Prevention of Sexual Abuse

The educational requirements for members are focused on four broad areas:

• appropriate behaviours and interactions with patients, including avoidance of boundary violations;
• recognition of and appropriate response to sexual abuse by other healthcare practitioners;
• understanding the nature of sexual abuse and its impact on the patient;
• understanding the legislative requirements of the Health Professions Procedural Code at s. 84 through s.85.7 (13).

The College has determined that all current members of at the College of Optometrists of Ontario, students currently in the optometry program at the University of Waterloo, and applicants for a Certificate of Registration to practise optometry in Ontario should receive education about these issues.

In the fall of 2017, all members of the College of Optometrist had to complete, as part of their annual renewal process, an e-learning module entitled “Professionalism, Ethical Decision-Making and the Prevention of Sexual Abuse of Patients.” This educational tool was aimed at helping optometrists understand what constitutes a professional boundary crossing or violation, what constitutes sexual abuse of patients and how unintentional boundary crossings could escalate.

Patients are entitled to receive optometric care free from sexually abusive behaviours. Practitioners must endeavour to care for their patients in an environment of trust and respect. The College has published an advisory for members regarding how to behave with patients. Members are encouraged to review this advisory periodically and compare their behaviours to the guidelines set out in the advisory. The College has also published materials describing its position on the Spousal Exemption Regulation, introduced in 2020, which allows for optometrists to treat their spouses without its automatically constituting sexual abuse.

The staff of the College of Optometrists of Ontario plays an important role in facilitating communication and resolution of patient/optometrist disputes and complaints. College staff and committee members may have the opportunity to support victims of sexual abuse through the reports, complaints, and disciplinary processes of the College. The College regularly provides training to its staff, Council, and committee members to ensure that those entrusted with this role are able to provide support and facilitate communication.

During the 2009/2010 Council year, the Patient Relations Committee began expanding on existing and developing new materials to assist optometrists in meeting their patients’ needs. In addition to the creation of the Partnership in Vision Care, due to expanding cultural diversity of the population in Ontario, the Committee worked on a cultural competency component for the website. 

Individual members of the public may not be aware of what behaviours differentiate normal optometric care from sexually abusive behaviour by an optometrist. The following information, which is provided to assist optometrists, is also intended to assist members of the public in identifying questionable requests or behaviours. Implicit in the provision of this information is the patient’s right to bring any questionable behaviour by their optometrist to the attention of the College.

It is important that patients are aware that optometrists are advised that:

• having a patient disrobe during an optometric examination is never appropriate;
• hugging and kissing is inappropriate and should never be initiated by the optometrist and respectfully declined if initiated by the patient;
• touching should only be used as necessary to facilitate the optometric examination;
• physical assistance may be required to facilitate patient positioning and manipulation of the head, eyelid or brow during an ocular examination;
• patients in a reclined position during an examination may feel vulnerable and the reason for reclining the patient should be explained;
• patients who are upset or nervous should be comforted with words rather than with touch;
• appropriate touching, such as shaking hands or assisting in the transfer of patients (for example from a wheel chair to examination chair), may enhance the comfort of a patient;
• before conducting a test that necessitates physical closeness, such as direct ophthalmoscopy (a test which involves the patient and optometrist sitting face to face) the test and how it is conducted should be explained to the patient;
• questions and conversations must not have any references to sexual practices, thoughts, and orientation except where necessary, as in cases of diagnosis and treatment of ocular manifestations of sexually transmitted disease;
• they should not comment on a patient’s appearance, clothing, or body unless clinically necessary;
• they should not tell jokes or stories of a sexual nature;
• they should not display material within the office that is sexually suggestive, or may be offensive to patients or staff; and
• they should ensure that a member of the office staff or a third party is in attendance when services are performed within the optometry office outside of normal office hours.

If a patient initiates sexually inappropriate conversation or behaviour, this should be respectfully discouraged and a record of the incident made. Having a staff member or third party in attendance throughout the examination may help prevent any misunderstanding or accusation. If the patient persists in the inappropriate behaviour, the optometrist should end the optometrist/patient relationship by dismissing the patient.

Sexual activity between an optometrist and a patient, even if perceived as consensual by those involved, is by definition considered to be sexual abuse of the patient.

The word “patient,” as it relates to the Code’s sexual abuse provisions, has been expanded; a former patient will remain a “patient” for one year from when the person would otherwise cease to be considered a patient (i.e., when the optometrist last provided care to the patient).

The Regulation under the RHPA establishes other criteria for defining a patient for such purposes. Without restricting the ordinary meaning of the word “patient,” an individual is a patient if there is a direct relationship/interaction between the individual and the optometrist and the optometrist has:

• issued billings or received health payments for a health care service; or
• contributed to a patient record/file for that individual; or
• received consent from the individual for health care services recommended by the optometrist; or
• prescribed a drug for which a prescription is needed, to that individual.

If any of the above interactions occur between an individual and an optometrist, then that individual is considered the optometrist’s patient, for the purposes of sexual abuse provisions. That individual will also continue to be considered a patient for one year after the termination of the optometrist/patient relationship. Any sexual act that occurs during that time between the optometrist and the individual would result in the optometrist being subject to mandatory revocation. Note that an individual is not a patient under these criteria when:

• emergency care is provided to a preexisting sexual partner; and
• there is no reasonable opportunity to transfer care to another health care professional.

Because of the broad definition of sexual abuse in the RHPA, a social relationship with a current or former patient may be considered sexual abuse. There are different types of social engagements that may be considered “dating.” However, sexual abuse occurs whenever a relationship with a patient involves behaviour or remarks of a sexual nature.

The legislation requires that all regulatory health Colleges have a program in place to provide funding for therapy and counselling for individuals who are alleging sexual abuse while they were patients of a regulated health professional. The College of Optometrists has established a segregated fund for this purpose and application forms are available for individuals who wish to request funding for therapy. Applications for funding are considered by the Patient Relations Committee.

• Application for Funding for Therapy and Counselling
• Attestation of Applicant
• Attestation of Counsellor (Regulated)
• Attestation of Counsellor (Non-Regulated)

An individual is eligible for funding if:

• it is alleged, in a complaint or report, that the individual, while a patient of a current or former member of the College of Optometrists of Ontario, was sexually abused by the optometrist; and
• the date of the alleged abuse must be on or after January 1, 1994.

The staff member responsible shall provide the necessary information to the Patient Relations Committee in order for the Committee to determine eligibility and to administer the fund. Payment will be made only to the therapist or counsellor chosen by the individual.

The Chair of the Patient Relations Committee informs Council of the status of the Fund on an annual basis.