Case 1: Hearing Tribunal Decision
File closure date: June 29, 2025
A Hearing Tribunal convened in March 2025, to consider the following allegation:
- On or about March 1- 20, 2023, Kukadiya engaged in sexual abuse, sexual misconduct, or conduct that was otherwise unprofessional conduct by touching a patient, PF’s breast, without a clinical reason or her informed consent.
On a balance of probabilities and after considering all of the evidence, the Hearing Tribunal made a finding of fact that Ms. Kukadiya did not touch Ms. P.F.’s breast. There was not clear, cogent and convincing evidence to establish the factual underpinnings of the allegation.
Decision of the Hearing Tribunal on allegations (posted July 8, 2025)
Case 2: Inappropriate Conversations Equal Sexual Misconduct
File closure date: Aug 6, 2025
Hearing Tribunal Decision
After a hearing in June 2024, the Hearing Tribunal found that:
The following allegation was proven on a balance of probabilities and constitutes unprofessional conduct in that it amounted to sexual misconduct under section 1(1)(m2) of the Health Professions Act (HPA), contravened a Code of Ethics or Standards of Practice, and harmed the integrity of the profession.
- On or between June 27, 2022 – October 6, 2022, while providing physiotherapy treatment to Patient S.B., Khan engaged in inappropriate discussions with Patient S.B. including one or more of the following:
- Khan discussed and/or asked about sexual activity and “rape”.
- Khan discussed vibrators and a sex toy website, PinkCherry.
The following allegation was proven on a balance of probabilities in that it contravened a code of ethics or standards or practice, and harmed the integrity of the profession.
- Further, or in the alternative to the above allegation, on or between June 27, 2022 – October 6, 2022, Khan was present when receptionist M.B. engaged in communications with patient S.B. regarding topics of a personal and/or sexual nature, and failed to take steps to address the inappropriate nature of the communications or to enforce appropriate boundaries, including one or more of the following topics:
- Sexual preferences and/or sexual orientation, including discussing “jumping into a girls’ train”, or words to that effect;
- Sexual activity and “rape”;
- A party with male dancers, including that Khan viewed a photo of a naked man;
- Being naked at home and/or in front of other people;
- Vibrators and a sex toy website, PinkCherry.
The Hearing Tribunal met in May 2025, to consider a joint submission on sanctions. The Hearing Tribunal ordered the following:
- Khan's practice permit with the College, and ability to practice physiotherapy in Alberta, shall be suspended for a period of four (4) months.
- Khan shall complete, at their own cost, the PROBE Ethics & Boundaries Program Canada course.
- Khan shall pay forty percent (40%) of the total costs of the investigation and hearing, to a maximum of $40,000.
Decision of Hearing Tribunal on allegations (posted February 4, 2025)
Decision of the Hearing Tribunal on sanctions (posted July 21, 2025)
Case 3: Following Legislative Responsibilities When Providing Physiotherapy Services
File Closure Date: Aug 17, 2025
Allegation
The patient attended the Clinic for physiotherapy services with the physiotherapist for management of a work-related injury.
The physiotherapist and the Clinic did not have a contract for provision of physiotherapy services with the Workers’ Compensation Board – Alberta (the “WCB”) during the period physiotherapy services were provided.
The physiotherapist made the patient aware that they were a non-contracted physiotherapy provider.
The patient chose to continue with physiotherapy services with the physiotherapist and attempted to receive reimbursement for the fees for physiotherapy services directly from the WCB.
The physiotherapist responded to a request for information from the WCB.
The patient was reimbursed for the attendances referenced in this initial response by the physiotherapist.
The patient had not been reimbursed for physiotherapy services for the remaining fees for physiotherapy services at the time the patient made their report to the College.
Investigation
The College investigated one allegation:
- In 2024, while providing physiotherapy services, the physiotherapist failed to share appropriate documentation with the Workers' Compensation Board - Alberta (the “WCB”).
The allegation related to the following Standards of Practice and the associated physiotherapist performance expectations:
- Documentation and Record Keeping Standard of Practice.
- The physiotherapist:
- Maintains and shares all documentation, correspondence, and records in compliance with applicable legislation and regulatory requirements including confidentiality and privacy Standards.
