply with a condition of his registration, constitutes unprofessional conduct as specified in the National Law. His conduct was of a lesser standard than that which might reasonably be expected of the health practitioner and includes a contravention by Mr Wilkinson of a condition to which his registration was subjected.
At the end of the evidence, the tribunal was left with the impression from [Mr Wilkinson] that he took the attitude to the principles set out in the Code of Ethics and the Ethical Guidelines do not apply to him. In the tribunal's opinion, such an approach by [Mr Wilkinson] reflects a somewhat arrogant view of the world.
Mr Wilkinson's clinical records are to be audited by a psychologist approved by the Board within 3 months of the Board approving the auditor, and at 6 and 12 months thereafter.
Allegation 2 - Failure to undertake performance assessment
... Ethical Standard C.7 requires that psychologists cooperate with ethics investigations by statutory bodies charged with the responsibility to investigate complaints against psychologists. In addition, Ethical standard B.1.2 requires that psychologists provide services within the boundaries of their professional competence, which includes complying with the law of the jurisdiction in which they practice including, in this instance, the National Law.
In my opinion, Mr. Wilkinson's conduct, by failing to attend a performance assessment as required by the Board under the National Law, was of a lesser standard than that which might reasonably be expected of the health practitioner and constitutes a contravention by Mr. Wilkinson of a requirement by the Psychology Board of Australia.
[1] For clarity in these reasons we have renumbered Allegation 1.1 as Allegation 1 and Allegation 1.2 as Allegation 2.
[2] Dated 20 December 2016 and 9 February 2017.
[5] Search of AHPRA registration database on 7 March 2017.
[13] Professor Ogloff addressed this further during cross-examination. He explained that if privacy obligations prevented the auditing of health professionals records, no such auditing would practically be possible. He also noted that in this case the auditor was a registered psychologist, bound by the same obligations as Mr Wilkinson is bound by. See transcript, page 44 and 48.
[16] We take Mr Wilkinson to be referring to late 2012/early 2013.
[18] VCAT Proceeding Z903/2015 Wilkinson v Psychology Board of Australia - orders and oral decisions only
[19] See the Board's closing submissions dated 20 September 2016.
Psychology Board of Australia
Wilkinson