Preventing Sexual Abuse

The College’s Patient Relations Program was developed to enhance relations between optometrists and patients.

An important part of the program’s mandate is to oversee measures for preventing or dealing with the sexual abuse of patients by optometrists. These measures include:

Educational Requirements

The educational requirement applies to all current registrants of the College, all students currently in the optometry program at the University of Waterloo, and all applicants to the College.

To help prevent sexual abuse, optometrists must be educated about these areas:

  • Understanding the nature of sexual abuse and its impact on the patient
  • Knowing the requirements of the Health Professions Procedural Code
  • Behaving appropriately with patients, including avoiding boundary violations
  • Recognizing and responding appropriately if they witness sexual abuse by other healthcare practitioners.

In the fall of 2017, all registrants of the College had to complete, as part of their annual renewal process, an e-learning module titled Professionalism, Ethical Decision-Making and the Prevention of Sexual Abuse of Patients. The module helps optometrists understand what constitutes sexual abuse, what a professional boundary crossing is, and how unintentional boundary crossings could escalate.

Guidelines for Member Conduct

Patients have the right to receive optometric care in an environment of trust and respect. The College has published an advisory for registrants on how to behave with patients. Registrants are encouraged to review this advisory periodically and compare their behaviours to the guidelines.

An Exemption Regulation was introduced in 2020 that allows optometrists to treat their spouses without this automatically constituting sexual abuse. The College has published materials describing its position on this regulation.

Training for College Staff and Council

The staff of the College of Optometrists of Ontario plays an important role in resolving complaints or facilitating the formal complaints and reports disciplinary processes. Both College staff and committee registrants may be called upon to support victims of sexual abuse through these processes. The College regularly provides training to staff, Council, and committee registrants entrusted with this role.

Informing the Public About the Rules

Patients have the right to bring any questionable behaviour on the part of an optometrist to the attention of the College. Some people may not be aware of what differentiates normal optometric care from sexual abuse. Here are some examples of rules that optometrists must follow.

Optometrists must not:

  • Ask a patient to disrobe during an optometric examination
  • Hug or kiss a patient, even if the patient initiates this
  • Comment on a patient’s appearance, clothing, or body unless clinically necessary
  • Ask questions or start conversations about sexual practices except where necessary, as in cases of diagnosis and treatment of ocular manifestations of sexually transmitted diseases;
  • Tell jokes or stories of a sexual nature
  • Display material in the office that is sexually suggestive or offensive to patients or staff
  • Engage in any sexual activity with a patient, even if both perceive the activity as consensual.

Safe, respectful touch

  • Touching should only be used as needed to facilitate the optometric examination. For example, an optometrist may need to position a patient or manipulate the head, eyelid, or brow.
  • Patients in a reclined position during an examination may feel vulnerable. The optometrist should explain why the patient needs to be reclined.
  • Patients who are upset or nervous should be comforted with words rather than with touch.
  • Optometrists may assist in the transfer of patients (for example from a wheelchair to the examination chair).
  • Some tests require physical closeness, such as direct ophthalmoscopy (a test that involves the patient and optometrist sitting face to face). Before the test, the optometrist should explain how it is conducted and why.
  • If performing services outside of normal office hours, the optometrist should ensure that a member of the office staff or a third party is in attendance.

If a patient initiates sexually inappropriate conversation or behaviour

The optometrist should respectfully discourage this behaviour and make a record of the incident. Having a staff member or third party in attendance throughout the examination may help to prevent any misunderstanding or accusation. If the patient persists in the inappropriate behaviour, the optometrist should end the optometrist/patient relationship.

Definition of ‘patient’ in sexual abuse cases

The Regulated Health Professions Act defines a person as a patient if the optometrist has:

  • billed or received payments for their health care or
  • contributed to their patient record or file or
  • received consent from them for health care services or
  • prescribed them drug.

The Health Professions Procedural Code expands the definition of ‘patient’  in cases of sexual abuse. A person remains a ‘patient’ for one year after the optometrist last provided care. Any sexual act that occurs between the person and the optometrist during that time could result in the optometrist having their licence to practise revoked. Because of the broad definition of sexual abuse in the RHPA, any social relationship with a current or former patient might be considered sexual abuse.

An optometrist may not be guilty of sexual abuse if they provide emergency care to their preexisting sexual partner when there is no reasonable way to transfer care to another health professional.

