Policy: Mandatory Reporting of Sexual Abuse by Massage Therapy Educational Facilities and Instructors

Background

The Regulated Health Professions Act (RHPA), places a mandatory requirement on regulated health professionals and on individuals who operate facilities where regulated health professionals work, to report incidents where they have reasonable grounds, obtained in the course of practicing the profession, to believe that a member of the same or different college has sexually abused a client. (RHPA, the Code, Section 85.1 and 85.2).

This mandatory reporting requirement was placed in the legislation in an effort to eradicate the sexual abuse of clients by placing a significant responsibility on healthcare professionals to put the client’s interests first and report inappropriate conduct.

Policy

The College of Massage Therapists of Ontario (the College) has determined that a Massage Therapist engaged in Massage Therapy instruction at an educational institution recognized by the Ministry of Training, Colleges and Universities is considered to be practising the profession. This, therefore, requires members to report suspected incidents involving the sexual abuse of a client to the appropriate regulatory college, under the RHPA (the Code, S. 85.1). In addition, these Massage Therapists are considered by the College to be practising at a facility as outlined in the RHPA (the Code, Section 85.2), and therefore, also subject to its reporting requirements.

Rationale

The College believes that the provision of Massage Therapy educational instruction is sufficiently intertwined with the practice of the profession to mandate the foregoing interpretation in the interests of protecting the public. Educational institutions involve relationships among students, instructors, other health professionals and clients. Given the power imbalance that exists between these individuals, it is important that regulated health professionals report any situation where they have reasonable grounds to believe a member of a regulatory college has sexually abused a client.

Reports by Students of Sexual Abuse

Due to the rapport they have established with instructors, students may advise them of incidents of previous sexual abuse committed by a regulated health professional. An instructor who becomes aware of a situation where a regulated health professional has sexually abused the student while under their direct care, should:

• Obtain the professional’s name from the student;
• Encourage the student to report the situation to the appropriate regulatory college;
• Advise the student of the instructor’s duty to report the information to the appropriate regulatory College regardless of whether or not the student files a complaint;
• Seek the student’s permission to disclose his/her name to the college; and
• Notify the complaints department of the appropriate regulatory college as soon as possible.

Reports by a Client of Sexual Abuse

A Massage Therapy instructor, who while supervising a student’s clinical practice, becomes aware of a situation in which there are reasonable grounds to believe that a health professional has sexually abused a client should:

• Obtain the professional’s name from the client;
• Encourage the client to report the incident to the appropriate regulatory college;
• Advise the client of the Massage Therapist’s duty to report the information to the appropriate regulatory college regardless of whether or not the client files a complaint;
• Seek the client’s permission to disclose his/her name to the college; and
• Notify the complaints department of the appropriate regulatory college as soon as possible

Note: Prior to filing the report, advice can be sought from the College.

If the information is obtained indirectly through a client’s disclosure to a student, the instructor should assist the student in following the above procedures. Technically, the student does not have a mandatory obligation to report the situation under the RHPA, 1991. The College would take the position, however, that the supervising instructor has a duty to report.

Scenario 1

Mary Thomas works as a Massage Therapy instructor at a local community college. One day, following a lecture on professional ethics, a student (Joan), approached Mary and asked to speak with her privately. Mary took the student to her office. It was obvious that Joan was very agitated. She advised Mary that the discussion of professional ethics, was of particular interest, because of a recent incident that involved Joan’s dentist.

Joan told Mary that she has allergies to some local anaesthetics, and for this reason her dentist uses gas when performing dental procedures. During a recent procedure, the dentist fondled Joan’s breast. At first, Joan who was drowsy, thought that there were dental instruments resting on her chest and that this was the reason for the touching. When she opened her eyes, however, she realized what was happening. Joan stated that she pushed the dentist’s hand away, and the incident was not repeated.

Joan said that it had been necessary to find a new dentist when she moved to the city to attend school and she has only seen this dentist twice.

Mary talked to Joan about her experience and encouraged her to report the incident to the Royal College of Dental Surgeons. Joan was reluctant to make the report. She seemed almost relieved when Mary advised that she had a mandatory obligation to report the dentist to his College. Joan then gave her permission for the disclosure of her name. Mary contacted the Royal College of Dental Surgeons the next day and filed the report.

Conclusion

Mary was very aware of the mandatory reporting requirements under the RHPA, 1991, and her responsibility to report incidents of suspected sexual abuse involving regulated health professionals and her clients. In this situation, while Joan was not her client, both the RHPA and the College’s policy require Mary to report the dentist’s alleged conduct to the Royal College of Dental Surgeons. The College takes this position because it believes that Mary is “practising the profession” when providing Massage Therapy instruction.

Scenario 2

A community college offers a programme in Massage Therapy. Students attend classes at the college, and complete clinical placements both on site in the college’s student clinic and at various community facilities. College instructors teach course work to students as well as supervising their practice in the on-site clinic. Sue Jones works as a Massage Therapy instructor at the college.

One day Sue was supervising students in the college’s student clinic. Towards the end of the afternoon George, one of the students, came to find her. He stated that he was part way through a client’s treatment when she became extremely agitated and started to cry. George tried to discuss the situation with the client but she was unwilling to speak with him. George was disturbed that he had upset the client and asked Sue if she would see if she could determine the problem. Sue went to see the client and during the conversation, the client disclosed to her that the student’s treatment triggered a memory involving a situation that occurred in the past involving another health professional. The client described an incident involving a physiotherapist. The client stated that during treatment for low back pain, the physiotherapist had inappropriately touched her pelvis. The incident as described by the client, led Sue to believe that the client had been sexually abused by the physiotherapist. The client provided the name of the physiotherapist and agreed to have Sue report the incident to the College of Physiotherapists of Ontario.

Sue and the student discussed the situation, and together contacted the College for advice. Sue then forwarded a written report to the College of Physiotherapists of Ontario outlining the situation as described to her and providing the names of the client, the physiotherapist, George and herself. A few weeks later, an investigator for the College of Physiotherapists of Ontario met with Sue and then with George to obtain more details relating to the report.

Conclusion

In this situation, Sue had a clear obligation to report this incident to the appropriate regulatory college. The regulatory college was able to take action as the client had agreed to allow her name to be disclosed.

If the client had not agreed to the disclosure of her name, Sue would still have been required to submit the report to the College of Physiotherapists of Ontario but no action could have been taken at the time. It is important that Massage Therapists document in their records, the client about whom the report was made. Should the College receive another complaint in the future, they can then contact Sue and ask her to contact the client again to see if she has changed her mind about disclosing her name. Clients are sometimes more willing to come forward when they realize that someone else has had a similar experience with the healthcare practitioner.

Approved: November 20, 1995  Revised: November 19, 1999
References: The Regulated Health Professions Act, 1991, The Code, S. 85.1, 85.2