FPSLREB Decisions
Decision Information
Suspension without pay (5 days) - Misconduct - Employee's attitude - Duty of civility - Physician - the employer suspended the grievor without pay for five days because the grievor had been disrespectful and discourteous toward the psychologist of one of the employer's clients in a telephone conversation - the employer had already noted a number of incidents relating to the grievor's attitude and behaviour - the employer argued that employees have a duty of civility - the employer claimed that the grievor had a very bad attitude toward it and its clients - the employer argued that in the circumstances, it had to send the grievor a clear message that his attitude could not be tolerated - the grievor acknowledged that employees owe their employer a duty of civility - the grievor claimed that the telephone conversation had been lively and that the psychologist in question had not felt offended or humiliated by it - the grievor argued that his conduct warranted at most a reprimand - the adjudicator held that the grievor had been disrespectful toward the psychologist - the adjudicator confirmed the five-day suspension without pay. Grievance denied.
Decision Content
File: 166-2-27712 Public Service Staff Before the Public Service Relations Act Staff Relations Board BETWEEN NICOLAE TANCIU Grievor and TREASURY BOARD (Veterans Canada)
Employer Before: Muriel Korngold Wexler, Deputy Chairperson For the Grievor: Luc Quesnel, Counsel, Professional Institute of the Public Service of Canada
For the Employer: Raymond Piché, Counsel
Heard at Montréal, Quebec, June 12, 1997.
Decision Page 1 DECISION On October 1, 1996 Dr. Nicolae Tanciu submitted a grievance challenging a suspension of five days without pay. The employer imposed this suspension on the basis that Dr. Tanciu’s behaviour in a telephone conversation with a client was lacking in professionalism, courtesy and respect. The grievance was duly referred to adjudication on February 17, 1997 and heard on June 12, 1997.
Facts The employer called André Lemieux and Louise Cléroux. The grievor testified on his own behalf and the parties submitted six pieces of documentation.
Dr. Tanciu is the principal physician for the Montréal district of the federal Department of Veterans Affairs. The clients of that Department are veterans of the First and Second World Wars, the Korean War and the Gulf War, as well as members of the Regular Forces and Royal Canadian Mounted Police. The Department is a “recognition” department and the clients have special status.
On September 18, 1996 Louise Cléroux, director of the Montréal district, Veterans Affairs Services, imposed a five-day suspension without pay on Dr. Tanciu following an incident between the latter and André Lemieux, Ph.D., a psychologist treating a client of the Department (“J.B.”). Ms. Cléroux wrote the following to Dr. Tanciu (Exhibit 1): [Translation] This concerns the letter sent to me by Dr. André Lemieux, a psychologist, regarding your telephone conversation with him. I have considered Dr. Lemieux’s complaint and the comments you sent me in this regard and have come to the conclusion that:
- you told Dr. Lemieux the reason for refusing treatment was that everyone does therapy;
- you lost your temper when Dr. Lemieux told you that your recommendation was contrary to that made by one of your peers and he asked you if you realized that your position was rigid and did not reflect the consensus of two professional bodies;
Public Service Staff Relations Board
Decision Page 2 - when he mentioned the question of reimbursement you flew into a rage and shouted [Translation] “Well, let him pay for them out of his pocket”;
- you also hung up on him. Your statements and your cavalier manner of dealing with Dr. Lemieux demonstrate a flagrant lack of courtesy and respect. Not only did you show a serious lack of professionalism, the effect of your behaviour was to tarnish the Department’s reputation.
A review of your disciplinary file indicates that the incident is not an isolated one. You have also been the subject of disciplinary action in the past for similar behaviour. On December 20 last I imposed a three-day suspension on you for, among other things, using offensive and humiliating language to one of our clients.
In view of the behaviour you adopted in this matter, the lack of professionalism, the impact of your behaviour on the image and reputation of the Department, the lack of remorse on your part, the contemptuous tone of your written remarks and your disciplinary file, I have decided to impose a five-day suspension on you without pay.
This suspension will be served from October 7 to 11 next. On those days you are prohibited from reporting to work without written authorization from me.
I trust that this action will finally prompt you to reflect and to alter your conduct so that your interpersonal relations with our clients and suppliers are characterized by courtesy and respect. I must tell you that if such incidents recur more severe action may be taken, possibly including dismissal.
Further, I encourage you to consult our Access program if this can help you meet these requirements.
A copy of this letter will be placed in your personal file. André Lemieux, Ph.D., has been a psychologist since 1980 and is a member of the Ordre des psychologues du Québec. He is also a professor at the University of Québec in Montréal and has a one-day clinic weekly. Mr. Lemieux has a doctorate in psychology. He is a specialist in educational and gerontological psychology.
Mr. Lemieux complained about Dr. Tanciu following a telephone conversation in which Mr. Lemieux asked for payment for therapy for “J.B.”, who at the time was a 63-year-old veteran. On May 9, 1996 Mr. Lemieux complained in writing to
Public Service Staff Relations Board
Decision Page 3 Louise Cléroux, director of the Montréal district and Dr. Tanciu’s immediate superior. This complaint read as follows (Exhibit 2): [Translation] We would like to make you aware of our professional opinion regarding the attitude of Dr. Nicolas [sic] Tanciu M.D. in processing the case of our patient Mr. [J.B.].
For the sake of clarity we will divide our comments into four points, namely:
1 - Case K1337906 (Mr. [J.B.]); 2 - Attitude of Dr. Nicolas [sic] Tanciu, M.D.; 3 - Dr. Tanciu’s behaviour to our patient; 4 - Dr. Tanciu’s attitude to our person, another health professional.
1 - Case of Mr. [J.B.], No. K1337906: On April 3, 1996 we received in our office at the Centre Professionnel de Ste-Rose, located at 254 Boul. Labelle, Suite 101, a 63-year-old veteran, Mr. [J.B.], who had just retired from the Canadian Armed Forces barely two years ago. This gentleman, who suffers from problems adjusting to civilian life, was referred to us by Mr. [B.]’s personal physician, Dr. André Beauchemin of 601 Place Marsan, Laval H7X 2J6, tel. 689-5180.
