Discipline Case Summary

March 2006

The following is a summary of a matter placed before a five-member panel of the Discipline Committee of the College of Physiotherapists of Ontario on Tuesday, October 11, 2005. 

In this matter, the panel considered and accepted an Agreed Statement of Facts filed by the College and Mr. Duvage, and found the registrant guilty of professional misconduct in relation to professional standards of practice and professional billing practices. 

The Allegations

The Discipline Panel found that the conduct alleged in the statement of agreed facts and joint submission on finding constitutes professional misconduct as defined in the College's Professional Misconduct Regulation of Ontario 861/93 as amended: paragraph 2 (standards of practice), 13 (failing to keep a record), 17 (issuing a misleading document), 18 (submitting a misleading account), 19 (charging an excessive fee), 25 (unprofessional conduct), 26 (breaching an undertaking) and 32 (continuing to treat).

Summary of Agreed Upon Facts

Rupasinghe Duvage was practising physiotherapy in Mississauga, Ontario. About eight years ago, there were serious concerns about Mr. Duvage's standards of practice including his assessments, treatment planning, reassessment, discharge planning and record keeping. There were also concerns about the accuracy of his accounts prepared for or submitted to insurance companies. In 1998 Mr. Duvage gave a written undertaking to the College agreeing to meet professional standards of practice and professional billing practices. Between that time and 2004, Mr. Duvage submitted or permitted misleading accounts to be submitted to Great West Life Insurance. These included accounts for orthotics and orthopedic shoes where the client had not yet received them or had not yet paid for them; accounts for massage therapy services when physiotherapy services similar to those rendered previously were billed as physiotherapy services; accounts where the need for the products or services had not been assessed, reassessed or documented; accounts where the dates for the services were inconsistent with clinical records; and accounts where the documentation submitted to Great West Life in support of the claims was altered or rewritten.

In addition, some of the fees Mr. Duvage charged were excessive. Between about 1998 and 2004, Mr. Duvage failed to maintain the standards of practice of the profession relating to assessments, clinical reasoning, treatment, reassessments and documentation.

Order on Penalty and Costs

The Discipline panel accepted a Joint Submission on Finding. The panel ordered that: 

1. The Registrar suspend Mr. Duvage's certificate of registration for four months. One month of the suspension can be suspended provided that Mr. Duvage fulfils the remaining provisions of the Order.
2. Mr. Duvage may serve the suspension in two installments, of two months and one month, so long as the entire three months is served by June 30, 2006.
3. Mr. Duvage appear before the Panel to be reprimanded and the fact of the reprimand recorded in the register.
4. A specified term, condition and limitation on Mr. Duvage's certificate of registration be as follows:
   • Mr. Duvage's practice and records be assessed by a remediator within three months of the Order; successful completion of a record keeping and business practices course within nine months of the Order, after which there will be up to ten monitoring assessments over two years.
   • Reimbursement to the College of the expenses of the assessment, courses and monitoring up to a maximum of $2,500.
   • Mr. Duvage pay $7,500 towards the costs and expenses of the College investigation and prosecution.
5. The Panel consent to Mr. Duvage's spouse, who is a support person in Mr. Duvage's clinic, receiving payment during the period of the suspension of up to $1000 per week from the practice if it is operated by a locum. Mr. Duvage was permitted no other benefit, direct or indirect, during the suspension.

The Panel's Reasons

In assessing the proposed penalty order, the Panel considered those audiences with a vested interest in the matter – the public, the registrant and the profession. The College, which governs the self-regulating physiotherapy profession, is charged with the responsibility of protecting the public. The insurance company/industry represents a specific subset of the public. As the payor, the company must be respected by registrants and treated with integrity. Registrants must be held to account for failure to comply with the standards of practice of the profession. 

Aggravating factors against Mr. Duvage included the College's serious concerns eight years ago over his standards of practice and the accuracy of his accounts to insurance companies. At that time Mr. Duvage gave an undertaking that he would meet professional standards of practice and professional billing practices. Mr. Duvage has breached that undertaking. The current findings again relate to issues of record keeping, billing practices, the submission of misleading accounts to insurers, charging excessive fees for some services and products, and failure to maintain the standards of the profession. The Discipline Panel considers that Mr. Duvage's conduct has demonstrated serious disregard for his professional obligations. 

There were also mitigating circumstances. This was the first actual finding of professional misconduct against Mr. Duvage. He demonstrated a willingness to accept responsibility for his actions, to cooperate with the College in its investigation and, in the Panel's view, sincerely agreed to remediate his practice and billing methods. 

This order gives notice that serious penalties will be imposed for failure to comply with professional obligations. It demonstrates to the public that professional misconduct is taken seriously by the College and is dealt with appropriately by the Discipline Committee. 

The Panel believes that this penalty fulfills the intended purposes of public protection, punishment and individualized remediation for the registrant, and sends a message of deterrence to the professional membership.