- The physiotherapist:
- Communication Standard of Practice
- The physiotherapist:
- Documents all communications accurately, clearly, professionally, and in a timely manner.
- The physiotherapist:
- Fees and Billing Standard of Practice
- The physiotherapist:
- Maintains current knowledge of funding sources for physiotherapy services and complies with funding requirements, policies and procedures.
- The physiotherapist:
- Legislative Responsibilities Standard of Practice
- The physiotherapist:
- Is knowledgeable of and complies with all relevant legislative and regulatory requirements in Alberta (e.g., privacy legislation, Workers’ Compensation Act, Radiation Protection Regulation) applicable to her/his practice.
- The physiotherapist:
Section 1 (1)(v) of the Workers’ Compensation Act (the “WCA”) defines “physician” as a person licensed or authorized under the Health Professions Act to practice any of the healing arts in Alberta, which includes physiotherapists. Physiotherapists are required to follow the responsibilities set out in the WCA for the reporting of workplace injuries.
Decision
The Complaints Director is charged with establishing the necessary facts to prove the allegations investigated, on a balance of probabilities, before a Hearing Tribunal. The Complaints Director must also consider whether, if the allegation is proven, the behaviour constitutes unprofessional conduct as defined by the Health Professions Act. In this case, the Complaints Director did not believe there was a reasonable prospect of establishing the facts necessary to prove the allegation before a Hearing Tribunal.
The evidence showed that the physiotherapist was honest with the patient and told the patient that they did not have a contract with the WCB to provide physiotherapy services and that the patient would be required to fund their own physiotherapy services and seek reimbursement from the WCB. The patient agreed to this arrangement and continued with physiotherapy services with the physiotherapist. The physiotherapist made an error in making this decision. The responsibility clearly falls on the physiotherapist to know, understand, and comply with the appropriate pieces of legislation, in this case the Workers' Compensation Act, and the relevant Standards of Practice of the College. It was not enough that the patient agreed to see the physiotherapist as a Non-Contracted Physical Therapy Provider. The physiotherapist was required to learn what was required of them to provide the necessary physiotherapy services, including documentation and reporting responsibilities to the WCB. The legislation goes further than a physiotherapist’s ethical responsibilities and carries risk if the physiotherapist does not comply with the legislation. It is each individual physiotherapist’s responsibility to know the legislation that pertains to their practice and to follow it.
There was no evidence that suggested that the issues identified in this complaint were a regular occurrence with the physiotherapist. One-time mistakes are just that: mistakes. The objective of the Health Professions Act’s Professional Conduct Process is to determine what if any, corrective action or restrictions must be put in place to ensure it is safe for the physiotherapist to continue working. While the Complaints Director did find that the actions of the physiotherapist impacted the patient’s ability to be reimbursed for their physiotherapy services by the WCB, the Complaints Director did not find there were any patient safety concerns because of the actions of the physiotherapist. The Complaints Director expects that the physiotherapist will learn not to make assumptions about their responsibilities under the various pieces of legislation physiotherapists practice under in future interactions with patients.
The Complaints Director recommended that the physiotherapist utilize this complaint as an opportunity to improve their practice in the following ways:
- Review the WCB material pertaining to Non-Contracted Physiotherapy Providers and develop policies and procedures to follow in the future relating to patients with work-related injuries including policies and procedures to ensure documentation is completed appropriately and submitted in a timely manner to the correct recipient.
- Review and reflect on the following Standards of Practice to address the issues identified in this decision:
- Review, reflect, and understand the various pieces of legislation that govern physiotherapy practice, specifically the Workers’ Compensation Act.
Key Message
Physiotherapists must be aware of and comply with their responsibilities under the various pieces of legislation that physiotherapists practice under in their interactions with patients. These responsibilities cannot be delegated to patients to interpret.
Case 4: Does the Physiotherapy Record Support the Physiotherapist’s Version of Events?
File Closure Date: Sept 7, 2025
Allegations
The patient attended four appointments with the physiotherapist, primarily relating to a right leg issue with a secondary history of long-standing lower back soreness and tightness.
Two key issues made up the patient complaint:
- The patient could not easily access the home exercise program prescribed by the physiotherapist.