Dr. Beauchemin diagnosed a family adjustment disorder and referred Mr. [B.] to a psychologist (Appendix 1). On April 3, 1996 Mr. [B.] began psychological therapy with us, continuing to the sixth treatment and providing satisfaction to the patient.
Our diagnosis confirmed that of Dr. Beauchemin, which may be classified according to the DSM-III-R as No. V62.89, namely a [Translation] “Disorder relating to a stage of life or other situational problem”, apparently not due to a mental disorder. Accordingly, in our professional opinion this did not require an extensive psychiatric assessment which would have been costly, pointless and without any apparent reason.
Though it was not part of our policy, we agreed to be paid by the federal Department of Veterans Affairs since we knew that the Department took the well-being of veterans very seriously. Accordingly, all was going well and the psychological treatment progressing when on April 29, 1996 we received a letter from Blue Cross (Appendix 2) indicating
Public Service Staff Relations Board
Decision Page 4 that we were only authorized to provide approved services to [J.B.] and that our action was denied. We asked our secretary to call the telephone number to find out the reasons for such a refusal. She told me that the Department of Veterans Affairs physician felt he should see a psychiatrist.
At our psychological interview of May 8, 1996 Mr. [B.] gave us a letter from the TBS analyst (Appendix 3), Johanne Allard, requesting a detailed recommendation from a psychiatrist and inviting Mr. [B.] to contact her for further details. We found it very strange that there should be a requirement of a psychiatric assessment before psychological treatment commences since this requirement has long been obsolete. The consensus of professional bodies is rather that a physician’s reference suffices for consulting a psychologist. That was the case here. We took the initiative of contacting Johanne Allard instead of Mr. [B.] since we felt our client would not be able to cope adequately with this administrative complication and we wanted to spare him any additional stress.
Further to our telephone call to Johanne Allard, she kindly directed us to Dr. Nicolas [sic] Tanciu, M.D., who had made this recommendation.
2 - ATTITUDE OF DR. NICOLAS [sic] TANCIU, M.D. We immediately telephoned Dr. Tanciu, identifying ourselves and indicating the reason for our call, namely the case of Mr. [B.].
Dr. Tanciu remembered the case and told us he required a detailed recommendation by a psychiatrist because nowadays everyone does therapy. We pointed out to him that we were registered with the Ordre des psychologues du Québec as No. 02710-80 and the Canadian Register of Health Service Providers in Psychology as No. 03338, and that those bodies were the legal guarantee of the therapy carried out by member psychologists. To this Mr. Tanciu responded that before referring to a psychologist he required not only an assessment by a psychiatrist but also [that] the patient could not use a private psychologist but a psychologist practising in a centre under the supervision of a psychiatrist. As I was amazed at this we asked him if he could refer us to the Department of Veterans Affairs regulations on this directive. Mr. Tanciu replied that it was a procedure of long standing and that he did not have to give me the regulations on it. We then asked him if he was a general practitioner and the number of his licence with the Ordre des médecins. He told us he had formerly been a surgeon. We asked him if he was a psychiatrist and he finally said he was a general practitioner. We then pointed out that his recommendation was contrary to that made by one of his
Public Service Staff Relations Board
Decision Page 5 peers in the Ordre des médecins and asked him if he realized how strict his approach was and that it did not reflect the consensus of our two professional bodies. Mr. Tanciu became angry and insisted this was his recommendation and that if we did not agree with it we could always file an appeal. We pointed out that the appeal process was very lengthy and interrupted the ongoing psychological treatment and asked him to indicate how psychological treatments already provided would be paid for. In a final burst of irritation Mr. Tanciu shouted [Translation] “Well, let him pay for them out of his own pocket”, told us there was nothing more to be said and hung up.
3 - Dr. Tanciu’s behaviour towards our patient In our view, Dr. Tanciu did not take the patient’s interests and well-being into consideration. He dealt with the case in a completely arbitrary manner, recommending an obsolete procedure which professional bodies have long since agreed to abandon. The very corporatist professional behaviour of Dr. Tanciu in analysing cases dealt with by the Department might eventually cause serious impediments to the medical treatment of veterans. Groups of elderly people, as is the case with veterans, are often traumatized by the rigid attitudes adopted by health professionals and avoid indicating certain needs for fear of reprisals. It is for this reason that research has indicated that sympathetic health professionals should be assigned to this group and should listen carefully to accounts of their vulnerable situations. We saw no sign of such qualities in Dr. Tanciu in dealing with our patient.
4 - Dr. Tanciu’s attitude to our person, another health professional
We deplore the following in Dr. Tanciu’s attitude to us in dealing with Mr. J.B.’s case. The facts are as follows.
1 - An arrogant attitude and very corporatist approach to handling this case.
2 - Failure to work together with any non-physician professional in determining a common position on the well-being of the patient.
3 - A rigid and completely subjective attitude in analysing the administrative aspects of the case, without reference to established rules.
4 - An outdated position in the recommendation made to our patient.
Public Service Staff Relations Board
Decision Page 6 5 - An uncomfortable position as the result of stopping psychological therapy of our patient following the subjective approval of Dr. Tanciu’s recommendation.
6 - A contemptuous lack of concern for our patient’s financial position as a result of Dr. Tanciu’s refusal to change his opinion in any way.
7 - A lack of good manners which is inexcusable in anyone, and still less someone in the health field.
We feel sure, Madam, that this letter will cause you some concern, but knowing that the Department of Veterans Affairs is anxious to ensure the well-being of veterans we feel you will do everything to bring about a satisfactory resolution of the matter.
We hope you will regard this criticism as constructive and intended to improve service for veterans.
