DISCIPLINE SUMMARIES
The College expert opined , in part , about Dr . Powell ’ s failure to recognize and maintain the psychotherapeutic frame of the physician-patient relationship , as follows : “… most sessions lasted longer , sometimes significantly longer , than scheduled … In addition , our discussion revealed that Dr . Powell ’ s justification for extending sessions instead of scheduling longer sessions in advance was based on a lack of knowledge and misunderstanding about psychodynamic principles as related to the frame . He indicated that scheduling a patient for a longer session would be treating them as ' special .' In fact , the opposite is true : extending sessions in the manner in which Dr . Powell practices is more likely to gratify a patient ’ s sense of being special because they are repeatedly “ gifted ” with extra time . Dr . Powell ’ s system of scheduling also reveals poor judgment when it comes to deciding how and when to start and stop sessions ... Appropriately managing no shows and cancellations is also part of maintaining the frame . As I learned from the interview , Dr . Powell told patients they would be held financially responsible for missing appointments and late cancellations , yet he did not hold them to that expectation . At one point he told me that when he did collect payment , he returned it because he felt bad about charging the patient . I believe this represents what is called a counter-transference enactment . Rather than working with albeit difficult and uncomfortable transference material , the issue was avoided , modelling an approach that did not reinforce responsible behaviour and dismissed problematic behaviour .” In an addendum to his report , the College expert amended his finding with respect to Dr . Powell ’ s lack of skill with reference to the frame regarding one patient . However , he noted two additional concerns with respect to the documentation of important clinical changes / situations and a lack of judgment in all of the 19 patient charts in which Dr . Powell failed to maintain an appropriate psychotherapeutic frame . In addition to these revisions , the College expert withdrew his concern regarding Dr . Powell ’ s lack of knowledge of monitoring lipid levels with respect to one patient . The remainder of the opinions reached in his initial report were maintained .
Inappropriate Billing Practices The College expert also opined that all 25 charts showed evidence of inappropriate billing and that Dr . Powell ’ s billing practices did not meet the standard of practice of the profession . Concerning billing practices included :
• Billing one unit for missed appointments ;
• Billing one unit for cancelled appointments ( including at least one appointment that was cancelled by Dr . Powell );
• Billing one unit for telephone calls to patients and telephone prescription renewals ;
• Routinely billing for long sessions . Dr . Powell ’ s average appointment for the patients reviewed is between 80 and 110 minutes ; 50 minutes is the generally accepted length for a psychiatric appointment ;
• Billing special visit premium codes ( A990A and A994A ) when appointments were not always eligible for a premium rate . These premiums are available to a psychiatrist when he or she attends the office on an urgent basis , when they were not otherwise scheduled to attend . Dr . Powell claimed these premiums in circumstances that did not meet the required criteria ; and
• Double billing for the same block of time . There are several instances where a patient was fit in or had their appointment extended on account of a cancellation and claims were submitted to OHIP for both patients .
ORDER The Discipline Committee ordered : a four-month suspension of Dr . Powell ’ s certificate of registration ; the imposition of terms , conditions and limitations on Dr . Powell ’ s certificate of registration ; a reprimand ; payment of a $ 20,000 fine to the Minister of Finance ; and payment to the College in the amount of $ 5,000 for costs . The terms , conditions and limitations on Dr . Powell ’ s certificate of registration include practising under a clinical supervisor for 12 months ; a reassessment of his practice following the 12 months of clinical supervision ; monitoring of his OHIP billings ; and unannounced College visits to his practice . For complete details of the Order , please see the full decision at www . cpso . on . ca . Select Find a Doctor and enter the doctor ’ s name .
At the conclusion of the hearing , Dr . Powell waived his right to an appeal and the Committee administered the public reprimand .
66
DIALOGUE ISSUE 1 , 2018