A performance audit by the Louisiana Legislative Auditors Office has found problems in the complaints process of the state Psychology Board. The audit, led by Ms. Emily Dixon, Performance Audit Manager, and begun in August 2021, examined the Board’s processes for licensing, monitoring, and enforcement. The performance of the board was compared to the requirements set forth in the Psychology Practice Act, and found to be in compliance with “most best practices.”
However, the auditors found numerous problems with the complaints committee performance. They said that the average time for resolving a complaint was 338 days and that the Board had no internal time frames for accomplishing its investigations. The auditors also stated that the board had no “disciplinary matrix,” and no way to track the nature and outcomes of complaints or to analyze the data. They also found numerous errors, inconsistencies, and lack of follow up.
The auditors sampled internal documents from fiscal years 2019 through 2021. During this three year time, LSBEP received 71 complaints and closed 63 of these complaints. Eight, or 12.7%, resulted in a public, disciplinary action. There was one, non-public, impaired psychologist procedure and 11 Letters of Education, also nonpublic. According to this data, 43 of the cases were dismissed with no action. A total of 85.7% were either dismissed or received a letter with educational information.
The auditors found that the board required an average of 338 days to resolve a complaint. The time ranged from eleven days to more than three years. Eight (12.7%) of the 63 complaints took more than two years to resolve, and an additional 13 (20.6%) of the complaints took more than one year to resolve.
” […] LSBEP has not established internal timeframes for resolving complaints, and its process for tracking complaints does not record accurate and complete information. As a result, the Board cannot ensure that it is investigating and resolving complaints in a timely manner,” they said.
The auditors found that LSBEP’s process for tracking complaints included inaccuracies and inconsistencies.
“LSBEP tracks complaint information in a spreadsheet, an investigation log, and a complaints log. However, we compared these three documents to each other and to LSBEP’s paper complaint files and Board meeting minutes that contain complaint outcomes, and found that none of the tracking documents were accurate or complete. For instance, the spreadsheet did not include all complaints, incorrectly listed some closed complaints as open, and did not include all instances of disciplinary action.
“[…] we found that three Letters of Education were sent to the licensees more than five months after the Board voted to send them.” And, “… we identified five complaints that LSBEP did not ensure were fully closed. These five complaints included one licensee who was never sent a Letter of Education that the Board voted to send in June 2019 about mandatory reporting of abuse.” The auditors sound that four complaints were never presented to the Board for closure.”
The auditors also found that “LSBEP has not adopted a disciplinary matrix that aligns with regulatory best practices to ensure that disciplinary actions are consistent and appropriately escalated based on the number and/or severity of violations.”
The auditors found the following categories and percentages of allegations. (See Audit Exhibit below.) The most frequent category of 25% came in from allegations of “Substandard Care, Negligence, or Malpractice.” This was followed by 20% for “Unprofessional Conduct, Discrimination, or Rude Treatment.” Next was “Failure to Maintain or Provide Accurate Patient Records” at 16%, “Multiple Relationships or Conflict of Interest,” and ‘Practice Without License, Misrepresentation of Credentials, or Practice Outside of Scope,” both at 14% of allegations.
The auditors noted, “According to LSBEP, staff create separate spreadsheets to track the compliance of each disciplined licensee and use calendar reminders for monitoring specific activities.
“However, these processes are not formalized in policy and staff have not followed them consistently. In addition, the Board does not have a process for systematically and periodically monitoring whether all disciplined licensees have performed required corrective actions, reimbursed disciplinary costs as ordered, and continue to comply with ongoing Board restrictions.”
The auditors noted that, “LSBEP did not report four (44.4%) of the nine adverse actions it issued during fiscal years 2019 through 2021 to the NPDB in accordance with federal law.”
The auditors recommended that the Psychology Board require all licensees to undergo a background check, Instead of just new licensees. And, they recommended that the Board query the National Practitioner Data Base for enforcement information when making license decisions and for continuous monitoring.
The auditors also indicated that the Legislature may want to authorize the Psychology Board to impose fines for discipline and administrative noncompliance.
In a response, the Board agreed with all the auditors’ recommendations. Specifically, they agreed to “… establish a system where complaints are prioritized and investigated on a case-by- case basis considering risk to the public in accordance with the Audit, the Act, LAPA, and other applicable law and oversight. This system will ensure complaints are processed within reasonable time periods, factoring in the complexity of the case. These procedures are currently in practice, but not explicitly stated in policy. Additionally, the board has recently hired two full-time employees including in-house counsel whose primary focus is on the complaint adjudication process. Timeframes for internal monitoring will be determined to ensure compliance.”
The Board agreed to “… establishing a process for tracking complaints that includes documenting the status, nature, and outcome of all complaints; periodically reviewing open complaints; and regularly analyzing complaint data to assess compliance with agency policy and identify opportunities for improvement. Over the past 3 years, the board has worked to improve financial stability in order to employ staff who can develop these processes understanding that this is vital to operations and best practice.”
The 37-page report is available online at https://app.lla.state.la.us/publicreports.nsf/0/dd11af03beda7797862588540052a678/$file/0002f3.pdf?openelement&.7773098