Conduct Matters - Quarterly report of all closed conduct files from Oct 1, 2024 – Jan 31, 2025.
Disclaimer: Decisions may vary depending on the circumstances. The reasons for a decision must be considered in light of the evidence and the actual issues pertaining to the allegation.
Case 1
Allegations
- During February 2022, at […], the investigated member failed to develop and implement an appropriate physiotherapy stroke rehabilitation intervention plan for the complainant’s husband (the Patient).
- During February 2022, the investigated member failed to act professionally and empathetically when communicating with the complainant.
Investigation
The investigation conducted interviews with the complainant and the investigated member. Written submissions were received from both parties. A detailed examination of the physiotherapy treatment record, in this case a multidisciplinary record also occurred.
The patient underwent a total hip replacement and suffered a severe stroke that same day. The patient had a 24-day stay in an acute care hospital. The patient received physiotherapy services nearly daily. Physiotherapy services were delivered on the unit as a suitable wheelchair and safe transport off the unit could not be arranged for the patient.
The investigation determined the investigated member did develop and implement an appropriate physiotherapy stroke rehabilitation plan for the patient.
The investigation also determined that the member investigated advocated for the patient to receive rehabilitation services despite slow and inconsistent progress.
Finally, there was no evidence the investigated member failed to act professionally and empathetically when communicating with the complainant.
Decision
The complaint was dismissed because there was no evidence to support either allegation.
Case 2
Allegations
The physiotherapist accessed and disclosed their family member's personal health information from Connect Care when unauthorized to do so.
The allegation relates to the College’s Code of Ethical Conduct, specifically the following item under “B. Responsibilities to the public”:
- Members of the physiotherapy profession have an ethical responsibility to conduct and present themselves with integrity and professionalism.
Investigation
The physiotherapist admitted to accessing their family member’s personal health information without appropriate permission.
The physiotherapist admitted to disclosing their family member's personal health information to their family member verbally.
The physiotherapist demonstrated remorse and admitted to a lack of judgment and demonstrated remedial work was done as part of their employment agreement with their employer.
Decision
Given the physiotherapist’s admission of guilt in this case, there is a reasonable prospect of establishing the facts to prove the allegation before a Hearing Tribunal.
There was no evidence presented in the investigation to support other inappropriate access of non-patient information by the physiotherapist. This was a one-time occurrence. An error of judgment must be distinguished from unskilled practice that arises from a lack of knowledge. The physiotherapist admitted their error in judgment. The physiotherapist demonstrated remorse in their written submission. The physiotherapist stated that this error would not occur again.
The physiotherapist has completed nine courses of the employer’s choosing in the area of privacy, appropriate use of Connect Care, and the access and use of information. Given this remedial work, the Complaints Director did not believe there is a significant risk to public protection at this time.
The Complaints Director recommended that the physiotherapist complete the following to improve their practice relative to the College’s expectations of regulated members.
- Review and reflect on the following:
- Code of Ethical Conduct
- Privacy Guide for Alberta Physiotherapists
- Privacy and Record Retention Standard of Practice
- The Legislative Responsibilities Standard of Practice
- Listen and reflect on the following:
Case 3
Allegations
The College received a Professional Conduct Employer Mandatory Reporting Form, pursuant to section 57 of the Health Professions Act (HPA). The report stated that it had been determined by the employer that the physiotherapist failed to provide patient care that reflected the best interest of the patient, ignored the advice and feedback from a therapy assistant regarding the treatment plan, and refused to engage the proper family member when requested by a registered nurse and physician for involvement in treatment. Based on the findings of the employer, a one-day suspension was enforced for these concerns. Section 57 of the HPA states “If, because of conduct that in the opinion of the employer is unprofessional conduct, the employment of a regulated member is terminated or suspended or the regulated member resigns, the employer must, as soon as reasonably possible, give notice of that conduct to the complaints director.”
Investigation
The Professional Conduct Employer Mandatory Reporting Form was reviewed. No specific patient information or dates of physiotherapy services were provided. When considering a Professional Conduct Reporting Form, specific first-hand information needs to be included. Names of the specific clients at risk and why they are at risk, documentation concerns for specific clients or the fraud concerns for specific files need to be included. The College must have specific instances and evidence to investigate.
The College does not investigate a physiotherapist’s practice in general terms. Legislation and case law have provided guidance to regulatory colleges on depth, breadth, and authority of investigations. Colleges do not have the resources to “turn over every rock” when investigating the conduct of a regulated member. Again, specific information and evidence must be included in the written complaint or on a Professional Conduct Reporting Form.
Another reason for the need for specific, first-hand information is because the regulated member who is named in the complaint has the right to know the case before them to defend themselves. The College must present the specifics in which it will be investigating to the regulated member. This allows the investigated member the ability to respond and explain or defend their conduct in a fulsome way.
