Case of the Month

Read real cases and their outcomes

The Clinic Owner Doesn’t Always Know Best

Apr 10, 2019

The Case

The College received an application for an Independent Practice Certificate of Registration from an individual who had successfully completed the written component of the Physiotherapy Competency Exam (PCE). The person had previously held a Provisional Practice Certificate of Registration for about a year.

The applicant failed to complete the clinical component of the PCE before their Provisional Practice Certificate expired. After two unsuccessful attempts, the applicant completed the clinical component on the final try and applied for an Independent Practice Certificate.

However, a few months before passing the PCE — Clinical, the College received notification from a patient that the individual had been holding out as a registered physiotherapist — illegally providing patient care and claiming to be a physiotherapist.

The applicant said that after informing the clinic owner — a registered physiotherapist — that they failed the clinical component, they were strongly encouraged to continue working at the clinic as a physiotherapist assistant to gain clinical experience.

This quickly escalated to the person conducting assessments independently, arriving at clinical diagnosis, developing treatment plans and goals, and working without informing patients that they were in fact a physiotherapist assistant. All invoices included the clinic owner’s name and registration number.

The Standards

The College is required to ensure that an applicant’s past and/or present conduct provides reasonable grounds to believe that they will practice the profession in a lawful way and ultimately deliver safe, competent and ethical patient care.

Applicants who do not meet these expectations may not be granted a certificate to practice or may have terms, conditions and limitations placed on their registration.  

Physiotherapist, PT or Physical Therapist are protected titles and the College standard, in accordance with the Physiotherapy Act, states that no person other than a member shall use these titles or hold themselves out as a person who is qualified to practice in Ontario as a physiotherapist.

A physiotherapy assessment is evaluative in nature and is the exclusive responsibility of a physiotherapist — assessments can not be assigned to physiotherapist assistants. Further, a patient must consent to having a PTA involved in their care. It’s imperative that a patient understands the individual roles and responsibilities of the physiotherapist and the PTA in the assessment, reassessment and progression of the treatment plan.

The Outcome

The case was reviewed by the Registration Committee.

The applicant felt that they were taken advantage of by their employer but also acknowledged that they could have walked away from the situation when they realized that their responsibilities at the clinic were exceeding the normal duties of a PTA and breaking College rules.

They further acknowledged that their conduct was wrong and unacceptable.

The applicant’s conduct demonstrated a disregard for the law and the principles of decency, integrity, and honesty that members of the profession are expected to uphold.

The College does recognize the power imbalance that can sometimes exist between employers and employees — however it is always the responsibility of the PT to ensure that they are following the rules.

The person expressed sincere remorse and realized the seriousness of the issue, so the College issued an Independent Practice Certificate with Terms, Conditions and Limitations including meeting with a Senior Physiotherapist Advisor and the successful completion of an ethics course. Costs associated will be paid by the physiotherapist. In addition, an investigation was launched against the clinic owner.

Physiotherapy Act, 1991

Restricted Titles, Credentials and Specialty Designations Standard

Working with Physiotherapist Assistants Standard

Supervision Standard

All About Consent

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  1. J | Apr 13, 2019

    I read Perspectives most months, and try to read the "Case of the Month" routinely, and I have a question;

    Where are these Physio's coming from?

    Is it just a matter of there being a "few bad apples", or is it something more systemic? Something that needs to be explored more deeply? Because regulation and punishment after the fact isn't nearly as effective as prevention before.

    When it comes to Ethics and Professionalism violations, is there a pattern? Are these clinicians more likely to have been trained at a certain school, certain province or certain country? Are they more likely to be in Private Practice or Public Sector? Rural settings or Urban settlngs? Ortho, Neuro, cardio or one of the smaller areas of practice? Are continuing education organizations such as APTEI, Orthodiv, AFCI, or NDT only emphasizing techniques without reviewing patient boundaries, consent and professionalism?

    Because I have to say, my experience has been that the colleagues I've worked with are very aware of their ethical responsibilities. And we've been discussing that a lot of us are getting fed up with these Physio's that do things that they should know they aren't supposed to be doing. It's making our professional lives more and more frustrating as we have to keep adapting to increasing rules and regulation requirements that are resulting from the actions of a few. 

    There are those of us in the profession who actually believe we are worthy of having the privilege of being "Primary Care Practioners". It is a privilege we have earned as a profession through progressing our education and our roles inour communities. And with that privilege comes the responsibility to behave as such. We will continue to struggle as Professionals to be considered equals in the health care system when some members of our profession continue tonot recognize the behaviours and responsibilities they must take responsibility for. 

    So if there is some way to identify a pattern of what's leading to the majority of college infractions and public complaints, can we look into that further? Because it just seems like a lot of the cases in Physiotherapy regulation have a lot to do with lack of proper education, immaturity, low self confidence, and a lack of understanding of what it means to be a "Professional"


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