Professional Discipline Presenter Name Agency

Professional Discipline Introduction Public access and perception Board’s responsibilities Understand Board policies and procedures Disciplinary processes are often the most public activities of regulatory entities and will shape the public’s perception of the board. Board has a responsibility for fiduciary concerns, fairness, and assuring the proper resources are allotted to the disciplinary process. Discipline process varies between jurisdictions, so the biggest concern is to ensure board members understand and support their board’s policies and procedures.

The Enforcement Process Intake Assessment Investigation Review / Screening Resolution (Formal or Informal) Findings & Order Compliance

Complaint is received and acknowledged Step 1: Intake Complaint is received and acknowledged Notification to practitioner File set-up File status tracking mechanisms Intake: Receiving and acknowledging complaints; setting up files and initiating complaint tracking. This is often the only point at which a consumer makes contact with a regulatory agency and the handling of telephone calls and correspondence at this stage has a real impact on the public’s perception of the regulator.

Initial screening of complaint Step 2: Assessment Initial screening of complaint Determine jurisdiction Assess risk to public – interim measures Assess issues for possible alternative resolution mechanisms Assessment: Screening complaints; applying the agency’s ‘standard of acceptance’; determining jurisdiction and the form of response that is appropriate for the complaint. In cases where an immediate public risk is perceived the regulator may have statutory powers to impose some form of immediate suspension of registration

Assign complaint to an investigator or investigative team Step 3: Investigation Assign complaint to an investigator or investigative team Evidence gathering Interviews Identify, obtain and review relevant documentation Investigation Report Investigation Assigning an individual or team to gather evidence and produce an investigation report. In some jurisdictions this work is undertaken by Board members or prosecutors rather than by investigators.

Step 4: Review / Screening Determining the disposition of the complaint Investigation/Screening Committee Complaints without merit are closed Complaints with merit move forward Review Determining the disposition of investigated complaints. At this stage a decision will be taken on prosecutorial viability or some other measure of whether there is ‘case to answer’. Complaints without merit will be closed and a level of action will be determined for those which merit further consideration.

Confidential / Informal Resolutions Step 5: Resolutions Confidential / Informal Resolutions Before the screening committee Written/Oral Cautions Irrevocable Undertaking Remediation Resolution: Hearing or otherwise deciding the case. This may be some form of informal process (such as a stipulated agreement or undertaking).

Public / Formal Resolutions: Step 5: Resolutions Public / Formal Resolutions: Consent Orders / Agreed Statements of Fact Contested hearings Discipline hearing before a Committee or Panel Similar to a trial Resolution: Hearing or otherwise deciding the case. This may involve formal resolution at a hearings before the Board, a tribunal or administrative law judge.

The Discipline Panel adjudicates by… Step 6: Findings & Order The Discipline Panel adjudicates by… Determining the facts based on the evidence Making findings Ordering sanctions Producing written decisions Decisions and orders can be appealed Final Orders: Disposing of the case, including imposing an appropriate sanction. The resolution process will establish facts based upon the evidence, apply the relevant law and, depending upon the legislative language, reach conclusions as to ‘liability’ or ‘guilt’. The person or body that conducted the hearing will often also make the final order. However, in some jurisdictions the findings in the case may be referred back to the Board or a committee which then makes the final order (either as to guilt and sanction or only on sanction).

The Board must monitor compliance with sanctions Step 7: Compliance The Board must monitor compliance with sanctions Sanction orders may include consequences of non-compliance Compliance Following up on final orders to ensure that they are being obeyed. Ensuring a high degree of compliance is an important part of maintaining public confidence in the regulatory process.

A Strong Enforcement Process… …is well publicized …is based on a well-organized, open and transparent process …operates in a timely manner …avoids appearances of institutional bias …defines misconduct, incompetence and other offences clearly …maintains internal consistency publicize their existence and role in handling consumer complaints Options include: Toll-free complaint lines; consumer-friendly websites distribution of information brochures; posting ‘how to complain’ notices in all registered practitioners' premises; advertising; speeches and other stakeholder outreach by board members; coordination of publicity and information with consumer groups,   develop well-organized complaint handling processes with clear guidelines on how to log complaints, who receives notification of the complaint, and within what period of time. set appropriate timescales for notices, the review of investigations and other key steps in the complaint handling process and adhere to them. Timescales and deadlines should be set out in legislation or clear policy statements. observe due process by separating the investigation, prosecution and decision-making processes. Where Board members participate directly in the disciplinary process they should not be involved in more than one of these three steps. specify the basis on which disciplinary action may be taken  such as misconduct or unethical behaviour. So far as possible, the basis on which action can be taken and any definitions of the terms used should be set out in the regulatory agency’s governing legislation or regulations. consider how to maintain consistency in relation to charges and sanctions so that the principle of fairness is observed. Set guidelines which enable consistent charging and sanction decisions to be made and which also allow for deviation where there are aggravating or mitigating circumstances that make it appropriate and can be explained.

Disciplinary Sanctions Principles and objectives Protect the public Maintain Confidence in the Board Deterrence General Specific Rehabilitation

Disciplinary Sanctions con’t Aggravating and mitigating circumstances Seriousness of the conduct Prior discipline history Single event vs. pattern of conduct Harm to specific individuals Misleading the Board/Agency Cooperation with the investigation Insight/Remorse

Disciplinary Sanctions con’t Typical Sanction Options Revocation / suspension of registration/license Restrictions on practice Terms and conditions (e.g., course of study) Periodic inspections / monitoring / reporting Restitution order Reprimand Fine The disciplinary sanctions available to boards vary significantly from jurisdiction to jurisdiction and often a Board’s governing legislation only provides a limited number of options. The sanctions which may be available include:   Revocation of registration; Suspension from practice for a fixed period or until specified conditions are met; Probation or some other form of restriction on practice, which may include, limitations on practice, supervision requirements or satisfactory completion of remedial activity; Denial of reinstatement or renewal of registration; Mandatory substance testing or submission to some other form of mental or physical evaluation; Censure and reprimand or a caution Restitution order, requiring the refund of fees and costs to a consumer; Administrative fine or monetary penalty.

Practitioner Misconduct Technical competence issues Lack of knowledge / skill / training Behavioral issues Breaches of Code of Conduct/Ethics Business issues Recordkeeping issues; Advertising issues Personal issues Impairment; Convictions Practitioner Misconduct is one of the most common forms of violations that regulatory boards face and may include: Physical harm or abuse of client Failure to maintain accurate records Failure to maintain standards of practice Code of conduct violations Fraud or falsifying of records Improper advertising Practice while intoxicated or mentally impaired Mental and physical impairment can affect a professional’s ability to practice properly, evaluations of the licensee’s state are crucial to ensure the board has all the needed information to make an appropriate decision. Chemical Impairment is one of the most common disciplinary issues Substance impairment progresses along the continuum of use, misuse, abuse and dependency Recognizing where a professional is on the continuum can help the board determine the degree of harm to the consumer as well as the appropriate course of disciplinary action and monitoring

Employ fair, transparent and timely processes Summary Employ fair, transparent and timely processes Provide for informal resolution options where appropriate Give specific training for Board members involved in discipline proceedings Board Members must be familiar with their organization’s discipline process and policies. The board is responsible for ensuring the process is transparent, timely and fair to all parties involved. The board is also responsible for supporting those directly involved with the disciplinary process with appropriate resources and training.

Contact Information Name Title/Organization Address City, State & Zip Phone E-mail CLEAR 403 Marquis Ave., Ste. 200 | Lexington, KY 40502 (859) 269-1289 | www.clearhq.org