Proposed Regulation – Spousal Exception
The recent amendments to the Health Professions Procedural Code (Schedule 2 to the Regulated Health Professions Act (RHPA), 1991) provide for the exception to the sexual abuse provisions when a health care practitioner treats his/her spouse, if the College Council has made a regulation that treatment of spouse did not constitute sexual abuse.
On June 6, 2014, the College of Optometrists of Ontario’s Council approved for circulation to members and stakeholders a proposed regulation that would create an exception that would allow optometrists to treat their spouses.
The proposed regulation must now be circulated for a period of 60 days to members and stakeholders to allow an opportunity for feedback and comments. This is a requirement under the RHPA. Following the 60-day circulation period, Council will consider all the submissions and, if warranted, give final approval to the regulation to be submitted to the Minister of Health and Long-Term Care. Please remember that only once the regulation is approved by Cabinet will optometrists be legally allowed to treat their spouses.
The following proposed regulation was approved by Council at its June 6, 2014 meeting for circulation to members and stakeholders for comment:
“Conduct, behaviour or remarks that would otherwise constitute sexual abuse of a patient by a member under the definition of “sexual abuse” in subsection 1(3) of the Health Professions Procedural Code of the Regulated Health Professions Act, 1991, shall not constitute sexual abuse if:
(a) the patient is the member’s spouse; and
(b) the member is not engaged in the practice of optometry at the time the conduct, behaviour or remarks occur.”
The accompanying guidelines should assist our members in properly applying the new regulation.
How can I provide my comments to the College?
Seeking member and stakeholder input is an important part of self-regulation in the health professions.
You may submit comments using email (preferable), mail, or fax:
College of Optometrists of Ontario
900 – 65 St Clair Ave. E.
Toronto ON M4T 2Y3
Comments due by September 2, 2014
Optometrists Treating Spouses – Guidelines
(Regulated Health Professions Act, 1991 – Health Professions Procedural Code1 defines)
Spouse: a person with whom:
- the optometrist is married, or
- the optometrist continuously lives in a conjugal relationship outside of marriage for a period of not less than three years.
Under the Health Professions Procedural Code (HPPC), health care professionals are prohibited from engaging in any type of sexual conduct, behaviour, or relationship with any patient, including a patient who may be the health care professional’s spouse. Such conduct, behaviour, or relationship constitutes sexual abuse, and is considered an act of professional misconduct, which carries a five-year minimum mandatory revocation of the health care professional’s certificate of registration. The purpose of the provisions with respect to sexual abuse of patients by health care professionals is to encourage the reporting of such abuse, to provide funding for therapy and counselling for patients who have been sexually abused by health care professionals and, ultimately, to eradicate the sexual abuse of patients by health care professionals (HPPC, Section 1.1).
A recent amendment to the HPPC allows the College to make a regulation that provides for an exception to the sexual abuse provisions if the patient is the optometrist’s spouse (as defined in the HPPC) and the optometrist is not performing an optometric service at the time the conduct, behaviour, or remarks of a sexual nature occur.
When treating their spouses, optometrists must ensure that any care provided and any treatment prescribed must:
- fall within the scope of practice of the profession
- follow accepted standards of practice of the profession, and
- be documented appropriately
Optometrists may need to identify situations where a personal, nonprofessional relationship might make it inappropriate to provide diagnostic and/or treatment services to their spouses. As a guideline, the following questions2 may assist optometrists in deciding whether or not to initiate treatment of their spouses. If optometrists answer yes to any of the following questions, they should refrain from treating their spouses:
- If my spouse were my patient, could the personal relationship affect my ability to recognize and act in the best interest of my spouse and remain clinically objective (e.g., tendency to over- or under-treat, not allow full testing, make timely referrals)?
- Would I be too uncomfortable to ask the questions necessary to make a proper diagnosis, particularly on sensitive topics (e.g., my spouse feeling uncomfortable revealing personal medical history)?
- Could the personal relationship with my spouse make it more difficult for me to maintain patient confidentiality (i.e., other family members’ need to know details) or make a mandatory report (e.g., MTO licensing)?
- Could the personal relationship affect my ability to allow my spouse to make a personal care decision with which I might disagree (e.g., my spouse feeling uncomfortable to seek other opinions)?
- If I were to treat my spouse, could the personal relationship affect my ability to establish and maintain a proper optometrist–patient relationship (e.g., obligation to examine outside office hours or off-site)?
2 Based on the Policy Statement “Treating Self and Family Members,” College of Physicians and Surgeons of Ontario.