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Recognizing Red Flags: Preventing and Addressing Serious Boundary Violations

Mar 19, 2024

Although rare in healthcare, egregious behaviour like serious boundary crossings and sexual abuse cannot be ignored. These cases have devastating impacts on the victims and the people closest to them, and they chip away at the trust and integrity of the healthcare system.

Overwhelmingly, health care providers – including physiotherapists – choose their professions because they want to help people. They are dedicated to following the rules and practicing safely and ethically.

The bulk of the work of a regulator, like the College of Physiotherapists of Ontario, is to support health care providers in achieving those goals. Health regulatory colleges support professionals in providing the best possible care.

And while we hope that every single health care professional, including more than 11,000 physiotherapists in Ontario, will consistently practice safely, ethically, and in accordance with the law – we unfortunately know that’s not the case.

Periodically, stories of egregious behaviour across health professions come up in the media and can generate a lot of attention. The nature of the allegations can sometimes lead the public to question the level of trust they place in health providers.

Regulators play an essential role in working to prevent such harm from occurring, addressing any issues that do arise through discipline and remediation processes, and supporting the patient as much as possible. 

How does the College Prevent and Address Boundary Violations?

Education: As much as possible, the College tries to prevent boundary violations by providing physiotherapists with the information and educational tools they need to support them in delivering safe, competent and ethical care. This includes setting standards that cover boundaries, sexual abuse, consent and communication.

In addition to standards, the College regularly develops resources to help physiotherapists better understand their professional requirements, including e-learning modules, blogs, the annual Professional Issues Self-Assessment (PISA) exercise, and webinars.

Investigating complaints: We’re required to investigate all complaints about the practice of registered physiotherapists in Ontario. Anyone can file a complaint, and sometimes, the College will become aware of serious issues through police investigations. After receiving the information, the College will conduct a thorough investigation, review the evidence and decide on an appropriate outcome. There is a zero-tolerance approach for sexual abuse, and all boundary violations are taken seriously.

Depending on the severity of the circumstances and the level of risk to the public, the Inquiries, Complaints and Reports Committee may decide to put immediate limitations on a physiotherapist’s practice or issue an interim order that requires them to stop practicing while the investigation is ongoing.

Following the investigation, the College may permanently take away a physiotherapist’s license to practice, or in lower risk cases, may require them to complete a remediation program to address gaps in their practice.

Funding for therapy and counselling: Cases of sexual abuse can be extremely difficult for the patient and the College will do whatever it can to support them throughout the complaint and investigation process. Part of this support includes a program that provides funding for therapy or counselling for patients who have been sexually abused by a physiotherapist.

Patients who have been approved for funding can receive up to $17,370 over a five-year period. Funds are paid directly to the therapist or counsellor. The College will also consider requests for financial assistance to help cover childcare or travel while attending therapy or counselling.

What can the Profession to do Help?

As a self-regulated profession, we all share the responsibility of making sure we are protecting the public interest. There are things that you can do to help mitigate serious boundary violations, particularly if you work with other health professionals.

Create a safe space: Consider how you can create a physically and psychologically safe space for all patients. This may include tailoring your approach depending on each patient’s unique needs and lived experience. Ask your patient what would make them feel most comfortable and regularly engage in ongoing professional development that supports patient-centred care. If you work with a larger team, arrange training for all staff members, develop policies that establish expectations for professional boundaries, and regularly check in to make sure staff are following the guidelines.

Watch out for red flags: Talk to your colleagues and pay attention to patient behaviour. In some instances, we have heard that clinic owners or other health professionals noticed that patients seemed uncomfortable or upset after seeing certain practitioners, or that an unusually high number of patients were not returning for appointments after seeing a certain provider. Remember – if you see something, say something.

Amplify the patient voice: Part of being able to identify red flags includes providing patients with a safe space to share their concerns and acting on the information they provide.

Make sure you provide safe avenues for patients to flag issues with their care and share feedback. This may include having clear, written procedures for sharing concerns, having staff available to answer questions, making patients aware of their rights and the role of regulatory colleges, or regularly conducting surveys about the patient experience. If a patient does share their concerns, be sure to take them seriously. Provide the patient with the College’s information to contact us if they choose, and make sure you’re following your mandatory reporting obligations.

Mandatory and Self-Reports: Physiotherapists are required to make mandatory and self-reports.

If you learn that a physiotherapist or other regulated health professional may have sexually abused a patient, a report must be filed with the College of the health care provider. The report must include the name of the provider who may have abused the patient and can only include the name of the patient if the patient has provided their consent.

By law, physiotherapists are required to self-report any major offences or charges under the Criminal Code of Canada as soon as reasonably possible, but within 30 days of being charged or being found guilty of an offence in any jurisdiction. Charges under the Criminal Code must appear on the Public Register – this includes any charges related to sexual abuse.

In support of the public interest, we all play a part in preventing and addressing the harms that arise from sexual abuse and boundary violations.

If you have any questions, or would like to chat through a challenging situation, consider contacting the Practice Advice team at 1-800-583-5885 (extension 241) or email



Boundaries and Sexual Abuse Standard

Boundaries and Sexual Abuse E-Leaning Module

Understanding Sexual Abuse

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