Hearing Tribunal Decision
March 31
Allegations
- On or about January 16, 2023, Musni failed to perform dry needling in a competent manner to the patient, the particulars of which include:
- Musni assigned the monitoring and removal of dry needles from the patient’s body to an unregulated person and physiotherapy support worker (“PSW”);
- Musni left the Clinic shortly after inserting dry needles into the patient’s body;
- Musni was not physically present in the Clinic when the dry needles were removed from the patient’s body by the PSW;
- Musni did not document the administration and/or removal of dry needles, including the number of needles inserted in the patient’s body, prior to assigning the removal of the dry needles to the PSW.
- Between January 17, 2023 and February 7, 2023, Musni failed to adequately respond to an adverse event (a needle embedded in the patient’s arm/shoulder area), the particulars of which include:
- Musni did not document a telephone call with the patient where the patient advised Musni that the patient found a needle embedded in their arm/shoulder area, despite it being an adverse event arising from Musni’s physiotherapy services;
- on January 18, 2023 with further modifications on February 2, 2023, Musni prepared a chart note for the January 16, 2023 appointment with the patient after Musni was aware of an adverse event arising from Musni’s physiotherapy services.
Decision
The Hearing Tribunal carefully considered the submissions of the parties. The Hearing Tribunal determined that it would accept the Joint Submission on Penalty presented by the parties. The parties were advised at the conclusion of the hearing that the Hearing Tribunal accepted the joint submission on sanction.
Orders of the Hearing Tribunal
- 30-day practice permit suspension
- Review of the following:
- College’s Standards of Practice
- Code of Ethical Conduct
- College’s Restrictive Activities webpage, “Using needle in practice”
- Submit a written reflective essay entitled, "The Importance of Patient Safety: Performing Dry Needling as a Physiotherapist" to the Complaints Director
- Payment of costs
Decision of the Hearing Tribunal on allegations and sanctions (posted January 19, 2026)
Did the physiotherapy services provided lead to an Achilles tendon rupture?
April 1
Allegation
The patient attended physiotherapy services eight times over a three-month period.
The patient alleged that exercises prescribed by the physiotherapist and interventions used by the physiotherapist led to a ruptured Achilles tendon.
The College investigated the following allegation: the physiotherapy services provided resulted in a rupture to the patient’s Achilles tendon.
Investigation
The patient and the physiotherapist had very different recollections of the exercises prescribed, and the interventions utilized during the provision of physiotherapy services.
Review of the physiotherapy record and communication with the Clinic determined that no home exercises were prescribed by the physiotherapist.
The physiotherapy record documented the use of the following interventions: ultrasound to the Achilles tendon, shockwave to the calf muscle, and soft tissue release of the calf and foot.
Decision(Outcome/Recommendations)
The recollections of both parties were given equal weight in this decision as the conversations between the two parties were not recorded and fall under “they said/they said” evidence.
The physiotherapist provided their rationale for using each of the interventions utilized.
The entries in the physiotherapy record were unsigned drafts. The physiotherapist described their reasons for this. The physiotherapist and the Clinic confirmed that the physiotherapist did not edit the entries in the physiotherapy record after the complaint was made by the patient.
The patient attended physiotherapy services with another physiotherapist during the period they attended with the investigated physiotherapist. This physiotherapy record was also reviewed. There was no evidence in this physiotherapy record to support the allegation.
Ultimately, there was insufficient evidence to support referring the allegation for a hearing tribunal.
The Complaints Director recommended that the physiotherapist review and reflect on the Documentation Standard of Practice and ensure that they are meeting the physiotherapist performance expectations of this Standard of Practice.
Key Message
A common theme across conduct decisions relates to the signing or closing of the daily entries in the physiotherapy record in a timely manner. All physiotherapists should ensure that they are meeting the performance expectations of all the Standards of Practice. Entries in the physiotherapy record that are signed as close to the day the physiotherapy services were provided are considered accurate reflections of what occurred during the provision of physiotherapy services that date.
