Brian O'Riordan, Registrar

As we approach the end of the calendar year, let me first wish Happy Holidays to all our readers. I hope that you will have a safe and healthy time of celebration with family and friends. 

This is our third on-line issue of ex·press.  Thank you to those who have shared your views and opinions about this format.  Please continue to send your feedback to: [email protected]

In this issue, you will find useful and practical advice about several important matters relating to your work as a speech-language pathologist or an audiologist.

This includes information about the new Practice Standard and Guideline (PSG) on Acquired Cognitive Communication; and when and how it is okay to disclose information without consent.

There are also important updates on “Transparency” and the joint College proposal for “Clinic Regulation”.  It will soon be time to access your Self-Assessment Tool (SAT) for 2016, and some changes in that regard are explained.

CASLPO Forums and E-Forums have been a great success.  Read about it all in our year-end review on member communication and information. 

There is also a listing of both suspended and revoked memberships.  And you will want to read the article summarizing a recent hearing before a Discipline Panel of the College.

This issue’s Feature Article is on “Hearing Loss and Cognitive Decline” and some new and interesting developments in this area.

Enjoy ex·press issue 3!

Brian O’Riordan
Registrar

The College, on October 22, formally recognized the 50th anniversary of the founding of the Ontario Speech-Language and Audiology Association of Ontario (OSLA).  Council was informed of the Registrar’s attendance at the OSLA Annual General Meeting, where Mr. O’Riordan presented a certificate of appreciation to OSLA recognizing its many initiatives and accomplishments over the years in advocating for the professions and espousing self-regulation in the public interest.

Peggy Allen, President, OSLA and Brian O’Riordan, Registrar, CASLPO

At its meeting on October 2, 2015, the Council of the college approved changes to its By-Laws to provide for greater transparency with respect to information on the Public Register concerning members. To review the Consultation Summary and Verbatim Feedback, click here.  Over 300 individuals provided input on the proposed changes.

The College’s annual budget for 2015-16 was also approved, along with a new 3 three-year Strategic Plan 2015-18.

The College’s Annual Report 2014 was approved for transmittal to the Minister of Health and Long-Term Care. Click here to view.

REVISED PRACTICE STANDARD AND GUIDELINES FOR ACQUIRED COGNITIVE COMMUNICATION (PSG ACCD)

Alexandra Carling-Rowland

Director of Professional Practice and Quality Assurance

We are pleased to inform you that the revised Practice Standard and Guidelines for Acquired Cognitive Communication Disorders (PSG ACCD) has been published on the CASLPO website in English and French.

Here are some changes you will see in the revised PSG:

• Standards have been developed as well as guidelines
• Easier to read format
• Detailed information on the evaluation of capacity to consent to treatment
• Content regarding the safety of patients and members
• Frequently Asked Questions section

We would like to thank the following members for their hard work and commitment to the project:

• The Speech Language Pathology Practice Advisory Committee members (2012-2015) who oversaw the revision. 
• The PSG authors: Sheila McDonald and Elyse Shumway
• The PSG focus group: Michelle Cohen, Lisa Kakonge-Clayton, Jenny Law, Melissa McCabe, Christine MacPherson, Sandra Sanmartin and Stephanie Muir Derbyshire
• Members who reviewed the PSG, completed the survey and gave us their comments

You can find all PSGs in the ‘Resources’ section of our website, caslpo.com

Practice Standard and Guidelines for Acquired Cognitive Communication (PSG ACCD)

Normes et Lignes Directrices de Pratique Sur Les Troubles Acquis de Communication Cognitive

Ontario Clinic Regulation

Brian O’Riordan
Registrar

Ontarians receive healthcare services in a variety of settings, including hospitals, clinics, and long-term care facilities. Some of these settings, such as hospitals and long term care facilities, are governed by legislation holding them accountable for their operations.  Certain types of clinics are also regulated, such as pharmacies and some medical and dental clinics.  However, there are many clinics that are currently not subject to oversight.

Health regulatory colleges have a mandate to protect the public.  However, achieving that mandate effectively can be a challenge in a system regulating only individual professionals, rather than their workplaces.

CASLPO has been working with a group of some 13 other health regulatory colleges, exploring whether a new model for regulating clinics would strengthen public protection and improve our healthcare system.  This project and consultation is not a government initiative.

While many clinics operate always in the patients’ best interest, an increasing number of troubling cases across many professions are coming to light in the media, complaint, investigations and elsewhere.   A model to hold these clinics accountable does not currently exist.

In our view, clinic regulation would increase transparency by providing a Public Register of clinics, holding clinic owners accountable for acting in the best interest of the public, and establishing safeguards against fraud and other inappropriate business practices. 

