College of Audiologists and Speech-Language Pathologists of Ontario v. Lochrie, 2023 ONCASPD 4

COLLEGE OF AUDIOLOGISTS AND SPEECH-LANGUAGE PATHOLOGISTS OF ONTARIO DISCIPLINE COMMITTEE

Date: November 3, 2023

File No.: 23-001-AS

BETWEEN:

College of Audiologists and Speech-Language Pathologists of Ontario

• and -

Christina Lochrie

FINDING AND PENALTY REASONS

Heard: October 6, 2023, by videoconference

Panel:

David A. Wright, chair Ioan Curca (AUD) Satpaul Singh Johal Jane Loncke (SLP) Donna Mooney

Appearances:

Natasha Danson, for the College Salvatore Caramanna, for Ms. Lochrie

Introduction

1The registrant, Christina Lochrie, admitted that she committed professional misconduct when she failed to keep proper records of her speech-language pathology services. The parties jointly submitted that the penalty for this misconduct should be: (i) a one-month suspension, (ii) an individualized mentorship program, (iii) a course in medical record-keeping and (iv) a reprimand. They also proposed costs of $5,000. We must accept a joint submission unless it is so problematic that it would bring the administration of the College’s discipline system into disrepute. The parties’ proposal does not present such concerns, and we made the requested order at the hearing. These are our reasons.

2Panel chair David Wright conducted case management conferences in this matter. The parties agreed that he could sit on this panel.

Finding of Misconduct

3These events happened between 2013 and 2015. The registrant was providing intensive speech-language pathology services to a child with a severe form of autism spectrum disorder. She often provided services to the child for six to eight hours per day, which were billed to the family and reimbursed by insurance. During this period, she first worked for someone else and then opened her own practice.

4Ms. Lochrie’s records of her intensive treatment of the child had many problems. These included:

• The records did not: (i) clearly indicate who made the entries, (ii) contain information about supervision of communicative disorders assistants, nor (iii) adequately report the involvement of others in the child’s care.
• The invoices from the registrant’s business did not clearly show what services were provided or who provided them.
• The records did not clearly show how the services provided fell within the scope of practice of speech-language pathology or show how the child was being assessed and reassessed in relation to speech-language pathology goals.
• The records did not sufficiently support the high volume of speech-language pathology services that were provided.

5Comprehensive record keeping is a core aspect of the practice of speech-language pathology. Adequate records ensure that all those involved in the client’s care at the time the services are provided or in the future are aware of the services and can make their own plan of care considering that information. They also support claims to insurers, invoices to clients and an analysis of what occurred should there be a complaint to the College or litigation. They lead to better care in many ways. The public must have confidence that all registrants of this College will maintain accurate and complete records.

6Each party retained an expert. Both experts found that the records did not meet the standard of practice of the profession. Considering the experts’ conclusions and Ms. Lochrie’s admissions, we found that she engaged in professional misconduct by failing to maintain a standard of practice of the profession, failing to keep required records, and engaging in unprofessional conduct (see, paras. 2, 19 and 37 of s. 1 of O. Reg. 749/93 made under the Audiology and Speech-Language Pathology Act, 1991, SO 1991, c. 19).

Penalty and Costs

7The agreed-upon penalty has four components:

• a one-month suspension;
• a reprimand;
• an individualized mentorship program, under which she will meet with a mentor approved by the College for six sessions, four months apart. The mentor will review her practice and report to the College at the end of the program; and
• completion of the medical record-keeping course at the University of Toronto.

8We must “accept and implement a joint submission in all but the most exceptional circumstances”: College of Audiologists and Speech-Language Pathologists of Ontario v. Dame, 2023 ONCASPD 3 at para. 6. It must be implemented unless it is so “unhinged from the circumstances” that implementing it would bring the administration of the professional discipline system into disrepute. This is because when the parties have a high degree of confidence the Committee will implement an agreement, there are benefits to the public, the registrant and other participants in the process, explained in detail in Dame at paras. 8-9.

9The parties cited several decisions, all following joint submissions, to demonstrate that this penalty is within the appropriate range. Most involved other misconduct in addition to record-keeping issues. Those that we find most comparable are two decisions of this Committee and one decision of the Discipline Committee of the College of Physicians and Surgeons of Ontario. In College of Audiologists and Speech-Language Pathologists of Ontario v. Ghazal (unreported, July 23, 2013) and College of Audiologists and Speech-Language Pathologists of Ontario v. Zartman (unreported, March 25, 2013), the misconduct consisted of both inadequate record keeping and failure to maintain the standards of practice of the profession. In the first case, the Committee imposed a one-month suspension, to be remitted if the registrant completed a medical records course and in the second, there was a two-month suspension, with one month remitted if the registrant completed courses and practice monitoring. In College of Physicians and Surgeons of Ontario v. Billing, 2017 ONCPSD 30, the Committee imposed a two-month suspension and clinical supervision on a doctor whose patient charts had multiple problems. These decisions demonstrate that the proposal is generally consistent with other cases.

10The suspension and our reprimand emphasize to Ms. Lochrie and the other registrants of the College the seriousness of failures in record-keeping. While these events took place long ago when the registrant was in the early years of her practice, the mentoring and course requirements will ensure that she fully addresses these problems going forward. The joint submission is appropriate and would not bring the administration of the professional discipline system into disrepute.

Order

11We made the following order:

1. Ms. Lochrie is required to appear before a panel of the Discipline Committee immediately following the hearing of this matter to be reprimanded, with the fact of the reprimand and the text of the reprimand to appear on the College’s public register.
2. The Registrar is directed to suspend Ms. Lochrie’s certificate of registration for a period of one month, commencing immediately.
3. The Registrar is directed to impose a term, condition and limitation on Ms. Lochrie’s certificate of registration requiring that Ms. Lochrie complete the following, to the satisfaction of the Registrar and at Ms. Lochrie’s own expense: a. An individualized mentorship program led by a speech-language pathologist pre-approved by the Registrar (the “Mentor”) relating to the findings in this case. The mentorship program must consist of six sessions where the first session occurs within three months of the end of the suspension set out in paragraph 2 above, and each subsequent session occurs every four months thereafter. As part of the mentorship, the Mentor will review Ms. Lochrie’s practice, which may include a review of patient records at the Mentor’s discretion. For purposes of clarity, a patient may also be one where Ms. Lochrie is supervising support personnel including a CDA (Communicative Disorders Assistant). The Mentor must provide a report to the Registrar at the end of the mentorship program to advise whether Ms. Lochrie demonstrated appropriate competencies in relation to the findings made in this case; and b. The University of Toronto Medical Record-Keeping course within six months of the date of this Order, where she must enroll in the course within two months from the date of this Order.
4. Ms. Lochrie is required to pay to the College costs in the amount of $5,000, within six months of the date of this Order.