Distinctions between in-clinic and at-home exercises are important to make for your patients and within your documentation. There should be no confusion regarding which exercises were or were not prescribed for the patient when your documentation is reviewed.
Details Matter – Document Them
April 8
Allegation
The patient, a Workers Compensation Board (“WCB”) funded patient, reported to the College that the physiotherapist did not complete full assessments, used interventions that were not appropriate, and failed to address the patient’s reports of changing symptoms during the episode of care.
The College investigated the following:
- Did the physiotherapist conduct a physiotherapy assessment and arrive at a physiotherapy diagnosis based on the patient's presenting condition?
- Was the treatment plan including neck traction and weights consistent with the physiotherapy diagnosis?
- Was there evidence in the physiotherapy record that the physiotherapist monitored the patient's response to treatment, including and modifying interventions/approaches as required, and obtaining ongoing informed consent?
Investigation
Both the patient and the physiotherapist provided written submissions to the investigation. The physiotherapy record was reviewed as was all documentation submitted to WCB by the physiotherapist.
Decision
- The physiotherapy record documented an assessment occurred and a physiotherapy diagnosis was made based on the patient’s presenting condition. This was a complex patient with many different injuries and conditions to be addressed. While specific assessment of some body areas did not occur, the physiotherapist’s documentation showed that these areas were being addressed in a secondary way by other components of the treatment plan.
It was not clear from the physiotherapy record whether the physiotherapist discussed this with the patient.
- The physiotherapy record and the rationale provided by the physiotherapist supported the use of neck traction, both manual and mechanical, and weights as part of the comprehensive physiotherapy treatment plan proposed for the patient.
It was not clear from the physiotherapy record whether the physiotherapist discussed the specifics of the treatment plan with the patient. Informed consent for treatment was documented in each entry but no specifics regarding the consent discussions were documented.
- The physiotherapy record supported that the physiotherapist documented unique subjective data on each attendance, thus providing evidence that the physiotherapist monitored the patient’s response to treatment.
The physiotherapy record documented many instances of physiotherapy services being monitored and adjusted.
The physiotherapy record documented informed consent to treatment as a “tick box” and was lacking specific data surrounding consent discussions.
There was no evidence to support referring this matter for a hearing tribunal.
The physiotherapist was recommended to review their documentation practices regarding the depth of consent discussions and to reflect on how they communicate components of reporting to WCB and treatment plan rationale to complex patients.
Key Message
Physiotherapists are required to document that consent was obtained and document the relevant details of the consent process reasonable for the clinical situation.
To provide further clarity for the reviewer of the physiotherapy record, greater depth and detail is required to provide a fulsome summary of consent discussions. Tick boxes do not add that depth and detail and provide little evidence that the consent discussion was truly informed.
Title: Why documenting consent discussions is important
April 22
Allegations
The complainant alleged that the physiotherapist provided manual therapy services under their clothing without informed consent and that the physiotherapist maintained hand contact with their lower back during an exercise without informed consent.
The College investigated two allegations:
- On or about April 1, 2025, the physiotherapist touched patient the patient's buttocks under their pants, without the informed consent of the patient.
- On or about April 1, 2025, the physiotherapist maintained contact with patient The patient's lower back during an exercise without the informed consent of the patient.
Investigation
The investigation focused on submissions from both parties and a review of the physiotherapy record.
The parties’ recollections of events were divergent and were given equal weight in the proceedings.
Review of the physiotherapy record revealed that verbal consent was obtained via a check mark next to the words “Consent to Rx.”
Decision
Giving equal weight to the recollections of both parties, the physiotherapy record became the primary source of evidence in this matter.
Allegation #1
A key component of Allegation #1 is that the touching must be of a sexual nature, and the physiotherapist must take all reasonable steps to confirm the patient’s understanding of the service and its rationale if there is the potential for the service to be perceived to be sexual in nature.
The evidence collected supported that the manual therapy intervention utilized was appropriate for the presenting symptoms. The evidence did not support the detail or specifics of the consent discussions had with the patient.
