Holding Out Doesn’t Get You Anywhere

The Case

The College received a complaint from a patient who attended several physiotherapy sessions at a clinic. The patient was under the impression they were being treated by a physiotherapist, however the person providing treatment was actually a physiotherapist assistant (PTA). The patient believed the PT was helping the PTA to “hold out” or present themselves as a physiotherapist.

The patient noted that their first few sessions were with the physiotherapist, but the PTA stepped in to provide treatment when the PT was unavailable and then continued providing treatment for the remainder of the sessions.

The physiotherapist never explained that a PTA would be involved in the patient’s care, so the patient assumed they were being treated by another PT.

The patient worked at a fitness facility near the clinic and started referring clients to the “physiotherapist” they were seeing. The patient did not realize that the individual was not a PT until a client mentioned an invoice that listed the name of a different physiotherapist and the PTA as a kinesiologist.

Other patients reported that their assessments were conducted by the PTA, invoices were either not provided or listed the name of another PT who they never met, and that the PTA presented themselves as a physiotherapist.

In their response to the College, the physiotherapist denied that they had any intention of helping the PTA to holding themselves out as a PT.

Although the physiotherapist acknowledged that they were not present for some of the assessments, they said they met with the PTA afterward to discuss and interpret tests and measures and form a treatment plan. The physiotherapist said they were always responsible for finalizing treatment plans.

They also acknowledged how patients were likely misled by the situation and that the PTA’s name and title should have appeared on all invoices.

The Standards

Physiotherapists often utilize PTAs to assist in the delivery of physiotherapy care. The requirements when working with physiotherapist assistants are detailed in the Working with Physiotherapist Assistants Standard.

Physiotherapists are required to assess each patient to establish a diagnosis, and determine treatment goals and a plan of care before assigning aspects of that care to a PTA. Once assigned, the physiotherapist is required to provide supervision of the treatment and continues to be responsible for the patient. A physiotherapy assessment is evaluative in nature and PT’s are not permitted to assign any physiotherapy intervention that has an evaluative component to support personnel.

The standard also requires that physiotherapists obtain consent from patients for the involvement of a PTA in the delivery of their physiotherapy care. Physiotherapists are required to explain the relationship between the physiotherapist and the PTA for the purposes of clarifying their individual roles and responsibilities in the assessment, reassessment, and progression of the physiotherapy treatment plan.

The Restricted Titles, Credentials and Specialty Designations Standard specifies that it is illegal for anyone who is not registered with the College to use the title “physiotherapist.” The standard further dictates that registrants of the College must not help non-registrants to “hold themselves out as” (claim to be) physiotherapists.

The Outcome

A Committee at the College makes decisions about these cases. The Inquiries, Complaints and Reports Committee (made up of PTs and members of the public) will decide if the matter should be referred to the Discipline Committee for a public hearing or if some other action is reasonable.

Given the situation what do you think is a fair outcome? Comment with your recommendation from the options listed below.

a. The Committee should take no action

b. The Committee should require the PT participate in a Specified Continuing Education and Remediation Plan (SCERP) to address these concerns

c. The Committee should require that the PT receive a caution that will appear on the Public Register

d. The Committee should refer this case to the Discipline Committee

Working with Physiotherapist Assistants Standard

Restricted Titles, Credentials and Specialty Designations Standard