The Case 

The College received information from a patient who said he was assessed and treated by an individual who was unjustly presenting themselves (holding out) as a registered physiotherapist. 

The individual in question had previously held a Provisional Practice Certificate with the College, however it expired after they did not pass the clinical component of the Physiotherapy Competency Exam. Under the direction of their boss (a registered PT), they continued to work at the clinic as a physiotherapist assistant to gain additional experience. (Read all about it in a previous Case of the Month—The Clinic Owner Doesn’t Always Know Best.)

As a result of the information from the patient, the College initiated a second investigation into the registered physiotherapist, Mrs. Z, who owns the clinic where the individual was holding out as a PT. 

The College reviewed a number of patient records where service was provided by the physiotherapist assistant. All of the records included an assessment conducted by the PTA but scheduled and billed under Mrs. Z’s registration number.

Seemingly, many patients were unaware that they were not being treated by a registered physiotherapist, and therefore couldn’t have possibly consented to being treated by an assistant. The patient who contacted the College indicated that he was assessed by the PTA and subsequently treated on three separate occasions before the assistant admitted that they were working under the direction of the clinic owner. 

Mrs. Z confirmed that patients were scheduled to see her. She would then delegate assessments and treatments to the PTA. The assistant would record the subjective and objective data in the chart and would then discuss the diagnosis and treatment plan with Mrs. Z before independently conveying it to the patient. Mrs. Z was not in the treatment room when the assessments were conducted but says she was available if needed.
 
Mrs. Z indicated that, in hindsight, assigning assessments to the PTA was not appropriate. 

The Standards

Physiotherapists often call upon PTAs to assist in the delivery of care to patients, however it’s imperative that the requirements of the Working with Physiotherapist Assistants Standard are met at all times.

Physiotherapists are required to assess each patient in order to establish a diagnosis, determine treatment goals and develop a plan of care before assigning any aspects of that care to an assistant. 

Physiotherapy assessments are evaluative in nature and physiotherapists cannot assign any physiotherapy intervention that has an evaluative component to a PTA. 

While a physiotherapist doesn’t necessarily need to be present for appointments between patients and assistants or Physiotherapy Residents, they are ultimately responsible for the level of supervision they provide as well treatment. It’s important that they are available to help the assistant if needed. 

The Working with Physiotherapist Assistants Standard also clearly outlines that PTs need to obtain valid, informed consent from the patient in order to involve a PTA or a student in the delivery of physiotherapy care. In this case, there was at least one instance where the patient did not know they were being treated by a PTA.

The Outcome

After reviewing the information, what do you think is an appropriate outcome for this case? Comment below! 

a. Nothing. I’m sure the physiotherapist was just busy, and the assistant was helping out as best they could.

b. Maybe they just misunderstood the rules. The PT should have to complete a mandatory remediation program to better understand the rules and standards.

c. The PT knew what was happening at the clinic and helped the PTA hold out as a registered physiotherapist—they should receive a caution.

d. This is professional misconduct. The PT should not be allowed to practice.

Working with Physiotherapist Assistants Standard

Supervision Standard

Restricted Titles, Credentials and Specialty Designations Standard

All About Consent