My support person hurt someone. Am I in trouble?

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.

19 thoughts on “My support person hurt someone. Am I in trouble?

  1. The CPO has taken a big step against the profession by mandating the PTA use to be published on the public register. Does the CPO not trust their own registrants or their judgement? If that is the case, the day is not far when the CPO would ban the PT use of PTA’s. This is a stride backwards pushing the profession into darkness!

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  2. I agree, the PTA supervision has always been adequate. The College just wants to keep changing things for no reason. Now the PT’s will fight to work without PTA’s. PT salaries will also suffer as employers would be forced to hire more PT’s.

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  3. I prefer to work without PTA’s if we work at non physio-owned clinics as assistants could have conflicts of interest. They abide by the policies of the business rather than college rules. Right infront of my face I saw how our boss sway PTA students and PTA’s to ignore PT’s.

    PTA’s = more profit for the non-PT employers = more business = more tax dues given to the government. No, I don’t think the college would ban PTA’s (are you kidding me?) but will incriminate PT’s when there are complaints on use of PTA’s. Unethical business practices continue to fluorish as they help with economy while poor PT’s are just statistics who unfortunately at the wrong place and time….

    Just think about this: Are there Chiro Assistants? Are there Osteopath Assistants?, etc.? PT’s should start thinking about the future. I had more work when I utilized assistants. Maybe it’s just me?

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    • I believe it might just be you!

      PTA supervision is still the PT’s responsibility. I don’t know what clinic you are speaking of, but I would have spoken up there and then as the PTA actions are your responsibility. The CPO’s job is to create standards which they have for PTA supervision. If some PT’s have a problem following them, the individual PT should be disciplined by the CPO, not the entire profession!

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    • How long can a one man army survive ? I m the only PT in a LTC of 250 beds, expected to meet college + ministry + organization standards !! It is practically impossible to work without PTAs in this setting 😦

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      • I totally understand this frustration! it is not an easy task, someone has to do it because our seniors/geriatrics population need someone to take care of them as well!! It would be unfair if PTs quit working in LTCs (as someone has suggested in one of the blogs) saying that the caseload is too heavy! There may be a “lot of jobs out there” (as mentioned in another blog) for PTs but what about the geriatric population?

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    • Regarding PTs working in the community: in wake of recent changes to OHIP funded PT services, PTAs go for home visits all by themselves via home care companies. Isn’t that a risk to public safety esp when there is no on site supervision by PT? What say does the college have on it? Or are they simply washing off their hands saying it is PT’s responsibility ?
      I strongly believe that American PTs r better off as the PTAs r regulated there !!

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      • I’m not a fool to train someone who is not qualified to prescribe exercises, apply electrical modalities, tape or measure assistive devices, etc. I will do it myself before they take my job for good and put the public at risks. So, PT’s let’s get up on our seats and do the job ourselves. If there’s too many patients or residents for you in that workplace, there are other jobs out there. If PTAs can do the job, I can’t blame these employers if they replace you. We ought to act like we are (AND WE ARE) irreplaceable.

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      • in response to Anonymous
        January 22, 2015 at 7:45 am -for some reason there is no direct link to reply to this msg.

        looks like you misunderstand the difference between PT and PTA. PTAs at no cost should be “trained someone who is not qualified to prescribe exercises, apply electrical modalities, tape or measure assistive devices, etc”
        ABSOLUTELY NOT!! these are all the tasks that are exclusive to PTs only!
        Its all about delegating tasks to trained and individuals (known as PTAs)whose competency has been tested by PTs.

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  4. Good start to new year. This might be the only good decision college might have taken to protect the public in recent years. Not to forget that this decision will not make any difference for few years in how physiotherapy is being practiced in Ontario. The way PTAs utilized in Ontario is completely different than any other province. Because of this type of practice most people think physiotherapy as machines and hot packs. Let me tell you how?

    In Ontario, non Physiotherapy Clinic owners hire more PTAs to work under one PT. This believed to improve revenue for most clinics (where new clients are referred through definite sources such as Doctors, lawyers etc.). PT might be working two to three days a week in such places. Usually PTAs run the show for rest of the week. Of course, PT is afraid from suggesting complicated part of therapy such as mobilization, goals oriented exercises etc. in a care plan as he or she knows that PTAs are not educated enough to carry out these treatments. So, patients are getting modalities, heat packs and ice packs. These clinics do not bother if a patient or two did not like their lower quality treatments because they have abundant supply of patients through their sources mentioned above. Most patients think that this (modalities and heat/cold pack) might be the best treatment for them (as it is suggested by a physiotherapist) and they quietly receive it until their insurance coverage runs out. Patients than blame physiotherapy by saying that it did not help. No wonder!!! THIS IS NOT AN ASSUMPTION. IT IS MY EXPERIENCE OF OVER TEN YEARS PRACTICE IN ONTARIO. I know that lots of physiotherapists will agree with me on this.