The physiotherapist erred by not documenting the specifics of the consent discussions. Not all errors meet the definition of unprofessional conduct in the Health Professions Act. The Complaints Director determined that, regarding Allegation #1, despite this error, there was insufficient evidence of unprofessional conduct to refer this allegation for a hearing tribunal.
Allegation #2
The evidence collected supported an appropriate rationale for using hand contact as feedback during the exercise performed in this matter.
However, there was no documentation to support this rationale was communicated to the patient. The physiotherapist stated that they believed implied consent existed as the patient had performed the exercise previously. Given there was a change in how the exercise was performed in the clinic, the Complaints Director believed the physiotherapist erred by not documenting this rationale and the specific consent of the patient for the appropriate contact.
Recommendations
The Complaints Director recommended that the physiotherapist reflect on the amount of detail they are documenting regarding their consent discussions and that the physiotherapist review the entirety of their consent process to ensure that they are meeting the physiotherapist performance expectations of the Informed Consent Standard of Practice.
Neither allegation was referred for a hearing. The complaint was dismissed.
Key Message
It is critical that physiotherapists accurately and completely document informed consent. The Consent Standard of Practice specifies the performance expectation that the physiotherapist “documents that consent was obtained and relevant details of the consent process reasonable for the clinical situation.”
The physiotherapist was correct when they stated that informed consent can be written or verbal. However, while the law does not generally require “written consent”, a consent form signed by the client provides evidence that consent has been obtained. If a physiotherapist chooses to accept verbal consent for physiotherapy services, they must document in the treatment record that verbal consent was received and the relevant details of the consent process.
Physiotherapists are advised to document the consent process including the information provided to the client and when/how consent was obtained. In accordance with the Consent Standard of Practice, a simple check box indicating that consent was received is not sufficient to fulfill the performance expectation as such consent documentation does not provide sufficient detail regarding the anticipated benefits, risks disclosed, and client questions discussed. Neither a check box nor a signed consent form signifies that a detailed informed consent discussion occurred.
In this case, the physiotherapist erred by not documenting specifics surrounding the consent discussions.
“They said / they said” between two colleagues
April 22
Allegation
The complainant alleged that the physiotherapist was not respectful during a telephone conversation about a mutual patient and made comments that could reasonably be perceived as unprofessional or discriminatory.
The allegation related to the following ethical responsibilities from the Code of Ethical Conduct. Members of the physiotherapy profession have an ethical responsibility to
- Conduct and present themselves with integrity and professionalism.
- Act honestly, transparently and with integrity in all professional and business practices to uphold the reputation of the profession.
- Refrain from harassment, abuse or discrimination of colleagues, employees, or students.
Investigation
The investigation received submissions from both parties.
Neither party recorded the telephone call. Thus, there was no direct evidence of the conversation.
The complainant did make notes about the call immediately following the conversation. The physiotherapist did not provide the investigator with any such documentation. Contemporaneous documentation, or notes made immediately following an interaction are considered to provide greater evidence of the conversation than recalling the conversation weeks or months after the fact.
Decision
Both parties agreed on the following:
- that the conversation occurred and was about a patient.
- Both parties agreed that the physiotherapist asked the complainant to speak “slowly.”
- Both parties agreed that there were offers and requests to exchange email communications.
- Both parties agreed that the physiotherapist asked the complainant where the complainant was from and where the complainant studied physiotherapy.
The physiotherapist admitted in their submissions that they “...did vent a little bit during the call.”
There was some evidence to support the complainant’s version of events documented in an internal incident report they submitted to their employer prior to making their complaint to the College.
As the conversations between the two parties were not recorded in real-time there was no documentary evidence the College could obtain to support or refute the allegations. The information collected by the investigator therefore relies heavily on the two parties’ submissions which is “they said/they said” and cannot be substantiated.
Considering the contemporaneous documentation of the complainant via the notes taken immediately after the conversation with the appropriate weight, there was insufficient evidence of unprofessional conduct as defined by the Health Professions Act to provide the Complaints Director with a reasonable prospect of establishing the facts necessary to prove the allegation before a Hearing Tribunal.