Also, not all practices rise to the level of unprofessional conduct as defined by the HPA. The Complaints Director must consider whether or not the behaviour was a “one-off” or is it consistent practice with the member. Even if the evidence suggests that the investigated person may have deviated from the minimum standards, not every breach of the standards will be sufficient to rise to the level of unprofessional conduct.
Decision
The Complaints Director’s decision focused primarily on this matter being a suspension, not a dismissal by the employer. In the event of a suspension, the physiotherapist will continue to work for the employer. If section 57 of the HPA did not exist, would the College have been made aware of the physiotherapist’s behaviour? The assumption is that there are processes in place to address the behaviour that led to the suspension and the report under section 57 of the HPA. Further, the College is quite clear on the College website about not getting involved with employer-employee disputes.
As no evidence was provided in this case, only general comments, and the matter was being dealt with through employer-employee mechanisms, the Complaints Director determined there was insufficient evidence to warrant further investigation by the College at this time and dismissed the complaint.
Case 4
Allegations
- The physiotherapist failed to obtain the complainant’s informed consent to have a physiotherapy student provide a physiotherapy assessment to the complainant.
- The physiotherapist failed to provide appropriate supervision to their physiotherapy student, as a result, the assessment provided by the student resulted in the complainant experiencing increased wrist symptoms.
Investigation
The investigation involved written submissions and interviews from the complainant, the physiotherapist, the physiotherapy student, and a staff member at the Clinic.
The physiotherapy record was also reviewed.
Decision
Allegation 1
There was evidence of a consent discussion surrounding the use of a physiotherapy student did occur with the complainant. There were conflicting submissions regarding the depth of the discussion with the complainant recalling a limited discussion and the physiotherapist recalling a more detailed discussion. The physiotherapy student offered their recollections and opinions in an interview as to the discussion they had with the complainant prior to physiotherapy services being provided.
The physiotherapy record reflected informed consent was gained by the physiotherapist and the physiotherapy student prior to physiotherapy services being provided.
There was evidence that the physiotherapist considered the appropriateness of assigning physiotherapy services to a physiotherapy student for the complainant and coupled with the physiotherapist’s experience, this was an appropriate decision by the physiotherapist.
There was no evidence that the complainant was aware of the steps taken by the physiotherapist to evaluate the physiotherapy student’s competencies nor was there evidence collected to support the physiotherapy student should not provide physiotherapy services in this case.
This allegation was dismissed as there was no evidence to support it.
Allegation 2
The complainant believed the physiotherapist should have been directly supervising the physiotherapy student.
The physiotherapist provided submissions outlining the steps taken by them and the physiotherapy student to progress from direct to indirect supervision. At the time of the incident, no formal written evaluations had been completed to provide documentary evidence of the physiotherapy student’s competencies.
The Standard of Practice is quite clear that different supervision strategies may be used by physiotherapists when assigning tasks to physiotherapy students. There was no evidence to support the assessment performed by the physiotherapy student was inappropriate or varied drastically from a prior assessment performed by the physiotherapist.
The complainant was seen in a complex rehabilitation program. There was no evidence collected or presented to indicate the care needs of the complainant were not considered when physiotherapy services were provided. While it was unfortunate that the complainant experienced an increase in symptoms following the assessment performed by the physiotherapy student, the complainant had a similar response to the assessment performed by the physiotherapist. Exacerbation of symptoms is, unfortunately, a possible occurrence with many components of physiotherapy programs, including assessment and reassessment. Exacerbation is not intended and the possibility of this was communicated to the complainant.
The allegation was dismissed as there was insufficient evidence of unprofessional conduct to support referring the allegation for a hearing tribunal.
Take away message: Physiotherapists should consider more fulsome discussion with patients and clients about the steps taken to ensure physiotherapy students are competent to perform proposed physiotherapy services, including different supervision strategies. This may improve communication, increase patient and client confidence, and limit the possibility of future complaints.
Case 5
Allegations
- The physiotherapist accessed their own Electronic Medical Records when not authorized to do so.
- The physiotherapist accessed other’s Electronic Medical Records with the same last name when not authorized to do so.
Investigation
This was a section 57 report, a mandatory report by an employer of termination of an employment agreement due to, from the employer’s perspective, unprofessional conduct.
The investigation consisted of document reviews, an interview with the employer, and a written submission from the physiotherapist.
An internal audit discovered a privacy breach. The physiotherapist was shown to have accessed their own medical records as well as the medical records of three individuals with the same last name.
The physiotherapist admitted to the allegations. The physiotherapist provided reasons for accessing the information and expressed remorse for doing so. The physiotherapist also identified there were appropriate processes for them to have accessed the information.
Decision
Given the physiotherapists’ admission and the evidence provided by the employer, there was strong evidence of unprofessional conduct to warrant sending this matter for a Hearing Tribunal.