About This Consultation

The purpose of this consultation is to solicit feedback from stakeholders about the preliminary clinic regulation model. The consultation period is open until December 31, 2015. Your feedback about the preliminary model is very important to the Working Group, because it will help us improve and refine the model, and determine if clinic regulation is right for Ontario. Pending the results of the consultation process, the Working Group may formally recommend that the Government of Ontario establish a clinic regulator.

To date, six town halls enabling in-person consultation opportunities have taken place across Ontario.

View the recorded Ontario Clinic Regulation Consultation Webinar: click here.

For more information, visit: ontarioclinicregulation.com

Brian O’Riordan
Registrar

To further the College’s ongoing commitment to making information on the College’s public register more accessible and transparent, amendments to the College’s By-law 2011-6, A By-law relating to the Register, were required. 

Hundreds of members took the time to respond to the College’s proposed changes in the By-Laws making more information publicly available concerning members, specifically respecting Registration – related information, certain orders issued by the Inquiries, Complaints and Reports Committee and more timely posting of already publicly-mandated disclosures concerning Discipline hearings and decisions.

Feedback was also solicited from the public and stakeholder associations. The College extends a thank you to all those who commented and completed the survey.  The detailed feedback can now be viewed on our website; click here.

Following the 60-day public consultation period (ending September 12, 2015), Council considered the feedback received and approved amendments to By-law 2011-6 at their October 2015 meeting.  By-law 2011-6 is found here

CASLPO Transparency By-Law changes take effect early in 2016.

For more information, see the Transparency area on the College website.

Disclosing Information without Consent: When and How?

Sarah Chapman Jay
CASLPO Practice Advisor, Speech Language Pathology

There are times in our professional lives where, for complex reasons, we have to consider disclosing personal health information (PHI) without the patient’s consent. 

The legislation that governs disclosure of health information is the Personal Health Information Protection Act, 2004 (PHIPA). PHIPA provides us with the following:

• Rules for the collection, use, retention and disclosure of PHI that protect the confidentiality of that information, and the privacy of individuals, while facilitating effective health care.
• Information regarding individuals’ right of access to their PHI and the right to require the correction or amendment of their PHI.

The term: “disclose” means to make PHI available or to release it to another health information custodian (HIC) or to another person. As a rule, consent is required to disclose an individual’s PHI, unless PHIPA allows the disclosure without consent.

Members must consider the purpose of the disclosure.  They should not disclose PHI if other information will serve the purpose, and may only disclose as much information as is necessary to meet the purpose.

Q: What are the circumstances in which I can disclose PHI without consent?

A: When any of the following apply:

1. Mandatory Reports to External Organizations:

• Suspected child abuse (Child and Family Services Act,1990)
• Harm or risk of harm to a long-term care resident (Long-Term Care Homes Act, 2007)
• Harm or risk of harm to a retirement home resident (Retirement Homes Act, 2010)

2. Mandatory Reporting to CASLPO, or other Health Regulatory Colleges

• Sexual abuse of a patient by a regulated health care provider (mandatory reporting to the College)
• Peer Assessment by a peer assessor

3. Risk of harm  

• Elder abuse, or other abuse
• When a patient presents a serious danger of physical harm to themselves or to another person
• Emergency situations, e.g. medical emergency

4. Legal authority to disclose information (subpoena, warrant, court order)

5. Auditing and accreditation

For more information, please refer to Sections 37-50 of PHIPA. These sections set out the circumstances in which PHI may be disclosed without consent, where it is reasonably necessary.

1) MANDATORY REPORTS TO EXTERNAL ORGANISATIONS:

Mandatory reporting refers to the members’ legal obligations to report child neglect and abuse.

Q: I have some questions about mandatory reporting. A colleague of mine and I were in a discussion about what our roles are as SLPs (private) working in the home. What do we do if we suspect any form of child abuse? Does CASLPO have a stance on this?

A: According to the Child and Family Services Act 1990 (CFSA), a person who performs professional or official duties with respect to children, who has reasonable grounds to suspect some form of child abuse or neglect, must report the suspicion and the information on which it is based to an approved agency such as a Children’s Aid Society. You do not have to get consent from the patient or family to disclose this information.

The CFSA states:

• Professionals who work with children must promptly report any suspicions that a child is or may be in need of protection directly to a children’s aid society.
• People working closely with children have a special awareness of the signs of child abuse or neglect, and have a particular responsibility to report their suspicions.
• Under the Act, persons who perform professional or official duties with respect to children include health care professionals
• Professionals should never hesitate to report suspected child abuse or neglect.
• Any professional who fails to report is liable upon conviction to a fine of up to $1,000.

The CFSA specifies that a person who acts in accordance with the “duty to report” will be protected from civil actions, unless the person acts maliciously or without reasonable grounds. The CFSA overrides any other provincial law that would normally prohibit the disclosure of information needed to make a report. In other words, the duty to report takes precedence over any other confidentiality provisions.

Q: Where do I document that I have filed a report to the College, or to Family and Children’s Services / Children’s Aid Society?