The Complaints Director did not refer the allegation for a hearing tribunal.
Recognizing that the complainant has voiced concern about the physiotherapist’s communication, and that the physiotherapist admitted they expressed opinions that they described as “venting” to a person they had just met, the Complaints Director encouraged the physiotherapist to use this complaint process as a reminder to always be mindful of the language they use when communicating with clients and others.
Key Message
All physiotherapists should always be mindful of the language they use when communicating with clients and others.
The importance of consent documentation
May 5
Allegation
The patient attended physiotherapy services once with the physiotherapist.
The patient alleged that a person other than the physiotherapist participated in their physiotherapy services by putting gel or lotion on the patient’s back without the patient’s consent.
The patient also alleged that they did not provide consent to the use of gloves, gels or lotions as part of their physiotherapy services.
Following their physiotherapy services, the patient noted a redness on their back that they attributed to the gel or lotion used at their physiotherapy appointment.
The College investigated two allegations:
- The physiotherapist failed to obtain informed consent from the patient for the use of another person (PT or PT Support Worker [PTSW]) in the provision of physiotherapy services, specifically manual therapy (massage).
- The physiotherapist failed to obtain informed consent from the patient for the use of disposable protective gloves and/or a topical product on the patient which resulted in, but may not have been limited to, redness of the skin on the patient's thoracic spine.
Investigation
As is the case in almost all professional conduct matters, the patient and the physiotherapist had very different recollections of the events on the day in question.
Thus, the key evidence collected by the investigator was the physiotherapy record and an interview with the person who applied the lotion to the patient. This person was an employee of the clinic at which the services were provided and typically provided administrative services but described themselves as acting as a PTSW when needed.
The physiotherapy record documented consent was obtained. There were no specific details of what was discussed and what specific consent was obtained.
The physiotherapy record also documented no known allergies or skin conditions. This was documented on a form completed by the patient and on the physiotherapist’s assessment form.
The products used during the provision of physiotherapy services were Pro-Medix Multipurpose Ultrasound Gel and Biotone Advanced Therapy Massage Lotion. The patient, the physiotherapist, and the PTSW confirmed that these were the products used.
The PTSW was not able to provide any evidence or independent recall regarding any consent discussions that occurred between the patient and the physiotherapist.
The PTSW stated that they were instructed by the physiotherapist to put lotion on the patient’s back and to tell the patient that the physiotherapist would then be in to do manual therapy. The PTSW stated that they informed the patient of what they were doing. The PTSW stated that when they applied the lotion, the patient got upset and got up from their prone position on the bed and immediately wiped the lotion off their back.
Decision
The Complaints Director gave the recollections of the patient and the physiotherapist equal weight in this decision.
Allegation 1
There was no documentation to support the use of a PTSW was agreed upon by the patient. The physiotherapist stated that they did inform the patient that they might use a PTSW in the provision of physiotherapy services and that the patient consented to this. The Complaints Director felt that using a word like might was not definitive and did not inform the patient fully. The Complaints Director believed that this was an error on the part of the physiotherapist but that this error did not rise to the level of unprofessional conduct as defined by the Health Professions Act. The Complaints Director recommended that the physiotherapist reflect on their choice of words when having consent discussions with patients and reestablish informed consent when treatment plans change especially when involving a PTSW. The Complaints Director also recommended that the physiotherapist document the specific details of all consent discussions.
The physiotherapy record documented that the physiotherapist tried to manage this challenging and unexpected situation after the fact. The patient was upset and left the clinic soon after the encounter without any resolution of the matter with the physiotherapist.
The physiotherapist documented their actions following the unexpected response of the patient which assisted the Complaints Director in determining what occurred.
