When the Optometrists and Dispensing Opticians Board (the ODOB) receives a notification about you, it decides which route under the Health Practitioners Competence Assurance Act 2003 (the HPCA Act) the concern belongs on: competence, health or conduct. It writes to you with the concern and asks for your written response by a date. It then decides whether to close the matter, order a competence review, deal with it as a health matter, or refer it to a Professional Conduct Committee. While the matter is open it can place interim conditions on your scope of practice or suspend your practising certificate. Speak to your indemnity insurer or professional association that day, obtain the clinical records and the dispensing records, keep them as they are, and reply before the date with a response that shows what you have changed.
Where a notification comes from
A patient or their whānau, another optometrist or dispensing optician, a general practitioner or ophthalmologist who received a late referral, a practice owner or an employer can each make a notification. Under the HPCA Act an employer must tell the Board when a practitioner resigns or is dismissed for reasons relating to competence (section 34), and a practitioner or employer who believes you may be unable to practise safely because of a mental or physical condition must tell the Registrar (section 45).
A complaint that your practice or conduct has affected a patient is passed by the Board to the Health and Disability Commissioner, as the Act requires. The guide to how an HDC complaint reaches your Council or Board explains what follows. The Board's letter names the concern, the route, the material enclosed and the date your response is due.
The three routes
Competence. Where the concern is that your practice may fall below the required standard, the Board can order a competence review under section 36. Reviewers look at your records, discuss cases with you and can observe your practice, then report to the Board. The guide to what happens in a competence review covers it in detail.
Health. Where a mental or physical condition may affect your practice, the Board can ask you to be examined, accept voluntary undertakings and impose conditions. The health route is separate from conduct and is described in the guide to the health process under the HPCA Act.
Conduct. Where the concern is about behaviour rather than skill, the Board can refer the matter to a Professional Conduct Committee under Part 4 of the Act. The Committee investigates and either recommends an outcome to the Board or lays a charge before the Health Practitioners Disciplinary Tribunal. The guide to how a Professional Conduct Committee process runs sets out your right to be heard.
The standards the Board applies, and the concerns it sees
The Board measures your practice against its Standards of Ethical Conduct and the Standards of Clinical Competence that apply to your scope of practice. Your response should name the standard the concern points to and answer it. The concerns the Board can be asked to look at include these.
- A missed or delayed referral. Signs that needed a referral to an ophthalmologist or a general practitioner, such as a raised eye pressure, a change in the optic disc, a visual field defect or symptoms of a retinal detachment, that were not acted on, or a referral that was made but not followed up.
- Records. A record that does not show the history taken, the tests done and their results, the findings, the advice given and the reason for the decision, or an entry added after the event without a date.
- Commercial pressure on a clinical decision. A prescription changed, a test skipped or a product recommended because of a sales target, a time limit set by the practice or a margin, rather than the patient's need.
- Boundaries. A boundary with a patient or a colleague: dual relationships, personal messages, contact on social media, comments or touch that were not part of the clinical task, or a relationship that begins during or soon after care.
A concern about records is read closely in every route, because the record is how the Board sees what you did. The guide to what happens when a boundary concern is raised covers boundary matters across all professions.
What happens, step by step
- The letter arrives. The Board sends the concern, the material and a date. Contact your indemnity insurer or professional association that day and ask the practice in writing for the records if you do not hold them.
- You respond in writing. Set out the facts from the record, your clinical reasoning at the time, what fell short, what you have done since and what you have understood, with the evidence attached. The guide to how to write a response to a Council or Board notification gives the structure.
- The Board decides the route. It closes the matter, writes to you with advice, orders a competence review, uses the health route or refers the matter to a Professional Conduct Committee.
- The review or investigation runs. Reviewers report on your competence; a Professional Conduct Committee gathers documents, can interview you and witnesses, and lets you respond before it decides.
- You are heard before any order. Before the Board imposes conditions, orders a competence programme or makes an interim order, it tells you what it proposes and gives you the chance to respond.
- The outcome is recorded. The Board records its decision, tells you what it has told your employer and what appears on the public register, and sets a date to review any conditions.
Interim orders
While a Professional Conduct Committee investigation is open, section 69 of the HPCA Act lets the Board suspend your practising certificate or place conditions on your scope of practice if it is satisfied that is needed to protect the public. It can also make an interim order while a competence or health matter is open. You are entitled to be heard first, and the Board can vary or revoke the order. A practitioner who has already arranged for a colleague to review referral decisions, or has changed the part of practice concerned, and shown that in writing, gives the Board a reason to choose conditions over suspension. The guide to interim suspension and conditions on practice explains the risk test.
