When the Osteopathic Council of New Zealand 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 a 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, get your treatment records, do not alter them, do not contact the patient, and reply before the date with a response that shows what you have changed.
Who can notify the Council and what the letter contains
A notification can come from a patient or their whānau, another practitioner, an employer or clinic owner, a court or another agency. Two notifications are mandatory under the HPCA Act: an employer must tell the Council when an osteopath resigns or is dismissed for reasons relating to competence (section 34), and a practitioner or employer who believes an osteopath may be unable to perform the functions required for practice because of a mental or physical condition must tell the Registrar (section 45).
Where a patient complains that your practice or conduct has affected them, the Act requires the Council to pass the complaint to the Health and Disability Commissioner. The guide to how an HDC complaint reaches your Council explains that path.
The letter tells you what the concern is, which route it is on, what material is enclosed and the date your response is due. Write the concern out in one sentence of your own: that sentence is what your response has to answer.
The three routes and who decides
Competence. If the concern is that your practice may fall below the required standard, the Council can order a competence review under section 36 of the HPCA Act. Reviewers appointed by the Council look at your treatment records, talk to you about your clinical reasoning and can observe you with patients, then report to the Council. The guide to what happens in a competence review describes the review and how to prepare for it.
Health. If the concern is that a mental or physical condition may affect your ability to practise, the Council deals with it under the health provisions of the Act. It can ask you to be examined by a doctor it names, accept voluntary undertakings and impose conditions. A health matter is kept apart from conduct; the guide to the health process under the HPCA Act explains how it runs.
Conduct. If the concern is about behaviour rather than skill, the Council can refer it to a Professional Conduct Committee under Part 4 of the Act. The Committee investigates, hears from you, and then recommends an outcome to the Council 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 respond and be heard.
What the Council measures you against
The Council assesses an osteopath's conduct against its Code of Conduct and the standards it publishes for osteopathic practice. Your response should answer the part of the Code the concern points to. Concerns the Council can be asked to look at include these.
- Consent. Treatment begun without an explanation of what it involves, its risks and the alternatives; a technique or an examination the patient did not expect; a patient who was not told they could stop at any point or have a support person present.
- Boundaries. A boundary with a patient or a colleague: dual relationships, personal messages, contact on social media, a relationship that begins during or after care, or comments about a person's body that were not part of the clinical task.
- Records. Notes that do not record the assessment, the consent discussion, the techniques used or the advice given, or entries added after the event without a date.
- Claims about treatment. Statements on a website, on social media or in the treatment room that the evidence does not support, or a course of treatment sold before the need for it was assessed.
- Open disclosure. An injury after treatment that was not explained to the patient honestly and promptly, or not recorded.
Boundary matters are covered in the guide to what happens when a boundary concern is raised.
What happens, step by step
- The letter arrives. The Council sends you the concern, the material and a date. Contact your indemnity insurer or professional association that day.
- You respond in writing. Your response sets 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 Council decides the route. On your response, the records and any further enquiries, the Council closes the matter, orders a competence review, deals with it on the health route, or refers it to a Professional Conduct Committee.
- The review or investigation runs. Reviewers report to the Council on your competence. A Professional Conduct Committee gathers documents, can interview you and witnesses, and gives you the chance to respond before it decides.
- You are heard before any order. Before the Council imposes conditions, orders a competence programme or makes an interim order, it tells you what it proposes and gives you the chance to respond in writing or in person.
- The outcome is recorded and reviewed. The Council records its decision, tells you what it has told your employer and what appears on the public register, and sets when any conditions will be reviewed.
Interim orders
While a Professional Conduct Committee investigation is open, section 69 of the HPCA Act lets the Council suspend your practising certificate or place conditions on your scope of practice if it is satisfied that is needed to protect the public. The Council 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 Council can vary or revoke it.
An osteopath who has already arranged for a support person or chaperone to be present for the kind of treatment concerned, accepted supervision from a named colleague, and set that out in writing gives the Council a reason to choose conditions over suspension. The guide to interim suspension and conditions on practice covers the risk test and how an order is lifted.
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 Council or to an employer.
- Get the records and keep them as they are. Treatment notes, consent forms, intake forms, appointment history, invoices, messages and clinic policies.
- Write the response against the record. Facts with references to the notes, your reasoning at the time, what fell short and what you have changed.
- Start remediation before you reply. A change to how you explain and record consent, an audit of your own notes, supervision with a named osteopath, a review of the wording on your website, and courses completed with dated certificates. Completed steps are evidence; intended steps are promises.
The outcomes
At the first stage the Council 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. On the health route it can accept undertakings or impose conditions.
A Professional Conduct Committee can recommend that the Council 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 the Tribunal weighs.
At each stage the Council asks whether patients are safe with you now. What you have done since the letter arrived answers that.
Where remediation fits
The part of a Council matter you control is what you have done since the concern was raised. Courses completed before your response goes, with dated certificates attached, are evidence of that. Ethics for Osteopaths and Professionalism for Osteopaths are written for osteopaths facing a concern about consent, boundaries, records or claims about treatment. Dealing with a Complaint or Investigation covers how to engage with the Council's process, and Insight for Fitness to Practise covers the difference between regret and insight.
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 Council or put in your remediation plan. The remediation courses for osteopaths facing an Osteopathic Council investigation are listed on one page, and the Council and Board investigation process explained shows where each course sits in the stages. The guide to showing insight and building a remediation plan explains how to present the certificates with your other evidence, and the guide to what happens after a notification to any Council or Board gives the whole HPCA Act process.
Sources and further reading
- Osteopathic Council of New Zealand: the Code of Conduct, the Council's standards for osteopathic practice and its pages on concerns about an osteopath.
- Health Practitioners Competence Assurance Act 2003: sections 34, 36, 45 and 69 and Part 4 on Professional Conduct Committees and the Tribunal.
- Health Practitioners Disciplinary Tribunal: published decisions, with the penalties imposed and the weight given to insight and remediation.
- Health and Disability Commissioner: the Code of Health and Disability Services Consumers' Rights and how a complaint is assessed.
Frequently asked questions
Who can make a notification to the Osteopathic Council about an osteopath?
Anyone. A patient or a member of their whānau, another osteopath, a practitioner you work with, a clinic owner or an employer. An employer must notify the Council when an osteopath resigns or is dismissed for reasons relating to competence, and a practitioner who believes an osteopath may be unable to practise because of a mental or physical condition must notify too. The Council can also act on information from the Health and Disability Commissioner, a court or its own recertification process.
Does a patient complaint go to the Health and Disability Commissioner first?
Where a patient complains that your practice or conduct has affected them, the HPCA Act requires the Council to pass the complaint to the Health and Disability Commissioner. The Commissioner then decides what to do with it, and can refer it back to the Council. The Council can still consider your competence or your health while that happens. Ask the Council in writing which route it is using and which body will contact you next.
Can the Osteopathic Council 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 Council suspend your practising certificate or impose 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 Council can vary or revoke the order.
What does the Council measure an osteopath's conduct against?
Its Code of Conduct and the standards it publishes for osteopathic practice. A concern about consent, boundaries, records, claims about treatment or open disclosure will be read against the part of the Code that applies. Read that part before you write, use the Council's own words when you say what fell short, and show the change you have made to your practice against the same standard.
Who should I speak to before I reply to the Council?
Your indemnity insurer, your professional association or a lawyer, on the day the letter arrives and before you put anything in writing to the Council or to an employer. Tell them the route the Council has chosen, what it has asked for and the date in the letter. Ask whether a lawyer should be instructed, what you can acknowledge, and how to word it. Healthcare Ethics New Zealand does not give legal advice.