As health care practitioners, naturopathic doctors must ensure that all patients receive care in a safe and professional environment.
The College has zero tolerance for client or patient abuse, and will take appropriate action when we receive information that a Registrant may have engaged in such behaviour.
Recognising the significant harm that it causes, the Regulated Health Professions Act, 1991(RHPA) mandates severe sanctions against Registrants guilty of professional misconduct relating to the sexual abuse of patients.
While the patient–practitioner relationship is based on mutual trust and respect, there is an inherent power imbalance favouring the naturopathic doctor. It is the responsibility of every naturopathic doctor to establish and maintain appropriate professional boundaries with all patients, which includes refraining from any conduct could be perceived as sexual abuse.
We have developed guidelines that set out Registrant expectations. They are intended to help NDs provide services in a professional manner that puts the patient first and fosters feelings of trust and safety.
Legislation and definition of sexual abuse
Sexual abuse of patients is defined as:
- sexual intercourse or other forms of physical relations between the Registrant and the patient,
- touching of a sexual nature of the patient by the Registrant, or
- behaviour or remarks of a sexual nature by the Registrant towards the patient
“Sexual nature” does not include touching, behaviour or remarks of a clinical nature appropriate to the service provided.
As required by the Health Professions Procedural Code (the Code), if a panel of the College’s Discipline Committee finds that a Registrant has committed an act of professional misconduct by sexually abusing a patient, it may:
- reprimand the Registrant; or
- revoke the Registrant’s certificate of registration for a minimum of five years if the sexual abuse consisted of, or included any of the following:
- sexual intercourse;
- genital to genital, genital to anal, oral to genital, or oral to anal contacts,
- masturbation of the Registrant by, or in the presence of, the patient;
- masturbation of the patient by the Registrant; or
- encouragement of the patient by the Registrant to masturbate in the presence of the Registrant.
In addition to the above penalties, the panel may:
- require the Registrant to pay a fine of up to $35,000 to the Minister of Finance of Ontario;
- require the Registrant to pay all or part of the College’s legal costs and expenses, the College’s costs and expenses incurred in investigating the matter, and the College’s costs and expenses incurred in conducting the hearing; or
- require the Registrant to reimburse the College for funding provided for therapy and counselling for patients who were sexually abused by the Registrant.
Treating a spouse
The definition of sexual abuse in the RHPA includes the treatment of spouses, even if there was a pre-existing spousal relationship prior to naturopathic treatment.
The Code defines spouse as:
- a person who is the Registrant’s spouse as defined in section 1 of the Family Law Act, or
- a person who has lived with the Registrant in a conjugal relationship outside of marriage continuously for a period of not less than three years.
Even though the spouse may have consented to be a patient and receive treatment, it is always the responsibility of the Registrant to be aware of the applicable laws. In this case, according to the definition in the legislation, providing naturopathic care to a spouse is considered sexual abuse.
However, in emergency situations where no other qualified professionals are available to provide the necessary care, Registrants may treat a spouse. The College considers this acceptable because the benefits of providing care outweigh the challenges posed by the relationship.
Preventing sexual abuse
Along with holding Registrants who commit acts of sexual abuse accountable, we also offer resources intended to prevent the sexual abuse of patients. One such resource, the Guideline for the Prevention of Sexual Abuse, can be found here.
Preventing sexual abuse includes establishing appropriate professional boundaries with patients. This means not only respecting their personal physical space, but also taking into account verbal, emotional and cultural cues.
Pay attention to how you convey information to patients as well as the words you use. Being aware of language, cultural and physical barriers that may interfere with clear communication can help you practice responsibly. Strive to be a compassionate listener, sensitive to the concerns and needs of your patients.
If touching is required during examination or treatment, explain what is involved and what the patient can expect before you begin to avoid any misunderstanding. Follow the principles of informed consent at all times.
Patients may feel particularly vulnerable in a health care setting and may not always express their concerns. Use your professional judgment to determine their comfort level and whether the presence of an additional person is advisable.
Mandatory reporting of sexual abuse of a patient
As stated in the College’s Mandatory Reporting Guideline, all health care practitioners have a responsibility to report sexual abuse.
If you have reasonable grounds, obtained in the course of practicing the profession, to believe that a naturopathic doctor or a Registrant of another college has sexually abused a patient, you must report it to the appropriate college. Information on the College’s complaints and reports process can be found here.
The legislation also states that the patient’s name is to be included in the report only if they give consent.
If you become aware that a patient might have been sexually abused by a health care provider, you must explain to the patient that you are legally obligated to report this to the provider’s regulatory college. Explain that you can only provide the patient’s name if they consent, but that not providing their name may make it more difficult to fully process the complaint.
If the patient does not consent to include their name, you must still make the complaint without it. If they do consent, it should be obtained in writing and kept on file.
You should also explain to the patient how they can make a complaint themselves and why they should consider doing so.
A report does not need to be made if you do not know the name of the alleged abuser; however, you should attempt to determine their identity.
This reporting obligation must be taken seriously, as we rely on the information to fulfill our mandate. It is important to understand what sexual abuse is and to be able to identify when it occurs. Please keep in mind that sexual abuse often does not start with overt actions from the abuser.
The seriousness of mandatory reporting is reflected in the time frames stated in the Code:
“The report must be filed within 30 days after the obligation to report arises unless the person who is required to file the report has reasonable grounds to believe that the member will continue to sexually abuse other patients, or that the incompetence or the incapacity of the member is likely to expose a patient to harm or injury and there is urgent need for intervention, in which case the report must be filed forthwith.”
The RHPA specifically addresses sexual abuse of patients by Registrants. There may be other types of sexual behaviour that, while not triggering a mandatory report to the College, would still be considered professional misconduct. For example, sexual harassment in the workplace is never appropriate and would be considered unprofessional, but it does not require a mandatory report. The subject of or witness to sexual harassment by a Registrant may voluntarily report that behaviour to the College.
Patient relations program
Under the RHPA, the College has a Patient Relations Program, which provides resources to help patients and Registrants understand professional behaviour and prevent sexual abuse.
The College maintains a fund to cover the costs of any therapy or counselling that patients need as a result of sexual abuse by a Registrant. Requests for funding are reviewed by the Patient Relations Committee.
Registrant Guide: Guideline for the Prevention of Sexual Abuse
Patient Guide: Understanding Sexual Abuse
Standard of Practice for Therapeutic Relationships and Professional Boundaries