For the purposes of this practice guideline, unless otherwise indicated, abuse may
be defined as treating others in a harmful, injurious, or offensive way and
includes, but is not limited to:

Refers to a Respiratory Therapist who is, or was, registered with the CRTO.

An individual who does not meet the definition of patient/client but who alleges sexual misconduct against a Respiratory Therapist. Examples include a Student Respiratory Therapist, family member of a patient/client, or other health care providers.

For the purposes of the sexual abuse provisions of the RHPA an individual is
considered a patient/client of the Member if there is a direct interaction between
the Member and the individual and any of the following conditions are met:

An individual may be, or may continue to be, considered a patient/client of the Member for at least one (1) year after any of the above contacts.

As defined in the Code sexual abuse means:

“Sexual nature does not include touching, behaviour or remarks of a clinical nature that are appropriate for the professional service being provided ³.

Conduct that amounts to sexual abuse pursuant to the Code
may also constitute sexual assault in the criminal context. Certain
situations can magnify the gravity of a sexual assault, such as
when the assailant is in a position of trust or authority over the
individual. Sexual assault is defined in the Criminal Code of
Canada (CCC) as any form of sexual contact without both parties’
voluntary consent⁴. According to the CCC, there is no consent if:

Acts of sexual abuse, assault or harassment by a Respiratory Therapist constitute Professional Misconduct ​⁶.

Accurate statistics on the prevalence of abuse, particularly sexual abuse, are difficult to obtain as only “about one in ten sexual assaults are reported to police”⁸ However, it is likely that health care practitioners will encounter survivors of sexual abuse/assault and other forms of abuse in their practice⁹. Research indicates (as of February, 2014) that:

The primary goal of Sensitive Practice is to facilitate feelings of safety for the client.
Procedures that may appear routine to the RT may be very traumatizing for abuse survivors, as it can cause them to feel exposed, vulnerable and powerless. The Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse outlines nine principles of sensitive practice that include respect, taking time, sharing information and respecting boundaries ¹³. The primary goal of sensitive practice is to facilitate feelings of safety and control. The following should be taken into consideration during every patient/client interaction:

Communication occurs through words, body language and active listening. RTs can ensure that they practice in a sensitive manner by:

Appropriate words, behaviour and touching can reduce the embarrassment, distress, and fear that some patients/clients experience in the course of receiving care. Touching must be appropriate to the service the RT is providing. RTs can ensure that they practise in a sensitive manner by:

Time and space constraints, especially in an acute care setting, sometimes mean that things are done to and around a patient/client that would not normally occur in other person-to-person interactions (e.g., intubation equipment placed on patient’s/client’s chest, oxygen tanks placed between a patient’s/client’s legs). RTs must always do what is necessary in a given situation to provide the best possible care to their patient/client, while also respecting the patient’s/client’s personal space and autonomy.

Preventing abuse is everyone’s responsibility. If you are the subject of, or witness to, abuse you have a professional and ethical duty to report the behaviour. In addition you may wish to consider the following recommendations:

Remember, it is not just the character of the incidents, but the number, frequency, and especially the pattern that can reveal the abuse or harassment.

REPORT the abuse to the person identified in your workplace policy, your supervisor, or a delegated manager. If your concerns are minimized, proceed to the next level of
management. Consider reporting the individual to his/her regulatory College.

The CRTO’s Zero Tolerance position statement, regarding abuse, states:

Please note that abuse in any form is considered to be professional misconduct and allegations will be referred to the Inquiries, Complaints and Reports Committee (ICRC).

Most RTs engage in the following two key relationships when practicing the profession:

Both types of relationships are built on trust, respect, compassion and honesty. RTs must always conduct themselves within these relationships in a manner that is free of all forms of abuse, including sexual abuse. The responsibility falls on the RT to know what meets the legal obligations and professional standards of acceptable conduct. Ignorance of these obligations or standards is not an acceptable defense. Professional standards regarding Professional Boundaries / Therapeutic & Professional Relationships are outlined in the CRTO Standards of Practice – Standard 12. RTs are also expected to adhere to their organizational policies regarding conduct.

In both therapeutic and professional relationships, an inherent power imbalance exists that favours the RT (e.g., between RT and patient/client, between staff RT and student, etc.). This power imbalance occurs because the RT has authority, knowledge, access to information and influence. This inequity can increase the potential for abuse and cannot be managed by obtaining consent.¹⁴

Patients/clients depend on the unique knowledge and skills of RTs to provide them with the care they need. The power imbalance places the patient/client in a dependent position, and it is the responsibility of the RTs to ensure that a proper therapeutic relationship is established and maintained. To do so, RTs must respect the dignity and privacy of the patient/client and their cultural, religious and sexual diversity.

It is the expectation that RTs:

To learn more about providing culturally competent care, please see the CRTO’s A Commitment to Ethical Practice.

RTs often work within an interprofessional team and are required to use a wide range of communication and interpersonal skills to effectively establish and maintain professional relationships. In addition, RTs teach students, manage staff and take part in the administration of their organization. It is essential that the standards for interactions in these professional relationships mirror the standards that apply to therapeutic relationships.

