Physiotherapists Area

Patients Area
Stakeholders Area

This information comes into effect as of June 4, 2009

Fitness to Practise

The fitness to practise provisions of the Regulated Health Professions Act (RHPA) address issues where a physiotherapist who may be compromising patient care as a result of incapacity. "Incapacity" refers to a situation where the physiotherapist is suffering from a physical or mental condition or disorder that makes it desirable in the interest of the public that the physiotherapist’s practice be subject to terms, conditions or limitations, or that the physiotherapist no longer be permitted to practise. Generally, a physiotherapist who has demonstrated a lack of insight into his or her illness to the extent that there is a valid concern that he or she will practise inappropriately is incapacitated.

Incapacity proceedings differ significantly from disciplinary proceedings. First, incapacity hearings focus on whether the health professional is ill, not whether he or she has failed to maintain the standards of practice of the profession. Also, a finding of incapacity usually results in rehabilitative, rather than punitive measures.

Initiating Incapacity Proceedings

A panel of the Inquiries, Complaints and Reports Committee (ICRC) or the Registrar may initiate incapacity proceedings after considering information that has been provided to them and where the information reveals that the physiotherapist may be incapacitated and that inquiries into a physiotherapist's capacity are warranted. These inquiries are made by a Health Inquiry Panel which is a panel of the ICRC. The physiotherapist is advised of the concerns that have been identified and the fact that a Health Inquiry Panel has been appointed to explore these concerns. The physiotherapist would be provided with the opportunity to make submissions at this point.

Health Inquiry Panel

A Health Inquiry Panel, composed of up to two public members of the ICRC and up to four professional members of the ICRC acts as an impartial fact-finder. It does not determine whether the physiotherapist is incapacitated. A Health Inquiry Panel may request information from the physiotherapist, meet with the physiotherapist, take statements from employers, colleagues, witnesses and/or patients and/or obtain a specialist report, hospital charts and other relevant health information.

A Health Inquiry Panel may require the physiotherapist to undergo a physical or mental examination. A physiotherapist who refuses to submit to the examination may have his or her certificate of registration suspended. At the conclusion of the inquiry, the College would send the physiotherapist the written report of the Health Inquiry Panel, as well as any medical or psychological evidence obtained during the course of the investigation In order for the physiotherapist to prepare any submissions.

The Role of the Health Inquiry Panel

The Health Inquiry Panel will consider all of the information obtained during the inquiries and consider any action, if any that should be taken. The Panel may decide to refer the matter to the Fitness to Practise Committee for a hearing. Before any such a referral, the ICRC will often seek an informal resolution with the physiotherapist's consent. A negotiated resolution spares both the physiotherapist would still ensure that the public interest is protected. Possible resolutions could include:
  • requiring the physiotherapist to participate in a treatment program;
  • obtaining reports from the treatment program and/or treatment providers; and/or
  • monitoring of on-the-job performance.

If the Panel believes that a physiotherapist's illness is exposing or likely to expose patients to harm or injury, it may also issue an interim order directing the Registrar to suspend, or impose terms, conditions or limitations on his or her certificate of registration, pending the outcome of a hearing. In such cases, the physiotherapist must first be given notice of the proposed order and the opportunity to make a written submission. Once the order is in effect, the onus is on the College to deal with the case as quickly as possible.

Fitness to Practise Committee

The Fitness to Practise Committee is responsible for holding hearings to determine the capacity or "fitness" of a physiotherapist to practise the profession. Hearings are conducted by panels composed of at least three people, one of whom must be a public appointee of the College Council.

The burden of proving that the physiotherapist is incapacitated rests with the College. If a physiotherapist is found to be incapacitated, the Fitness to Practise panel may:
  • revoke the physiotherapist's certificate of registration;
  • suspend the physiotherapist's certificate of registration (generally until the physiotherapist has demonstrated to the College's satisfaction that he or she has recovered);
  • impose terms, conditions or limitations on the physiotherapist's certificate of registration for a specified or indefinite period of time.

The panel may also specify criteria that must be satisfied for the removal of terms, conditions or limitations or for the suspension to be lifted.

Are Fitness to Practise hearings open to the public?

Unlike disciplinary hearings, a fitness to practise hearing will only be open to the public if the physiotherapist involved makes a written request in advance to the Registrar. Before agreeing to an open hearing, the panel must be satisfied that the negative consequences of revealing the information will not outweigh the desirability of an open hearing.

Are the results of hearings made public?

Any member of the public is entitled to know the results of every incapacity proceeding in which a physiotherapist's certificate of registration was revoked or suspended, or had terms, limitations or conditions imposed on it. This information is made available on the College’s public register.

Appeals

The physiotherapist may appeal a decision of the Fitness to Practise Committee to the Divisional Court. Despite any appeal, an order or decision made by the panel or Committee will take effect immediately.

Can the College inform the physiotherapist's employer of the incapacity investigation?

While it may be necessary to contact a physiotherapist's employer during the course of an investigation, the employer is not privy to any of the details of the investigation, including medical reports or other evidence used to establish the existence, nature and extent of a physiotherapist's incapacity. As well, while an employer will usually know the results of a hearing, neither the College nor the physiotherapist is under any obligation to share information about the details of the hearing. That said, an employer will almost always be aware of any terms or conditions that involve the physiotherapist's conduct in the workplace, e.g., mentor visits, requirements for performance reports.
 
For further information, please contact the Director, Professional Conduct at 416-591-3828 or 800-583- 5885 Ext. 233 or via email at investigations@collegept.org.