Discipline Case Summary

The following is a summary of a discipline case heard by a five-member panel of the Discipline Committee of the College of Physiotherapists of Ontario on June 12, August 27, 28, 29, September 3, 5, 6, 10, 11, 12, 1996 and January 8, 9, 10 and 11,1997.

Allegations

The following is a summary of a matter placed before a four member panel of the Discipline Committee of the College of Physiotherapists of Ontario on March 10-12, 30-31, April 1 and June 23, 1998.

1. Mr. K practised as a physiotherapist with a clinic in Scarborough, ON
2. In January, 1996, the College received a complaint from Mr. M. regarding Mr. K's treatment of Mr. M's back. Mr. M. complained that Mr. K never "laid his hands" on him and would hook him up to machines and then leave. Mr. M. would not see Mr. K again during the visit.
3. In March, 1996, the Complaints Committee referred the matter to the Executive Committee and requested an investigation into Mr. K's practice.
4. In May, 1996, the investigation was concluded with a number of deficiencies in Mr. K's practice identified.
5. In July, 1996, Mr. K signed an Acknowledgement and Undertaking with the College and undertook to ensure that the following would take place in regard to his physiotherapy practice:
   • He would conduct a full assessment on all clients in his care;
   • There would be evidence that a clinical judgment process had been utilized in the development of the treatment plan;
   • There would be evidence of planned reassessments to determine client progress towards stated goals;
   • There would be evidence of effective discharge planning; and
   • The clinical records would provide evidence of the clinical process.
6. Mr. K also undertook to comply with all of the College's guidelines, regulations and Standards of Practice.
7. Mr. K agreed to cooperate with a physiotherapist who would act as a mentor to assist him with the improvement of his practice and to immediately comply with the mentor's recommendations. Mr. K agreed to meet with the mentor three to four times. At those meetings, the mentor was to review a selection of current charts and observe Mr. K's conduct and record at least one initial assessment of a new patient.
8. In October, 1996, the Complaints Committee decided not to refer the complaint to the Discipline Committee.
9. In August, 1996, January, and April, 1997, the mentor, Ms C., met with Mr. K. During these reviews, the mentor noted numerous deficiencies including the lack of subjective information in patients charts. Records often did not contain details about functional limitations, occupation, objective data, treatment goals, modalities used, patient education and discharge summaries. Progress notes were not made in a timely fashion. The records fell below the accepted standards of practice.
10. The mentor advised Mr. K. that improvements in all areas of clinical assessment and documentation were required and recommendations were made. Mr. K did not take reasonable steps to implement the mentor's recommendations in breach of the Undertaking he gave to the College in July, 1996.
11. Mr. K requested that the mentor attend at his clinic in October, 1997 to perform a fourth review of his practice. The following deficiencies were noted:
    • Mr. K had still not improved the quality or comprehensiveness of objective data collected about patients, nor had he improved the details of functional restrictions, dosage, location and method of application of modalities;
    • Progress notes did not include sufficient subjective or objective data, professional analysis or specific treatment plans to be of value;
    • In the cases of two patients, the lack of evidence of any acknowledgement by Mr. K of communications from referral sources severely compromised patient care.
    • In the case of patient MA, crucial medical information was not addressed or considered by Mr. K in his treatment plan, thus rendering the treatment plan inappropriate. Mr. K also demonstrated a lack of understanding of anatomy and physiology. He also failed to perform a reassessment of the patient after an absence of 10 months;
    • In the case of patient MI, the referring physician's request for treatment was not addressed in the treatment plan. A new diagnosis by the physician was not noticed. Mr. K did not comment on how this new diagnosis would affect the patient's treatment.
12. The conduct alleged above constitutes professional misconduct under paragraph 2 (failing to maintain the standards of practice), 25 (unprofessional conduct) and 26 (breaching an Undertaking provided to the College) of section 1 of Ontario Regulation 861/93. The conduct also constitutes incompetence as defined in s 52(1) of the Code.

Plea

Mr. K pleaded not guilty to the allegations.

Finding

Upon reviewing the evidence presented, the panel found that the quality or comprehensiveness of objective data collected and details of functional restrictions while sparse, would meet standards of record keeping. The panel also found that Mr. K's progress notes included sufficient subjective or objective data and that his professional analysis and treatment plans, while deficient in certain areas, could be followed by another attending physiotherapist. The panel concluded that there was a lack of acknowledgement of communication from referral sources, but that there was no evidence that this severely compromised care. In addition, the panel found that Mr. K had taken into account to a minimal degree the information provided by the physician.

The panel found Mr. K guilty with regard to continued deficiencies in recording dosage, location and method of treatment application, to the extent that another physiotherapist would not be able to follow the treatments undertaken. The panel also found that Mr. K failed to perform an assessment of patient MA after an absence of 10 months. The panel therefore found Mr. K guilty for failing to maintain the standards of practice of the profession.

The panel reviewed the patient records filed along with the other evidence, and found Mr. K not guilty of incompetence. The management and treatment skills evident in the records did not support the conclusion that the member's care of his patients met the definition of incompetence as found in the Code.

The panel found the member not guilty of breaching an Undertaking with the College. The panel found that Mr. K cooperated fully with the College's investigation of his practice and that he complied substantially with the mentor's recommendations. With regard to attendance at courses that the mentor recommended, the panel decided that there was no evidence that Mr. K willfully neglected to pursue the courses.

The panel found Mr. K not guilty of unprofessional conduct as there was no evidence to support this allegation.

Penalty

After hearing submissions from both parties, the panel made the following Order, as a term and condition of Mr. K's certificate of registration:

1. Mr. K attend the E1V1 course in the fall of 1998.
2. Within two months after the completion of the course:
   • Mr. K attend at a physiotherapy clinic similar to his own, to be selected by him and approved by the Registrar. Mr. K will engage in clinical practice with particular attention to record keeping and reassessment skills, and will be tutored by a physiotherapist recognized for his/her knowledge and experience in the field of orthopaedic and private practice;
   • A minimum of 10 clients will be treated by Mr. K over a six-week period, three half days per week;
   • The cost of the tutoring period is to be borne by Mr. K;
   • At the end of the six-week period, the tutor shall submit to the College a report confirming Mr. K's attendance, the number of patients followed, the number of assessments and re-assessments done, and the scope of education material covered. The report should not be a critique of his clinical performance.
   • On completion of this rehabilitation process, Mr. K's practice will be assessed twice (with regard to record keeping and reassessments) after one month and six months. The evaluations shall be conducted by an evaluator selected and approved by the Registrar, independent of the tutoring process. These evaluations must be on-site at Mr. K's practice and at his cost.
   • Mr. K will fully cooperate with the educational and evaluative processes. He shall apply the skills gained to his own practice. Should his record keeping and reassessment skills be found deficient at the six months evaluation, the College shall take appropriate action.

The panel believes that the Order will protect the public and assist the rehabilitation of the member.

Appeal

Mr. K appealed the finding and penalty to the Divisional Court. In July, 1999, the Court dismissed the appeal and ordered that Mr. K pay $2,000 in costs to the College.