Boundaries and Sexual Abuse Standard

Updated: Recently Updated
August 1, 2017

1. Authority and Responsibility

Physiotherapists must maintain professional boundaries with their patients at all times. Physiotherapists must not sexually abuse their patients.

2. Managing Professional Boundaries

Boundaries in patient care are physical and emotional limits of the therapeutic relationship between the patient and the physiotherapist. The physiotherapist’s responsibility is always to act in the patient’s best interest and to manage the boundaries within the therapeutic relationship.

When managing the boundaries of the therapeutic relationship, the physiotherapist must:

  • recognize that each patient’s boundaries will be unique to their own experiences, including their culture, age, values or experiences of trauma.

  • be sensitive to the practice setting, especially when providing care in an informal environment, such as a patient’s home.

  • respond appropriately when a professional boundary is breached. This involves identifying the breach, correcting the inappropriate behaviour, and documenting the actions taken to address the breach in the patient’s record.

Some examples of situations that pose a risk for a boundary violation include personal disclosure by the physiotherapist, giving or receiving gifts, engaging in business or leisure activities with a patient, and most frequently, comments, words or gestures that are not directly related to clinical care.     

3. Restrictions for Maintaining Professional Boundaries

When a close or intimate relationship exists between the physiotherapist and the patient because of an emotional or other strong bond, it can impair the physiotherapist’s professional judgement.

  • Physiotherapists must not enter into intimate or romantic relationships with their patients or their patients' relatives or support persons.

  • Physiotherapists must not treat their relatives or those with whom they have a close or intimate relationship, except in the case of an emergency, in which case, fees cannot be charged.

  • Physiotherapists must not enter into intimate or romantic relationships with former patients unless:

    • at least one year has elapsed since the patient was discharged from physiotherapy care,

    • the imbalance of power inherent in the therapeutic relationship between the physiotherapist and the patient no longer exists, and

    • the patient is no longer dependent on the physiotherapist. 

4. Sexual Abuse

Sexual abuse of a patient means,

(a) sexual intercourse or other forms of physical sexual relations between the member and the patient,

(b) touching, of a sexual nature, of the patient by the member, or

(c) behaviour or remarks of a sexual nature by the member towards the patient.

For these purposes “sexual nature” does not include touching or conduct of a clinical nature appropriate to the service provided.

5. Mandatory Reporting of Sexual Abuse

If a physiotherapist becomes aware that a regulated health professional may have sexually abused a patient, they must report it to the professional college to which the other health professional belongs. Failure to do so may result in disciplinary action by the College.

Related links

News Item

The Ontario government passed Bill 87, the Protecting Patients Act on May 30, 2017. This legislation brought in several changes to how Colleges deal with matters of sexual abuse.

Read more: Bill 87, Protecting Patients Act

Changes that are in effect as of May 30, 2017:

  • Touching of a sexual nature of a patient’s genitals, anus, breasts or buttocks will now result in mandatory revocation of a certificate of registration

  • For findings of sexual abuse that do not result in revocation, the minimum penalty must include a suspension. Before the required minimum penalty included a caution only.

  • The following additional information will be available and maintained on a physiotherapist’s profile on the Public Register:

    • The date the member dies

    • Cautions and education and remedial activities that are ordered will remain on the member’s profile permanently

    • A copy of the specific allegations of every matter referred to the Discipline Committee that have not been fully resolved

    • When the Discipline Committee makes no finding of professional misconduct or incompetence, the outcome will be posted on the Public Register for 90 days

    • Findings of incapacity

  • The Inquiries, Complaints and Reports Committee can now order an interim suspension of a member when it receives a complaint or appoints an investigator. The Committee can do this if it feels that the member’s conduct or behaviour is likely to put patients at risk. Historically, the Committee could only order an interim suspension when the investigation was complete.

  • The Inquiries, Complaints and Reports Committee and the Discipline Committee can no longer impose gender-based restrictions (a male member can only practice on male patients or a female member can only practice on a female patient)

  • The fines for failing to report sexual abuse have increased to $50,000 for individuals and to $200,000 for corporations

Future Changes that will Come into Effect

  • Patients who complain about sexual abuse by a health professional may seek funding for therapy or counselling at the time a complaint or report is received, instead of having to wait until the Discipline Committee makes a finding

  • “Patient” in relation to sexual abuse is defined to include anyone who stopped seeking treatment from a member within one year. The government may set additional criteria to define a patient for the purposes of sexual abuse provisions

  • New mandatory self-reporting obligations will include:

    • Registration with all other regulatory bodies and any findings of professional misconduct or incompetence (but not incapacity) made by those bodies

    • All charges for an offence and any resulting bail conditions or other similar restrictions, or if restrictions have been agreed to by the practitioner

Understanding Sexual Abuse