Chapter 11: Professional Misconduct
What is Professional Misconduct?
The term professional misconduct can be applied to a variety of activities and behaviors. Professional misconduct is any behavior that negatively impacts the practice of medical laboratory technology or impairs an MLT’s ability to practise competently. Remember that you represent your profession at all times, and in everything that you do, and act accordingly.
Employers can determine and impose appropriate discipline and remediation to address substandard performance in the workplace. The final determination of what is and is not professional misconduct, however, lies with the College, not the employer.
Examples of what would be considered professional misconduct include:
- Practising without a licence or helping someone else to do so
- Falsifying test results
- Falsifying or amending requisitions without authorization
- Failing to follow established standards of practice, regulations, and procedures
- Failing to report results and/or keep required records
- Breaching patient confidentiality
- Divulging private information in social media
- Failing to divulge a criminal conviction
- Practising while impaired by drugs or alcohol
- Practising outside the scope of practice
- Misrepresenting your credentials
- Practising under an assumed name without permission
- Behaving inappropriately while representing the profession in a public venue
- Conflict of interest
- Verbal, physical, or sexual abuse of a patient
- Discrimination
- Stealing
- Refusal to cooperate with the College
- Failure to report professional misconduct of a colleague or employee
(Note that the above list is not exclusive: potential scenarios of professional misconduct are numerous and varied.)
The CSMLS Code of Professional Conduct (reproduced in the introduction to this handbook) provides a broad description of the conduct expected of medical laboratory technologists. Employer policy is another essential resource for MLTs who work for others. In specific situations, ask yourself whether the conduct could result in harm to a patient, client, or colleague, and what most reasonable MLTs would do in the same circumstances.
SCENARIO:
Anne is a technologist working in the immunology lab. It’s her son’s birthday and she knows she has to leave on time at the end of the day. She’s doing antibody ELISA testing, and when she reads the results, she’s dismayed to see that the positive control well is negative. This is going to hold her up, even if the run can’t be repeated today.
There are, however, other positives in the run, so Anne knows the test is working. She assumes that she must have forgotten to add the positive control specimen to the well. The negative control well is negative, and the positives will all be confirmed with a second test, so Anne goes ahead and reports the results, signs off for the day, and goes home to her son’s birthday party.
Without a valid positive control result, Anne has falsified not only the quality control results, but also the patient sample results. Because the test results are not reliable, she may be putting patient wellbeing and lives at risk. If her actions are discovered, she may lose her licence to practise, and therefore her job, and she will not be able to work as an MLT. Given the obvious violation of employer protocol, the risk to patients, and the risk to Anne’s employment, most technologists would have taken the steps necessary to ensure that the tests were repeated, and the necessary people notified about the delay in results. Anne’s actions constitute professional misconduct.
Family Members and Friends
SCENARIO:
It’s Friday in the microbiology lab and Peggy’s sick, again. She’s had a whole string of urinary tract infections and this has all the typical features of another one. She’s miserable, and she’s scheduled to work the weekend. She doesn’t want to let the lab down or oblige someone else to work in her place on short notice, and she’s almost out of sick time anyway. She knows she needs a urine culture, and probably an antibiotic, but she doesn’t want to spend the evening in emergency or a walk-in clinic. She decides to take the specimen herself.
Peggy uses a sterile urine container from the microbiology supplies and collects and plates a urine specimen. When the culture is positive the next morning, she fills out a requisition and hands the plates to the technologist doing urines for proper workup. Then she calls her doctor’s office with a preliminary report. She asks her doctor to call in a prescription for her at her local pharmacy.
Peggy’s backed into a corner with her recent health issues and her work schedule, and she’s feeling terrible. It’s easy to understand why she would consider this solution, and how she might rationalize it to herself: the urine culture’s going to be taken anyway, the lab will be paid because a proper report is sent, she’s doing the lab a favor because she might otherwise have had to take sick time, her doctor knows her and doesn’t mind etc. This way, too, she’ll feel better faster.
Peggy is risking her licence, and therefore her job by doing this. In falsifying a requisition and ordering tests on herself, she’s practising outside her scope of practice. Using lab supplies and employer time to do tests on herself is stealing. If either her doctor or a co-worker reports her actions (and they should do so), Peggy will be investigated for professional misconduct and the results are likely to be far worse than spending a Friday evening waiting to see a doctor. Medical laboratory technologists must access health care by the same routes as everyone else, and cannot take shortcuts like this.