Mr. Lemieux testified as follows. On May 2, 1996 Johanne Allard, a TBS analyst, sent a form to “J.B.” indicating that his request for payment of fees for psychological services was denied because he should have consulted a psychiatrist, not a psychologist. Attached to this form was a letter of April 26, 1996 from Huguette Lemonde, Chief, Health Care Benefits, Veterans Affairs Canada, confirming this refusal without explanation.
“J.B.” had consulted Mr. Lemieux as the result of a handwritten prescription by Dr. André Beauchemin on March 25, 1996, on which the latter had noted: [Translation] “Family adjustment disorder”.
Mr. Lemieux testified that on April 3, 1996 he saw “J.B.”, who complained of difficulties adjusting to civilian life. He had become disoriented. He had situational and family disorders. “J.B.” was not suffering from a mental disorder. Mr. Lemieux felt he could treat him. Mr. Lemieux did not know Dr. Beauchemin, a general family doctor, and did not consult him about “J.B.”. However, he found that “J.B.”’s case needed brief therapy, one visit a week for several weeks. When Mr. Lemieux met with “J.B.”, the therapy was urgent because a divorce was also in question. Mr. Lemieux did not secure his fees before starting “J.B.”’s therapy because of the urgency of the situation. Accordingly, Mr. Lemieux considered he could treat “J.B.” and began therapy, telling his secretary to send the documents requesting payment of his fees to the Department. Mr. Lemieux had had very positive experience with the Department when his brother-
Public Service Staff Relations Board
Decision Page 7 in-law, the later Homer DesLauriers, had received exceptional care and the Department had borne all the expense. Personally, Mr. Lemieux avoided dealing with the federal government and when “J.B.” came to see him he decided to take a calculated risk and made an exception.
Then, after six therapy sessions, “J.B.” showed Mr. Lemieux the form signed by Ms. Allard refusing payment of his fees and the letter from Ms. Lemonde. These two documents gave a telephone number. Mr. Lemieux accordingly telephoned Ms. Allard for further information as “J.B.” was confused by this refusal. Ms. Allard referred Mr. Lemieux to Dr. Tanciu, who had made the decision to reject the application. Mr. Lemieux then telephoned Dr. Tanciu to discuss “J.B.”’s case as between colleagues. Dr. Tanciu remembered “J.B.”’s case very well and replied that he had recommended a psychiatric assessment because [Translation] “Anybody does therapy nowadays”. Mr. Lemieux accordingly told him of his qualifications. However, Dr. Tanciu replied that [Translation] “Moreover, if he recommended a psychologist it would be one working under the supervision of a psychiatrist in a general hospital”. Mr. Lemieux asked him whether there were any regulations or directives of the Department on the matter. Dr. Tanciu answered there were not but [Translation] “it was a long-standing practice”. Mr. Lemieux felt increasingly uncomfortable and so asked Dr. Tanciu his specialty and his membership number in the Ordre des médecins du Québec. Dr. Tanciu told him to file an appeal and Mr. Lemieux asked whether Dr. Tanciu knew what a psychologist was.
Mr. Lemieux stated that the conversation was not a pleasant one and that it took place in front of “J.B.”. If “J.B.” had actually been with Dr. Tanciu he would have been still more upset. Mr. Lemieux therefore decided to bring this incident to the Department’s attention. “J.B.” and Mr. Lemieux discussed the matter and “J.B.” told him to do whatever he wanted. A month later, on May 9, 1996, Mr. Lemieux wrote up the complaint (Exhibit 2) because he was very surprised at the attitude and behaviour of a professional like Dr. Tanciu. Mr. Lemieux was shocked by Dr. Tanciu’s answer suggesting that “J.B.” pay for the psychological care out of his own pocket when Mr. Lemieux simply wanted to talk to Dr. Tanciu to discuss the treatment already given. Mr. Lemieux telephoned for “J.B.”’s welfare because otherwise the care would have had to stop. Mr. Lemieux assumed that the Department took its clients’ welfare into account and this was why he had already begun “J.B.”’s treatment. Mr. Lemieux Public Service Staff Relations Board
Decision Page 8 expected that Dr. Tanciu would act in good faith. Further, it is usual for psychologists not to be under the supervision of a psychiatrist. Mr. Lemieux found Dr. Tanciu’s attitude unprofessional. He pointed out that he has taught therapy, practises one day a week and often sees people referred by Dr. Beauchemin, as in “J.B.”’s case.
Louise Cléroux, director of the Montréal and Gatineau District and Dr. Tanciu’s immediate superior, said the following. She was responsible for managing operations and client services and supervised about 70 people. On May 8, 1996 Mr. Lemieux telephoned her. He wanted information about departmental directives and policies on the approval of health services and costs paid by the Department. Ms. Cléroux told him he had to put his complaint in writing if he wanted to make an official complaint. The purpose of this conversation was to ensure that the client “J.B.”’s therapy was not interrupted. Mr. Lemieux said he even thought of filing a complaint with the Ordre des médecins du Québec. When Mr. Lemieux’s written complaint arrived Ms. Cléroux gave Dr. Tanciu a copy of it. Then, on July 10, 1996, Ms. Cléroux discussed the complaint with Dr. Tanciu, who told her that [Translation] “Nowadays anybody does therapy”. Dr. Tanciu had the responsibility of deciding whether “J.B.”’s claim was admissible. According to Ms. Cléroux, under the Department’s policy the claim was admissible when the recommendation for treatment by a psychologist was signed by an attending physician or psychiatrist. “J.B.” met the eligibility conditions and Dr. Tanciu was aware of this.
