Discipline Case Summary

The following is a summary of a matter placed before a four-member panel of the Discipline Committee of the College of Physiotherapists of Ontario on June 1, 1998.

An Agreed Statement of Facts was placed before the Committee.

Background Information

1. Mr. Z worked at the XXYYZZ, Toronto, from on or about June 1, 1996 to on or about February 1997. His hours at XXYYZZ were Monday to Friday from approximately 9:00 a.m. to approximately 6:30 or 7:30 p.m. Mr. Z was the only physiotherapist working at XXYYZZ during this time.
2. Mr. Z also worked part time at the ABC Rehabilitation Clinic, Mississauga, from on or about May 1996 to on or about January 15, 1997. His hours at ABC were Saturdays only from approximately 9:00 a.m. to approximately 2:00 p.m. He was the only physiotherapist working on Saturdays at ABC but other physiotherapists worked at the clinic on weekdays.
3. From on or about December 6, 1996 to on or about January 15, 1997 there was no physiotherapist working weekdays at ABC. Mr. Z continued to work Saturdays at ABC during this period.
4. Standards and Record Keeping
5. Some of Mr. Z's patients stayed on treatment longer than the course of treatment proposed to the insurer. In some cases, up to twice as long as the proposed course of treatment.
6. Mr. Z continued to treat patients who were referred back for physiotherapy by their physicians without regard to whether further physiotherapy was indicated for the patient. Mr. Z acknowledges that he courted too much weight to physicians' opinions in continuing to treat referred patients.
7. Mr. Z failed to perform indicated re-assessments or treatments or in the alternative, his charting is inadequate and largely illegible and does not reflect indicated assessments or treatments. For example, each chart entry is very similar to any other, both within the same chart and from one chart to another. Some patient charts did not contain initial assessment forms. Handwritten assessments which did exist often did not give specific treatment plans, but instead gave only the modality to be used.
8. Assessments were generally typed up at a later date in the form of reports to the insurer. These reports contained much more information than that on the handwritten assessments and contained general treatment plans. The typed version of treatment plans for patients were often very similar to each other.
9. Typed assessments often stated that the goal was to restore the patient's independent level of functioning to the pre-accident level, however, the patient's pre-accident level of function was not generally documented. Mr. Z states that whenever the reports are silent on a patient's pre-accident functioning, it was understood to mean that the patient had normal average functioning before the accident.
10. Where typed progress notes or re-assessments were made for the insurer, the detail in the typed version could not generally be found in the corresponding chart entry.
11. Parameters for modalities such as ultrasound and interferential current were often not documented in the patient's charts.
12. There was little or no evidence in progress notes that any of the treatment plans which had been proposed to the insurer had been carried out. There were often no list of specific stretches or exercises, numbers of repetition or duration of exercises in the progress notes.
13. There was no evidence of discharge planning other than that in typed reports to insurers when Mr. Z identified how much longer the patient may be on treatment.
14. Mr. Z did not keep an attendance register at either XXYYZZ or ABC. Patients signed a sign-in sheet at each visit.
15. At ABC, Mr. Z assessed or re-assessed patients, developed and instructed non-physiotherapy staff on standard treatment plans or protocols that would be administered by non-physiotherapy staff, and was available to answer questions for non-physiotherapy staff. Mr. Z assumed responsibility for the ongoing care of patients at the clinic from on or about December 6, 1996 to on or about January 15, 1997 when no other physiotherapist worked at the clinic. Mr. Z states that he was not aware of the fact that no other physiotherapist worked at the clinic during this time.
16. From on or about December 6, 1996 to on or about January 15, 1997 Mr. Z ought to have known that the non-physiotherapy staff at ABC chose what physiotherapy modality to use on patients and altered treatment plans without a re-assessment by Mr. Z. This activity by non-physiotherapist staff occurred on weekdays in Mr. Z's absence.
17. In the alternative, Mr. Z failed to make adequate inquiries regarding the activities of non-physiotherapy staff at ABC. Mr. Z agrees that he did not make any inquiries, as he assumed that the staff would have been properly supervised by other physiotherapists working from Monday to Friday.

Plea

Mr. Z pleaded guilty to professional misconduct under paragraph 25 of Section I of Ontario Regulation 861/93.

Decision

The Committee gave due consideration to the Notice of Hearing and the Statement of Agreed Facts and Joint Submission on Penalty, and found Mr. Z guilty of professional misconduct.

Penalty

Following a series of submissions on penalty, the Committee made the following Order:

1. That the Registrar suspend Mr. Z's certificate of registration for a period of sixty days to commence on a date that she fixes
2. That Mr. Z notify the Registrar of the College of Physiotherapists of Ontario in writing of his practice arrangements for a period of two years from today's date
3. That Mr. Z pay a fine in the amount of $500 payable to the Minister of Finance for Ontario within 120 days of this order
4. That after the registration suspension is complete, the Registrar is directed to impose as a limitation on Mr. Z's certificate of registration that he practice only under supervision for 1000 hours. The supervisor will evaluate Mr. Z's assessment and treatment of patients, record keeping and use of support personnel, and will provide reports to the College. The costs of the supervision are to be borne by the member to a maximum of $400 per evaluation
5. That there be four independent evaluations of Mr. Z's practice undertaken by a physiotherapist chosen by the College. These evaluations are to occur three months, six months, twelve months and eighteen months after the completion of his suspension, and the results of those evaluations will be provided to the Registrar and a copy to Mr. Z.
6. That Mr. Z provide to the Registrar proof of successful completion of the E2 E3 course

Costs

The Discipline Committee ordered that Mr. Z pay to the College of Physiotherapists of Ontario the sum of $1000 to help defray the cost of the investigation within six months of the date of this Order.