- Following an appointment where kettlebell deadlifts were used as part of the physiotherapy services provided, the patient experienced significant back pain, a new symptom.
Investigation
Allegation 1
The physiotherapist determined that the patient could lift 10 pounds safely with this exercise and did not try any repetitions with a lighter weight. The response of the patient to the exercise was not expected by the physiotherapist.
The patient reported that they did not know why they were performing this exercise relative to their right leg pain. The patient had no experience with kettlebells. The patient reported to the investigator that they were able to complete the repetitions asked by the physiotherapist with some challenges and noted lower back pain as they were leaving the appointment. This lower back pain worsened over the coming days.
Allegation 2
The patient and the physiotherapist both provided descriptions of the instructions given for the kettlebell exercise that were fundamentally the same.
There were no description of the exercise and no exercise program document within the physiotherapy record that included this exercise to corroborate the instructions that were given to the patient.
Allegation 3
The patient began experiencing lower back pain following the appointment in which the kettlebell was lifted. The patient tried self managing these new symptoms for six days and then contacted the physiotherapist. They spoke on the phone, and the physiotherapist instructed the patient to stop all exercises, and they would reassess the patient’s condition at their next appointment. The next appointment was seven days hence.
The physiotherapy record did not show a reassessment occurred. The entry was nearly identical to the prior entry in the record. No new exercises or self management strategies were made available to the patient within a timely manner after this appointment. One month after the appointment, exercises were made available to the patient; these exercises did not align with the exercises documented in the physiotherapy record.
Decision
Allegation 1
While the Complaints Director believed the evidence supported the fact that the amount of weight used for the kettlebell exercise resulted in increased symptoms for the patient, the Complaints Director did not believe there was sufficient evidence to prove that prescribing the amount of resistance for the kettlebell exercise rose to the level of unprofessional conduct as defined by the Health Professions Act, of displaying a lack of knowledge of or lack of skill or judgment in the provision of professional services. The physiotherapist made a decision based on the patient’s presentation; sadly, this decision resulted in increased symptoms for the patient.
What was not proven was that the physiotherapist educated the patient about the risks of increased or new symptoms with this new exercise as there was nothing documented in the physiotherapy record to support its prescription. This was one example in this case of a flawed physiotherapy record.
Allegation 2
This allegation was dismissed as the Complaints Director did not believe there was sufficient evidence of unprofessional conduct to support referring the allegation for a hearing tribunal.
Allegation 3
There were three main components that contributed to the Complaints Director’s decision on this allegation:
- The phone conversation between the physiotherapist and the patient.
- The nature of the appointment following the phone conversation.
- The home program provided to the patient at the appointment following the phone conversation.
The patient and the physiotherapist agreed that the phone conversation occurred and that the patient was advised to discontinue all their exercises at that time. There was no documentation within the physiotherapy record of this conversation. There was an internal note completed months after the appointment that documented the details of the conversation. Given this was completed months after the fact, it was not believed to be reliable.
The physiotherapy record did not support the assertion of the physiotherapist that a reassessment occurred, and the new symptoms reported by the patient were addressed in a fulsome manner. Given the other documentation issues identified in this investigation, the physiotherapy record was not a reliable piece of evidence to inform the decisions.
The physiotherapy record documented that exercises were performed during the appointment. There was no documentation that supported that these exercises were provided to the patient in a manner that the patient could reproduce at home except from memory. Physiotherapists are expected to provide patients with education to enable and optimize their transition to self-management. The patient made several requests to the physiotherapist that their home program be updated and uploaded to the Clinic’s patient portal. There was no evidence to support the physiotherapist did this in a timely manner to assist the patient.
Ultimately, the Complaints Director determined that while there was evidence that the physiotherapist failed to meet the performance expectations of the Risk Management Standard of Practice in this case, the breach did not amount to a finding of unprofessional conduct as defined by the Health Professions Act.
The documentation in this case was poor. The physiotherapist was formally cautioned regarding this deficiency in their practice.
The physiotherapist was recommended to do the following to improve their practice:
- Reflect on this case and improve their knowledge and use of their exercise prescription software and patient portal or establish new methods of providing patients with consistent and clear records pertaining to their home exercise programs.
