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Conduct Matters: Informed Consent, a Basic and Fundamental Obligation

The Complaint

A patient submitted a detailed and broad complaint of unprofessional conduct against a physiotherapist. In summary, the patient attended physiotherapy for issues related to their back. The patient stated that they did not provide consent to the treatment techniques given by physiotherapist for the assessment and treatment of their neck. The patient stated that the physiotherapist provided treatment techniques in which they were not competent to perform, and as a result, that they suffered various physical complications and symptoms as a result of the neck assessment and treatment.

The Investigation

An investigation was conducted to determine if there was evidence supporting:

  • Lack of informed consent
  • Incompetent practice

Consent

  • Aside from a blanket consent on the intake form, there was no evidence to suggest that the physiotherapist had documented ongoing informed consent with respect to treatment of the cervical spine. It was not an isolated incident; it had occurred on multiple occasions with this patient.
  • Based on the findings of the investigation, the Complaints Director determined there was evidence of unprofessional conduct for failing to obtain patient consent.

Competence

  • The evidence did not support the allegations that the treatment provided was outside the physiotherapist’s level of competence, nor did the facts support that the given treatment resulted in an increase of the patient’s symptoms for the months following this specific treatment.

Attempted facilitated resolution

The Complaints Director determined that there was reasonable prospect of establishing the facts necessary to prove the allegations if the matter were to go to a hearing, however facilitated resolution was sought first. The Health Professions Act allows for the Complaints Director to resolve the complaint by way of facilitated resolution provided there is consent from both the complainant and the investigated member. The Complaints Director provided the patient with an overview of the issues that were to be addressed by way of an Agreement and Undertaking, however the patient did not consent to facilitated resolution therefore, the matter was referred to a hearing.

The Hearing

After considering the evidence, the Hearing Tribunal found that the physiotherapist did not meet the standard of obtaining and documenting the patient’s ongoing informed consent for the treatment provided to the cervical spine. The Tribunal determined that the breaches of the Standards of Practice and Code of Conduct in this case were sufficiently serious and constituted unprofessional conduct. The Hearing Tribunal found that the physiotherapist had breached:

The Hearing Tribunal’s decision on sanction were as follows:

  • The physiotherapist shall receive a reprimand
  • The physiotherapist shall pay a portion of the investigation costs
  • The following conditions are placed on the physiotherapist’s practice permit:
    • Completed one or more education module(s) that are satisfactory to the Complaints Director that address both informed consent and documentation
    • Reviewed the College of Physiotherapists of Alberta’s practice guideline on informed consent
    • Participate in three chart reviews over a period of 18 months to ensure compliance with both the documentation and record keeping, and consent standard.

These conditions were applied to the physiotherapist’s practice permit and were removed upon completion 18 months later. 

Page updated: 20/04/2022