In Nova Scotia, medical laboratory technology is a self-regulating profession. This means that the provincial government, via the MLT Act, agrees that the NSCMLT can regulate the profession in the interests of public safety. The NSCMLT deals with situations like the scenarios described above, and can revoke or suspend MLT licences, among other forms of discipline.
Anyone who has previously had a licence to practise medical laboratory technology revoked or suspended, or who has been convicted of a criminal offense, anywhere, is required to inform the College. This may not necessarily result in disciplinary action, but the College must make that decision.
Complaint Process
Investigation of possible professional misconduct by the NSCMLT begins upon receipt of a complaint (or report). A complaint can be made by anyone, including the registrar of the NSCMLT, and the person guilty of professional misconduct (self-reporting).
With the exception of a complaint made by the registrar, all complaints should be made in writing to the NSCMLT registrar.
NSCMLT Investigation of Professional Misconduct
The process for investigation of alleged professional misconduct is laid out in the MLT Act (Discipline; Sections 44 – 70). Upon receipt of a complaint, the investigation committee of the College can decide not to pursue it if they deem it frivolous, a labor union matter etc. If the College investigates the complaint it may:
- Appoint a committee to investigate the complaint
- Obtain legal advice
- Hire other professional assistance, such as medical or psychological consultants
A committee investigating a complaint against you may:
- Immediately suspend or restrict your licence temporarily (in circumstances where the safety of the public could potentially be at risk)
- Interview you, or any other member of the College
- Expand the investigation to include other possible professional misconduct, or other relevant matters, that come to light during the course of the investigation
- Require you to undergo medical and/or psychological assessments
- Require you to undergo examination to prove your competency in the profession of medical laboratory technology
The committee must provide you with a copy of the complaint, as well as copies of the results of any examinations. They must also inform you in writing of decisions and actions taken, and respect your right to privacy.
SCENARIO:
In a previous scenario, Anne chose to report test results even though the positive control did not work. The next time the test is performed, her deceit is discovered when the positive control is again negative and Sara, the technologist doing the run, does a little investigating. Sara finds that the positive control vial was replaced just prior to Anne’s run, and a positive control for a completely different test has been accidentally used. Sara realizes that Anne would have obtained a negative result and that she must have falsified the positive control result.
Realizing that this sort of conduct is unacceptable in a medical laboratory technologist, Sara reluctantly the incident to the registrar of the College. (The employer is obliged to report the incident to the College as well.) The registrar initiates an investigation into the complaint by informing the disciplinary committee.
Based on the evidence immediately available, the disciplinary committee suspends Anne’s licence to practise, pending the results of the full investigation. Without a licence, she is unable to work and must await the decision. Ultimately, she is found guilty of professional misconduct, a result that could result in permanent loss of her licence. Because this is her first offense, however, the college imposes a $500 fine, bills Anne for the cost of the investigation, and requires her to enroll in a professional development course.
Investigations of professional misconduct don’t always result in disciplinary action. The committee may also dismiss the complaint, find you not guilty of professional misconduct, refer the decision to another party (such as a mediator or hearing committee), or work with you to resolve the matter.
Discipline Process
In most cases, the investigation committee will be able to resolve the complaint without referring it further and may even resolve it informally. Where disciplinary action is warranted, it may involve anything from a reprimand to retraining to establish competency, or even loss of your registration and licence to practise. The disciplinary committee may:
- Require you to undergo medical or psychological treatment
- Fine you up to $15,000, plus costs
- Suspend your licence temporarily
- Restrict your licence or impose conditions upon your practice as an MLT
- Revoke your licence
In some circumstances you have the right to appeal decisions and/or requirements; however, you may have to pay the costs of such an appeal yourself.
Medical laboratory technologists who have their licences revoked can reapply for a licence after two years.
Conclusion
Professional misconduct is a serious matter than can result in the loss of your licence to practise in the profession of medical laboratory technology. Both co-workers and employers are obliged to report professional misconduct to the College if they discover it. The best way to avoid having to deal with an accusation of professional misconduct is to maintain the highest possible professional standards at all times.
The full details of the investigation and disciplinary process are written out in the MLT Act. Should you be accused of professional misconduct, your first step should be to read the legislation in order to be fully informed about your rights and obligations.
