The Minister’s Task Force on the Prevention of Sexual Abuse of Patients by Health Care Professionals and the RHPA – What’s It Got to Do with Me?
On September 9, the Honourable Dr. Eric Hoskins, Minister of Health and Long-Term Care, released the recommendations of the Sexual Abuse Task Force (SATF). These recommendations contain some groundbreaking changes to the way health care is regulated in the province. On December 8, Bill 87 was introduced in the legislature; if passed, the bill will implement many of these recommendations.
Optometry is fortunate that its members understand their responsibility to patients and to the public in general. While not perfect (no profession is), one can see how there might be a perception that sexual abuse is a problem given that optometrists spend most of their time with patients in closed rooms with the lights off. Happily, that is not the case.
The College has been asked why it has placed so much emphasis on the prevention of sexual abuse by practitioners. The short answer is this: society has a heightened awareness of which behaviours are appropriate in the context of a professional relationship, and which are not. Behaviours such as “locker room talk” might have been indulged or tolerated 15 years ago. No longer.
Mandatory Reporting So if sexual abuse of patients is not a big problem for the profession, how do these recommendations affect optometrists? One of a health care practitioner’s regulatory responsibilities is to file reports, whether to the government, another college, or another agency, when it is mandatory to do so. This includes reporting sexual abuse of patients. If a patient mentions to their optometrist that another health care professional (whether an optometrist, a physician, a chiropractor . . . anyone) has touched them inappropriately, made remarks of a sexual nature, or has been sexually inappropriate toward them, the optometrist MUST report that information to the registrar of the relevant health college. For the purposes of a proper investigation, it is best if the patient provides consent. But if the patient refuses, the obligation to report remains. To encourage reporting, the SATF is proposing an increase in fines for failure to report.
Definition of Patient–Practitioner Relationship The SATF has recommended that colleges determine if or when it is appropriate for a practitioner to have a relationship with a former patient; that is, what is the appropriate “cooling off” period after the professional relationship ends? This discussion may help members determine when it is that a person becomes a patient and when that patient is no longer. It is a question that all professions have struggled with for years, and the answer is different for each. For example, it is generally accepted that for practitioners who provide mental health/psychological services, it is never appropriate to have a personal relationship with a current or former patient. For others, including optometrists, there might be an appropriate length of time when the patient–practitioner relationship is no longer thought to exist.
Changes to Discipline Processes and Proceedings The SATF has proposed to strike a new agency that would hear complaints and, as a tribunal, conduct discipline hearings of cases of sexual abuse of patients by regulated health care practitioners. The members of the panel would not be health care practitioners themselves, but lay people with a mandate to consider these cases. The proposal also recommends increasing the number of situations that would result in mandatory revocation of a practitioner’s certificate of registration, as well as requiring mandatory suspension in other, less serious, cases. Under the proposal, patients would have access to college-funded therapy from the time the complaint is lodged; currently they may access funding only after the Discipline Committee has issued its decision.
What is the College Doing?
Taking Every Opportunity to Provide Feedback The Ministry’s proposed implementation of the SATF recommendations is a long and detailed process that will result in amendments to the Regulated Health Professions Act. The College, in collaboration with the other health regulatory colleges, will offer feedback on it.
Educating Members in Professional Boundaries The College's Patient Relations Committee is in the process of developing a one-hour online educational module for members. We expect it to be ready mid-2017. This module will help members to reflect upon, and understand, the responsibility to their patients when they embark on a patient–practitioner relationship. Blurring the lines between personal and professional is where problems occur. Ensuring that optometrists understand the power imbalance of the patient–practitioner relationship and keep their personal and professional lives separate is the key to eliminating any perception of inappropriateness.