The Situation

Miranda is a physiotherapist working in a private clinic. She recently completed a spinal manipulation course where she learned about the indications, contraindications and precautions of performing spinal manipulation. Miranda had the opportunity to practice the technique on other learners under supervision and was evaluated by the course instructors. 

Miranda is anxious to try out the new techniques on her own with her patients. She has heard that she must roster with the College but is worried that if she does that, she will be more likely to be selected for a peer assessment. Since she is trained, and feels competent, she decides to go ahead using this technique when her patients would benefit from it.

A new PT starts at the clinic and is shocked to learn that unrostered members are performing rostered activities. She calls the College and makes a report about Miranda.

The Requirement

Under the law that governs health care delivery, spinal manipulation is a controlled act. Controlled acts are health care activities that can be performed only by people who have the appropriate legal authority. For physiotherapists this includes being listed on the College roster. Access additional resources related to controlled acts and rostering. 

Access additional resources related to controlled acts and rostering

The Consequences

Because Miranda is not yet rostered, she is not permitted to perform spinal manipulation unless she is delegated to perform the activity by someone who has the appropriate authority and will supervise her. 

In this case, she had just begun to perform the activity. When we called her to ask about it, we were able to confirm that her training met all of our expectations, she rostered immediately and the file was closed. If she had not properly trained, or if she continued to perform spinal manipulations without rostering, this report would likely have wound up before the Inquiries, Complaints and Reports Committee.

By the way—we were able to have the conversation with Miranda without revealing the source of our information. We are not always able to maintain confidentiality in cases like this one, but we will do so when possible. We believe that part of professionalism is guarding the profession by monitoring each other. Ideally, if you see something happening that doesn't seem right, you will speak with your colleague, but if that is not possible, or does not result in change, then it’s your duty (sometimes ethical, sometimes legal) to let us know about the problem.

The Regulated Health Professions Act (RHPA)

The Regulated Health Professions Act (RHPA) lists 13 Controlled Acts. 

Physiotherapists are authorized to perform 6 controlled acts—provided they are used to treat conditions within the scope of practice and according to the standard of practice of the profession. PTs must roster with the College before performing any of these activities (except communicating a diagnosis). 

These 6 acts are:

• tracheal suctioning 
• spinal manipulation 
• acupuncture (including dry needling)
• treating a wound below the dermis 
• pelvic internal exams (this includes putting an instrument, hand or finger, beyond the labia majora, or beyond the anal verge)
• administering a substance by inhalation