The Situation

June couldn’t believe it. Her husband, Joe, had received a third-degree burn from a hot pad applied during physiotherapy treatment and when they told the physiotherapist of the injury, he didn’t even seem to care. So she complained to the College.

The PT reported to the investigator that with Joe’s consent, he applied a hot pack to his shoulder. He said that he had asked Joe if the temperature was comfortable and he confirmed that it was.

The PT reported that he did not detect any redness on Joe’s shoulder following the treatment. He said he performed manual therapy techniques and applied Interferential Current (IFC). He then instructed an assistant to apply electrical muscle stimulation.

When asked by the College investigator for his records to verify these details, it came out that the PT had minimal documentation of the visit.

What happened next and what did the Inquiries, Complaints and Reports Committee do?

Joe's burn was acknowledged by the patient, his wife, the PT, Joe’s doctor and the Inquiries, Complaints and Reports Committee (ICRC). However, there were opposing views as to the where and how Joe had been burned. It’s a common scenario, often seen at the College in complaint cases, where the Committee is faced with two opposing views of the same event.

In situations like these, the ICRC looks for corroborating information—this might be a witness or physical evidence. But the Committee always looks to the PT’s records to see what information they provide to confirm or contradict either party’s version of events.

In this case, in addition to the statements from the PT, Joe and his wife, the Committee also had a photo of the patient’s injury and a note from Joe’s doctor reporting a third degree burn. The Committee observed that the records didn’t show that the PT had conducted appropriate skin sensitivity testing or had had any discussions with the patient about his comfort during the treatment or the subsequent report of the burn.

In the absence of anything in the record that might have been helpful, the ICRC looked at the photo of the burn and considered the clinical circumstances. They found that though rare, burns are a known risk of both hot packs and IFC. Photographs of the burn showed a red square on the skin that the Discipline Committee determined to be consistent with a burn caused by IFC, rather than the heat the patient had used at home or the hot pack.

The Consequences

Based on their finding that the burn had happened at the clinic, the ICRC recommended that the PT:

• Incorporate appropriate skin sensation testing techniques in his practice.
• Have a more responsive and proactive approach to adverse reactions to ensure patient confidence and safety.
• Consider the importance of documentation and record keeping.