Between July 19, 1995 and May 1996 the employer had noted a number of incidents involving Dr. Tanciu’s attitude and behaviour. On November 22, 1995 Dr. François Déziel, the Department’s senior medical consultant on pensions in the head office (Charlottetown), wrote Dr. Tanciu describing what the Department expected of him. Additionally, on November 21, 1995 Ms. Cléroux and Dr. Déziel met with Drs. Tanciu and Jean-Louis Lajoie, both district physicians supervised by Ms. Cléroux. At that meeting they discussed district decisions which had been reversed by the Appeal Board. The Appeal Board sits at the regional level. Ms. Cléroux explained that the district physicians’ decisions denying health services were often reversed after additional information had been obtained. Dr. Déziel insisted that district physicians obtain the necessary information before rendering a decision. He asked them to ensure that they had additional information when a case was not clear and to contact the attending physician, and in cases of doubt to consult the [Translation] “national Public Service Staff Relations Board
Decision Page 9 physician”. Moreover, they discussed the Department’s approach to decisions on eligibility for health services. At the meeting, Dr. Tanciu did not refuse to comply with these directives.
Further, on December 20, 1995 Ms. Cléroux had imposed a five-day suspension without pay following an incident between Dr. Tanciu and a departmental client (Mr. Parker) that occurred in a medical examination. Dr. Tanciu filed a grievance, which was duly referred to adjudication and was the subject of an arbitral award (Board file 166-2-27311). The five-day suspension was canceled and replaced by a letter of reprimand. Additionally, on April 22, 1996 Ms. Cléroux received an harassment complaint against Dr. Tanciu, which was resolved when Dr. Tanciu apologized to the complainants. Accordingly, no disciplinary action was taken as a result of this complaint.
Following Mr. Lemieux’s telephone call on May 8, 1996, and during the week of May 16, Dr. Rolland Chiasson, senior medical consultant, treatment, was in Montréal. Ms. Cléroux therefore sent him “J.B.”’s file and Dr. Chiasson reversed Dr. Tanciu’s decision. On professional medical matters Ms. Cléroux referred files processed by Dr. Tanciu either to Dr. Déziel, if the question was one about pensions, or Dr. Chiasson, if the question involved treatment. Dr. Chiasson also met with Dr. Tanciu to discuss “J.B.”’s case and the departmental policy on the payment of psychologists’ fees.
Then, on July 10, 1996, Ms. Cléroux met with Dr. Tanciu officially to discuss Mr. Lemieux’s complaint. Dr. Tanciu told her that he was not pleased when he received the complaint in question. He wanted to discuss the complaint at once. He answered that he had discussed “J.B.”’s file with Dr. Chiasson and that the decision had been reversed to allow “J.B.” to receive psychological treatment. Ms. Cléroux told him to be careful what he said since she had received another oral complaint from a Mr. Marette, though he had refused to put it in writing. Dr. Tanciu commented that Mr. Marette’s allegations were false and added that Mr. Lemieux had not asked for authorization before beginning “J.B.”’s treatments and that nowadays anybody did therapy. It was therefore preferable to ensure that a psychiatrist referred the client to a recognized psychologist practising in a hospital environment. According to Dr. Tanciu, it was Mr. Lemieux who lost his temper in the telephone conversation.
Public Service Staff Relations Board
Decision Page 10 Ms. Cléroux testified that Dr. Tanciu’s function was to apply the departmental policy and he was required to consider the application accordingly. He should have considered the frequency of use of the services, regardless of whether “J.B.” had authorization before or after beginning his therapy. “J.B.” had no prior history, so the Department did not expect him to apply for approval before beginning the health treatment.
At the meeting of July 10, 1996 Dr. Tanciu spoke out quite strongly. He was not pleased and he was certain he had used the correct approach. In his opinion it was better for “J.B.” to be referred by a psychiatrist and he agreed with Dr. Chiasson that a general practitioner’s reference could be accepted but, at the same time, he also felt sure that the reference should come from a psychiatrist if the client was to be given the best service. At this meeting Ms. Cléroux asked him to put his comments in writing and he did so on July 15, 1996 (Exhibit 3).
On July 16, 1996 Dr. Chiasson wrote Ms. Cléroux his comments. Dr. Chiasson explained that Dr. Tanciu’s conclusions about “J.B.”’s application were wrong because the policy in effect provided for 20 treatments when the prescription came from a physician, and only when the treatments required were above that number was it advisable to consult a psychiatrist if possible. Even that was not absolutely necessary. Dr. Chiasson explained this to Dr. Tanciu at their meeting in May 1996. Further, Dr. Chiasson added that Dr. Tanciu should have acted more professionally (Exhibit 4, page 2): [Translation] It was clearly totally inappropriate to indicate that the veteran could pay for the services out of his own pocket.
It was totally inappropriate to hang up on the caller. It was inappropriate to indicate that everyone gets therapy nowadays. The point was, if his physician indicated he needed it, then in the absence of contrary evidence, he needed it.
Dr. Tanciu, for his part, wrote on July 15, 1997 that he had agreed with Dr. Chiasson on [Translation] “accept[ing] the reference of an attending general practitioner to a qualified psychologist, whoever it might be”. Dr. Tanciu added that he
Public Service Staff Relations Board
Decision Page 11 had [Translation] “therefore agreed to give up insisting on providing clients with a guarantee of the best medical solution, even if the essential purpose of departmental physicians and their reason for being there was to do precisely that. At the same time, it was agreed to refer the case for decision at a higher medical level if following a series of treatments administered by the therapist the latter asked for such treatments to be extended (supposedly in order to consolidate the good results)” (Exhibit 3, page 1). He wrote (Exhibit 3, page 2):
[Translation] Finally, I arrived at the agreement with Dr. Chiasson mentioned above (which I repeat is not in keeping with our duty to offer clients the best care). In some cases it is difficult to get to a specialist: in country places, in isolated areas, patients are far from an ideal specialist. We agreed that reference to a non-physician professional might be tried and the client could have treatment without too much delay.
However, in the case in question the client was from the Laval area where access to a psychiatrist presented no problem, and it goes without saying that if a psychiatrist had expressed the opinion that treatment by a psychologist could suffice (because he also suspected there were functional disorders) I would have approved the reference at once.
