Quarterly report of all closed conduct files from April 1 – June 30, 2024.
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
The physiotherapist failed to provide physiotherapy services to the patient in a professional manner.
Investigation
The patient attended one individual and two group physiotherapy sessions before discharging themselves.
Evidence obtained supported that there was an issue with the therapeutic relationship from the start. The patient alleged that the physiotherapist failed to treat them warmly or provide encouragement or clear direction during the physiotherapy sessions. The patient had discussed their concerns with the physiotherapist, and the physiotherapist offered an apology; however, from the patient’s perspective, the issue was not resolved satisfactorily.
The treatment record showed that the physiotherapist reviewed the patient’s care plan during the first two sessions. However, the physiotherapist and patient had differing opinions about the extent of the conversations and how the information was received by the patient. The treatment record did not include any discussions with the patient regarding their progress, status, relationship, or questions about exercises. There was no documentary evidence to support or refute the allegation.
Decision
There was insufficient evidence to support a finding of unprofessional conduct by a hearing tribunal. The complaint was dismissed, however, the physiotherapist was encouraged to undertake the following activities to improve service delivery
- Complete the Alberta Patient-Centered Communication E-Learning Module
- Review and reflect on the Client-Centered Care Standard of Practice
Case 2
Allegation
The physiotherapist accessed the complainant’s electronic medical records (EMR) when not authorized.
Investigation
An audit of the complainant’s EMR showed that the physiotherapist accessed the complainant’s EMR two times without cause or consent. The complainant had never been a patient of the physiotherapist.
The physiotherapist acknowledged accessing the complainant’s records on two occasions when not authorized. No evidence was collected to indicate that the physiotherapist disclosed the patient’s information to another party, or that this type of privacy breach was a common occurrence for the physiotherapist.
Decision
The physiotherapist was issued a formal caution, which will remain on their registration record. To ensure the physiotherapist is aware of and complies with privacy legislation going forward, the physiotherapist was strongly encouraged to undertake the following activities:
- Listen and reflect on the College’s Podcast Episode “Privacy 101 for Physiotherapists.”
- Review and reflect on the College’s Privacy Guide
- Complete the College of Physiotherapists of Ontario Ethics E-Learning Module
Case 3
Allegation
The physiotherapist failed to treat the patient in a respectful, client-centered approach throughout the delivery of physiotherapy services.
Investigation
The patient’s initial complaint was that during the objective assessment of a pelvic health examination, the physiotherapist spoke over them and did not allow them to ask questions. The physiotherapist described the education provided to the patient and did admit to talking a lot during the assessment. Given no witnesses were present for these interactions, the way these interactions took place could not be substantiated.
During the investigation, two additional matters were raised.
Acupuncture treatment was provided without documentation of this occurring, or the appropriate consent being obtained.
The treatment record showed that the physiotherapist obtained verbal and written consent to assess the patient. The written consent form was a blanket consent for treatment with no specific risks identified relating to acupuncture. The documentation did not include consent for treatment with acupuncture. The treatment record provided no evidence that acupuncture treatment was performed. Given the time that had passed and the lack of documentation in the treatment notes, it was difficult to evaluate what, if any, discussion surrounding consent for acupuncture treatment occurred.
There was evidence to support that the physiotherapist did not respect the patient’s request to terminate their therapeutic relationship. The patient emailed the physiotherapist, saying they were not returning for treatment and did not wish to see the physiotherapist again. The physiotherapist sent two follow-up emails after this date. The content of the emails from the physiotherapist was sent with the intent of supporting the patient’s treatment plan and future care.
Decision
While there are areas that the physiotherapist could reflect on to improve service delivery, the alleged practice did not rise to the level of warranting a referral for a hearing.
The complaint was dismissed; however, the physiotherapist was strongly recommended to undertake the following to improve future practice:
- Complete Alberta Patient-Centered Communication E-Learning Module
- Review and reflect on the Pelvic Health Guide — College of Physiotherapists of Alberta (cpta.ab.ca)
- Review and reflect on Client-Centered Care — College of Physiotherapists of Alberta (cpta.ab.ca)
- Ensure all treatment provided and consent conversations are documented in each chart note for each service delivery date.
Case 4
Allegation
The patient’s low back symptoms were exacerbated due to treatment provided by the physiotherapist.
Investigation
The patient’s allegation stems from the second appointment, which occurred two weeks after the initial assessment. The patient stated that the “spinal cord massage” provided by the physiotherapist increased their lower back pain that lasted for one week.
On the first visit, the physiotherapist obtained verbal informed consent from the patient to provide massage and the 3 sets (10 sec oscillations) of grade III central posterior-anterior (PA) glides along the patient’s lumbar spine (L2 -L5). On the second visit, the physiotherapist stated and documented that the patient’s symptoms had generally improved following the first appointment. The physiotherapist provided treatment similar to the first visit. The physiotherapist and the patient both reported that approximately midway through the PA mobilizations the patient reported that the treatment was painful. The physiotherapist reported changing the PA pressure from grade III to grade II. The patient then complained that PAs were still painful, and the patient asked the physiotherapist to stop, which they did.
The treatment record entries for both appointments were the same, except for the second entry, which added a subjective report of feeling better, additional exercises, and cupping. There was no documentation that the patient complained of pain during the PAs or that the physiotherapist stopped or made adjustments. There was no substantiated evidence that a reduction in the grade of mobilization occurred.
Decision
While it is plausible that mobilizations provided by the physiotherapist resulted in an increase in the patient’s report of pain, there were no significant concerns about the physiotherapist’s competence or ethics.
