The Situation

The patient was concerned—really concerned. She said that when she booked the appointment she was told that her physiotherapist would be a registered PT named Monique. She was initially assessed by a second-year student, and assumed that she would receive her follow up treatments from the PT, but never did meet her. She was worried that her insurance company wouldn’t reimburse her for treatments provided by someone who was not registered. And, billing under someone else’s name didn’t seem right to her. When the College did its investigation, they spoke with PT Monique. She said that she had previously directly observed the student’s assessment and treatment skills and was satisfied with her knowledge and skills. Monique reported that she was in the building while the patient was seen, and was available for consultation. She reported that she discussed patients and their treatment plans with the student after initial assessments. She mentioned that she had discussed this patient’s treatment plan with the student on several occasions.

The Committee’s Decision 

After reviewing the facts, the Committee decided not to take remedial action, but offered the physiotherapist recommendations and advice in three areas: 

The importance of student learner supervision

The panel had concerns about the level of supervision the student received. Depending on the observed experience, knowledge, skills and judgement of a student, it may be appropriate for a student to undertake the care of a patient (given consent is obtained). However, there is an obligation for ongoing evaluation to ensure that the student’s performance meets generally accepted professional standards of practice. In this case, there was no evidence in the record that demonstrated that the supervision was ongoing. 

Appropriate billing

The patient believed that the clinic was not conducting its business “in an honest way” because the bills were submitted with the PT’s name, rather than the students. The Committee said that physiotherapists who are supervising a student assume professional accountability for all aspects of the care provided, as well as documentation and billing. However, the Committee suggested that the PT should be sure in future that she take the time to explain the billing practice to the patient to avoid confusion. It was clear this patient was not provided with enough information to make informed decisions about her care at the clinic.

The importance of getting informed consent

The Committee could not determine exactly what took place in the conversation between the patient and the student because they gave slightly differing accounts. However, the Committee did note that the record contained a signed consent form for care by “a healthcare provider” at the clinic, which the Committee found to be very vague. Unfortunately, there was no evidence in the record that the patient specifically consented to being treated by a student. 

The Committee said that in a situation where some or all of the care is to be provided by a student, this should be specifically discussed with the patient. It would have been reasonable for the PT to introduce herself and the student, and to have requested consent for treatment by a student. 

The Committee indicated that it was hopeful that the PT would incorporate all of its advice into her practice and that should the College receive a complaint, inquiry or report concerning this PTs practice in the future, any panel considering the complaint would be made aware of this case.

The Committee advised Monique to:

• Review the Standard: Supervision of Student Learners
• Make clear communications a priority and in the future, clearly explain to patients that that sessions will be billed using the PT’s name and registration number, even if the care is provided by a PT student. 
• Always provide patients with enough information to make informed decisions about his or her care.