Guide:
Sexual Abuse Standard

Because it is the law. The legal definition of sexual abuse, in the context of providing health care to patients, includes behaviour, remarks or touching of a sexual nature, as well as intercourse or other sexual relations.

As a physiotherapist, you are expected to maintain professional boundaries in all circumstances. This includes recognizing signs of a potentially inappropriate interaction and taking steps to deal with it, even when initiated by a patient.

These expectations exist to protect the patient, but they can also protect you.

Being found guilty of sexual abuse can result in the loss of your ability to practice as a physiotherapist. Colleges are required to take away your ability to practice if you are found guilty of sexual abuse.

Please refer to section 51(5) of the Health Professions Procedural Code, Schedule 2 of the Regulated Health Professions Act, for the mandatory penalties that apply for sexual abuse.

If your patient is making inappropriate advances, you cannot ignore the situation, even if it’s uncomfortable. Your patient could interpret your actions, or your inaction, as willingness to begin a relationship. Consider talking to a colleague or the Practice Advisors before having a respectful conversation with the patient.

Under Ontario law, an individual is considered a patient for at least one year after active treatment ends. However, the therapeutic relationship may extend beyond that year if there is still a risk of power imbalance or dependence.

Someone may still be considered a patient after one year if:

• You continue to play an ongoing role in their care decisions (even informally)
• The patient remains dependent on your knowledge, authority, or support
• The nature of the relationship creates a lasting influence or reliance, even without active treatment sessions

If any of these apply, the individual is still considered a patient and all professional boundaries and protections against sexual abuse are still in place.

For example, let’s say a patient came to see you after a serious motor vehicle accident. After 18 months of treatment, they are being discharged with a home exercise program. You are required to testify at a court proceeding related to the patient’s injuries. This court date could happen anytime in the next 12 months. The patient will remain your patient until your professional obligations related to the court date are finished.

No. Under Ontario law, physiotherapists must not provide treatment to anyone with whom they have a sexual relationship, including a spouse or partner.

For physiotherapists in Ontario, spouses and sexual partners are not exempt from the definition of sexual abuse. This means that if you attempt to treat your spouse or partner as a patient, it will be considered sexual abuse given the pre-existing sexual relationship you have with them.

The only exceptions are when care is provided in an emergency, or when care is minor in nature. In both cases, no fees can be charged.

• Emergency treatment means urgent, short-term care that cannot reasonably be delayed until another provider is available, and where no practical alternative for timely care is available. For example, offering first aid at the scene of an accident.
• Minor treatment means care that is brief, low-risk, and does not establish or continue a therapeutic relationship. For example, applying a bandage, giving quick advice on safe movement after an acute strain, or helping with positioning at home.

These exceptions are meant to ensure that spouses are not left without help in urgent or minor circumstances. They do not allow physiotherapists to take on their spouse or partner as a patient, provide ongoing care, or bill for services.

If you do need to treat a spouse or partner for the reasons outlined above, you must document what emergency assistance or minor treatment was provided.

Physiotherapists must always explain treatments clearly and obtain informed consent before proceeding.

However, some physiotherapy treatments involve areas of the body or techniques that patients may find intimate or sensitive, like treatment of the chest wall, gluteal muscles, or inner thigh. Patients also have their own boundaries for what they consider intimate or sensitive. In these situations, physiotherapists have an added responsibility to be especially clear, use plain language to describe the treatment and get the patient’s consent.

This includes explaining:

• What the treatment involves (the area of the body, the technique, and the purpose)
• Why it is clinically necessary and how it may help
• How privacy, draping, and consent will be managed so the patient feels safe and respected.

Clear explanations give patients a better sense of what will happen and why. Communication can help avoid misunderstandings and enable patients to give consent that is informed and meaningful.

A physiotherapist must never end a patient’s care in order to pursue personal interests such as a friendship, dating, or any other personal relationship. Doing so puts the physiotherapist’s needs ahead of the patient’s and compromises their care, which is never acceptable. The duty to provide safe, effective, and continuous care always come first.

The power imbalance between a physiotherapist and patient does not end when treatment does. By law, a person remains a patient for at least one year after active treatment ends. Any attempt to begin an intimate relationship during that time would be sexual abuse.

If you genuinely need to end a therapeutic relationship, such as if the patient requires services beyond your competence, the reason must be related to clinical care, not personal interest. Patients must never be put in a position where their access to care is compromised by the physiotherapist’s personal interests.

For more information about appropriately discontinuing care, please see the Duty of Care Standard.

Under the Regulated Health Professions Act (RHPA), it is sexual abuse when a health-care provider touches, behaves or makes remarks of a sexual nature towards a patient, as well as having physical sexual relations.

If you think a patient is being sexually abused, you need to make a mandatory report to the College. Reports must be made as soon as possible but no later than 30 days after the incident. Reports about physiotherapists can be emailed to investigations@collegept.org or submitted using this online form.

If you are unsure about these requirements, contact the Practice Advisors.

You cannot include the patient’s name in your report unless you have written consent from the patient or their representative. If you do not have consent, you are still required to make a report without the patient’s name.

The RHPA requires health-care providers to report when they have reasonable grounds to suspect the sexual abuse of a patient. There can be a $25,000 fine for anyone who does not report.

Let the patient know, early in the process and in plain language, that you are legally required to report sexual abuse by a regulated health professional to that professional’s College.

Explain that you need their written consent to include their name in the report. They may choose not to share their name, in which case you still must make the report. However, be clear to the patient that investigations may be limited without a patient’s name. For example, the College generally cannot review the provider’s chart/records or confirm details as easily without a name, which can make taking action more difficult.

Reassure the patient that their care with you will not be affected, offer to explain what happens after a report and connect them with supports.