Professional Reporting Obligations 1

You are a physiotherapist working in a private practice. You are treating a woman who sustained a Colles' fracture of her (R) arm after falling down the stairs of her backyard deck. You have been seeing her twice a week since her cast was removed two weeks ago. She appears very nervous and is always very anxious about being home before her husband gets back from work because he likes to have his dinner on time or he gets upset. During her last appointment, the patient was accompanied by her five-year-old daughter who told you that her daddy "gets mad" sometimes and hits her mommy. You begin to wonder if the fall down the stairs was an accident.

Response

During the course of treatment with a patient, a physiotherapist may be presented with information that causes the physiotherapist to consider taking further action or, in some situations, legally obliges them to make a report to the appropriate agency.

The first thing physiotherapists must do is to clearly differentiate between the two instances. It is essential to act appropriately. In some situations, physiotherapists must comply with the obligations stipulated in the applicable legislation governing the circumstances and/or individuals implicated in the content of the information. In those instances, disclosing the information to another health professional governed under the Regulated Health Professionals Act (RHPA) or to a teacher or social worker is not adequate and does not absolve the physiotherapist from the obligation of making a mandatory report.

Patients will occasionally share information with their physiotherapists that poses ethical dilemmas and compels them to weigh their professional obligations related to confidentiality and disclosure of information against a risk of harm piece, either to the patients themselves or to the public at large.

Examples of information that falls into this category include:

1. disclosure by the patient to the physiotherapist that, even though their driver's licence has been revoked because of residual impairments resulting from a traumatic brain injury, the patient continues to drive
2. where a patient is contemplating suicide because they are unable to continue to cope with their diagnosis and the quality of life issues associated with the diagnosis

Although very thoughtful consideration on how to deal with scenarios such as these is required, physiotherapists are not bound by law to act in a prescribed way when resolving these issues. Having said that, there are professional, legal and ethical factors to consider when faced with similar situations where decisions must be made about a course of action when information has been disclosed to them. The College Practice Advisory Service is often utilized as a resource by physiotherapists as they work through these dilemmas.

Issues to Consider

Does the physiotherapist have a legal obligation to report suspected abuse of her patient by the patient's spouse or partner?

Does the physiotherapist have a legal obligation to report suspected abuse of the daughter?
What are the consequences associated with a failure to report in a situation where reporting is mandatory?

What other obligations, besides legal, does the physiotherapist have?

Does the physiotherapist have a legal obligation relating to suspected abuse of the patient?
Although the idea of an adult possibly engaging in abusive behavior towards another adult is very upsetting, the physiotherapist does not have any legal obligation to report this suspicion to any agency or person(s) in authority. However, the physiotherapist may elect to engage in some preliminary dialogue with the patient, assuring the patient that the information will be kept confidential. The purpose is not to obtain confirmation that the suspicion is correct, but rather to offer suggestions about resources that may be helpful if the patient needs them. These may include women's advocacy groups, shelters, and the family doctor for counselling.

Does the physiotherapist have a legal obligation to report suspected abuse of the daughter?
If a person has reasonable grounds to suspect that a child is or may be in need of protection, the person must promptly report the suspicion and the information upon which it is based to the Children's Aid Society (CAS).

The Child and Family Services Act (1990), was passed to promote the best interests, protection and well-being of children and applies to a person under the age of 18. The Act places an obligation on members of the public, including professionals who work with children, to report promptly to the CAS if they suspect a child is or may be in need of protection. This includes physical, sexual and emotional abuse, neglect and risk of harm.

The physiotherapist must consider, given her suspicions regarding the mother, whether these are reasonable grounds for suspicions about the daughter. The physiotherapist does not need to be sure. "Reasonable grounds" are what an average person, given his or her training, background and experience, exercising normal and honest judgment would suspect.

What are the consequences associated with a failure to report in a situation where reporting is mandatory?
Any professional or official who fails to report a suspicion that a child is or may be in need of protection, where the information on which that information is based was obtained in the course of his or her professional duties, is liable on conviction to a fine of up to $1,000.

What other obligations, besides legal, does the physiotherapist have?
A physiotherapist is always required to adhere to the professional obligations described in the legislation governing the practice of physiotherapy. In this scenario, the physiotherapist is faced with a legal and moral dilemma requiring her to honour her obligations and behave in an ethical and sensitive manner.

Scenarios such as these require thoughtful consideration of all the issues present in the situation. Physiotherapists are encouraged to seek assistance from legal counsel, the College and any other resources that they believe can assist them in developing an appropriate course of action that will satisfy legal, ethical and professional obligations.

Additional Resources
Professional Reporting Obligations