What you can do now
- Get advice before you write. Speak to your indemnity insurer, your professional association or a lawyer before anything goes in writing to the Board or to an employer.
- Gather the records. The clinical record, test results and images, the referral letter and when it was sent, the dispensing record, appointment history and any practice policy you worked under.
- Write against the record and the standard. Facts with references, your reasoning at the time, what fell short against the Board's standards, and what you have changed.
- Start remediation before you reply. A written referral protocol you now follow, an audit of your own records, peer review of cases with a named colleague, and courses completed with dated certificates.
The outcomes
At the first stage the Board can take no further action, write to you with advice, or send the matter down one of the three routes. After a competence review it can find that your practice meets the standard, order a competence programme with a supervisor and a timeframe, or place conditions on your scope of practice. A Professional Conduct Committee can recommend that the Board take no further action, counsel you, order a competence review or impose conditions, or it can lay a charge before the Tribunal. The Tribunal can cancel your registration, suspend it for up to three years, impose conditions, censure you, fine you and order costs, and its decisions are published. The guide to a Health Practitioners Disciplinary Tribunal hearing describes what it weighs.
Where remediation fits
What you have done since the concern was raised is the part of a Board matter you control. Courses completed before your response goes, with dated certificates attached, are evidence of that. Ethics for Optometrists and Dispensing Opticians and Professionalism for Optometrists and Dispensing Opticians are written for practitioners facing a concern about referral, records, commercial pressure or boundaries. Documentation for Healthcare Professionals answers a records concern, and Dealing with a Complaint or Investigation covers how to engage with the Board's process.
Each course is NZ$200, takes 2 CPD hours, is self-paced with immediate access, and ends with a dated certificate issued by Healthcare Ethics Courses that you can submit to the Board or put in your remediation plan. The remediation courses for optometrists and dispensing opticians facing an ODOB investigation are on one page, and the Council and Board investigation process explained shows where each course sits. The guide to showing insight and building a remediation plan explains how to present your evidence, and the guide to what happens after a notification to any Council or Board gives the whole process.
Sources and further reading
- Optometrists and Dispensing Opticians Board: the Standards of Ethical Conduct, the Standards of Clinical Competence and the Board's pages on concerns about a practitioner.
- Health Practitioners Competence Assurance Act 2003: sections 34, 36, 45 and 69 and Part 4.
- Health Practitioners Disciplinary Tribunal: published decisions and the penalties imposed.
- Health and Disability Commissioner: the Code of Health and Disability Services Consumers' Rights.
Frequently asked questions
What does the ODOB measure an optometrist or dispensing optician against?
The Board's Standards of Ethical Conduct and the Standards of Clinical Competence that apply to your scope of practice. A concern about a missed referral, your records, a decision made under commercial pressure or a boundary will be read against the standard that covers it. Name that standard in your response, say plainly what fell short of it, and show the change you have made to your practice against the same standard.
What happens if I missed or delayed a referral?
The Board can ask for your records, your reasoning and the practice's referral process, and can order a competence review if it is concerned about your clinical judgement. Your response should set out what you saw, what you recorded, why you decided as you did, and what you now do differently. A written referral protocol you follow, an audit of your own cases and peer review with a named colleague are evidence of that change.
Can the Board suspend me while it looks into the concern?
Yes. While a Professional Conduct Committee investigation is open, section 69 of the HPCA Act lets the Board suspend your practising certificate or place conditions on your scope of practice if it is satisfied that is needed to protect the public. It can also make an interim order while a competence or health matter is open. You are entitled to be heard before an order is made, and the Board can vary or revoke it.
My employer set the sales targets. Is that my responsibility or theirs?
The Board looks at the decision you made for the patient in front of you. A target set by a practice does not change the standard you are measured against. Your response can describe the pressure honestly, but it should also say what you did, what you would now do, and what you have changed, such as raising the target in writing with the practice. Take advice before you write about your employer.
Who should I speak to before I reply to the Board?
Your indemnity insurer, your professional association or a lawyer, on the day the letter arrives and before you put anything in writing to the Board or to an employer. Tell them the route the Board has chosen, what it has asked for and the date in the letter. Ask whether a lawyer should be instructed and what you can acknowledge. Healthcare Ethics New Zealand does not give legal advice.