    I do not have any immediate hope of improvement from this decision. Certainly, it should make some difference in long run.

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  5. I don’t understand your comment (and it’s you, not me.) Can you or anyone who understand your post explain? If a PT has a problem following the college (s)he have to be disciplined and not the entire profession? What are you talking about??? Did you read what Shenda wrote? We are only held liable if we knew that PTA’s have a tendency to not listen to our directions, otherwise PTA’s are held responsible. Fine. But If you care enough to comb through the work of your assistant (and I’m not saying micromanaging) even just for one week, just ONE week, you would realize that the way a PTA carries out your treatment would not be the way you would hope it to be. As soon as you realize that they may be putting “a little twist” to your care map, you might be changing jobs every week.

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  6. Another rule and another regulation.Hmm
    First thing to be regulated is Non-Physiotherapist owned clinics who make mockery of the profession by getting referrals from doctors, lawyers and also paying incentives to the patients by giving gifts .

    Recently i heard a ad in one of the radio program (Desi Beats with Dev Sagar & Alka (Punjabi/Hindi) : 1 PM – 3 PM) at 1650 am when i was out on lunch break that the physiotherapy treatment is free by a clinic. I called them to check their claim and was informed that they have several packages. it will be explained along with my Free treatment of physiotherapy. I asked them can i get free massage instead of physiotherapy they said no its only physiotherapist who can do free treatment, as the massage therapist are paid higher wages.

    I think sometimes i need to check myself if i am hallucinating about what i hear.

    The ‘wise” members of CPO who are making these rules are best in the regulatory business.

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  7. No, you re not hallucinating. There are no RMTA’s (Registered Massage Therapy Assistants) that is why they are more expensive. If there is a safe, effective and therapeutic massage that any profession can give, it is US physiotherapist who can do this. However, we were too busy mastering everything (else) that we gave this opportunity to others, and also too busy and too caring to delegate tasks when we ourselves can do the job, to the point that we sometimes are misunderstood by patients (of not caring enough to touch them). If you look at the history, it was originally us who did the massage and exercise therapy. Even people who cannot read and write in some poor countries thought physiotherapists do massage. This is not to say that all PT’s should start massaging, my message is to start doing manual therapy (be it joint mob, facilitation techniques while exercising,massage, manipulation, taking their vital signs, chest physiotherapy, etc.) as we have to be hands-on and be more interactive with our patients. Not just to say hi to them, advise, write notes, delegate and repeat. I have experience all sorts of assistance in my job -PTA’s, RKin’s, AT’s, students, personal trainers, PT Aides, even RMT’s when I had to delegate at one point. I realized I am good (on my own) and I prefer to be with my patient.

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  8. I am a resident physio and I do not even know if i will still have my job tomorrow or not but I do not let my patients to be seen solely by the PTA. Each visit the patients go through me. I give direct instructions to the PTA. I do not believe that PTAs should work unsupervised at all. I am not comfortable assigning treatment to a PTA whom I have not tested to be competent. Thankfully I work for a company where the bosses are PT themselves. I would think several times before joining a NON PT owned business and if I do, I will lay out the terms and conditions specifically. A PTA is an assistant! Whom is he assisting if PT is not on site? As long as home care physiotherapy is concerned, assigning a task that can be carried out by a psw or a family member to the PTA would be the max I will do.

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    • so true, this is exactly what is happening in community right now? shouldnt we be concerned about our profession and public safety?

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  9. “And, patients have a right to expect to receive care that is just as good as if you had delivered it yourself.” (from Shendra’s blog)..not even other physiotherapists can give the same care as a specific physiotherapist with a honed skill set or years of experience…how can it “be as good as if you had delivered it yourself?” Support is not a substitute for a physiotherapist, and should not be billed as physiotherapy, ever.

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  10. so true. even if i as a PT were to cover another PT due to time constraints or absences, and saw the PT’s plan of care that I concur with, execution between the two of us will vary. Example is carrying out exercise in supine, sitting or standing, to progress or pause a particular exercise for that day or week, etc. If I were to outline to my PTA on how I as a PT would like the former to carry out my treatment plans, it would take ages that I would have carried out the treatment myself and finished the task long ago, and not worry about PTA regulations, end of story.

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