The Complaints Director determined that the risk to public protection was small in this case given the physiotherapist’s employment had been terminated and they no longer had the ability to access medical records in the manner in which they did in this case. The physiotherapist’s reasons for accessing the medical records inappropriately did not matter in this case. The access was still inappropriate and constituted a privacy breach. The Complaints Director considered that the physiotherapist admitted to the allegations, demonstrated remorse, and demonstrated self-reflection by identifying appropriate methods for accessing the information in the decision.
Given the above, the Complaints Director did not have significant concerns about the physiotherapist’s competence or ethics and was confident the physiotherapist would not continue to access medical information inappropriately.
The complaint was dismissed pursuant to section 66(3)(b) of the Health Professions Act.
Given the strength of the evidence gathered in the investigation and the physiotherapist’s admissions, a formal caution regarding this matter will remain on the physiotherapist’s registration record.
The Complaints Director strongly recommended the physiotherapist undertake the following remedial actions to ensure that they are aware of and comply with privacy legislation going forward:
- Review and reflect on the following:
- Legislative Responsibility Standard of Practice
- Privacy and Record Retention Standard of Practice
- Privacy Guide for Alberta Physiotherapists
- Listen and reflect on the following:
- Complete the following:
Case 6
Allegation
Failure to meet the College of Physiotherapists of Alberta's Documentation and Record Keeping Standard of Practice.
Investigation
The physiotherapist’s employer initiated a complaint after discovering issues with the physiotherapist’s charting practices. The employer was interviewed, and several documents were reviewed during the investigation. The physiotherapist provided a written submission. Strong evidence was provided that documentation was not completed. The member also admitted that documentation was not completed.
Decision
The Complaints Director determined that there was strong evidence to support a finding of unprofessional conduct in that the investigated member was not documenting sufficient information to allow another physiotherapist to manage the clients’ conditions.
The Complaints Director proposed that the physiotherapist enter into a Facilitated Resolution with the Complaints Director rather than referring this matter for a hearing. The physiotherapist agreed to this process. As a result, the physiotherapist must:
- At their own expense, complete a course, approved by the Complaints Director, specific to health professional documentation and record keeping.
- Participate in three chart audits over a minimum of 18 months to ensure that the physiotherapist consistently meets the Documentation and Record Keeping Standard.
- Meet the minimum audit criteria established by the Complaints Director for each chart audit.
- Provide payment to the College for partial cost of each chart audit.
Case 7
Allegations
The complainant attended for physiotherapy services with the physiotherapist between 2021 and 2023 for the same episode of care under a Workers’ Compensation Board – Alberta (WCB) claim.
After seeing the images from the Hamas attack on the Kibbutz Be’eri in Israel on October 7, 2023, the complainant decided to submit a Professional Conduct Reporting Form to the College about the physiotherapists’ conduct.
Based on the information provided by the complainant, the College investigated four allegations of unprofessional conduct:
- The physiotherapist touched the patient’s breast when it was not appropriate to the service provided.
- When providing physiotherapy services, the physiotherapist took a picture of the patient in the treatment room and did not obtain consent to do so.
- While providing physiotherapy services in 2023, the physiotherapist touched the corner of the patient’s head and moved the patient’s hair from their forehead without explaining the reason why.
- The physiotherapist said “I saw a lot of those” to the patient and did not provide an appropriate context for the comment. For context, the patient believed the physiotherapist was referring to the patient’s breasts when they said this.
Investigation
This was an extensive and lengthy investigation. Numerous interviews were conducted including the complainant, the physiotherapist, and colleagues of the physiotherapist. Documents were submitted by the complainant, the physiotherapist, WCB, the complainant’s physician, and the physiotherapist’s employer.
The physiotherapy records of the patient were reviewed, including records from multiple clinical settings and the WCB
Decision
Allegation 1
To meet the threshold of sexual abuse as defined in the Health Professions Act (HPA), there must be touching of a sexual nature of the breasts. Further, “sexual nature” does not include any conduct, behaviour or remarks that are appropriate to the service provided. The direct evidence gathered by the investigator relating to this allegation consisted of the submissions of the patient and the physiotherapist and the documentation within the physiotherapy records. The investigation revealed that during a routine assessment for a shoulder condition, contact with the patient’s breast tissue may have occurred. If this contact did occur, there was a reasonable chance it was accidental or inadvertent. The Complaints Director concluded that there was not a reasonable prospect of proving that sexual abuse, as defined by the HPA, occurred in this case. This allegation was not referred to as a hearing tribunal.
Allegation 2
The patient recalled the physiotherapist taking a picture of the patient after telling the patient the physiotherapist was going to take a picture. The patient did not recall the physiotherapist explaining why a picture was taken or what was going to happen to the picture.
