Psychiatrist guilty of unprofessional conduct for using outdated diagnostic scale

Organisation: Position: Deadline Date: Location:
Belsham

Dr Brendan Belsham

A Johannesburg child psychiatrist who has written a book about attention deficit hyperactivity disorder (ADHD) has been fined R40,000 by the  Health Professionals Council of SA for unprofessional conduct. He had used an outdated  diagnostic scale in assisting with the diagnosis of ADHD of a child and then prescribed a treatment plan using Ritalin

MedicalBrief Note: An earlier version of this item identified Dr Brendan Belsham as a psychologist. Due to the failure of the HPCSA to provide us with the official findings, despite several requests, MedicalBrief had relied on published newspaper reports, which incorrectly identified Belsham as a psychologist. That is incorrect. He is a psychiatrist. We apologise for perpetuating the error.

The Times reports that the finding against Dr Brendan Belsham, author of the book What’s the Fuss About ADHD, was delivered on 1 April. The report says Belsham declined to comment.

The finding follows a complaint to the council in February 2018 which was levelled against Belsham by Johannesburg father David Nefdt-Epstein. Nefdt-Epstein’s complaint centred on the accuracy of tools Belsham was using to assist in diagnosing children, including his son, with attention deficit hyperactivity disorder (ADHD). Belsham diagnosed his son with ADHD in 2017.

The report says, according to the complaint, Belsham had claimed to use the Conners Rating Scale to make the diagnosis. The scale – used by health professionals internationally –consists of a checklist of behaviours that caregivers, teachers, parents and children over the age of eight can complete.

In February 2018, it was reported that the checklist that Nefdt-Epstein was given was in fact distributed to health professionals by Novartis South Africa, the makers of the ADHD medication Ritalin, in about 2002. At the time, South African company JvR Psychometrics, the sub-Saharan representative of the copyright holder of Conners, which is based in Canada, was quoted as saying the version distributed by Novartis was “an old, short form used many years ago for research” and was no longer internationally accepted.

JvR’s MD, Dr Jopie de Beer, was quoted as saying that those using it would probably not have the scoring-key manual that was provided and as such would not be able to generate “norm-referenced” scores. “(These) are very important because they take into account the age of the individual and compare them to a normal population. Without normed scores, there is no reference point to understand the severity of the symptoms,” de Beer said, adding that this would violate “professional and legal requirements”.

The report says JvR issued cease-and-desist letters to health professionals using the outdated questionnaires as they owned the copyright in South Africa for the Conners Rating Scale.

Novartis South Africa spokesperson Vaychel Raman was quoted as saying in 2018 that they shared materials with healthcare professionals regularly to keep them updated on the latest trends in clinical practice. “These materials are regularly updated and old materials withdrawn from circulation when updated.

The report says in its finding. the HPCSA states: “The Committee resolved that Dr Belsham is guilty of unprofessional conduct (and) to impose a penalty of R40,000. Further noted that in terms of his management of the patient there was no wrongdoing (he followed appropriate procedures, the rating that he used is readily available although modified) (sic).”

Nefdt-Epstein said in the report it had been an enormously tough journey “not only for us but especially for my son”. He said Belsham had used the outdated diagnostic scale in assisting with the diagnosis of ADHD with his son, and then prescribed a treatment plan using Ritalin. But Nefdt-Epstein said he believed his son did not require such an extreme intervention, especially with a diagnostic tool that had no merit in determining the severity of the diagnosis.

“We feel vindicated in terms of the HPCSA’s ruling. The ultimate goal was to show that parents should not be afraid to question and stand up against the so-called experts. When we take our children to the professionals, we as parents should expect the highest level of integrity beyond reproach. It is all about accountability, which there has to be.”

The Times report

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