A: The circumstances that led you to file a report must be documented, and that documentation must be both accessible and retained. However, consider the risk of harm for the patient, family and yourself. You may choose to document in a separate section of the patient record, or in a separate location, so that information can be easily redacted (removed) without putting yourself or others at risk of harm.

2) MANDATORY REPORTING TO CASLPO, OR OTHER HEALTH REGULATORY COLLEGES:

Q: What are the repercussions when I file a mandatory report to the College about another member? If it involves a patient, do I have to get their consent?

A: The Regulated Health Professions Act 1991 (RHPA) provides that no action or other form of legal proceeding can be made against a person for filing required reports (under the RHPA) in good faith. Provisions in the Act also prevent retaliation against people who make the required reports.

It is mandatory for regulated health professionals to file a report if they have "...reasonable grounds, obtained in the course of practising the profession, to believe that another member of the same or a different College has sexually abused a patient." Operators of facilities where regulated health professionals practice are also required to report sexual abuse of a patient.

Reports must be made if you have reasonable grounds, obtained in the course of practising your profession, to believe that another Member of a College has sexually abused a patient. A report does not need to be made if you do not know the name of the alleged abuser. The report must be made, in writing, to the Registrar of the College of the Member who is the subject of the report within 30 days of learning of the alleged sexual abuse. The report must be submitted immediately if you have reasonable grounds to believe that the sexual abuse is on-going or if sexual abuse of other patients could occur. Although you must discuss with the patient your intention to report, the patient’s name cannot be revealed unless the patient agrees in writing to this disclosure. However, you are required to provide an explanation of the alleged sexual abuse, which might include other forms of PHI, even if the patient does not give you consent to reveal their name.

Failure to make a mandatory report is an offence punishable with a fine of up to $25,000.00 for a first offence and not more than $50,000.00 for a second or subsequent offence.

These obligations are described in the Health Professions Procedural Code, Schedule 2 Section 85.1- 85.5 RHPA.

Q: I have been selected for peer assessment.  I know that I have to provide evidence from my patient records for auditing purposes. My employer has concerns about disclosing personal health information to the peer assessor without consent. What should I do?

A: The RHPA outlines the authority of Colleges and the peer assessors to obtain PHI in the Quality Assurance process. The relevant provisions in the Act permit peer assessors to enter and inspect premises where a member practises, and to inspect records relating to a member’s care of patients without consent. 

All information collected by the peer assessor is confidential. The ability of the peer assessor to access confidential patient records applies “despite any provision in any Act relating to the confidentiality of health records” (RHPA, Schedule 2, Section 82 (5)). This means despite other privacy legislation, such as PHIPA, you are able to disclose PHI without consent to the peer assessor and the College.

The information collected by a peer assessor about you and your caseload cannot be shared with another committee of the College, apart from the Quality Assurance Committee (PHIPA Section 83) (Appendix II).

3) RISK OF HARM

Q: What are the requirements for reporting illegal and/or abusive situations to the police regarding adult patients? What happens if they confide in us about abuse they have suffered? Do we keep this information confidential unless they give us permission to report it? 

A: You have to consider if the patient or anyone else is at risk of harm. You must assess the client and situation carefully. This may include some or all of the following:

• Review the relevant legislation
• Consult with appropriate personnel (supervisor, manager, colleagues, risk manager, social worker or the College)
• Consider the need for a legal opinion.

According to PHIPA, PHI may be disclosed, without consent, by a health information custodian (HIC), if the HIC:

“believes on reasonable grounds that the information is needed to eliminate or reduce a significant risk of serious bodily harm to the client, another individual or a group of persons.” PHIPA 36.1.i

If you believe that your patient or family member is at significant risk of serious bodily harm, you can make a report to the police or another agency involved with the care of the adult without the patient’s consent to disclose that information.

If the adult is a resident of a long term care home or a retirement home, the Long-Term Care Homes Act, 2007 (LTCHA) and the Retirement Homes Act, 2010 (RHA) will guide you. A member must file a report with the director appointed by the Minister of Health and Long-term Care or with the Registrar of the Retirement Homes Regulatory Authority where any of the following result in harm to a resident:

• improper care or incompetent treatment or care
• abuse of a resident by anyone
• neglect of a resident by a staff member or licensee
• unlawful conduct
• misuse or misappropriation of a resident’s money

Q: Can personal health information be disclosed in an emergency or other urgent circumstances?

A: Although another health care professional may view the situation as urgent, you as the treating SLP/Audiologist should determine if it is an emergency as it relates to your services. If you determine it is an emergency, there should be documented rationale for proceeding to disclose PHI without consent.

PHIPA allows for disclosure of PHI without consent in emergency or urgent situations. The Information and Privacy Commission developed a Fact Sheet issued in 2005 entitled, Disclosure of Information Permitted in Emergency or other Urgent Circumstances.

