Scene 1: You assessed your patient and made a plan that included having her walk with a walker. But one day, in your absence, your support person independently decides that the patient is ready to use a cane instead. This was really bad judgement. Now the patient has fallen and broken her hip. Are you responsible?
Maybe. One of the questions we would ask is whether you knew that your support person might make an independent treatment decision.
Scene 2: Your support person sexually abused a patient. Are you responsible?
Maybe. The College would want to know whether there were any hints that the person was likely to behave inappropriately and whether you had taken the right actions to correct it.
We know that you want clear answers from us, but in these situations it’s impossible. Our investigation would involve the questions posed above and more. Every situation has to be evaluated in its own context. The bottom line is that you, the PT, are responsible for decisions or actions taken by a support person acting under your authority. And, patients have a right to expect to receive care that is just as good as if you had delivered it yourself.
So, if you aren’t sure whether your support person has the knowledge, skills and judgement to carry out your treatment plan, you’d better train that person and supervise them until you are sure.
If your employer hired someone whose work you would not want carried out under your name, make your objections loud, clear and official. If you have observed any questionable ethical behaviour on the part of someone working for you, take steps to ensure it doesn’t happen again. If you think your PTA shows questionable clinical judgement, you must give very clear instructions, including direction about the limits of their decision-making authority.
On the other hand, if you are thoughtfully and appropriately using support persons to make certain that you can deliver safe and effective care to as many patients as possible, thank you on behalf of all of us PT patients across Ontario.
You may be aware that Council approved putting more information about PTs on the Public Register at its meeting in December 2014. One of the things that will now appear on the Register, starting July 1, 2015, is whether you work with support personnel. This was a tough decision for Council and the subject of a long debate. Ultimately, they decided to go ahead because patients are entitled to know who is delivering their care and because Council is hopeful that having the information on the Public Register may help to remind all PTs that this is another area where quality practice is very important to the College.
We know that support personnel are a necessary and often a valuable addition to PT practice today. We will be putting lots of background information on our website so that patients understand more about these practitioners and what to expect from a PT who uses support personnel.
In the meantime, you should use your good judgement to determine whether the support personnel that you work with need closer supervision, better training or a narrower range of assigned tasks.
Do you use support personnel? How do you ensure that they deliver the same quality of care as you would yourself? We want to hear from you.