Discipline Case Summary

The following is a summary of a matter placed before a five-member panel of the Discipline Committee of the College of Physiotherapists of Ontario on October 16, 2000. The Panel considered an Agreed Statement of Facts and accepted that it established professional misconduct as alleged. Accordingly, the Panel found Mr. R guilty of professional misconduct under paragraph 2 (standard of practice) and paragraph 25 (unprofessional conduct) of section 1 of Ontario Regulation 861/93, Professional Misconduct, Physiotherapy Act, 1991.

Statement of Agreed Facts

The College and Mr. R placed the following Agreed Statement of Facts before the Panel:

1. Mr. R, a registered physiotherapist, worked at ABC123 Physiotherapy, located in ABC, Ontario, from on or about October 23, 1995, to on or about November 1996. He was hired as the physiotherapy manager.
2. Mr. R was the only physiotherapist at the clinic from on or about October 23, 1995, until on or about July 1996, when L. was hired. L. worked at the clinic from on or about July 1996, to on or about October 28, 1996.
3. L. was working under a supervised practice certificate and other than during Mr. R's vacation from on or about July 16, 1996, to on or about August 14, 1996, Mr. R was the supervising physiotherapist for L. Mr. R arranged supervision for L. during Mr. R's holidays, and the College agreed with these arrangements.
4. For the first month that Mr. R was employed at ABC123 Physiotherapy, the clinic operated from about 9:00 a.m. to 5:00 p.m., Mondays to Fridays and from 10:00 a.m. to 4:00 p.m. on Saturdays. Once D., the kinesiologist, was hired in November 1995, the clinic hours were extended to approximately 8:00 a.m. to 8:00 p.m. on Mondays to Fridays and they continued from approximately 10:00 a.m. to 4:00 p.m. on Saturdays.
5. Mr. R's hours of work were from approximately 9:00 a.m. or 10:00 a.m. until approximately 5:00 p.m., Mondays to Fridays. He worked occasional Saturdays in 1995.
6. During Mr. R's vacation, L. worked from approximately 11:00 a.m. to approximately 5:00 p.m., Mondays to Fridays. After Mr. R returned from vacation, L. worked from approximately 3:00 p.m. or 4:00 p.m. to approximately 8:00 p.m., Mondays to Fridays and on Saturdays, L.'s hours fluctuated between four to six hours.
7. D., kinesiologist, worked at the clinic from on or about November 1995, to on or about November 1996. D. worked Mondays to Fridays from approximately 10:00 a.m. to 8:00 p.m. D. also worked Saturdays from on or about November 1995, to on or about July of 1996, from approximately 10:00 a.m. to approximately 4:00 p.m. According to Mr. R, D. worked for approximately one hour each morning prior to Mr. R's arrival at the clinic.
8. Mr. R completed assessments of new patients. Following these assessments, Mr. R spoke with D. about the treatment to be provided to the patients. After this initial contact, most of Mr. R's supervision of support staff was by a television monitor located at his desk which displayed a view of the gym area and by a two-way audio system. Mr. R also spoke with clinic staff daily about patients to the extent that there were concerns about treatment. Mr. R also personally treated patients with neurological involvement, or if they were in an active stage of injury. This amounted to approximately 10% of all of the clinic's patients.
9. There was no evidence in the charts of the specifics of the treatment to be provided to patients, such as the modality or dosage or the staff member who performed the service.
10. The charts did not contain progress notes or evidence of reassessments.
11. There was no evidence in the charts of discharge planning.
12. In fact, Mr. R did not document the progress of treatment, reassess or plan for the discharge of the patients for whom he had assumed professional responsibility.
13. Mr. R knew or ought to have known that patients often signed in, stayed for a brief period of time (insufficient for meaningful treatment) and left the clinic, and that this was billed to insurers under Mr. R's name or registration number as a regular treatment.
14. Mr. R failed to put into place a system to ensure the accuracy of, or assume responsibility for the accuracy of, the invoices submitted to insurance companies compared to the patient sign-in sheets. In fact, the owners of the clinic were able to defraud insurance companies throughout 1996.
15. The conduct above constitutes professional misconduct under paragraph 2 (standards of practice), paragraph 25 (unprofessional conduct) of Section 1 of Ontario Regulation 861/93.

The Panel accepted that the agreed to facts established professional misconduct and found Mr. R guilty of professional misconduct under paragraph 2 and paragraph 25 of section 1 of Ontario Regulation 861/93.