The College of Optometrists of Ontario views any form of abuse of a patient, whether sexual or otherwise, as professional misconduct that will not be tolerated. The Regulated Health Professions Act, 1991 (RHPA) and the Health Professions Procedural Code (the Code) set out specific requirements for the manner in which the College deals with sexual abuse and provides severe sanctions for members who are found to have sexually abused a patient. This advisory sets out the legislated standards of conduct that are required of members and provides guidelines to assist members in preventing allegations of sexual impropriety.
Sexual abuse is defined in the Code as:
a) sexual intercourse or other forms of physical sexual relations between the member and the patient;
b) touching, of a sexual nature, of the patient by the member; or
c) behaviour or remarks of a sexual nature by the member towards the patient.
According to the Code, touching, behaviour or remarks of a clinical nature appropriate to the services provided are not considered to be touching of a “sexual nature.”
Because of the power differential in the optometrist/patient relationship, it is always the responsibility of the optometrist to maintain appropriate boundaries. Sexual activity between an optometrist and a patient, even if perceived as consensual by those involved, is by definition, considered to be sexual abuse and therefore, professional misconduct.
If a member is found to have committed an act of professional misconduct by sexually abusing a patient, sanctions imposed by a panel of the Discipline Committee may include any or all of the following:
If the sexual abuse consisted of or included:
a panel of the Discipline Committee is required by the Code to:
In addition, the optometrist may be fined up to $35,000 and be required to reimburse the College for the cost of therapy and counselling provided for the sexually abused patient under a program established by the College.
The word “patient,” as it relates to the Code’s sexual abuse provisions, has been expanded; a former patient will remain a “patient” for one year from when the person would otherwise cease to be considered a patient (i.e., when the optometrist last provided care to the patient).
Regulation under the RHPA establishes other criteria for defining a patient as it relates to the Code’s sexual abuse provisions. Without restricting the ordinary meaning of the word “patient,” an individual is a patient if there is a direct relationship/interaction between the individual and the optometrist and the optometrist has:
If any of the above interactions occur between an individual and an optometrist, then that individual is considered the optometrist’s patient, for the purposes of sexual abuse provisions. That induvial will also continue to be considered a patient for one year after the termination of the optometrist-patient relationship. Any sexual act that occurs during that time between the optometrist and the individual would result in the optometrist being subject to mandatory revocation.
Note that an individual is not a patient under these criteria when:
Because of the broad definition of sexual abuse in the RHPA, a social relationship with a current or former patient may be considered sexual abuse. There are different types of social engagements that may be considered “dating,” however sexual abuse occurs whenever a relationship with a patient involves behaviour or remarks of a sexual nature.
The best course of conduct for members is not to date any current or former patients. If an optometrist intends to date a patient, he or she must first terminate the patient/practitioner relationship by dismissing the patient in accordance with the Professional Misconduct Regulation and then wait the one-year period from that time. The College policy on Discontinuation of Service can be found here.
|The RHPA does not provide exemption from the sexual abuse provisions for a spouse who is also a patient.|
Members need to be exceptionally careful in their interaction with patients to ensure that their behaviour is not misinterpreted. Suggestive comments, profanity or sexual jokes may be misunderstood and could lead to allegations of professional misconduct and sexual abuse. Optometrists should be aware of how their behaviour may be perceived by the patient as well as anyone who may observe or overhear the interaction.
Members should also be aware that patient expectations differ based on cultural background, religion, gender, age, and sexual orientation. Accordingly, a high level of respect and sensitivity is required to ensure that people of all backgrounds are treated with dignity.
The College advises all members to take a second look at their behaviour, be alert to the potential for allegations of sexual impropriety and, where necessary, change their behaviour.
The following advice is provided to assist members in preventing allegations of sexual impropriety or sexual abuse:
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 misunderstanding or accusation. If the patient persists in the inappropriate behaviour, the optometrist should end the optometrist/patient relationship by dismissing the patient.
While not dealt with in the RHPA, any form of harassment of office staff, including professional associates, may lead to allegations of professional misconduct.
A staff member who has received assessment or treatment services from an optometrist is considered to be a patient for the purpose of applying the sexual abuse provisions of the RHPA.
If, in the course of practising the profession, an optometrist forms reasonable grounds for believing that another regulated health professional has sexually abused a patient, the optometrist must make a report to the Registrar of the College of which the alleged abuser is a member. The report must be made within 30 days of obtaining such information and must contain the name of the reporter, the name of the alleged abuser, the details of the alleged abuse, and the name of the patient (but only if the patient consents in writing to the inclusion of his or her name in the report). An optometrist that fails to make a mandatory report of sexual abuse is subject to a serious fine up to $50,000.
The College has set aside funds for the Patient Relations Fund. The legislation provides that patients who were sexually abused by their optometrist may apply for funding for therapy and counselling. This funding is available once it is alleged, in a complaint or report, that the individual while a patient of a current or former member of the College was sexually abused by that optometrist.
Approval for funding is based on an application by the victim of sexual abuse. Consideration of the application is by the Patient Relations Committee. The maximum amount that can be paid for therapy or counselling is fixed by the regulations under the RHPA at the equivalent of the OHIP-insured rate for 200 half-hour sessions with a psychiatrist.
The legislation allows the College to make regulations specifying alternative criteria for funding. The Council has not made any such regulations.