Q: I am carrying out some audiology research about ethical dilemmas and would like to know about duty to report? Are the rules different when it involves research and confidentiality?

A: In your capacity as a regulated health professional, you still have to abide by the legislation, regulations and requirements of the College regardless of the situation. If there is significant risk of harm to a research participant that you become aware of, then there is a duty to report. If you become aware of child abuse or neglect in you capacity as a researcher, you must report. If you are conducting research in a long-term care facility or retirement home, you have a duty to report.

4) LEGAL AUTHORITY TO DISCLOSE INFORMATION:

Q: A physiotherapist at work has had a complaint filed against them. The Physiotherapy College’s investigator has asked to look at my section of the client’s file. Can I disclose this information without getting consent from my patients?

A: Yes, you can disclose this information without your patients’ consent. PHIPA has a section entitled “Disclosures related to this or other Acts”

43. (1) A health information custodian may disclose personal health information about an individual,

(b) to a College within the meaning of the Regulated Health Professions Act, 1991

You have the right to ask the investigator for proof that they work for the College of Physiotherapists of Ontario. Once you are satisfied, you may disclose your patient records without patient consent.

There are other legal proceedings that may require the disclosure of PHI. PHIPA permits disclosure for a proceeding in which the HIC or an agent of the HIC is a party or witness. HICs may also disclose to comply with a summons, order or similar requirement issued in a proceeding or a procedural rule relating to the production of information in a proceeding.  (2004, c. 3, Schedule A, s. 41 (1).)

5) AUDITING AND ACCREDITATION:

Q: My administration supervisor at our school board has requested an audit of our SLP files. What if this person is not a health information custodian? Can he have access to the records without consent?

A: A HIC may disclose PHI about an individual without that individual’s consent to a person conducting an audit or reviewing an application for accreditation or reviewing an accreditation. However, the audit or review must relate to services provided by the custodian and the person does not remove any records of PHI from the custodian’s premises. (PHIPA, part IV, 39, (1) (b)).

Q: ANY OTHER PRACTICE ADVICE QUESTIONS?

A: Members of the public and the College are welcome to contact any of the practice advice team if there are additional questions or issues that need to be addressed. Practice Advice is an important service CASLPO provides to the membership. Members benefit from the one on one conversations and advice to help meet standards of practice thereby protecting the public. Dedicated staff are available to answer questions in English and French about legislation, regulations, standards of practice and College expectations and how they apply to different areas of professional practice.

CASLPO does not provide legal advice. Practice Advice is provided in response to specific inquiries and may not be relevant in all circumstances. Finally, the Practice Advice Program is intended to support but not replace professional judgment.

Practice Advice Team:

LINKS AND REFERENCES:

• Personal Health Information Protection Act 2004,
• Regulated Health Professions Act 1991,
• Child and Family Services Act, 1990,
• Long-Term Care Homes Act, 2007,
• Retirement Homes Act, 2010,
• Health Care Consent Act, 1996
• www.ipc.on.ca,
• Disclosure of Information Permitted in Emergency or other Urgent Circumstances.
• CASLPO’s Sexual Abuse Prevention Program

Colleen Myrie

Director of Registration Services

Membership Suspensions and Revocations

The Health Professions Procedural Code of the Regulated Health Professions Act, 1991 requires information about suspended members to be made available to the public by each regulatory college.

The following individuals are currently under suspension for failing to pay their annual fees for 2015/2016 in accordance with section 24 of the Code:

Audiology Certificates Suspended

Speech-Language Pathology Certificates Suspended

While under suspension:

1. The individual is not permitted to practice as an audiologist or as a speech-language pathologist in Ontario.
2. The individual is prohibited from using the titles “audiologist”, “speech-language pathologist” or “speech therapist” or a variation or abbreviation or an equivalent in another language in Ontario.
3. The individual is prohibited from holding himself or herself out as a person who is qualified to practice as an audiologist or a speech-language pathologist in Ontario.
4. The College will inform the individual’s last employer on record of the individual’s suspension.
5. A notation of the suspension appears indefinitely in the College’s public register.

In addition, the following certificates were revoked for failing to pay the annual fees for 2014/2015 in accordance with section 26 of Ontario Regulation 21/12:

Audiology Certificates revoked

Speech-Language Pathology Certificates revoked

After a certificate has been revoked:

1. A notation of the revocation appears indefinitely in the College’s public register.
2. The former member must satisfy the following requirements for reinstatement to the College:
   1. The former member must pay any applicable fees and penalties required by the by-laws.
   2. The former member must satisfy the Registrar that he or she has corrected the deficiency or deficiencies that provided the grounds for the revocation of his or her certificate.
   3. The former member must meet all of the requirements for the class of certificate of registration being reinstated, as those requirements read on the day that the applicant submitted the application to the Registrar. 