Allegation 2
The Complaints Director considered that written consent and documented consent for the use of gloves, gels, and lotions is not standard practice by physiotherapists. In the Complaints Director’s experience, given that the patient and the physiotherapist identified no known allergies or skin sensitivities existed, a verbal discussion of the use of gloves, gel or lotion was reasonable, and specific documentation was not necessary regarding consent for the use of these products. The physiotherapist stated that a verbal discussion did occur. The patient stated it did not. Given the lack of evidence, the Complaints Director did not believe that Allegation #2 could be proven for a hearing tribunal. The Complaints Director recommended that the physiotherapist reflect on the amount of detail they document regarding informed consent and modify their practice accordingly.
The complaint was dismissed.
Key Message
All physiotherapists should ensure sufficient details are documented about their consent discussions particularly when involving a PTSW.
As treatment plans change, particularly when something changes from possibly occurring to definitely occurring, physiotherapists must provide explanations and opportunities for questions and discussion and then re-establish and document informed consent.
Physiotherapy Support Workers – Informed Consent and Assignment of Tasks
May 14
Allegation
The patient submitted a written complaint following the patient experiencing an increase in symptoms and a reduction in function after receiving physiotherapy services from a physiotherapy support worker (PTSW) and after receiving dry needling intervention from a physiotherapist.
The College investigated two allegations:
- The physiotherapy support worker ("PSW") supervised by the physiotherapist performed manual therapy on the patient that resulted in increased symptoms and decreased function for the patient.
- The physiotherapist used needles in practice without the patient’s consent resulting in increased symptoms and reduced function for the patient.
Investigation
Regarding Allegation 1, the investigation focused on:
- the informed consent process for the use of the PTSW in the provision of physiotherapy services.
- The manual therapy performed by the PTSW.
- The assignment of the manual therapy performed by the PTSW by the physiotherapist.
- The assessment and management of the patient following the patient’s reported increase in symptoms and reduction in function.
Regarding Allegation 2, the investigation focused on:
- The informed consent process for the use of needles as a physiotherapy intervention.
Decision
The patient, the physiotherapist, and the PTSW had distinctly different recollections of the events surrounding the provision of physiotherapy services in this matter. This affected the Complaints Director’s confidence in the strength of the available evidence.
Allegation 1
The physiotherapy record did not clearly document informed consent was given by the patient for the involvement of a PTSW in the patient’s care except for the date in which the manual therapy was performed by the PTSW. All the parties agreed that the PTSW was involved in the provision of physiotherapy services prior to this date.
The patient, the physiotherapist, and the PTSW all described how the PTSW was used during the provision of physiotherapy services. This use was primarily in supervising the patient’s performance of exercises and adding and removing exercises from the patient’s routine when assigned this task by the physiotherapist.
The patient described the manual therapy they recalled the PTSW performing with them.
The physiotherapist and the PTSW described the manual therapy as an assisted figure four stretch for the piriformis.
The patient stated the manual therapy was done a week before the physiotherapist and the PTSW recalled it being performed.
The physiotherapy record supported the physiotherapist and PTSW’s version of events for the date the manual therapy was performed and the patient’s response to the manual therapy.
The physiotherapist described the steps they took prior to assigning the manual therapy to the PTSW to ensure the PTSW was competent to perform the manual therapy.
Given the above, the Complaints Director did not believe the available evidence supported referring Allegation 1 for a hearing.
Based on the Complaints Director’s opinion that the physiotherapist erred by not documenting informed consent for the involvement of a PTSW in the provision of physiotherapy services as soon as those assigned services occurred, the Complaints Director recommended that the physiotherapist reflect on their documentation practices regarding the use of a PTSW and ensure that the documentation practices align with the stated Standard, Expected Outcome, and Performance Expectations of the Documentation Standard of Practice and the Supervision Standard of Practice.
Allegation 2
There were no witnesses to the informed consent discussions regarding the use of needles as a physiotherapy intervention in this matter.
The Complaints Director gave both the patient’s recollection of events and the physiotherapist’s version of events equal weight in the decision.
The physiotherapy record documented the following regarding informed consent for the use of needles as a physiotherapy intervention.
The College recommends but does not require that written consent be obtained for the use of needles in practice.
The physiotherapist noted that, because of their self-reflection as a result of this complaint, they have modified their practice to include written consent for the use of needles as a physiotherapy intervention.