Program to Provide Funding for Therapy and Counselling

The Health Professions Procedural Code requires health colleges to have a program to support patients who come forward with allegations of sexual abuse. The Program of Funding for Therapy and Counselling is administered by the College’s Patient Relations Committee. The fund covers the cost of therapy and counselling for patients who allege sexual abuse by a registrant of the College.

Payment is made directly to the therapist or counsellor that the person choses.

Related FAQs

  • You are eligible to apply for funding if:

    • An allegation has been made, in a formal complaint or report, that you were sexually abused and
    • The alleged abuse was by a current or former registrant of the College of Optometrists and
    • The alleged abuse occurred while you were a patient, or up to a year after receiving optometry care and
    • The date of the alleged abuse was on or after January 1, 1994.

  • Applications for funding are considered by the Patient Relations Committee. The committee is made up of four optometrists and four members of the public. The committee reviews each application and decides:

    • Whether the applicant meets the eligibility criteria and
    • The amount of funding that is to be awarded for therapy and counselling.

  • No. Recent changes to the Regulated Health Professions Act allow funding to be available before any finding of guilt is made. These changes are in effect as of May 1, 2018.

    A decision by the Patient Relations Committee that you are eligible for funding is not a finding of professional misconduct against the optometrist. It will not be considered by any other committee of the College dealing with the matter.

  • The College may help to pay for past therapy under some conditions:  

    • Past therapy must not have already been paid by any provider (OHIP or private insurance).
    • The therapy must have taken place after the reported abuse.
    • The applicant or therapist must provide invoices or receipts with therapy costs and dates.

    The therapist must agree to reimburse the applicant for past therapy fees. This is because the College is required by law to pay the therapist directly.

  • You need to complete an Application for Funding for Therapy and Counselling. This form gives the Patient Relations Committee the information they need to assess your eligibility. You will also have to complete an Attestation of Applicant form. On this form you must state that:

    • You have no family ties to the therapist or counsellor you chose and
    • The services are not eligible for payment by any other provider, such as OHIP or private insurance.

    You can start the application process before you have chosen a therapist or counsellor. Once you have chosen them, they will have to complete a form before funding can begin. If your therapist or counsellor is a regulated health professional, they must complete an Attestation of Counsellor (Regulated). If they are unregulated, they must complete an Attestation of Counsellor (Non-Regulated).

    Contact the College for any help you need with the application or for more information:

    Tel:               416-479-9295
    Fax:              647-417-6862
    Toll Free:       1-833-402-4819
    Email:           complaints@collegeoptom.on.ca

  • The funding is available for a five-year period. The starting date is the earlier of these two dates:

    • The date that you first received therapy related to the alleged sexual abuse or
    • The date of your complaint or report alleging you were sexually abused by the optometrist.

    To receive the full benefit of the funding, you should apply as early as possible.

  • If you want to apply for this funding, please contact the College:

    Tel: 416-479-9295
    Fax: 647-417-6862
    Toll Free: 1-833-402-4819
    complaints@collegeoptom.on.ca

  • College staff will confirm receipt of your application. They will tell you whether any more information is required. Staff will also keep you informed of the timelines for the Patient Relations Committee’s review of your application.

  • No. The committee will make its decision based on the documents you send.

  • No.

  • Yes. You, your therapist or counsellor, and the College must keep all information obtained through the application process confidential. This includes the fact that funding has been granted.

  • The maximum amount is about $16,000, but it can vary based on the circumstances. The amount is based on a formula provided in the regulation. Once your application is processed, the College will notify you of your amount. If the services being used are partially covered by OHIP or a private insurer, the College pays only the amount not covered.

  • Yes. The funding must be used only to pay for therapy or counselling. There may be funding for other purposes in the future, but it is not currently approved or available.

    You will not receive the money. The College must pay your therapist or counsellor directly, after receiving their invoice.

  • The funding for therapy and counselling is meant to help you deal with the effects of the alleged sexual abuse. You are free to find the type of therapy or counselling that works best for you. Here are some things to consider:

    • Do they have training or experience in treating the effects of sexual abuse?
    • Are they a member of a regulated health profession? If not, you have no way of knowing whether they are qualified to practice. You may also not have a governing body to contact if you have concerns about their conduct or skills.
    • How many sessions will you need to attend and at what cost? You will have to pay any amount over the maximum amount approved for you.

  • Yes.

  • The College will send you reports to keep you informed of how much money is left for the costs of your therapy or counselling. You can contact us if you need extra information.

  • If you want to apply for this funding, please contact the College:

    Tel: 416-479-9295
    Fax: 647-417-6862
    Toll Free: 1-833-402-4819
    complaints@collegeoptom.on.ca