Alexandra Carling-Rowland
Director of Professional Practice and Quality Assurance

CHANGES TO THE 2016 SELF-ASSESSMENT TOOL

The College continually reviews the Professional Standard Indicators for the Clinical and Non-clinical Self-Assessment Tools (SAT). Why...?

• You, the members give us feedback about the Professional Standard indicators that are clear and relevant to your practice, and the indicators that are problematic

• Members must be knowledgeable about legislative requirements and changes relating to their practice

• The College needs to add or change indicators to reflect the current work environment and the knowledge and skills required by members

Changes to indicators are highlighted in yellow.

PRACTICE STANDARD 1. MANAGEMENT PRACTICES

INDICATOR 1.3

I perform the controlled act of prescribing a hearing aid for a hearing impaired person (Regulated Health Professions Act, (1993) 27(2)10) according to practice standards and the position of the College

Rationale: We are separating the controlled act of prescribing a hearing aid from the delegation of other controlled acts.  This will guide members to evaluate their knowledge, skills and judgement appropriately, and provide the College with accurate aggregate data.

INDICATOR 1.4 (NEW)

I have been delegated a controlled act (Regulated Health Professions Act, (1993) 27, 28, & 29) and perform the controlled act according to the Position of the College

Rationale: Members are increasingly delegated a controlled act in order to perform instrumental assessments and provide certain types of clinical intervention. The College is required to ensure that these members have the requisite knowledge, skills and judgement and are following the position of the College. This new indicator enables members to reflect on the College’s requirements and provides accurate aggregate data regarding the numbers of members delegated to perform controlled acts.

INDICATOR 1.8 (OLD 1.7)

I am knowledgeable about mandatory reports outlined in the Regulated Health Professions Act, Schedule 2, Sections 85.1 – 85.5 and in the Child and Family Services Act, 1990

Rationale: The Minister of Health and Long Term Care has directed health regulated colleges to review their processes for sexual abuse prevention. The College decided that the Quality Assurance Program was an effective place to ensure that all members are knowledgeable about mandatory reports. Mandatory reports include child abuse, sexual abuse, member incompetence, incapacity and professional misconduct.

Regulated Health Professions Act (1991)

85.1 (1) A member shall file a report in accordance with section 85.3 if the member has reasonable grounds, obtained in the course of practising the profession, to believe that another member of the same or a different College has sexually abused a patient.

85.2 (1) A person who operates a facility where one or more members practise shall file a report in accordance with section 85.3 if the person has reasonable grounds to believe that a member who practises at the facility is incompetent, incapacitated, or has sexually abused a patient.  1993, c. 37, s. 23; 2007, c. 10, Sched. M, s. 61.

85.3 (1) A report required under section 85.1 or 85.2 must be filed in writing with the Registrar of the College of the member who is the subject of the report.  1993, c. 37, s. 23.

85.4 (1) Concerns regulated health professionals who provide psychotherapy

85.5 (1) A person who terminates the employment or revokes, suspends or imposes restrictions on the privileges of a member or who dissolves a partnership, a health profession corporation or association with a member for reasons of professional misconduct, incompetence or incapacity shall file with the Registrar within thirty days after the termination, revocation, suspension, imposition or dissolution a written report setting out the reasons.  1993, c. 37, s. 23; 2000, c. 42, Sched., s. 36.

Child and Family Services Act (1990)

Duty to report child in need of protection

72. (1) Despite the provisions of any other Act, if a person, including a person who performs professional or official duties with respect to children, has reasonable grounds to suspect one of the following, the person shall forthwith report the suspicion and the information on which it is based to a society:

1. The child has suffered physical harm, inflicted by the person having charge of the child or caused by or resulting from that person’s,

i. failure to adequately care for, provide for, supervise or protect the child, or
ii. pattern of neglect in caring for, providing for, supervising or protecting the child.

2. There is a risk that the child is likely to suffer physical harm inflicted by the person having charge of the child or caused by or resulting from that person’s,

i. failure to adequately care for, provide for, supervise or protect the child, or
ii. pattern of neglect in caring for, providing for, supervising or protecting the child.

3. The child has been sexually molested or sexually exploited, by the person having charge of the child or by another person where the person having charge of the child knows or should know of the possibility of sexual molestation or sexual exploitation and fails to protect the child.

PRACTICE STANDARD 3. PATIENT/CLIENT CENTRED PRACTICE

INDICATOR 3.2

I obtain and document consent to collect, use, retain, and disclose personal health information, as required.

Rationale: Many members work in an environment, such as a hospital, where they can frequently rely on assumed, implied consent for the collection, use and disclosure of personal health information. This is known as the ‘Circle of Care’. By adding “as required” to the indicator it ensures that those members who need to obtain explicit consent do so, but those in the Circle of Care are not required to obtain consent unnecessarily.

ANY QUESTIONS?