- Review the College’s Documentation Module, “The Write Stuff.”
- Reflect on the Complaints Director’s comments in the decision and integrate that feedback along with their learnings from “The Write Stuff” to improve their practice.
Key Message
Comprehensive, accurate, and contemporaneous documentation is a key element of the provision of safe and effective physiotherapy services.
The physiotherapy record is the primary piece of documentary evidence examined in a Professional Conduct proceeding.
Most Professional Conduct files have some form of documentation issue.
Ask yourself:
- If a complaint is made, will my chart provide a clear, detailed record of the assessment, analysis / rationale, planning and follow-up?
- Is my clinical reasoning present within my documentation?
- Can my documentation be read and understood without my input?
- Is there a clear list of the exercises my patients are performing at a certain point in time? Are there parameters to those exercises?
Stop doing the following:
- Leaving entries as “Draft” or “Unsigned.” The defense is often “Oh that is in case I want to make any changes to the entry” and “I sign them all a week later.” This is an error. Entries in the record should be signed or marked completed or closed, whatever the wording, at the time they are written. Late entries or amendments should be marked as such. This adds reliability to your documentation. It does not detract from it.
- Copying entries over and over again. Document unique portions of each and every interaction. Document changes to exercises, repetitions, weights used, muscles needled, acupuncture points, transfer status, etc. Incorporate specifics to the education you provided to patients.
- Adding information after the fact, especially if you have received notice from the College of an investigation. This significantly impacts the reliability of the documentation and your credibility.
Case 5: Failure to Explain the Risks and Benefits of Physiotherapy Services
File Closure Date: Sept 14, 2025
Allegation
The patient was dissatisfied with way the physiotherapist communicated with them regarding the amount of pain to tolerate during exercise. The patient felt the physiotherapist was putting the patient at risk of further injury by instructing them to work through their pain tolerance.
The College investigated one allegation:
- The physiotherapist failed to explain the risks and benefits of the physiotherapy treatment proposed that day to the patient, specifically regarding the material risks (for example, working with and through pain) associated with the proposed physiotherapy treatment.
Investigation
The investigation focused on submissions from the patient, the physiotherapist, and a review of the physiotherapy record including Workers' Compensation Board reporting.
There were issues with the reliability of the physiotherapy record. Entries were often identical to prior entries, contained no documentation of the specifics of education provided to the patient, and did not contain enough detail to support the physiotherapist’s assertion that the patient should work through tolerable pain to maintain their range of motion.
Surgical protocols and reports from the patient’s surgeon were reviewed to see if there was any evidence to support the physiotherapist’s advice that the patient work through tolerable pain. There was no such evidence obtained.
Decision
As with many communication issues, both sides of the conversation were considered by the Complaints Director. The patient identified a witness to the conversation, their partner, and this was also considered by the Complaints Director.
The physiotherapy record did contain an entry summarizing the conversation. This entry was made two days late and was made in addition to an entry that was fundamentally identical to previous entries in the chart. This impacted the physiotherapist’s version of the conversation relative to the patient and witness versions.
A detailed review of the documentation in this case did not meet the performance expectations of the Documentation Standard of Practice. Specifically, not enough specific information about the education provided to the client was documented. This meant that there was little evidence to support the physiotherapist’s assertion that the advice given to the patient was appropriate and supported by the physiotherapist’s clinical reasoning.
Further review of the physiotherapy record showed that, despite what may have been said to the patient, the patient was not prescribed exercises, nor did they have interventions performed on them that significantly put the patient at a greater risk of harm.
Ultimately, the Complaints Director determined that the evidence did not support referring the allegation for a hearing tribunal.
However, the physiotherapist was formally cautioned that their documentation did not meet the performance expectations of the Documentation Standard of Practice.
The Complaints Director recommended that the physiotherapist review and reflect on the following College documents to improve their practice:
- Communication Standard of Practice
- Documentation Standard of Practice
- Informed Consent Standard of Practice
- Consent Guide for Alberta Physiotherapists
- Managing Challenging Situations Guide for Alberta Physiotherapists
The Complaints Director also recommended that the physiotherapist complete the College’s Documentation module, “The Write Stuff,” to further improve their practice.
