Duty to Report Suspected Child Abuse or Neglect

Manus. That’s Latin for hand and PTs use their hands to treat patients, it's "physical therapy" after all. It’s where we get the words manufacture (made by hand) and manuscript (written by hand). Manus is also the root for manipulate, something physiotherapists do skillfully in their role. Manipulate has a second meaning – deceive someone or prey upon them for your advantage. That’s where another vital professional role comes in.

Physiotherapists have mandatory reporting obligations when they have reasonable grounds to believe a fellow physiotherapist, or another regulated health care professional, has sexually abused a patient. Not coincidentally, mandatory comes from manus too. It’s a command to put something figuratively into your hands, to entrusting you.

Health professionals take that trust seriously, though there are exceptions. An American Medical Association study found that one in three doctors who knew of an incompetent or impaired colleague failed to inform their professional authority, despite a duty to report. In another study of nurses working in pediatric and emergency care units in Taiwan, 21% said they failed to report a suspected case of child abuse. 

This profession doesn't fare any better. For a study in the Australian Journal of Physiotherapy, 2,200 physiotherapists reviewed a vignette describing alleged sexual misconduct. Only 19% said they’d report a colleague to their regulator. 

Yet another study, in the Italian Journal of Physiotherapy, found that physiotherapists are willing to take action to stop misconduct at work. But how far would they go? Among physiotherapists surveyed, significantly more would report the misconduct within the organization than to an external authority with the power to intervene.

In Ontario, the Regulated Health Professions Act defines sexual abuse of a patient as:

• sexual intercourse or other forms of physical sexual relations between the regulated health care provider and the patient
• touching of a sexual nature of the patient by the care provider
• behaviour or remarks of a sexual nature by the care provider towards the patient.

Within 30 days of learning of the alleged incident on the part of another physiotherapist, a PT must make a mandatory report to the College. In the case of possible abuse by another regulated health care professional, the report goes to their regulator. A facility operator or employer has a similar obligation.

If the person has reasonable grounds to believe the health care provider will continue to sexually abuse the patient or other patients, a report must be filed immediately.

Under the RHPA, failure to make a mandatory report may result in prosecution, and a heavy fine (up to $25,000 for a first offence and up to $50,000 for a subsequent one; for facilities/employers the fines are even higher). The College may also take action.

What Would You Do?

Here’s what you’re led to believe. A fellow health care professional (let's call this person X) is flirting with or dating a patient. Or X touched a patient in a sexual manner (not in a clinically appropriate way). Maybe X said something sexually suggestive or made sexually offensive comments. Or perhaps X had sex with a patient (even if it’s “consensual”). 

What do you do next? The reporting obligations are clear, yet studies of health care professions reveal four common stumbling blocks.

1. Uncertainty – did the incident occur and, if it did, is it really sexual abuse? 
A report can’t be based on rumour or innuendo. Information must come from a credible source – you, a patient, the parent or guardian of a patient or another third party. Remember, the threshold is “reasonable grounds”, not certainty. You may have grounds to suspect sexual abuse even if you haven’t spoken to the patient. However, speaking with the patient is an important step as you should try to get their permission to share their name. If you have information, it’s not your role to investigate and confirm it –  it’s your role to report it. 

2. Downplaying the impact on patients.
Physiotherapists, like every regulated health care provider, must act professionally and ethically. Sexual abuse is a serious breach of that. Even if patients don’t protest, even if they initiated an intimate relationship with a care professional, it doesn't matter. There’s no patient consent to sexual abuse.

3. Ignoring or underestimating the process.
The process starts with you. Don’t assume the issue is being handled, the College will find out some other way or this is solely up to the patient to complain. It’s your duty to report all relevant information in a timely manner, so that this College (or other health care regulators) can act. Trust that the process will then play out in a fair manner. Self-regulation is about the profession regulating itself. Don't put the responsibility on the patient, it's up to you!    

4. Fear of retribution – a backlash from the accused, colleagues or the institution.Having concerns about the fallout is natural. Yet as a physiotherapist you always have a fundamental responsibility in your hands. When reporting on possible sexual abuse, it’s the same responsibility you possess in any other area of being a health care professional – putting the interests of patients first.