Please contact
Alex Carling-Rowland, Director of Professional Practice and Quality Assurance
[email protected]

CASLPO Forums: A Year in Review

Alexandra Carling-Rowland
Director of Professional Practice and Quality Assurance

The College is constantly seeking to improve communications with you, our members. CASLPO Forum has replaced the Regional Seminars. We will still visit different areas of the province every year to meet members face to face, but, as a result of member feedback on the Regional Seminars, the focus has changed.
A forum is defined as “a place or opportunity to discuss a subject”.  We want to make CASLPO Forum more interactive and give members an opportunity to discuss their issues as they relate to the College, regulations and standards of practice. 

Our three goals are:

• To provide members with the latest updates from the College including new projects, processes and documents
• To answer the members’ questions and discuss their issues
• To discuss common practice issues through authentic clinical scenarios

We have recorded four short vignettes which are available on the website (click here).  This information used to be part of the Regional Seminar.  If you attend a Forum we will send you the link to the videos and you can still ask questions about the content.

• The role of Regulatory Colleges and CASLPO’s Mission, Vision and Values
• The importance of Self-Regulation
• CASLPO services
• The difference between the College and an Association

The first CASLPO Forum took place at the CASLPO Offices in Toronto on May 28th 2015.  The month of May was chosen to help celebrate ‘May is Better Speech and Hearing Month’.  It was also an excellent opportunity for staff at the College to meet members.  Since then we have presented to, and enjoyed discussions with, members in Kitchener, North Bay and Kingston.

We would like to thank specific members and organizations who kindly helped us to host the CASLPO Forums:

Maureen Evans, SLP member, Grand River Hospital, Kitchener
Michele Mitchel, SLP member, North Bay Regional Health Centre
Jennifer Davidson Harden, Chief Psychologist, Limestone District School Board, Kingston
Christiane Kyte, SLP member, Dufferin-Peel Catholic District School Board

Suggested Topics for future E-Forums

Members have been asked for suggestions for future E-Forums.  Here is what we have received so far.

• Use of Support Personnel
• Record Keeping
• Circle of Care and obtaining consent
• New CASLPO documents
• School Board Topics
• Cases sent to the Discipline Committee
• Audiology versus Hearing Instrument Specialist scopes of practice
• Use of the Doctor title
• Concurrent Intervention

Thanks for all of your feedback.  It does make a difference.

A Summary of a Recent Hearing before the Discipline Committee

Courtney Campbell

Director of Professional Conduct

The Inquiries, Complaints and Reports Committee of the College referred specified allegations of professional misconduct against Brenda Berge to the Discipline Committee for a hearing.

The College alleged that the member engaged in professional misconduct on various grounds related to her use of the title “doctor”, or a variation or abbreviation, in the course of providing or offering to provide health care services in Ontario.

A hearing with respect to these allegations was held by the College's Discipline Committee on October 28, 29 and 30, 2014 and December 18, 2014.  At the outset of the hearing, the member brought a motion challenging, amongst other things, the process followed with respect to the referral of these allegations to the Discipline Committee, as well as the constitutional validity of section 33 of the Regulated Health Professions Act, 1991 (‘RHPA’) and its applicability in the circumstances.

Section 33 of the RHPA prohibits audiologists from using the title 'doctor', or a variation or abbreviation, in the course of providing or offering to provide health care services to individuals in Ontario.  In the agreed statement of facts, Ms. Berge acknowledged that she referred to herself as “Dr. Brenda Berge,” as well as variations and abbreviations of “Dr. Brenda Berge,” on her practice website and on other websites, on business cards and on her business sign.  Her motion, therefore, was brought to challenge the constitutionality of section 33 of the RHPA which prohibited her from referring to herself in these ways.

The Discipline Committee’s findings concerning these allegations were released on March 31, 2015. In its decision, the Discipline Committee dismissed the member's motion and, relying on the parties’ agreed statement of facts, found that the member engaged in professional misconduct as follows:

• Breaching section 33 of the RHPA by using the title “doctor” in the course of providing or offering to provide health care services in Ontario.
• Inappropriately using a term, title or designation in respect of the member's practice.
• Improperly advertising or permitting advertising with respect to the member's practice.
• Engaging in conduct or performing an act, relevant to the practice of the profession, that, having regard to all the circumstances would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.

A hearing with respect to sanction and costs was held by the College’s Discipline Committee on September 2, 2015.  The Discipline Committee’s decision with respect to sanction and costs was released on October 25, 2015.  The Discipline Committee ordered as follows with respect to sanction:

• Directing the member to appear before it to be reprimanded, on a date to be fixed.
• Directing the Registrar to suspend the member’s certificate of registration for a period of three continuous months, one month of which shall be remitted.  The suspension shall commence on a date to be fixed by the Registrar, although such date shall be within three months of the Order taking effect.
• Directing the Registrar to impose a term, condition and limitation on the member’s certificate of registration,
  • Requiring that she successfully complete a course in ethics, focusing on professional obligations, such as the ProBe course, to the satisfaction of the Registrar, and at the member’s own expense.
  • Requiring the member to undergo two unannounced inspections per annum at the member’s expense, to a total of $500.00 per inspection, over the course of three years. 