The physiotherapist did not recall taking a picture of the patient but stated that it was normal practice for them to take pictures of patients to demonstrate to the patient areas for the patient to improve. The physiotherapist stated that it was normal practice for them to gain consent to do so.
There was no evidence of a picture in the physiotherapy record. There was no documentation of a consent discussion or education about a picture being taken.
The physiotherapist did note that this allegation, along with the College Selected Activity for 2024 on Consent, prompted them to make changes to their standard practice going forward when it came to taking pictures of patients.
The Complaints Director concluded that failing to obtain consent on one occasion to take one picture did not rise to the level of unprofessional conduct as defined in the HPA.
There was not a reasonable prospect of proving unprofessional conduct before a hearing tribunal for this allegation. This allegation was dismissed.
The Complaints Director recommended the following to the physiotherapist to improve their practice:
- Review and reflect on the Informed Consent Standard of Practice
- Establish policies and procedures for the taking and storage of pictures and the obtaining of consent for the taking and storage of pictures of patients
Allegation 3
Both the patient and the physiotherapist agreed that the physiotherapist touched and moved the patient’s hair when assessing the patient for concussion. The patient stated the physiotherapist did not need to move their hair and did not explain to the patient why the physiotherapist moved their hair. The physiotherapist believed that implied consent was given for them to examine the patient’s head for signs of a wound when the patient consented to assessment of their condition, given the patient said they had hit their head on a nightstand.
A challenge existed for the investigation and the Complaints Director in that there was no documentation in the physiotherapy record of this assessment. The physiotherapist admitted that they had failed to chart on this assessment and interaction. Thus, no evidence existed that the patient provided consent for assessment of their condition.
Also, there were no recording devices present during the assessment, so this became a “they said / they said” situation where further investigation was deemed unlikely to reveal further evidence.
The Complaints Director was concerned that there was no treatment entry for the date in question. However, the physiotherapist acknowledged that, as soon as they discovered this entry was missing, they did not wish to compromise the integrity of the investigation by adding a late entry to the treatment record. The Complaints Director also considered that the patient had attended over 140 sessions with the physiotherapist during this episode of care. One missing entry over such a period was not unreasonable.
The physiotherapist should have explained their rationale for touching the patient’s head and moving their hair. Implied consent was not sufficient in this case. The physiotherapist bears several responsibilities to ensure that the patient clearly understands the components of the physiotherapy services being provided. The Complaints Director weighed whether one instance of failing to obtain fully informed consent rose to the level of unprofessional conduct as defined by the HPA. The Complaints Director considered the physiotherapist told the investigation they reflected on this allegation while completing the College Selected Activity 2024 on informed consent and had made changes to their practice.
Given that the physiotherapist admitted the behavior, showed self-reflection and considered ways to improve their practice, and that the contact was appropriate for the assessment of the condition, the Complaints Director concluded that this conduct did not rise to the level of unprofessional conduct as defined in the HPA.
The Complaints Director had the following recommendations for the physiotherapist to improve their practice:
Allegation 4
The only direct evidence available to the Complaints Director were the submissions of the patient and the physiotherapist. The patient recalled the physiotherapist saying “I saw a lot of those” to them. The patient also recalled hearing the physiotherapist use similar phrasing with other patients during their episode of care with the physiotherapist. The patient believed that this phrase was not respectful.
The physiotherapist stated that they would not have used that phrase and could have said something like “I have seen this before” and would use a phrase like that to demonstrate empathy and highlight the physiotherapist’s experience with similar conditions.
Because the events of the day were not captured or recorded in real time, and because there were no witnesses to the conversation, this is a “they said / they said” situation. The Complaints Director was cognizant of the fact that two people can experience the same event and have very different recollections of that event. The Complaints Director did not believe further investigation would yield further evidence to support this allegation. This impacted the reasonable prospect of establishing the necessary facts before a Hearing Tribunal. Given this lack of evidence, the Complaints Director dismissed this allegation.
Conclusion
None of the allegations were referred for a hearing. The physiotherapist was provided with several recommendations to improve their practice. This lengthy conduct process was challenging for all those involved, particularly the patient and the physiotherapist.
It is important for physiotherapists to remember that, as the provider of services, the physiotherapist bears several responsibilities to ensure that the patient clearly understands all components of the physiotherapy services provided. These include but are not limited to ensuring the client understands any hand contact for the purposes of providing assessment and treatment, the reason and rationale for components of the assessment or treatment including taking photographs, and that comments made to enhance the therapeutic relationship may have the opposite effect.
Many of these topics were covered in the College Selected Activity 2024 on Consent but bear regular review by all physiotherapists.
These topics are especially important in cases such as this when the episode of care was lengthy. The lines of a therapeutic relationship can blur over time as familiarity grows between the patient and the physiotherapist. Physiotherapists must be mindful that there is always an inherent power imbalance in the physiotherapist-client relationship.
