Late last week, the Physiotherapy Board of New Zealand (PBNZ), released a statement titled Serious concerns about physiotherapists conduct (currently available on their website here, the full text is also reprinted at the bottom of this post).
Tthe statement was prompted after the suspension of a New Zealand physiotherapist for being found guilty of professional misconduct reached the news. The male clinician was found guilty of having sex with a client (details here). He was subsequently fined $5,000NZD, ordered by the Board not to treat female patients, had his practice supervised every fortnight and complete a course about proper professional boundaries, but he was not struck off.
There are a number of striking things about the Board’s statement that are worth highlighting.
Firstly, they refer to a “rise in complaints”. We have no current data to go on, because all current complaints are confidential to the Board, but the statement would point to the fact that there are a significant number of new cases on the books over and above the normal course of events.
Physiotherapy is a relatively benign profession when it comes to patient complaints. Given the amount of intimate contact inherent in physiotherapy practice, complaints are quite rare. Prior to last week’s announcement, there had been no prosecutions with the Health Practitioners Disciplinary Tribunal in five years (you can see a full account of all prosecutions going back to 2003 here).
Of the 75 complaints lodged with PBNZ between 2012 and 2015, only a handful have resulted in any action, and mostly this was in the form of an educational update for the practitioner.
Most strikingly, complaints occur among 0.53 to 1.6% of male physiotherapists in NZ, and 0.08 to 0.36% of the female population during that time.**
This, of course, does not take into account the number of patient contacts that each individual therapist might have undertaken, in which case the incidence of any complaint would be infinitesimally smaller.
The data also doesn’t take into account the possibility that offenders may be offending in a variety of ways or the level of unreported discomfort caused by therapists’ behaviour. This echoes the findings of some research work we’ve been doing with PBNZ recently, which points to the vast ambiguity surrounding the meaning of unprofessional behaviour. Terms like malpractice, discredit, boundary and scope of practice issues are used interchangeably, not only by professional bodies around the world, but also through the scant literature which has looked at this questions critically.
In 2012 I co-authored a paper titled Discipline, desire, and transgression in physiotherapy practice (Nicholls & Holmes, 2012), which looked at some of the complexities of touch in physiotherapy and argued for the need for the profession to transgress its traditional restrictions in order that we might better serve future patients.
My belief is that touch lies at the heart of our practice and, without wanting to diminish the effect of this therapist’s actions on a vulnerable young woman, cases like this provide an opportunity for us to debate what proper touch means in physiotherapy, and how it needs to be thought about, taught and practiced in the 21st century.
*The title of this post originated in an earlier NZ newspaper report from 1998 when a similar case appeared in the popular media (Guyan, 1998).
** This data derWe will be reporting the full data
SERIOUS CONCERNS ABOUT PHYSIOTHERAPISTS CONDUCT
In light of recent events and the decision of the Health Practitioners Disciplinary Tribunal the Physiotherapy Board of New Zealand and Physiotherapy New Zealand have released a joint statement.
“We are alarmed in the rise of complaints formally investigated – either through a Professional Conduct Committee, or the Health Practitioners Disciplinary Tribunal. The overwhelming majority of these cases relate to sexual misconduct” states Janice Mueller (Chairperson, Physiotherapy Board).
“As Registered Physiotherapists, the public expects the highest professional and ethical standards from our profession. The trust placed in Physiotherapists by patients should not be abused – this is a given” says Ian D’Young (President, Physiotherapy New Zealand).
Professional standards of conduct are in place – the Aotearoa New Zealand Physiotherapy Code of Ethics and Professional Conduct (the Code) – is published jointly by the Physiotherapy Board and Physiotherapy New Zealand. These are a mandatory for physiotherapists practising in New Zealand. The Code states:
“Physiotherapists must not exploit any patient/client whether physically, sexually, emotionally, or financially. Sexual contact of any kind with patients/clients is unacceptable. Physiotherapists must establish and maintain appropriate professional boundaries with patients/clients and their whanau and families.”
Physiotherapy is ‘hands-on’. The public’s confidence in our profession will be seriously damaged if practitioners are not mindful of their ethical and moral responsibilities. PNZ and the Physiotherapy Board are consistent in the message of public safety.
The Physiotherapy Board and Physiotherapy New Zealand are committed to maintaining the highest standards of the profession, and the public’s confidence”
If you are concerned about the conduct of a Physiotherapist we encourage you to contact the Board on 04 471 2610 or through our website.
Nicholls, D. A., & Holmes, D. (2012). Discipline, desire, and transgression in physiotherapy practice. Physiotherapy Theory and Practice, 28(6), 454-465. doi:10.3109/09593985.2012.676940 (link to full pdf in text above).
Guyan, C. (1998, January 14). No sex please, we’re physios. The Evening Post, p. 1