Key Messages
- Ensure you communicate and document your instructions to clients, especially regarding the risks and benefits of physiotherapy services, so that your rationale may be understood by others without your input.
- Ensure that your documentation meets the performance expectations of the Documentation Standard of Practice.
- Document specifics of conversations, especially challenging ones.
- Ensure that your documentation provides a clear, detailed record of assessment, analysis, planning, and follow up.
Case 6: Consent and History Taking
File Closure Date: Sept 14, 2025
Allegations
The patient attended two physiotherapy appointments with the physiotherapist intern for upper body pain and stiffness. There were two allegations.
- In September 2024, the physiotherapist intern did not obtain informed consent from the patient for the participation of another individual in the provision of physiotherapy services.
- In September 2024, the physiotherapist intern failed to complete a medical history appropriate to the provision of physiotherapy services, as part of the assessment of the patient’s presenting condition.
Investigation
Allegation #1
The investigation produced evidence that the patient felt coerced into having a physiotherapy assistant (“PTA”) student be part of the provision of physiotherapy services. This was due to the way in which consent was asked. The patient was asked in front of the PTA student whether it was okay for the PTA student to participate in the patient’s appointment. The patient initially gave their consent but, within a few minutes, withdrew their consent as they did not feel comfortable with that arrangement. As soon as the physiotherapist intern knew the patient withdrew their consent, the PTA student was asked to leave the treatment cubicle.
The PTA student was interviewed to gather their independent recollection of the events surrounding the consent discussion.
Allegation #2
The investigation produced evidence that an assessment was completed at the initial appointment. This included a medical history. The patient felt this medical history was not detailed enough for the physiotherapist intern to understand their entire medical history. The patient also felt that the physiotherapist intern should have known to ask more questions and gather more information about how their stress impacted their clinical presentation. The physiotherapist intern reported that when they asked the patient about their stress, the patient informed the physiotherapist intern that the patient would prefer to discuss that further with their psychologist. Hearing this, the physiotherapist intern reported that they continued with other aspects of the assessment.
Decision
There was insufficient evidence to support referring either allegation for a hearing tribunal.
Regarding Allegation #1, the physiotherapist used a standard way of introducing the PTA student to the patient and, after reflecting on the patient’s concerns, has modified their practice. Also, a key piece of evidence was that all parties agreed that as soon as the patient withdrew their consent, the physiotherapist intern respected this decision and had the PTA student leave the treatment cubicle.
Regarding Allegation #2, the physiotherapy record supported the fact that a medical history was completed, and the physiotherapist intern had sufficient information to begin their assessment of the patient.
However, the Complaints Director did identify concerns with the practice of the physiotherapist intern in this case.
A review of the audit log for the physiotherapy record showed that the physiotherapist intern made an amendment to the physiotherapy record after receiving the Notice of Investigation from the College. No context was provided with the amendment to support adding the amendment by the physiotherapist intern. This was an error in judgement and impacted on the weight given by the Complaints Director to the physiotherapist intern’s version of events as it affects the reliability of the documented information.
There was no evidence that any data from the original entries was changed. This lessened the level of concern of the Complaints Director regarding the physiotherapist intern’s documentation practices.
The Complaints Director recommended that the physiotherapist intern complete the following to reflect on and improve their practice:
- Review and reflect on the College’s Consent Guide for Alberta Physiotherapists.
- Continue to review and reflect on how they ask patients for consent surrounding the participation of students and/or support workers in the provision of physiotherapy services.
- Review and reflect on the College’s e-learning module, Patient Centred Communication.
- Review and reflect on the College’s documentation e-learning module, The Write Stuff.
Key Messages
- The Complaints Director reviewed his own experiences with introducing students to patients and found they aligned with those used by the physiotherapist intern in this case. However, given what we continue to learn about trauma-informed practices, providing patients with the opportunity to decide about the use of any supervisee or support worker without that supervisee present should be considered to reduce any feelings of pressure on the patient to allow that supervisee to participate in the provision of their physiotherapy services.
- All physiotherapists should review their documentation practices and stop leaving notes as draft or unsigned. Documentation made after the fact needs to be documented as such to adhere to the Standards of Practice. Rationale should be given when adding amendments after the fact.
