This article originally appeared in the September/October 2020 issue of the Ontario Medical Review magazine.
How to protect against threats or risk of harm by patients
Given the recent, tragic event in Alberta in which Dr. Walter Reynolds of Red Deer died following a targeted attack at his walk-in clinic, the issue of physician safety has rightly become a topic of considerable discussion. OMA Legal Services has prepared an important update to highlight some of the issues surrounding physician safety, including concrete options that members may consider useful in protecting themselves, their staff, and their patients.
Members may use the following information in conjunction with the College of Physicians and Surgeons of Ontario (CPSO) policies to assist in determining the best course of action when addressing safety issues that may arise in specific circumstances (policies are accessible at cpso.on.ca).
Members may also wish to consult the various articles published by the Canadian Medical Protective Association (CMPA) related to physician safety and managing patient aggression, including:
The CPSO’s Policy on Ending the Physician-Patient Relationship expressly provides that physicians are not required to comply with the expectations set out in the Policy where, “in the physician’s judgment, the patient poses a genuine risk of harm to the physician, the physician’s staff, or to other patients. In these circumstances, physicians are under no obligation to engage with the patient prior to ending the relationship.”
A physician can end the doctor-patient relationship as long as the professional obligations governing termination of that relationship are met. The CPSO Policy entitled Ending the Physician-Patient Relationship is accessible at cpso.on.ca.
Every situation needs to be evaluated on its own merits, but examples of situations which may lead a physician to end the relationship include:
The CPSO policy provides further examples of circumstances that may lead to the breakdown in the doctor-patient relationship including:
The decision to end a doctor-patient relationship is necessarily fact specific and will often depend on the particular patient at issue. Through the CPSO policy referenced above, the College provides guidance for physicians regarding their professional obligations when ending this relationship.
There are general expectations of physicians in these circumstances – such as the application of clinical judgment and compassion and that reasonable efforts are made to resolve the situation in the best interests of the patient – and there are specific expectations, such as those relating to patient notification and the provision of interim care. The policy also recognizes physicians may not always need to provide the rationale for discontinuing the relationship to the patient where there is a genuine risk of harm.
Full details of all the relevant obligations can be found by reading the CPSO policy.
If you have questions about ending the doctor-patient relationship, the Canadian Medical Protective Association is available to assist. Visit the CMPA website for more information.
It is not a breach of patient privacy to call police if you have been physically threatened or assaulted. Under PHIPA, Personal Health Information (PHI) may be disclosed to facilitate an investigation or where the disclosure is necessary to reduce or eliminate a significant risk of bodily harm to a person or group of persons.
Any report to the police should disclose only the nature of the incident and the minimal amount of personal health information required to prevent or reduce the risk of harm.
If you have concerns about calling the police, or what to disclose, you are encouraged to contact the CMPA for advice where practicable. There are certain legal measures that may be taken to protect a physician in circumstances where a patient is exhibiting aggressive behaviour or threatening a physician’s personal safety.
Physicians and their staff have a right to a safe work environment. Unfortunately, patients and their families may engage in abusive behaviour from time to time. Physicians are entitled to have a zero-tolerance policy with respect to abusive and disruptive behaviour.
If personal safety is not a concern, disruptive patients should be clearly told that their behaviour is not acceptable. If a policy exists, it is helpful to have it posted in the office prominently. Disruptive patients should be advised of the consequences of any recurrence (e.g., ending the doctor-patient relationship).
If there is repetitive disruptive or abusive behaviour, or if there is a major or severe incident, the physician should consider ending the doctor-patient relationship in accordance with the CPSO’s policy.
If there is a physical threat or assault, the physician may notify the police or, in a hospital setting, a security guard. Typically, the report to the police should disclose only the nature of the incident and Personal Health Information required to prevent the harm.
If you have concerns about calling the police, or what to disclose, you are encouraged to contact the CMPA for advice where practicable. There are certain legal measures that may be taken to protect a physician in circumstances where a patient is exhibiting aggressive behaviour or threatening a physician’s personal safety.
In all cases, the physician should document disruptive and/or abusive behaviour clearly and factually in the chart.
There are many ways to increase the safety of your medical office and lower the risk to yourself, your staff and your patients. Choosing how to arrange your practice will inevitably be a personal exercise, but below are some helpful measures to assist in creating a safe environment at the office:
Disclaimer: this document is provided for information purposes and is intended for general guidance only. It should not be regarded as comprehensive or a substitute for professional or legal advice. The information provided does not supersede CPSO policies or the law. Before taking any particular course of action, strongly consider contacting the CMPA, CPSO, and/or the Information and Privacy Commissioner of Ontario, as these matters are fact specific and depend on the particular circumstances that exist in each case.