Dialogue Volume 14 Issue 1 2018 - Page 66

DISCIPLINE SUMMARIES The College expert opined, in part, about Dr. Pow- ell’s failure to recognize and maintain the psychother- apeutic 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 knowl- edge 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... Appro- priately 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 rep- resents what is called a counter-transference enact- ment. Rather than working with albeit difficult and uncomfortable transference material, the issue was avoided, modelling an approach that did not rein- force responsible behaviour and dismissed problem- atic 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 appro- priate psychotherapeutic frame. In addition to these revi- sions, 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 opin- ions 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 66 DIALOGUE ISSUE 1, 2018 that Dr. Powell’s billing practices did not meet the stan- dard of practice of the profession. Concerning billing practices included: • Billing one unit for missed appointments; • Billing one unit for cancelled appointments (includ- ing 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 aver- age appointment for the patients reviewed is between 80 and 110 minutes; 50 minutes is the generally ac- cepted length for a psych X]X\[Y[¸(К[[XX[\][Z][H\ NNLH[NNMJH[\[Y[\H[^\[YXB܈H[Z][H]K\H[Z][\\H]Z[XH˜HXX]\[H܈H][HٙXHۈ[\[\\[^H\H\\HY B[Y][ [Z[YY\H[Z][\[\[\[\]YYY]H\]Z\Yܚ]\XN˜[(XH[[܈H[YHو[YK\H\B]\[[[\\HH]Y[\][܈YZ\\[Y[^[YۈX[وH[[][ۂ[Z[\\HXZ]YT܈]Y[˂ԑTH\\[H[Z]YHܙ\YH\[[۝\[[ۈو[8&\\YX]HوY\][ێH[\][ۈو\\ۙ][ۜ[[Z]][ۜ›ۈ[8&\\YX]HوY\][ێH\KBX[^[Y[وH [HHZ[\\ق[[N[^[Y[HYH[H[[[و K ܈˂H\\ۙ][ۜ[[Z]][ۜۈ[8&\\YX]HوY\][ۈ[YHX\[[\H[X[\\\܈܈ L[۝HKB\\Y[و\XXH[H L[۝ق[X[\\\[ێ[ۚ]ܚ[و\T[ B[[[[[YYH\]\XXK܈\]H]Z[وHܙ\X\HYHB[X\[ۈ]˘˛ۋK[X[H܂[[\Hܸ&\K]Hۘ\[ۈوHX\[[Z]Y\œY[\X[[H[Z]YHYZ[\\YBXX\[X[