Case of the Month
The Case
The College received a complaint from the parent of a patient who received physiotherapy treatment after a car accident. The parent submitted the complaint after they received a call from the clinic telling them that their former spouse had cancelled all the patient’s future appointments. The complaint was made against the clinic owner, who is also a registered physiotherapist. In their response to the College, the clinic owner clarified that they did not treat the patient. The patient received care from another physiotherapist on staff, who was not named in the complaint.
The clinic owner noted that they were unaware of any separation or custody dispute between the parent and their former spouse. The parent who submitted the complaint did not share a custody agreement with the clinic, and there was no reason to believe the consent provided by the parent (acting as the substitute decision maker for the patient) was not valid.
The parent who made the complaint said that cancelling the remainder of the appointments would cause harm to the patient. According to the clinic owner, the parent used threatening and abusive language when communicating with clinic staff. In response, the clinic owner sent a letter to the parent that outlined the concerns with the parent’s behaviour, provided a discharge date for the patient, and listed alternative treatment providers.
The parent also claimed that the physiotherapist did not provide all of the requested clinical records, including a full list of past and future appointments for the patient. The clinic owner disputed this claim, and said they provided a complete copy of the clinical record, including the dates for all past appointments. However, the clinic owner noted that the clinic does not keep a record of cancelled appointments, so this information was not shared with the parent.
The Standards
According to the Health Care Consent Act (HCCA) and the College’s Consent Resource, if a patient is not capable of providing valid consent for the proposed care, a substitute decision maker can make decisions on their behalf. The HCCA also specifies that if “a treatment is administered to a person with a consent that a health practitioner believes, on reasonable grounds and in good faith, to be sufficient for the purpose of this Act, the health practitioner is not liable for administering the treatment without consent.”
In this case, the clinic owner was not responsible for obtaining consent for treatment they didn’t provide. Additionally, the parent indicated that they had the authority to provide consent for the patient, and there was no reason for the clinic owner to believe that custody was an issue. For more information about obtaining consent when custody is in question, be sure to read the College’s blog post Considerations for Obtaining Consent when Custody is in Question.
As outlined in the Providing or Refusing Care Standard, a physiotherapist can discontinue care if they believe the patient may become abusive. In this case, the clinic owner sent a letter to the parent that explained the concerns with the parent’s behaviour, communicated the intention to discharge the patient, and suggested alternative treatment providers.
The Record Keeping Standard states that it must be possible to retrieve and reproduce a complete clinical and financial record for each patient throughout the required retention period. In this case, the physiotherapist sent the clinical records to the parent by mail, free of charge, upon request. Regarding cancelled appointments, the standard does not require physiotherapists to keep an appointment schedule beyond the dates recorded in the clinical record.
The Outcome
After careful consideration, the Committee determined that the physiotherapist followed all the standards and guidelines regarding consent, providing or refusing care and record keeping. As a result, the Committee took no action with the complaint.
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