Dr. Tanciu mentioned the possibility that “J.B.” was suffering from disorders caused by organic lesions. He explained (Exhibit 3, page 3): [Translation] As disorders caused by organic lesions are identified, discovered and treated with maximum competence by a psychiatrist, often assisted by a neurologist, it is clear that psychological treatment has no validity and occasions needless cost because it is not covered by medical care insurance.
That was my judgment as a physician and that is why I refused the reference to a psychologist, before reference to a psychiatrist. What is more, consultation of a psychiatrist would have been free, covered by the R.A.M.Q. like any reference for consultation of one physician by another, and the Department would not have to approve any payment of any kind. It was only Mr. Lemieux, the psychologist, who saw the danger of great expense in reference to a psychiatrist! - an amazing proof of bad faith.
Public Service Staff Relations Board
Decision Page 12 The departmental policy of October 1992 provides the following (Exhibit 5(b)): 3.0 POLICY 3.1 There may be circumstances where payment is requested for the costs of psychological services received in private clinics, even though these services are available as an insured service in hospitals or through provincial programs at designated locations or clinics.
3.2 In such cases, payment may be made for psychological services received in a private clinic only if:
(a) it is confirmed that treatment in a public institution is not available or, if available, only after considerable delay (one month or more) and the District Medical Officer/Regional Medical Officer (DMO/RMO) confirms that this delay would be detrimental to the clients [sic] health; and
(b) treatment is provided by a registered psychologist for a condition in which delay is contra-indicated.
3.3 In such cases, payment may be made for services provided by psychologists registered and listed in the province/territory in which the services are provided. In provinces/territories having no legislation to license psychologists, psychological services may be approved only if provided by or under the direction of a licensed psychiatrist.
3.4 Access to necessary psychological services provided by a registered psychologist may be approved as outlined in the Related Health Services Benefit Grids for up to 20 treatment units in a calendar year.
On August 21, 1996 Ms. Cléroux again discussed this policy with Dr. Tanciu. He did not agree with the policy because he said the best service was to go through a psychiatrist, except that Dr. Tanciu’s function was simply to apply the policy. Ms. Cléroux stated that the Department tried to see [Translation] “whether the client could first go to the provincial level for treatment, and if that was not possible, the Department would provide service because of the delay”. In “J.B.”’s case Mr. Lemieux thought the treatment was immediately required. Further, if Dr. Tanciu had doubts about this or about the treatment he should have consulted the attending physician to find out the situation and make an informed decision. According to Ms. Cléroux Dr. Tanciu made a mistake in handling “J.B.”’s case. If the Department considers that
Public Service Staff Relations Board
Decision Page 13 the client (“J.B.”) needs treatment and the treatment is eligible treatment, the application is approved. Dr. Tanciu should have made sure that the wait would not adversely affect “J.B.”’s treatment. “J.B.” was in the care of a physician and a recognized and licensed psychologist. Accordingly, “J.B.” met the formal requirements and if Dr. Tanciu had any professional concern, he did nothing about it. It was Dr. Tanciu who should have called the attending physician. The Department does not make clients wait for their treatment.
Ms. Cléroux explained that Dr. Tanciu never altered his position and beliefs. Moreover, the Department does not have many requests for psychological treatment and in “J.B.”’s case the treatment was immediately required. In his file, “J.B.” had noted he was separated and was receiving allowances because his income was low. The Department therefore had an interest in ensuring that the psychological treatment continued.
Ms. Cléroux stated that she decided to impose a disciplinary penalty on Dr. Tanciu as a result of his comments and those of Dr. Chiasson. Ms. Cléroux explained that she took into account the approach to treatment of “J.B.”’s case. Dr. Tanciu should have acted according to the rules and called Dr. Beauchemin, the attending physician, to confirm that the latter had considered “J.B.”’s age (63 years) and the possibility of physiological disorders. Ms. Cléroux confined herself to Mr. Lemieux’s complaint and decided that the incident warranted five days’ suspension without pay. Dr. Tanciu should have respected the responsibilities confided to him by the employer. Further, consulting a psychologist is not in the cultural pattern of persons such as “J.B.” (63 years old). He had left the Canadian Forces two years before and had family and adjustment disorders (separation and divorce). Accordingly, the therapy should not have been interrupted and Dr. Tanciu should have ensured that “J.B.” was covered. Mr. Lemieux was also not someone who dealt frequently with the Department: it was his first contact and he was not in the habit of dealing with the government. Dr. Tanciu therefore had a duty to treat him courteously. He could have explained to him on the telephone that he was going to review “J.B.”’s case or refer the matter to Ms. Cléroux. Dr. Tanciu told Ms. Cléroux that he had not lost his temper in his telephone conversation with Mr. Lemieux and had terminated their conversation because he had already lost enough time. Dr. Tanciu also admitted that it was he who hung up the telephone to end the verbal tussle. Public Service Staff Relations Board
Decision Page 14 Ms. Cléroux explained that Dr. Tanciu used a disrespectful tone and was not courteous in his oral and written exchanges with Mr. Lemieux. In this regard Ms. Cléroux referred me to Exhibit 3, Dr. Tanciu’s written comments on July 15, 1996 in answer to Mr. Lemieux’s complaint of May 9, 1996. She pointed out that the tone of his written comments was contemptuous, condescending, very arrogant and [Translation] “he was always right”. She said this accurately described Dr. Tanciu’s attitude.
Dr. Tanciu generally saw three to four clients a day. The Montréal office has 5,000 active clients for two physicians (two part-time and Dr. Tanciu, who is full-time). To Ms. Cléroux’s knowledge, Dr. Tanciu does not regularly call the attending physician or another specialist for information before making decisions on eligibility for treatment or the amount in pension cases. Ms. Cléroux has never seen Dr. Tanciu take the initiative in making such a contact to assist in dealing with a case.
