Case of the Month

Read real cases and their outcomes

  • No Notes is Bad News

    Mar 18, 2019

    The Case

    The College was contacted by a third-party insurer following the review of a number of physiotherapy claims made by a member. After conducting their investigation, the insurer submitted a formal complaint to the College.

    The physiotherapist was also the owner of a multi-disciplinary clinic that frequently treated patients following car accidents. Many treatments were covered, at least in part, by the patients’ insurance companies.

    The insurer noted that many of the treatment records were nearly identical and that treatments would continue for months or years with no adjustments or notes about the patient’s progress.

    They also found that in some cases, invoices were submitted on dates when the patient did not actually attend the clinic.

    The College then reviewed an additional selection of charts from the PT that supported the insurer’s notes in the complaint. Further, the College found that many charts were missing key elements including record of assessment or reassessment by a physiotherapist, record of patient consent, or rationale for the continued course of treatment.

    In some cases, there were no clinical notes at all, even though the patient or insurer was billed for treatment using the PT’s name and registration number. Some charts revealed that patients were receiving upwards of 150 or 200 treatments with only a handful, or even fewer, clinical notes.

    The Standards

    Clinical records are important communication tools that allow the physiotherapist and others to track the patient's past and current status, determine future care needs, give evidence of the care provided, collaborate when providing care, and transfer a patient’s care smoothly. In this case, many of the patient charts did not meet the requirements of the Record Keeping Standard and were missing critical elements including discussions about ongoing consent to treatment, objective measures and outcomes, and progress notes.

    Additionally, the PT did not take reasonable steps to ensure that their name and registration number were used appropriately as outlined in the Fees, Billing and Accounts Standard—which states that physiotherapists must never create accounts that are inaccurate, false or misleading.

    Further, a review of the patient charts highlighted that the PT was not acting in accordance with the Essential Competencies and Code of Ethics, as many charts were not individualistic and were missing justification for ongoing treatment.

    The Outcome

    The PT’s certificate of registration was suspended for a period of 15 months and they are required to successfully complete an ethics course and a comprehensive review of College standards.

    They must also participate in a three-year practice enhancement coaching program with a focus on fees and billing, assessment and treatment, and record keeping. The suspension and terms, conditions and limitations appear on the Public Register.

    The physiotherapist will pay all costs associated with the remediation and coaching programs in addition to $8,000 to the College.

    Record Keeping Standard

    Fees, Billing and Account Standard

    Consent

    Essential Competencies

    Code of Ethics

    A College of Physiotherapists of Ontario Case of the Month about poor record keeping that ultimately led to an insurance (and College) investigation.
    Full story
    • Case of the Month
    • ethics
    • Delisted
    • insurer
    • Consent
    • registration number
    • billing
    • fees
    • record keeping
  • Missing: Consent, Communication and Acknowledgement

    Feb 19, 2019
    A College of Physiotherapists of Ontario Case of the Month about how lack of consent, communication and acknowledgement can lead to a complaint.
    Full story
    • complaint
    • treatment
    • Consent
    • Boundaries
    • physiotherapy scope
    • Communication
    • Case of the Month
  • Float On, but Don’t Say it’s Physiotherapy

    Jan 23, 2019
    A College of Physiotherapists of Ontario Case of the Month about a PT, a float therapy clinic, and some potentially questionable billing practices.
    Full story
    • insurance
    • Delisting
    • registration number
    • billing
    • fees
    • scope of practice
    • float therapy
    • physiotherapy
    • Case of the Month
  • There is Such a Thing as Too Friendly

    Dec 11, 2018
    A Case of the Month about a physiotherapist becoming too friendly with a patient, with additional reference to record keeping and billing practices.
    Full story
    • patient
    • physiotherapist
    • relationship
    • friendship
    • professional boundaries
    • therapeutic relationship
    • record keeping
    • informed consent
    • Consent
    • mechanical traction
    • insurance
    • accounts
    • billing
    • fees
    • Boundaries
    • Case of the Month
  • When Acupuncture Goes Very, Very Wrong

    Nov 13, 2018
    A Case of the Month about acupuncture treatment going horribly wrong, leading to a complaint against a physiotherapist.
    Full story
    • physiotherapist
    • physiotherapy
    • acupuncture
    • Case of the Month
  • 1,200 Hours Short of a Certificate

    Oct 19, 2018
    A College of Physiotherapists of Ontario Case of the Month about a physiotherapist who did not have sufficient practice hours when applying for a certificate of registration.
    Full story
    • Ontario
    • College of Physiotherapists
    • physiotherapist
    • Case of the Month
    • practice hours
    • registration
    • certificate
  • Can’t We All Just Get Along?

    Sep 17, 2018
    A College of Physiotherapists of Ontario Case of the Month about physiotherapists managing challenging collaborative care relationships.
    Full story
    • specialty designations
    • restricted titles
    • PTA
    • physiotherapist assistant
    • physiotherapist
    • physiotherapy
    • relationships
    • collaborative care
    • Case of the Month
  • Don’t You Forget About Me

    Aug 21, 2018
    College of Physiotherapists of Ontario Case of the Month about a physiotherapist who forgot about a patient during an acupuncture session.
    Full story
    • ICRC Committee
    • essential competencies
    • physiotherapy
    • acupuncture
    • Case of the Month
  • Caught Up in the Cryo Hype

    Jul 18, 2018
    A Case of the Month detailing how a physiotherapist wrongly incorporated cryotherapy in treatment plans and billed the services as physiotherapy, violating the standards of the College of Physiotherapists of Ontario.
    Full story
    • physiotherapist assistant
    • advertising
    • billing
    • physiotherapy
    • cryotherapy
  • You Can’t Laser Over History

    Jun 14, 2018
    June 2018 Case of the Month from the College of Physiotherapists of Ontario. The case outlines the use of laser therapy on a patient with a history of melanoma.
    Full story
    • physiotherapist
    • College of Physiotherapists
    • essential competencies
    • record keeping
    • laser therapy
  • The Snowball Effect

    Feb 20, 2018
    Full story
  • No Laughing Matter

    Dec 11, 2017
    Full story
  • Cheung Charged – Not A PT: Always Check the Public Register Before You Hire

    Nov 13, 2017
    Full story
  • Pilates Problems

    Oct 13, 2017
    Full story
  • Is what you’re doing REALLY physiotherapy? Or is it something else…

    Sep 07, 2017
    Full story
  • I’m Pretty Sure That’s Personal Training, Not Physiotherapy

    May 10, 2017
    Full story
  • Using Restraints on a Patient: Helpful or Harmful?

    May 09, 2017
    Full story
  • Physiotherapists MUST register with the College to Practice in Ontario

    Apr 04, 2017
    Full story
  • Does Past Behaviour Indicate Future Actions?

    Apr 04, 2017
    Full story
  • No Second Chances When It Comes to Patient Care and Record Keeping

    Feb 15, 2017
    Full story

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