The Legislation requires all regulatory health Colleges, including the College of Optometrists, to have a Patient Relations Program that includes measures for preventing or dealing with the sexual abuse of patients by optometrists, including:
- educational requirements for members;
- guidelines for the conduct of members with their patients;
- training for the College’s staff; and
- the provision of information to the public.
Section 85.7 of the Health Professions Procedural Code requires that every regulated health College also have a Program of Funding for Therapy and Counselling. This funding program is administered by the Patient Relations Committee. It is intended to compensate the cost of therapy for anyone who, while a patient, was sexually abused by a member of the College.
The College recognizes that a proactive Patient Relations Program, developed to enhance relations between members and patients, has the potential to improve patient care and reduce confrontations. In September 2013, College Council approved a revised Partnership in Vision Care document that articulates the collaborative nature of the relationship between optometrists and their patients. This collaboration is necessary to achieve and maintain optimum vision health.
The educational requirements for members are focused on four broad areas:
- appropriate behaviours and interactions with patients, including avoidance of boundary violations;
- recognition of and appropriate response to sexual abuse by other healthcare practitioners;
- understanding the nature of sexual abuse and its impact on the patient;
- understanding the legislative requirements of the Health Professions Procedural Code at s. 84 through s.85.7 (13).
The College has determined that all current members of at the College of Optometrists of Ontario, students currently in the optometry program at the University of Waterloo, and applicants for a Certificate of Registration to practise optometry in Ontario should receive education about these issues.
Guidelines for Member Conduct
Patients should be able to receive optometric care free from sexually abusive behaviours. Practitioners must endeavour to care for their patients in an environment of trust and openness. The College has published an advisory for members regarding how to behave with patients. Members are encouraged to review this advisory periodically and compare their behaviours to the guidelines set out in the advisory.
Training for College Staff
The staff at the College of Optometrists of Ontario plays an important role in facilitating communication and resolution of patient/optometrist disputes and complaints. College staff may have the opportunity to support victims of sexual abuse through the reports, complaints, and disciplinary processes of the College. The College regularly provides training to its staff to ensure that those entrusted with this role are able to provide support and facilitate communication.
Communication and the Doctor/Patient Relationship
During the 2009/2010 Council year, the PRC began expanding on existing and developing new materials to assist optometrists in meeting their patients’ needs. In addition to the creation of the Partnership in Vision Care, due to expanding cultural diversity of the population in Ontario, the Committee began working on a cultural competency component for the website. As a part of this initiative, they compiled some tips for enhancing the doctor/patient relationship across cultures.
Provision of Information
Individual members of the public may not be aware of what behaviours differentiate normal optometric care from sexually abusive behaviour by an optometrist. The following information, which is provided to optometrists to avoid allegations of sexual impropriety or abuse, is also intended to assist members of the public in identifying questionable requests or behaviours. Implicit in the provision of this information is the patient’s right to bring any questionable behaviour by their optometrist to the attention of the College.
It is important that patients are aware that optometrists are advised that:
- having a patient disrobe during an optometric examination is never appropriate;
- hugging and kissing is inappropriate and should never be initiated by the optometrist and respectfully declined if initiated by the patient;
- touching should only be used as necessary to facilitate the optometric examination;
- physical assistance may be required to facilitate patient positioning and manipulation of the head, eyelid or brow during an ocular examination;
- patients in a reclined position during an examination may feel vulnerable and the reason for reclining the patient should be explained;
- patients who are upset or nervous should be comforted with words rather than with touch;
- appropriate touching, such as shaking hands or assisting in the transfer of patients (for example from a wheel chair to examination chair), may enhance the comfort of a patient;
- before conducting a test that necessitates physical closeness, such as direct ophthalmoscopy (a test which involves the patient and optometrist sitting face to face) the test and how it is conducted should be explained to the patient;
- questions and conversations must not have any references to sexual practices, thoughts, and orientation except where necessary, as in cases of diagnosis and treatment of ocular manifestations of sexually transmitted disease;
- they should not comment on a patient’s appearance, clothing, or body unless clinically necessary;
- they should not tell jokes or stories of a sexual nature;
- they should not display material within the office that is sexually suggestive, or may be offensive to patients or staff; and
- they should ensure that a member of the office staff or a third party is in attendance when services are performed within the optometry office outside of normal office hours.
If a patient initiates sexually inappropriate conversation or behaviour, this should be respectfully discouraged and a record of the incident made. Having a staff member or third party in attendance throughout the examination may help prevent any misunderstanding or accusation. If the patient persists in the inappropriate behaviour, the optometrist should end the optometrist/patient relationship by dismissing the patient.
Sexual activity between an optometrist and a patient, even if perceived as consensual by those involved, is by definition considered to be professional misconduct.
Because of the broad definition of sexual abuse in the RHPA, it is problematic for an optometrist to have a social relationship with a current patient. There are different types of social engagements that may be considered “dating.” However, professional misconduct occurs whenever a relationship with a patient involves behaviour or remarks of a sexual nature.
Program to Provide Funding for Therapy and Counselling
The legislation requires that all regulatory health Colleges have a program in place to provide funding for therapy and counselling for individuals who are sexually abused while they are patients of a regulated health professional. The College of Optometrists has established a segregated fund for this purpose and application forms are available for individuals who wish to request funding for therapy. Applications for funding are considered by the Patient Relations Committee.
Eligibility for Funding
In order for an individual to be eligible for funding:
- there must have been a finding by the Discipline Committee that the person, while a patient of a current or former member of the College of Optometrists of Ontario, was sexually abused by the optometrist; and
- the date of the alleged abuse must be on or after January 1, 1994.
The staff member responsible shall provide the necessary information to the Patient Relations Committee in order for the Committee to determine eligibility and to administer the fund. The Chair of the Patient Relations Committee informs Council of the status of the Fund on an annual basis.
Discontinuation of a Discipline Hearing
In the event that the College is unable to commence or to continue a Discipline hearing after allegations of sexual abuse have been specified, the person alleging abuse may still apply to the College’s Patient Relations Committee for funding if the hearing does not go forward for one of the following reasons:
- The member dies
- The member cannot commence or continue because of medical reasons
- The member resigns
- Or for any other reason that the Discipline Committee decides that the hearing should not commence or continue