Ms. Cléroux explained that Dr. Tanciu’s function is to apply the policy and his attitude must change. He is the only physician in the Montréal and Gatineau district whose cases run into problems. Ms. Cléroux wanted Dr. Tanciu to understand that he had an attitude problem. His behaviour and attitude were contrary to the Department’s policies and entire philosophy of client service. As Dr. Tanciu became angry when he spoke to Ms. Cléroux, she preferred the version of Mr. Lemieux, who wrote that it was Dr. Tanciu who lost his temper in their telephone conversation, because this was confirmed by her own observations. Ms. Cléroux expected employees of the Department to act courteously and professionally. Dr. Tanciu should not have exacerbated the argument and should have reacted courteously. He had a behaviour problem and Ms. Cléroux suggested that he consult the “Employee Assistance Program” (EAP). It was important for Dr. Tanciu to realize his position, as it was serious and he was the only one who could change it.
Ms. Cléroux concluded that this incident required a severe penalty so Dr. Tanciu would understand that his attitude and behaviour could not be tolerated and would have to be corrected. The earlier disciplinary action (Board file 166-2-27311) had not had any effect on him and the “J.B.” case was more serious than the Parker incident. Ms. Cléroux added that training would not change Dr. Tanciu’s attitude because what
Public Service Staff Relations Board
Decision Page 15 was necessary was for him to accept he could have been wrong in handling the “J.B.” case.
Dr. Nicolae Tanciu testified as follows. He admitted he insisted on reference to a psychiatrist in the “J.B.” case. He made a medical judgment and stated [Translation] “[that he did not] give a kick about the policy”. He was entitled to reject the application if the reference did not come from a psychiatrist. However, he added that there were situations in which he might approve [Translation] “intervention by a non-professional”, alluding to Mr. Lemieux. Dr. Tanciu explained he could not disclose departmental directives and policy in his telephone conversation with Mr. Lemieux. Mr. Lemieux had to request them in writing and it was not because he did not want to give them to Mr. Lemieux, he did not have [Translation] “the right” to reveal them, and everyone was well aware of this rule. Dr. Tanciu added he did not have the right to disclose the Department’s policies or philosophy. Mr. Lemieux could obtain them, but not from Dr. Tanciu.
Dr. Tanciu explained the reason for his refusal in the “J.B.” case. In that case there was no reference by a physician to another professional made on an [Translation] “official document with a name”. Dr. Beauchemin and Mr. Lemieux did not know each other and both should have been involved in treating “J.B.”. According to Dr. Tanciu, [Translation] “Dr. Beauchemin did not refer the case, he sent it away, because he wanted to be rid of “J.B.””. Dr. Tanciu arrived at this conclusion because Dr. Beauchemin did not refer “J.B.” [Translation] “to an established clinical psychologist practising in a general hospital or attached to a faculty of medicine”. Mr. Lemieux was [Translation] “an unknown psychologist, with no reputation, not well known”. Accordingly, it was not a reference and [Translation] “this type of reference is not current practice”. To Dr. Tanciu, not only was it not a proper reference but it was also illegal and irregular because it was made to [Translation] “someone not well known”. Dr. Tanciu added that he explained this to Mr. Lemieux on the telephone. His comments on July 15, 1996 (Exhibit 3) were explanations which Dr. Tanciu gave Ms. Cléroux in response to Mr. Lemieux’s allegations. Dr. Tanciu explained that in using the tone described by Ms. Cléroux he was not being contemptuous of anyone and his punctuation might suggest he was not serious or was joking, but that was not the case.
Public Service Staff Relations Board
Decision Page 16 Further, Dr. Tanciu was not persuaded that “J.B.” needed psychological treatment. When Dr. Tanciu denied the treatment he had not seen Dr. Beauchemin’s prescription. This prescription [Translation] “appeared” after his refusal. In noting down the refusal Dr. Tanciu did not indicate he was refusing because the psychologist had not been identified (Exhibit 6). In Exhibit 6 Dr. Tanciu wrote he was denying the application because: [Translation] Consultation of a psychologist is requested by a psychiatrist — only — and it must be a psychologist who is not only officially recognized and a member of their association but also working for a psychiatric care unit (a hospital, institution and so on) and not simply in a private office. He must be attached to a care unit.
Dr. Tanciu testified that he knew [Translation] “all about the policy and the substance of the physician’s [sic] policy” because he was the Department’s district physician with the greatest seniority. “J.B.” was in a central location where there were hospital and university centres. Accordingly, the best treatment was that provided by the best qualified person. In “J.B.”’s case, however, a general practitioner and an anonymous psychologist were in question. Accordingly, Dr. Tanciu wanted to know the reason why the general practitioner had not referred his patient (“J.B.”) to a more qualified physician. Dr. Tanciu presumed that “J.B.” had a psychiatric problem. In his opinion, Dr. Beauchemin wanted to get rid of “J.B.” because his prescription gave no specifics. According to Dr. Tanciu the expression [Translation] “adjustment disorders” meant nothing. Dr. Tanciu wanted “J.B.” to be seen by a psychiatrist who would refer him to [Translation] “a specific psychologist”.
Dr. Tanciu went on to say that when Mr. Lemieux telephoned he wanted explanations which he received from him. Dr. Tanciu told him that [Translation] “alternative medicine [was] the fashion”. Dr. Tanciu stated he had been a university professor before leaving Romania and had come to Canada as a refugee in 1969. Moreover, he was older (67 years old) than Mr. Lemieux. He therefore had to persuade Mr. Lemieux that it was his function to decide on the “J.B.” case. According to Dr. Tanciu, a general practitioner is sometimes unable to make a diagnosis and must then refer the case to a specialist. Dr. Tanciu explained that he did medical work (he is
Public Service Staff Relations Board
Decision Page 17 a general practitioner himself) and [Translation] “all physicians with some professional standing, pedigree and professional conscience will refer a patient to a specialist”.