Given the lack of evidence to support the allegation, the Complaints Director did not refer Allegation 2 for a hearing.
Key Message
The details of informed consent processes and discussions must be included in the physiotherapy record to support the physiotherapy services provided by physiotherapists and PTSWs.
If you are assigning portions of physiotherapy services to PTSWs, ensure that your documentation meets the performance expectations of the Documentation Standard of Practice to support your use of the PTSW.
Title: Pneumothorax with dry needling
May 14
Allegation
The patient had a long-standing therapeutic relationship with the physiotherapist.
After receiving their typical physiotherapy services, including dry needling, the patient began to experience unexpected symptoms of difficulty breathing and thoracic pain.
The patient attended the emergency department and was diagnosed with pneumothorax. The patient was managed medically and discharged.
The patient informed the physiotherapist of the adverse event at their next, regularly scheduled physiotherapy appointment.
The patient submitted a written complaint to the College on the advice of the emergency department staff.
The College investigated the following allegation:
- The physiotherapist failed to safely and effectively administer dry needling with the patient, resulting in a pneumothorax.
Investigation
The investigation heard from the patient in this case that the physiotherapist had informed the patient of the risk of pneumothorax with dry needling, the typical signs and symptoms of pneumothorax, and what to do if a pneumothorax was suspected.
The patient stated that they knew to attend the emergency department because of the informed consent discussions the patient had with their physiotherapist.
The patient also stated that they would not have filed a complaint with the College had the patient been told a formal professional conduct process would be conducted prior to submitting the written complaint.
The College investigated the physiotherapist’s rationale for using dry needling as a physiotherapy intervention with this patient, the content of the informed consent discussions with the patient, how the physiotherapist performed the dry needling used, the management of the adverse event by the physiotherapist, and the practice changes made by the physiotherapist as a result of the adverse event experienced by the patient.
Decision
There was no evidence of unskilled or unprofessional conduct in this matter.
The physiotherapist and patient agreed that informed consent discussions included the risk of pneumothorax and what the patient should do if they experienced any typical symptoms of pneumothorax.
The physiotherapist identified that they did not educate the patient about atypical symptoms of pneumothorax. The physiotherapist reported that they now include these symptoms as part of the informed consent discussions with patients: shortness of breath (dyspnea), change in respiratory movements (affected side), sudden sharp chest pain, increased neck vein distension, weak and rapid pulse, fall in blood pressure, dry hacking cough, shoulder pain, and that sitting upright is the most comfortable position.
The patient stated that they did not contact the physiotherapist to discuss their post dry needling symptoms because they knew the physiotherapist was away and that the patient knew to contact Health Link or the emergency department for guidance and management.
The patient stated that they continued to trust their physiotherapist and wanted to remain in a therapeutic relationship with their physiotherapist despite experiencing a pneumothorax.
The physiotherapist described safe and effective dry needling practices.
The physiotherapist described their management of the adverse event experienced by the patient in this case.
The physiotherapist described changes that they have made to their practice as a result of this matter including a review of their practice of dry needling, discussions with mentors, and refinement of their informed consent practices.
Given the above, the Complaints Director’s opinion was that there was no evidence of unprofessional conduct in this matter. The complaint was dismissed.
Key Message
This matter is an excellent example of a case when a special risk associated with a restricted activity occurs. All physiotherapists that perform restricted activities are expected to do the following:
- Perform restricted activities that they are competent, authorized, or supervised to perform, in accordance with the Standards of Practice.
- Assess the risks and benefits associated with the activity and communicate these to the client to obtain the client’s informed consent prior to performing the restricted activity.
- Establish critical event management plans related to potential adverse events associated with restricted activities and routinely review these plans with other staff within the practice environment.
Working in a culture committed to patient safety involves meeting the above performance expectations and taking responsibility for your actions through self-reflection and practice improvement.
If you practice dry needling, consider how you would have managed and reacted to a similar complaint made by a patient that continued to trust and value your services as their physiotherapist.
