- Regulated Health Professions Act (RHPA), 1991 SO 1991, c18;
- Pharmacy Act, 1991, SO 1991, c36
- Family Law Act, RSO 1990, c F.3
- Human Rights Code, RSO 1990, c H.19
- Funding for Therapy or Counselling for Patients Sexually Abused by Members, O Reg 59/94
- Funding for Therapy and Counselling
- Zero Tolerance of Sexual Abuse and Harassment (Pharmacy Connection, Winter 2018)
- The Protecting Patients Act 2017: New Regulations Now in Effect (Pharmacy Connection, Spring 2018)
College Contact: Pharmacy Practice
The following guideline document complies with the requirement of the Regulated Health Professions Act (RHPA) that the College take measures to prevent and deal with the sexual abuse of patients.
The purpose of the provisions in the RHPA with respect to sexual abuse of patients by members is to encourage the reporting of such abuse, to provide funding for therapy and counseling for patients who have been sexually abused by members and, ultimately, to eradicate the sexual abuse of patients by members.
The Ontario College of Pharmacists (OCP) Code of Ethics states that members have moral obligations in return for the trust given them by society. A member is required to act in the best interest of and advocate for the patient, observe the law, uphold the dignity and honour of the profession, and practice in accordance with ethical principles and his or her respective standard of practice.
Members are expected to take responsibility for their actions.
Both pharmacists and pharmacy technicians, as regulated health professionals, are expected to set a high standard of behaviour in the work environment. OCP regards any act of abuse or harassment of a patient, customer, staff person and / or colleague, as unacceptable and such actions are subject to investigation as professional misconduct.
Ignoring harassment or abuse is equal to condoning the abuser’s actions and further harming the victim, and may be subject to sanction.
There is no single all-encompassing definition of what constitutes a professional boundary. Boundaries are based on trust, respect and the appropriate use of power. In the context of this guideline, a boundary is the point at which a relationship changes from professional and therapeutic to unprofessional and personal.
According to the Family Law Act, a spouse is defined as either of two persons who are married; or, either of two persons who are not married to each other and have cohabited continuously for a period of not less than three years; or, either of two persons who are in a relationship of some permanence, if they are the natural or adoptive parents of a child.
The sexual abuse of a patient by a member is defined as:
- Sexual intercourse or other forms of sexual relations between the member and the patient;
- Touching of a sexual nature, of the patient by the member; or
- Behaviour or remarks of a sexual nature, by the member towards the patient.
Harassment means engaging in a course of vexatious comment or conduct that is known or ought reasonably to be known to be unwelcome.
Harassment may include bullying, intimidating or offensive jokes or innuendos, displaying or circulating offensive pictures or materials, or offensive or intimidating phone calls (1).
The Member – Patient Relationship
Members have an obligation to establish relationships with patients based on trust, support and mutual respect and further, are responsible for maintaining the professional integrity of the relationships.
A co-existing sexual and patient relationship is considered to be professional misconduct and an act of sexual abuse (2). OCP does not exempt the treatment of spouses from this rule, and as such, does not permit the provision of routine care to a spouse.
What Is An Appropriate Boundary?
An appropriate boundary of a member-patient relationship would be one that complies with the Code of Ethics and OCP’s philosophy.
Maintaining Appropriate Professional Boundaries (3)
- Show sensitivity and respect for the patient’s privacy and comfort at all times.
- Outside of clinical necessity, avoid any physical contact with a patient that could be perceived as inappropriate.
- Avoid any behaviour or remarks that may be interpreted as sexual by a patient.
- Endeavour to be aware or mindful of a patient’s particular cultural or religious background.
- Do not make sexualized comments about a patient’s body or clothing.
- Do not criticize or comment unnecessarily on a patient’s sexual preference.
- Do not ask details of sexual history or behaviour unless related to the purpose of the consultation.
- Be cognizant of social interactions with patients that may lead to romantic involvement.
- Do not talk with your patients about your own sexual preferences, fantasies, problems, activities or performance.
- Learn to control the consultation setting and to detect possible erosions in boundaries.
Preventing Sexual Abuse and Harassment
A member must not become sexually involved with his or her patient.
- Under the RHPA, any form of sexual relations between a member and a patient (including a spouse unless the college has adopted a spousal exemption regulation) is considered to be sexual abuse. In the event that a member of a college not exempting spousal treatment is required to provide care to a spouse in an emergency or incidental situation, the member must transfer care as soon as is practical (4).
- When in doubt as to whether a therapeutic relationship exists/ has terminated, members should refrain from any personal relationship.
- Sexual contact with a former patient may be considered professional misconduct even though it is not sexual abuse as defined under the RHPA. A sexual or romantic relationship is inappropriate in cases where the therapeutic relationship has created a vulnerability or dependency on the part of the patient that affects the patient’s ability to act freely.
- Sexual relationships between members and caregivers raise concerns about breach of trust and power imbalance. It is advisable that members refrain from sexual or romantic relationships with these individuals.
A member must not harass or otherwise intimidate his or her patient.
A member is required to file a report in writing with the Registrar if he or she has reasonable grounds, obtained in the course of practicing their profession, to believe that a member, of the same or different college has sexually abused a patient. The report must be made within 30 days and may only include the patient’s name where written consent has been given by the patient or, if the patient is incapable, the patient’s representative. The report must include the name of the member filing the report, the name of the member who is the subject of the report and an explanation of the alleged sexual abuse. Once a report is received, the information will be reviewed by the Registrar to determine the next steps, including appointing an investigator and initiating a formal investigation.
There is a $25,000 fine for failure to report. Members are indemnified for making reports in good faith.
The RHPA requires that Ontario’s regulated health professions develop sexual abuse prevention programs. The College has undertaken to educate members and students about these issues and has provided training to key College staff on how to handle complaints involving topics of a sexual nature.
Funding For Therapy & Counseling
Pursuant to the RHPA, the College has established a fund for therapy and counseling for persons who, as patients, were sexually abused by a member of the College. The maximum amount of funding that may be provided is the amount that the Ontario Health Insurance Plan would pay for 200 half-hour sessions of individual out-patient psychotherapy with a psychiatrist on the day the person becomes eligible for funding. The Patient Relations Committee administers the fund.
Sexual Relationships with Former Patients:
The member should terminate the therapeutic relationship with a patient prior to initiating a sexual or romantic relationship. The member must consider whether the therapeutic relationship has created a vulnerability or dependency on the part of the patient that may make it inappropriate to engage in a sexual or romantic relationship.
- Ontario, Ministry of Labour. Workplace Violence and Workplace Harassment.
- Health Professions Regulatory Advisory Council. The Spousal Patient; p. 11. 3
- Adapted from the College of Physicians and Surgeons of Ontario Maintaining Appropriate Boundaries and Preventing Sexual Abuse. [CPSO has revised this policy and the original is no longer available.]
- Incidental care has been defined by the Ontario Court of Appeal as minor in nature, casual or arising in fortuitous conjunction with a spousal relationship. For example, as cited in V.L. v. College of Chiropractors of Ontario, 2008 CanLII 56709 (ON SCDC)