Dr. Tanciu stated that Dr. Chiasson had not reversed his decision (the rejection) in the “J.B.” case, except that the Department had paid for the six treatments given by Mr. Lemieux and claimed by “J.B.”. However, this payment was not a reversal of his decision to reject “J.B.”’s application for payment for the six treatments. Dr. Tanciu noted that Dr. Chiasson is much younger than himself. It is important to note that in his testimony Dr. Tanciu had difficulty listening to the questions of counsel for the employer and answering them. He also used a dry, loud tone of voice.
According to Dr. Tanciu the departmental policy at issue in the “J.B.” case (Exhibit 5) had nothing to do with his decision as the senior physician in the district. “J.B.” would have been entitled to consult Mr. Lemieux if he had lived in the Gaspésie, where there is no university centre, and there again Dr. Tanciu would have asked for references from a psychiatrist. Dr. Tanciu indicated he had not contacted Dr. Beauchemin because he could not ask [Translation] “uncomfortable questions” and point out to him he had made no [Translation] “specific reference”. To Dr. Tanciu, this was a form (reference to a physician), not policy. [Translation] “What matters is substance and content”. With Dr. Tanciu’s refusal, “J.B.” would have known he had to consult a psychiatrist and that his case was not urgent. The psychiatrist would then have seen him two or three months later and a proper reference would have been made to a [Translation] “well-known and competent” psychologist practising in a hospital or clinic. Dr. Tanciu would have approved this reference and it did not matter that it would have taken over three months before “J.B.” finally received psychological treatment: [Translation] “That would not have made any difference”. Dr. Tanciu explained that this reference would have been to a therapeutic psychologist who was [Translation] “a real professional”. Mr. Lemieux’s explanation that the treatment was immediately required did not satisfy Dr. Tanciu. Dr. Tanciu described it as [Translation] “not credible”. In Dr. Tanciu’s opinion, [Translation] “Mr. Lemieux had long been aware that any treatment required prior approval”. Moreover, he was better qualified than Mr. Lemieux to decide about “J.B.”’s welfare.
Dr. Tanciu did not recall the meeting with Dr. Déziel on November 21, 1995. He had no recollection of the discussion of decisions reversed by the Appeal Board
Public Service Staff Relations Board
Decision Page 18 because of oversights and lack of information and of the requirement that information be obtained by contacting the attending physician before rendering a decision. Dr. Tanciu stated that the first time he heard this was when Ms. Cléroux testified in the case. Dr. Tanciu added that [Translation] “Ms. Cléroux made up a lot of things in her testimony”.
Dr. Tanciu reviewed the Department’s policy (Exhibit 5) and concluded that an attending physician referred his patient to an institution (a general hospital). He insisted that in his telephone conversation with Mr. Lemieux it was the latter who lost his temper. Dr. Tanciu wanted to know how far he could take his rudeness. Mr. Lemieux was a frustrated and angry man and Dr. Tanciu [Translation] “played along”. It was Mr. Lemieux who [Translation] “insulted” him and [Translation] “dragged him in the mud”. Dr. Tanciu denied raising his voice and saying [Translation] “Well, let him [“J.B.”] pay out of his own pocket”. According to Dr. Tanciu, he said [Translation] “You ran the risk of not having your fees paid. The patient will have to pay out of his own pocket”. Dr. Tanciu said this was consistent with the policy of the Department when an application is not approved. Dr. Tanciu added that he answered Mr. Lemieux’s questions [Translation] “pleasantly” and ended their conversation with [Translation] “Good-bye, I must go, you have found out what you need to know. I have work to do and clients waiting”. He explained he was not irritated but had to end the conversation.
ARGUMENT Raymond Piché, counsel for the employer, submitted the following. “J.B.” was a veteran who, according to his attending physician and Mr. Lemieux, an established psychologist, needed psychological treatment immediately. The treatment was begun and “J.B.” claimed Mr. Lemieux’s fees for six treatments. Dr. Tanciu rejected the claim and Mr. Lemieux telephoned him to discuss “J.B.”’s case. Dr. Tanciu testified and his manner of answering questions could be seen. Dr. Tanciu tried to justify his position. He repeated several times that he was a competent physician and his word should be taken on such matters. Mr. Lemieux felt that “J.B.” needed immediate care and he was badly treated by Dr. Tanciu. Dr. Tanciu explained his refusal in his testimony and added that the delay in reference and obtaining psychological treatment did not matter. Dr. Tanciu adopted a surprisingly rigid position. He refused to abandon his position: [Translation] “The best treatment by the best physician”. However, “J.B.”’s
Public Service Staff Relations Board
Decision Page 19 problem, adjustment disorders, was very minor and a psychiatrist was not needed. Dr. Tanciu adopted a theoretical position that was not in accordance with the policy of the Department. However, Dr. Tanciu did not want to hear about it: he stood firm. Exhibit 3, dated July 15, 1996, demonstrates inconceivable arrogance. Dr. Tanciu accused Mr. Lemieux of dishonesty and deceit.
Mr. Piché added that an employee must observe certain duties of civility as described in the article “L’obligation de civilité du salarié” by the writers Claude D’Aoust, Sylvain St-Jean and Gilles Trudeau, published in Relations Industrielles, vol. 41, No. 1 (1986), at pp. 157 to 179. Mr. Piché also cited Metikosh (Board file 166-2-14166), Tanciu (Board file 166-2-25763) and Tanciu (Board file 166-2-27311). Mr. Piché concluded that Dr. Tanciu had a very bad attitude towards his employer and clients of the Department. His attitude was inappropriate and there had to be a clear message that this attitude could not be tolerated and had to be corrected.