In its reasons with respect to sanction, the Discipline Committee noted it considered the risk to the public, and the importance of members upholding the basic tenets of self-regulation in making its decision.  In ordering the reprimand and suspension, the Discipline Committee was of the view that for self-regulation to be effective, each member must abide by the current and relevant legislation.  Furthermore, the Discipline Committee remarked that while a member may disagree with a rule or expectation of the College and the Government of Ontario, they cannot simply ignore it.

The College asked the Discipline Committee to order costs against the member.  In support of its request, the College provided the Discipline Committee with material that demonstrated that its actual hearing costs were in the range of $260,000, however the College asked the Committee to order the member to pay $100,000 over a one year period.  The Discipline Committee ordered as follows with respect to costs:

• The member is ordered to pay to the College its costs fixed in the amount of $97,595.00, to be payable over three years in accordance with the following schedule: the first $15,000.00 shall be paid with sixty days of the Order becoming final and the remaining amount shall be paid in two equal installments of $41,297.50, the first $41,297.50 payment to be paid twelve months after the Order becomes final and the second $41,297.50 payment to be paid twenty-four months thereafter.

The Discipline Committee’s rationale for making an order requiring the member to pay costs was based on the length of the hearing, as well as the amount of costs associated with the hearing.  Noting that the member had the right to take the steps that she did, the Discipline Committee explained she could not do so expecting that she should not share in the costs incurred in this type of case.

The member has appealed the Discipline Committee’s findings that she engaged in professional misconduct as described above to the Ontario Superior Court of Justice (Divisional Court).

For copies of the full text of the Discipline Committee’s decisions, please contact the Director of Professional Conduct at 416-975-5347 ext. 221.

Hearing Loss and Cognitive Decline - Emerging Evidence

Sherry Hinman

Drawing a link between hearing loss and cognitive impairment is nothing new. Stig Arlinger reviewed literature going back to the early 1990s that demonstrated “a significant correlation between uncorrected hearing loss and reduced cognitive functions” (Arlinger, 2003). But research on this topic has become even more active over the last few years. Recently, the important connections between sensory and cognitive aging were the focus of a National Insitute on Aging workshop that resulted in a recent review article (Albers et al. 2015).

The Evidence

Several theories have been proposed to explain this link, none of them definitive. Is it that people who don’t hear well become more isolated, less socially active? Could the emotional consequences of feeling excluded from conversations lead to depression?

In a recent study from France, investigators not only drew the link between hearing loss and cognitive decline, but demonstrated a difference in cognitive skills once hearing aids were used—to the point where those with corrected hearing loss scored similarly on a cognitive test to their peers without a hearing loss (Amieva, 2015).

Frank Lin, an expert in epidemiology and a professor of geriatric medicine and of otolaryngology, has done extensive research in this area. In one recent study, he speculates on possible explanations for the link between hearing loss and dementia. He proposes that “there may be an overdiagnosis of dementia in individuals affected by hearing loss, or vice versa—an overdiagnosis of hearing loss in individuals with cognitive impairment” (Lin et al., 2011).

Lin also suggests “that both hearing loss and progressive cognitive impairment could be caused by a common neuropathologic process, possibly the same that leads to Alzheimer’s disease.” Or there could be another process that causes both problems, for example, vascular disease or other factors related to family history. One  further proposal he makes is that “hearing loss may be causally related to dementia, possibly through exhaustion of cognitive reserve, social isolation, environmental deafferentation, or a combination of these pathways” (Lin, 2011).

From Correlation to Causality: We’re Not There Yet

Kathy Pichora-Fuller is an audiologist and psychologist, a professor in the department of psychology at U of T, and an adjunct scientist at the Toronto Rehabilitation Institute and at the Rotman Research Institute at Baycrest. She has conducted research that links auditory and cognitive processing. She warns that people should be cautious about drawing conclusions. “Everyone knows there are links between hearing loss and problems with cognitive decline. But we don’t know why there is a connection.”

She points out that people with a hearing loss who get and wear hearing aids are in the minority. “Those people have active lives, they want to stay connected, and they are the ones who live longer. Those who don’t [fit this category] may be more vulnerable because they cope with their hearing loss by stopping activities.”

What we need, she explains, is randomized controlled studies. “The French research is a good preliminary study. But we need evidence-based practice and several studies before we can draw conclusions about causality.”

Learning From the Evidence

Pichora-Fuller suggests that even in the absence of a good explanation of the nature of the association, there is much we know and much we can do as clinicians. Amplification is a no-brainer. “Anyone remembers better if they get a better signal,” she explains, “even people who don’t have a hearing loss. Studies show that as intensity of sound increases, we remember better. When there’s a clearer signal, we don’t have to work as hard.”

