The Case
The College received a complaint from a patient who had been receiving physiotherapy for a number of years. The patient attended the same clinic over the treatment period and regularly saw the same physiotherapist before submitting a complaint to the College citing concerns with the PT’s practice related to fees and billing, obtaining consent for treatment and maintaining professional boundaries.
The patient indicated that funds had been fraudulently billed to her insurance and when she approached the owner of the clinic, she provided her with a credit for services. The physiotherapist denied any billing fraud and noted that the patient was questioning the use of the term exercise as she did not always use the gym during treatment.
The patient also indicated that the PT incorporated mechanical lumbar traction into her treatment without obtaining consent to do so. The patient said that had she been informed of the potential risks associated with mechanical traction, she would not have consented to treatment. She said she was left alone while the treatment caused pain and dizziness, ultimately resulting in long-term damage to her spine.
The physiotherapist indicated that he explained the risks associated with mechanical traction to the patient and that he had obtained consent. He recalled staying with the patient for the first 10 minutes of treatment to ensure there were no issues before informing the patient that he would be leaving the clinic and the remainder of her session would be handled by another physiotherapist and an assistant. The other PT indicated that she helped steady the patient upon completion of treatment but that she was able to leave the clinic and get in her car independently.
Finally, regarding professional boundaries, the patient indicated that over the course of several years she was involved in a significant personal friendship with the PT which included messaging, personal visits and gift giving. The physio indicated that he had shared his personal contact details with the patient and had visited her home to help with a personal favour but denied giving the patient any gifts.
The Standards
Based on a review of the patient chart, including financial records, the College did not find any evidence of inappropriate billing practices, in accordance with the Fees, Billing and Accounts Standard. Furthermore, a review by the insurance company did not identify any irregularities. As a result, the College took no action with this portion of the complaint.
The patient and the physiotherapist had conflicting stories about whether or not informed consent had been obtained for mechanical traction and unfortunately for the PT, her story could not be validated as there was no documentation of the conversation in the patient’s record.
As outlined in the College’s Record Keeping Standard, physiotherapists are required to document “discussions with the patient to obtain ongoing consent to assessment, treatment, and involvement of other care providers.” The Health Care Consent Act also requires that PTs obtain informed consent prior to treatment—meaning the patient has all the necessary information (including risks, benefits and side effects) in order to make an informed decision.
When reviewing the Boundaries and Sexual Abuse Standard, the College felt that the physical and emotional limits of the therapeutic relationship had been compromised — specifically acknowledging visiting the patient in her home for non-therapeutic purposes and allowing the patient to bring gifts to the clinic as concerns.
The Outcome
The physiotherapist must complete a review of the relevant College rules and resources and meet with the Senior Physiotherapist Advisor to discuss the importance of obtaining and documenting informed consent and maintaining appropriate boundaries with patients. The College believes that these remedial actions will prevent similar issues from arising in the future.
Fees, Billing and Accounts Standard
Record Keeping Standard
Boundaries and Sexual Abuse Standard
Health Care Consent Act