Luc Quesnel, Dr. Tanciu’s counsel, submitted the following. Dr. Tanciu recognized he had a duty of civility to his employer. Mr. Lemieux was not a vulnerable client but a psychologist who called the Department after beginning “J.B.”’s treatment. When Dr. Tanciu rejected “J.B.”’s application, he used his judgment and took into account the interests of his employer and of the claimant. There were discrepancies in “J.B.”’s file and as he lacked sufficient information Dr. Tanciu rejected the application. In doing this Dr. Tanciu had applied the policy of the Department (Exhibit 5) in “J.B.”’s case, together with his experience as a physician. In his opinion, a psychiatric specialist was in a better position to clarify the situation regarding “J.B.”’s treatment. Mr. Lemieux had begun the treatment and if the Department did not approve payment of his fees he would drop “J.B.”. Dr. Tanciu thought “J.B.”’s case was not an emergency situation. His judgment was medical and it was wise for him to insist on a psychiatrist’s opinion. Dr. Tanciu answered Mr. Lemieux’s allegations in writing on July 15, 1996.
In their telephone conversation Dr. Tanciu and Mr. Lemieux were not of the same opinion. Mr. Lemieux found the fact that Dr. Tanciu terminated their conversation unprofessional. They had a lively conversation. Mr. Lemieux also put his complaint in writing at Ms. Cléroux’s request. The employer had no good reason to discipline Dr. Tanciu. Further, Mr. Lemieux indicated that he had not felt offended or
Public Service Staff Relations Board
Decision Page 20 humiliated by the telephone conversation. Mr. Quesnel noted that the case did not involve civility at the workplace, and the fact that the harassment complaints had been settled made it clear that Dr. Tanciu was approachable.
Mr. Quesnel added that it was perhaps the tone, speech, imposing appearance, erudition and possibly the aggressive nature of Dr. Tanciu’s voice which might have given the impression of a bad attitude, although this had not been a handicap before Mr. Lemieux’s complaint. Dr. Tanciu was a physician who stood on his reputation and in this connection Mr. Quesnel referred to the second Tanciu decision (Board file 166-2-27311). He felt there was a difference between medical competence and managerial skill. In any case, there was no question of medical fault in the instant case. Mr. Quesnel explained that the reason Dr. Tanciu did not recall the November 21, 1995 meeting was that Dr. Déziel worked with pensions whereas Dr. Chiasson was responsible for treatment.
Mr. Quesnel maintained that the five-day suspension without pay would not improve the working climate. The employer had not shown that Dr. Tanciu should have said nothing and that he was wrong in speaking to Mr. Lemieux. The case perhaps indicated a need for training, but the situation did not in any way merit the disciplinary action imposed. “J.B.”’s treatment had never been interrupted and the only person in the case who had “paid” was Dr. Tanciu. The five-day suspension without pay was not appropriate and the incident merited no more than a reprimand. In support of this conclusion Mr. Quesnel referred to the comments by Dr. Chiasson on July 16, 1996 (Exhibit 4), where he noted that perhaps Dr. Tanciu should take a course on professional conduct.
Mr. Piché responded that the evidence had not shown that Dr. Tanciu made a proper medical decision. On the contrary, his decision was reversed by Dr. Chiasson. Dr. Tanciu had a serious problem understanding his employer’s instructions and expectations.
Public Service Staff Relations Board
Decision Page 21 REASONS The employer had the burden of proof and he discharged it. Mr. Lemieux was a credible witness. His principal allegations were in fact confirmed by Dr. Tanciu’s testimony and evidence (Exhibit 3).
Dr. Tanciu refused to recognize that Mr. Lemieux is a qualified psychologist licensed and recognized in Quebec and Canada. Even in his testimony he described Mr. Lemieux as [Translation] “anonymous and unknown”. He thus treated him with contempt and without respect. In his comments of July 15, 1996 Dr. Tanciu accused Mr. Lemieux of making things up. Further, the Department’s policy (Exhibit 5) is quite clear. A general practitioner may send a patient to a psychologist and the resulting treatment is admissible and approved. However, Dr. Tanciu insisted on not carrying out this policy and would only approve if the reference came from a psychiatrist. According to Dr. Tanciu, the best treatment was that provided by the best qualified person, and in his opinion a psychiatrist was that person. He said quite clearly [Translation] “[that he did not] give a kick about the policy”. “J.B.” did not have a psychiatric problem, rather a problem adjusting to civilian and family life. Dr. Tanciu did not even obtain information on “J.B.”’s case and simply rejected the application because he insisted on a psychiatrist looking after “J.B.”.
I was able to observe Dr. Tanciu’s behaviour and attitude when he testified. Dr. Tanciu had no respect for Mr. Lemieux. He did not regard Mr. Lemieux, who is a psychologist, as a professional. Dr. Tanciu testified with arrogance and gave the impression that it was his right as a physician not to have his decisions questioned when he refused to recognize Mr. Lemieux as a professional or “J.B.”’s treatment. Further, he said that Dr. Beauchemin referred “J.B.” to Mr. Lemieux because he wanted to be rid of him. I find such a comment very indicative of his attitude as described by Ms. Cléroux. Dr. Tanciu did not have Dr. Beauchemin’s prescription when he rejected “J.B.”’s application and had never discussed the case with the attending physician. How then could he have come to such a conclusion?
To summarize, Ms. Cléroux imposed a five-day suspension without pay on Dr. Tanciu for his arrogant and impolite attitude to Mr. Lemieux. In the circumstances of the instant case that disciplinary penalty was fully merited. Dr. Tanciu has a serious
Public Service Staff Relations Board
Decision Page 22 problem. He must understand that he is employed by the federal Department of Veterans Affairs and is required to observe and comply with his employer’s instructions and policy. The employer cannot accept and excuse an attitude such as [Translation] “I don’t give a kick about the [Department’s] policy”. That cannot be tolerated. Dr. Tanciu had better realize that he should avoid having further disciplinary problems. He should also lower his tone when dealing with his superiors, colleagues and clients of the Department. In conclusion, the Board recommends that he act courteously and professionally at all times.
For these reasons, the grievance is dismissed.
Muriel Korngold Wexler Deputy Chairperson OTTAWA, August 5, 1997
Certified true translation Serge Lareau
Public Service Staff Relations Board