Issues related to abuse, sexual abuse, sexual assault and sexual harassment can also
arise for RTs outside of therapeutic relationships with patients/ clients. Just as in
therapeutic relationships, professional relationships are based on trust and respect
for boundaries. As outlined in the CRTO Standards of Practice, the RT is expected to
appropriately manage these professional relationships by:

Student RTs (as well as other students that an RT may be teaching) are dependent on the RT for their training and for an unbiased evaluation. As a result, a power imbalance exists in both the school setting (RT professor to student) and in the clinical care setting (staff RT to student). It is important to understand that the relationship an RT has in these situations is purely to assist the student in gaining the knowledge, skills and abilities necessary to become a competent professional. Students also must understand that
abuse of any form by an RT should not be tolerated. If a student feels they are being abused by an RT, the student should follow the process of their educational facility and contact the CRTO.

Dating Dating and other forms of affectionate behavior between an RT and their
patient/client may constitute sexual abuse as defined by the RHPA. As discussed
earlier in this document, the relationship between an RT and their patient/client has
an inherent power imbalance.

There can be no sexual contact between an RT and their patient/client for a oneyear period following the termination of the professional relationship. In some
instances, it will never be appropriate to date a former patient (such as when the
patient/client was particularly vulnerable). Once a patient/client is discharged from
the hospital or permanently transferred to another RT, the waiting period is a
minimum of one year before the patient/client and RT can enter into a sexual
relationship. Waiting less than one year constitutes sexual abuse of a patient/client.

In addition to a power imbalance existing between an RT and a patient/client, a
similar inequity exists between an RT and a Student Respiratory Therapist (SRT)
where the RT is directly or indirectly supervising the student. As a result of the RT’s
status and influence over the SRT (being educated by the CRTO Member), an RT
may not have a personal relationship with the SRT. Such a personal relationship is
unprofessional conduct and may be considered sexual misconduct resulting in a
public discipline hearing and onerous sanctions against the RT.

In general, RTs are advised to avoid personal relationships with anyone over whom
they may be perceived to have professional influence (e.g., family members of
patients/clients) for a minimum of one year following the end of professional
practice interactions

If a Member is found guilty of professional misconduct (abusing a patient/client;
failing to file a report of abuse; contravening the RHPA, etc.), the panel of the
Discipline Committee may take any one or more of the following actions ¹⁶

For more frank acts of sexual abuse, the Code sets out a mandatory penalty of at
least revocation and a reprimand.

Suspected abuse by a health professional is difficult to deal with in any situation. It is an RT’s ethical, professional, and sometimes legal responsibility to report any incidents of unsafe professional practice or professional misconduct (physical, verbal, emotional and/or financial abuse involving a regulated or non-regulated health care provider) to the appropriate authority.

The CRTO Standards of Practice states that an RT is accountable for the following:

In addition, the RHPA requires RTs to submit a report when they have reasonable grounds, obtained during the course of practising their profession, to believe that a member of the CRTO or a different College has sexually abused a patient/client.

Although there is no obligation under the RHPA to report sexual abuse of non-patients, (e.g. co-workers or students) there is a professional obligation to report another member of the CRTO where there is reason to suspect professional misconduct. (CRTO Standards of Practice – Standard 13 )

A report must be filed with the Registrar of the appropriate College within 30 days of the incident being brought to the RT’s attention, unless the RT reasonably believes the abuser will continue to abuse, in which case they must file the report immediately. The report must be in writing and include:

The RHPA expressly states that anyone making a report in good faith and on the belief that there are reasonable grounds is protected from retaliation (HPPC , Ss.92.1).

The Child and Family Services Act (CFSA) exists to protect and promote the best
interests and well-being of children under 16 years of age. The legislation articulates
the duty to report a child in need of protection and outlines the reasons a child
might be in need of protection19, which includes but is not limited to a child that:

The CFSA outlines that health care professionals have a particular responsibility to
report suspicions of abuse of children. The Act makes it an offence for a health care
professional to not report their suspicion when it is based on “information obtained
in the course of his or her professional or official duties”20. The Act also articulates
the ongoing duty to report subsequent suspicions of abuse, even if the health care
professional has already made previous reports on the same child.

As with reporting abuse of adults under the RHPA, the Child & Family Services Act has several provisions protecting anyone “providing information in good faith” (Child & Family Services Act).

Occasionally, an RT may be subject to abuse by a patient/client, the patient’s/client’s family members, and/or other individuals in their workplace environments. RTs should take the appropriate steps to protect themselves when their personal safety is threatened and report all incidents of abuse to the appropriate person (i.e., manager/supervisor). If there is a significant threat or risk of injury to a Member, it may be necessary to leave the area and reassess the situation. The decision to withdraw or withhold care or services from a patient/client is not common and only used as a last resort. Please refer to your employer’s policy. For information on documenting such incidents, see the CRTO Documentation PPG – Withdrawal of Care/Services Due to Abuse or Violence.