Case 7: Acknowledging When Things Don’t Go as Planned
File closure date: Oct 10, 2025
Allegation
The patient alleged that the physiotherapist reapplied an electrical modality without turning off or reducing the intensity of the electrical modality. This resulted in an involuntary muscle contraction, involuntary movement of the patient’s arm, increased pain, and reduced function for the patient for several months.
The physiotherapist failed to safely and effectively apply an electrical modality which resulted in increased symptoms and reduced function for the patient.
Investigation
The investigation consisted of written and oral submissions of the patient and the physiotherapist, a review of the physiotherapy record, and a review of the electrical modality instruction manuals and parameters.
Decision
The patient was consistent across all their submissions.
The physiotherapist was inconsistent across their submissions, confounding the available evidence by offering different versions of what occurred.
The physiotherapy record, typically a reliable piece of evidence, was not reliable in this case as the entries were not made contemporaneously and had information added to the entries after the date the physiotherapist received notification of the complaint from the College.
The physiotherapist opined that the electrical modality had an automatic shutoff feature if the start button was not pressed and thus could not have delivered in an unintended intensity of electric current. This could not be supported by a review of the manuals for the electrical modality or in speaking with a supplier of the electrical modality.
The Complaints Director determined that on a balance of probabilities, even though the patient’s version of events were more likely to have occurred than not, and the patient did experience increased pain and decreased function because of the reapplication of the electrical modality without adjusting the intensity of the current, the evidence did not support referring the matter for a hearing tribunal as this was more likely a one-time error on the part of the physiotherapist than unprofessional conduct as defined by the Health Professions Act.
The physiotherapist was formally cautioned about their documentation practices and their conduct regarding the use of an electrical modality relating to this case. The Complaints Director strongly recommended that the physiotherapist complete the following to improve their practice:
- Review the safe application of electrical modalities, specifically reducing the intensity of the electrical current when reapplying, moving, or adjusting electrode placement or location.
- Complete the College’s e-learning module, “The Write Stuff.”
Key Message
- For the physiotherapy record to be considered a reliable piece of evidence, it must meet the standards set in the Documentation Standard of Practice.
- Physiotherapists must understand how their electronic medical record functions.
- Late entries in the physiotherapy record must be documented as such with a reason for the late entry.
- If you are involved in the professional conduct process, consider your responses to the investigator before giving them. Be honest, professional, consistent, and show self-reflection about your practice and the investigated matter.
Case 8: Inaccurate Billing
File Closure Date: Oct 31, 2025
Allegation
The patient learned that physiotherapy services had been billed to their extended health benefits provider for dates that they did not receive physiotherapy services.
The College investigated the following allegation:
On two dates, the physiotherapist failed to meet the performance expectations of the Funding, Fees, and Billing Standard of Practice when billing the patient for physiotherapy services.
Investigation
The investigation focused on a review of the physiotherapy record including financial information and submissions from the patient and the physiotherapist.
Decision
The evidence showed that the physiotherapist did err and billed for physiotherapy services on dates that the patient did not receive physiotherapy services.
The physiotherapist, once made aware of the error via the complaint made against them, conducted an internal investigation and discovered why the error had been made. The physiotherapist corrected the error and described to the Complaints Director the changes that they have made to their practice as a result of the professional conduct process. This included more regular reviews of submissions to minimize the occurrence of billing errors.
The Complaints Director was satisfied that, despite there being strong evidence to support the allegation, the objectives of the professional conduct process were met. Those objectives are to determine what, if any, corrective action or restrictions must be put in place to ensure it is safe for the physiotherapist to continue working.
Key Message
It is important for any physiotherapist under investigation to realize that self-reflection and correction of errors or mistakes is an important component of the professional conduct process.
The College is mandated to ensure that the public receives safe and effective care from competent and ethical physiotherapists. The College is clear that this is different than a customer service complaint process where an individual may be unhappy with their care or service and are seeking resolution or compensation.
As evident in this case, even though there was strong evidence to support the investigated allegation, the actions of the physiotherapist mitigated the position of the Complaints Director when it came time to render a decision. The evidence did not support referral for a hearing tribunal, and the complaint was dismissed.
