The Situation

Last winter the College received a complaint from a patient who was concerned that her physiotherapy treatment consisted of laser therapy despite a noted history of melanoma. The patient was seen for a total of six sessions to address pain in her right hip flexor and was assessed by physiotherapist HS. During the initial assessment HS noted that the patient had melanoma a “few years ago” but there was no evidence to suggest that additional information about the health history was collected to screen for risks and contraindications. Ten days after the assessment the patient was seen by her physician for a skin check during which time suspicious moles were identified on her right hip—ultimately leading to surgical removal. The patient began laser therapy at her physiotherapy clinic shortly after, and completed four sessions, including two with HS. During her fourth session she mentioned her history of melanoma, as well as the scheduled removal of a mole in the area the laser was placed, to another PT and laser therapy was discontinued. 

HS indicated that the patient told her she had “no lesions under current investigation” and that no moles were observed on the patient, however these details were not mentioned in the clinical record. 

The Standards

The Essential Competency Profile for Physiotherapists in Canada, 2009 indicates that when performing a clinical assessment, physiotherapists are required to “consult with the patient to obtain information about his/her health, associated history, previous health interventions, and associated outcomes.” It also specifies that physiotherapists are required to “safely perform a physiotherapy assessment, taking into account patient consent, known indications, guidelines, limitations and risk-benefit considerations.”

In this case, laser therapy contraindicates with suspected malignancies and shouldn’t have been applied to any areas near potential melanoma sites. Caution should be taken with patients who have a history of cancer in the past five years.  

Additionally, the clinical records were not in accordance with the College’s Record Keeping Standard as they did not contain relevant information about the patient’s health history—more background regarding the history of the melanoma should have been included and the PT did not document a discussion that allegedly took place. 

The Outcome  

This case highlights significant issues pertaining to proper clinical assessment. As such, the Inquiries, Complaints and Reports Committee requires HS to appear to be cautioned and write a reflective paper demonstrating an understanding of the severity of the issues and changes that will be implemented in practice going forward. Additionally, the caution will appear on the Public Register.