Patients rely on and put their trust in physiotherapists to help them achieve their goals regarding their illness or injury. Physiotherapists work to gain a patient’s trust by listening to them, working with them, and hopefully empowering them to create positive change. During the course of treatment, a physiotherapist may encounter situations in which they are legally required to disclose personal or private information to the authorities which may break that patient’s confidentiality and affect their trust. These legal requirements are set out to help protect the patient and the public from harm, but it can still be a difficult time for the physiotherapist, the patient, and their therapeutic relationship. This article will explain what mandatory reporting is and provide several examples of when this would be done by the physiotherapist.
What is Mandatory Reporting?
There are certain situations where the Health Professions Act requires physiotherapists to report information to appropriate government agencies. Several such scenarios relate to vulnerable populations and in these instances, the physiotherapist does not have an option even if the patient has told the physiotherapist not to say anything. Breaking a patient’s trust can have a negative effect on the patient’s therapeutic relationship with the physiotherapist, but the reporting is done to try and keep that patient or the public safe from harm. Below we will examine situations in which physiotherapists are legally obligated to report.
Vulnerable People Abused by Those in a Position of Power
The Government of Alberta has passed two pieces of legislation to protect those they consider vulnerable. In both pieces of legislation, the physiotherapist has a legal obligation to act on information that leads them to believe that a vulnerable person is being abused. We can view each through the legislation that is set out to protect them.
The Child, Youth and Family Enhancement Act
The first vulnerable group are minors, which are those under the age of 18. Physiotherapists are required to report situations of abuse, neglect, and other circumstances that would require intervention. To protect and help the minor, this Act requires the physiotherapist to contact local police or the Child Abuse Hotline.
The Protection of Persons in Care Act
The second vulnerable group are dependent adults who are receiving publicly funded care or support services. Dependent adults could be any person over the age of 18 with physical or mental impairment who is in the care of others. They can be at an increased risk of abuse and mistreatment by their caregivers or others that have access to them or their finances. In the case where the dependent adult is receiving publicly funded care or support, the physiotherapist would be required to contact local police or the Protection of Persons in Care Hotline to organize assistance for that adult.
Sexual Abuse or Sexual Misconduct
Another scenario to consider is when the physiotherapist is at work and becomes aware of a situation where another regulated health professional has been responsible for sexual abuse or sexual misconduct of a patient. Health professionals are in a position of power in relation to their patients and unfortunately, there have been instances in which the physiotherapist has become aware that a health professional has used that power imbalance inappropriately. There are strict rules around health professionals being sexually involved with their patients, and all regulated health professionals in Alberta are subject to prohibitions on sexual abuse and sexual misconduct of patients.
If a physiotherapist has reasonable grounds to believe another health professional has engaged in sexual abuse or sexual misconduct of a patient, then that physiotherapist must report that matter to the College of the health professional in question.
When There Is Not Mandatory Reporting
The above scenarios leave the physiotherapist with no choice but to report the situation to the proper authorities. However, there are times when the physiotherapist faces a dilemma about reporting a situation and breaching a patient’s privacy because the legislation does not require a report but it may be the right thing to do ethically. This most often occurs when patients are suffering from mental health emergencies or are having suicidal thoughts.
In these situations, the physiotherapist is legislatively enabled to breach the patient’s confidentiality and privacy. When deciding to do so they must:
- Perceive that there is a clear risk of harm to the patient or any other person.
- The danger poses a risk of serious bodily harm or death.
- There is a sense of urgency created by the threat of danger.
When all of the above requirements are met, provincial legislation allows for a patient’s privacy to be breached.
Physiotherapists often work with patients who have severe injuries, illnesses, or deal with long-term pain which can have significant negative effects on their personal and professional lives. It is common for these patients to experience mental health struggles such as anxiety, depression, and suicidal thoughts. Although physiotherapists cannot treat any of these disorders, patients often tell their physiotherapist about their mental health struggles and will at times express suicidal thoughts.
Mental health is a complex issue that is best addressed by a mental health professional. However, a physiotherapist may ask the patient some questions and provide them with resources that the patient can access to get help. If it becomes apparent that the threat of self-harm is more serious and meets the criteria set out in legislation, the physiotherapist may breach privacy and call for emergency help.
Unfortunately, some mental health emergencies are directed outward as a patient’s frustration or anger at their situation boils over. The same legislated ability to report the situation would be applicable if a patient disclosed a threat to harm someone else such as the person who injured them in a car accident or their claims adjuster that denied their claim. The threat would have to meet the same 3 requirements before the physiotherapist would be able to alert the local authorities.
Patient Intoxication
There have been situations where patients have arrived at physiotherapy appointments under the influence of drugs, alcohol, or prescription medications. If a patient comes to an appointment intoxicated it means that they are unable to make informed decisions about their care. It may also affect their physical function as well as alter their sensations of pain. None of these enable safe delivery of physiotherapy care and physiotherapists are unable to provide care when it is not safe to do so. In these instances, the physiotherapist would need to turn the patient away and rebook the appointment.
If that patient drove to the clinic and/or is driving home from the clinic after the physiotherapist has refused to treat them due to intoxication, the physiotherapist has a moral obligation to report the situation. The Government of Alberta and local police strongly encourage reporting of impaired drivers and legislation enables this reporting. This scenario takes the patient’s safety in mind but also the public at large as the intoxicated patient can injure someone else due to their behaviour.
Summary
Mandatory reporting is a legislated obligation of physiotherapists when they have identified a situation in which a vulnerable person needs urgent help, or which may put the public or the patient in harm’s way. The legislation is there to protect vulnerable populations and to keep the public safe. The patient should be aware of the physiotherapist’s legal duty to do so and keep in mind that the physiotherapist is required to work in the patient’s and the public’s best interests.
If you would like more information about other challenging situations where a physiotherapist may or may not have a reporting requirement, you can find it on page 19 of the Managing Challenging Situations Guide.