This matter was not referred to a hearing, however, the physiotherapist was provided with the following recommendations to improve future practice:
- Reflect on the treatment provided to the patient on the second appointment, and the patient’s response to this treatment.
- Consider furthering their knowledge in manual therapy as part of their ongoing clinical education, especially if the physiotherapist plans on continuing to work with patients experiencing low back pain.
Case 5
Allegations
The physiotherapist:
- Continuously failed to comply with procedures regarding work absence.
- Documented treatments that occurred while they were not at work.
- Was unable to recall their unexplained absence one week following the occurrence.
Investigation
There was evidence that the physiotherapist was aware of the procedures to follow for calling in an absence and failed to comply with these procedures.
There was no evidence to support that the physiotherapist documented treatments that occurred while they were not at work. This allegation was specific to whether the physiotherapist documented that they treated patients before arriving at work at 10:30 a.m. on a specified date. The physiotherapist and their employer both agreed that the physiotherapist was late for their shift and that the physiotherapist treated patients after they arrived at work. The schedule showed two patients were scheduled to be seen before 10:30 a.m. However, the electronic medical record supported that the patient visits and charting occurred after 10:30 a.m. while the physiotherapist was at work.
No evidence was obtained that the physiotherapist did not attend to their own health and well-being. On three occasions, the physiotherapist took action to abstain from work or modify their work to attend to their health and/or well-being.
Decision
A one-time incident of not following the proper process would not normally warrant an investigation. However, the continuous failure to comply with the employer’s process is a concern. It does not reflect the physiotherapist’s code of ethical conduct to act honestly, transparently, and with integrity in all professional and business practices to uphold the reputation of the profession. While the physiotherapist’s professionalism regarding allegation #1 was concerning, this was not significant enough to pose a significant risk to public protection. The matter was not referred to a hearing and the matter was dismissed. The physiotherapist was provided with the following recommendation:
- Complete the 2022 College-Selected Activity on Professionalism again and reflect on the risks of their professional behaviour and what actions they can take to mitigate these risks.
Case 6
Allegations
The performance of a squat resulted in a tear of the patient’s right peroneus brevis tendon requiring surgical repair.
Investigation
The patient was being treated for a work-related lower back injury and participated in an initial physiotherapy assessment with Physiotherapist A. The patient's treatment record included a past medical history of ankle surgery with reduced mobility and the completion of a comprehensive movement assessment. The dorsiflexion range of motion of the right ankle was documented as well as the patient’s ability to perform a half squat. Physiotherapist A developed an exercise program for non-specific low back pain. Goblet squats were included in the patient’s exercise program by Physiotherapist A. There was no documentary evidence to support or refute that the patient informed Physiotherapist A about their ability to do squats. The next day, the patient was seen by Physiotherapist B (a “float physiotherapist”), who had the patient perform the exercise program developed by Physiotherapist A. Evidence indicated that the goblet squat exercise was modified by Physiotherapist B to a sit-to-stand exercise when the client expressed they could not do a squat.
Decision
There was no evidence to directly correlate that the sit-to-stand exercise performed by the patient resulted in the tearing of the peroneus brevis tendon. There was insufficient evidence specific to the investigated allegation to support a finding of unprofessional conduct by a hearing tribunal. The complaint was dismissed.
Case 7
Allegations
The performance of a squat resulted in a tear of the patient’s right peroneus brevis tendon requiring surgical repair.
Investigation
Physiotherapist B was a “float physiotherapist” and reviewed Physiotherapist A’s intake assessment. The evidence indicates that Physiotherapist B determined that the exercise program was appropriate except for goblet squats. The goblet squats were omitted from the patient’s exercise program and replaced with sit-to-stand exercises from a workout bench or plinth. Physiotherapist B modified the sit-to-stand exercise by raising the plinth in response to the patient’s reports of right ankle pain during the exercise.
Decision
Evidence supports that Physiotherapist B demonstrated critical thinking and professional judgement to modify the treatment plan to meet the patient’s needs. There was no evidence to directly correlate that the exercise performed by the patient caused a tear of their right peroneus brevis tendon. This matter was not referred for a hearing. There was insufficient evidence specific to the investigated allegation to support a finding of unprofessional conduct by a hearing tribunal. The complaint was dismissed.
Case 8
Allegations
On numerous occasions, the physiotherapist failed to sufficiently document treatments provided and/or enter documentation of treatments in a timely manner.
Investigation
The employer conducted two chart audits of the physiotherapist's documentation and record-keeping practices. Numerous deficiencies were identified. The physiotherapist admitted that they missed detailed information in their charting and struggled with it.
The Investigator did not undertake an independent chart audit of the physiotherapist’s records using the College’s Documentation and Record-Keeping Standard as there was a high degree of similarity between the College’s documentation standard and the employer’s chart audit form, thus making an independent chart audit unnecessary.
Decision
There was sufficient evidence presented in the employer’s chart audits and the physiotherapist’s own admission that completeness of charting was an issue. The evidence collected was strong, thus warranting caution and recommendations. The physiotherapist was strongly recommended to complete the following remedial actions to improve their charting practices:
- Reflect on how incomplete and delayed charting can impact clients and other members of the health care team.
- Develop internal measures to ensure complete and timely charting.
- Continue to collaborate with their employer to meet the employer’s internal expectations and the College’s Standard of Practice regarding Documentation and Record Keeping.
- Complete the College’s Documentation Module.
