The Case

The College received a complaint from a patient who attended physiotherapy appointments for a couple of months following a knee injury. A typical appointment for the patient included exercises in the open gym area followed by electroacupuncture in a private treatment room. The patient noted that electroacupuncture typically lasted for 15 minutes and the physiotherapist would check on them halfway through.

During one appointment, the patient was moved to the private treatment room following the exercises. The physiotherapist applied two needles on either side of the kneecap, left the treatment room and closed the door.

Nobody checked on the patient after approximately 35 minutes. The patient yelled out for help, but still nobody came. The patient had not been given a call bell or another way of calling for help during treatment.

Twenty minutes later, a staff member at the clinic opened the door to the treatment room and was surprised to find that the patient was still there. The staff member told the patient that they were locking up for the night and that the physiotherapist had already left the clinic. The staff member removed the needles from the patient’s knee, and the patient left the clinic.  

Shortly after, the physiotherapist called the patient to let them know that they had left the clinic due to a family emergency and advised the patient not to remove the acupuncture needles as the PT was on their way back to clinic to remove them. The patient mentioned that another staff member had already removed the needles.

The patient experienced pain in their knee that subsided after a few hours and did not experience any further complications. The patient felt that the physiotherapist did not make enough of an effort to apologize for leaving the clinic abruptly during treatment and did not follow up after the fact to make sure the patient was ok. The patient cancelled the remainder of their physiotherapy appointments and did not return to the clinic.

The Standards

Unfortunately, this is not the first time that the College has featured a case like this. Emergencies happen and there will always be situations where physiotherapists need to leave the clinic abruptly and possibly in the middle of a treatment session. However, even in these unexpected moments, physiotherapists still have professional and ethical obligations to their patients. At a minimum, the physiotherapist should have notified another staff member that they were leaving, and a patient was still present at the clinic.

Patient safety is a basic, entry to practice competency for physiotherapists. In this case, the physiotherapist acknowledged that the patient was left alone in a private space, with the door closed and no way to contact someone if an adverse event occurred. The College recently spoke about the importance of using a call bell in a blog post. A call bell, or anything that can get the physiotherapist’s attention, easily connects the patient and PT and gives the patient the confidence that they can get help when needed. Not having this option may negatively impact the therapeutic relationship or lead to a traumatic experience for the patient.

Additionally, according to the Controlled Acts and Restricted Activities Standard, physiotherapists are not permitted to delegate acupuncture to another health professional. Even if the PT didn’t intentionally delegate the removal of the needles to another staff member, it is essentially what happened.

Finally, the patient noted that the physiotherapist did not apologize or take accountability for leaving the patient unattended at the clinic. While physiotherapists are not professionally required to apologize for a misjudgment or error, the College does expect physiotherapists to listen to patient concerns and to show basic courtesy in their communications with patients, as outlined in the Six Keys to Communication resource. An apology can go a long way and according to Ontario’s Apology Act, apologizing for something does not make a person liable under the law. Offering an apology however may lead to the PT and patient resolving the situation without a formal complaint.

The Outcome

This case highlights serious concerns with patient safety, performing controlled acts and communication. As a result, the physiotherapist was required to complete a Specified Continuing Education or Remediation Plan (SCERP) and they received a caution. The costs of the SCERP were paid by the physiotherapist and the caution will be listed on the Public Register permanently.

Essential Competencies for Physiotherapists

Controlled Acts and Restricted Activities Standard

Six Keys to Communication

Call Me: The Importance of Using a Call Bell