But not all the answers point to amplification. Pichora-Fuller explains that “when people are in their 40s, they begin to have problems. They don’t hear well in noise and they might have problems on the phone or at the theatre. But they’re not ready for aids.” These people don’t reach the point of having their hearing tested until 20 years later. “We can’t wait for people to come to audiologists. They’ve already ‘dropped out’ [of full participation] by then. Their brains have already begun reorganizing during the 20 years it takes them to see an audiologist.”

So how do we keep these people from waiting so long to seek help? Pichora-Fuller speculates, “Do we develop wellness programs that target architectural standards and other technology besides hearing aids?” This is not such a far-fetched idea. There are now free or inexpensive hearing assistive devices apps for the iPhone that can be downloaded from the iTunes store. Crazy idea? No crazier than $15 pharmacy reading glasses for presbyopia. Pichora-Fuller says ideas like this shouldn’t make audiologists feel threatened any more than optometrists feel threatened by the availability of pharmacy reading glasses. “In the United States, these alternatives are considered part of affordable hearing care,” she says.

The Role of the Audiologist

Regulated health care professionals such as audiologists, with their years of education and training, could also play more of a role in screening for dementia. “The average age of first-time hearing aid buyers is 70 years old,” says Pichora-Fuller. “And 15% of the population aged 70 have clinically significant cognitive decline. So it’s reasonable to assume that a certain number of patients have this problem. Clients may mention memory problems. Audiologists should listen to what they’re saying and ask, ‘Do you have concerns about your memory?’ It’s a piece of the history.”

“The audiologist can play a critical role by explaining, maybe you have a memory problem but for sure you have a hearing problem, and doing something about your hearing problem is going to help.”

She says this is an area with which audiologists have to become more comfortable. “The population is aging, and hearing loss is becoming more common. Hearing loss makes it a lot harder to do the things we know keep us healthy—staying mentally, physically, and socially active (Pichora-Fuller, Mick, & Reed, 2015.”

“The science is there,” she says. “People with hearing loss are at risk. People used to associate audiologists with aging. Now they should be seen as people who help you stay healthy.”

References

Amieva, H., Ouvrard, C., Giulioli, C., Meillon, C. Rullier, L., & Dartigues, J-F. (2015). “Self-reported hearing loss, hearing aids, and cognitive decline in elderly adults: A 25-year study.” Journal of the American Geriatrics Society. 63(10): 2099–2104. DOI: 10.1111/jgs.13649 http://onlinelibrary.wiley.com/doi/10.1111/jgs.13649/abstract

Arlinger, S. (2003). “Negative consequences of uncorrected hearing loss: A review.” International Journal of Audiology. 42 Suppl 2(2): 2S17–20 DOI: 10.3109/14992020309074639 http://www.researchgate.net/publication/10612964_Negative
_consequences_of_uncorrected_hearing_loss_A_review

Lin, F.R., Metter, E.J., O’Brien, R.J., Resnick, S.M., Zonderman, A.B., & Ferrucci, L. (2011). “Hearing loss and incident dementia.” Arch Neurol, 68(2): 214–220. doi:  10.1001/archneurol.2010.362 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277836/

Pichora-Fuller, M.K., Mick, P.T., & Reed, M. (2015). Hearing, cognition, and healthy aging: Social and public health implications of the links between age-related declines in hearing and cognition. Seminars in Hearing, 36, 122–139.

To learn more about hearing loss and cognition, visit these websites:

• WHO World Report on Aging and Health 2015: This is the first time that hearing has ever been included in this report. http://apps.who.int/iris/bitstream/10665/186468/1/WHO_FWC_ALC_15.01_eng.pdf
• 33rd World Congress of Audiology 2016: This is the first time the WCA is being held in Canada in over 20 years. Sponsored by the Canadian Academy of Audiology (CAA) and Speech-Language and Audiology Canada (SAC), the congress will be held in September 2016 in Vancouver:  http://www.wca2016.ca/
• McMaster Optimal Aging Portal four-part series on hearing loss: including two posts on the connection between hearing loss and cognition, by Kathy Pichora-Fuller. http://www.mcmasteroptimalaging.org/citizens/blogs/-in-category/
  categories/health-conditions/hearing-and-ear-problems
• Institute of Medicine: Part of the National Academies of Sciences, Engineering and Medicine. Hearing was a topic for the first time. http://www.hearingreview.com/2015/04/iom-holds-open-session-accessible-affordable-hearing-care/

Lisa Gibson

[email protected]

Do you or your colleagues have a positive patient impact story to share?

Consider sharing an experience about either your practice setting, technology usage or innovative programs implemented.

Email Lisa Gibson, Executive Office and Communications Manager for more information.