BEHAVIOUR AND REMARKS OF A SEXUAL NATURE

PURPOSE OF THE STANDARD

The purpose of this standard is to ensure that the public is provided with care in an atmosphere, which places no sexual demands upon them and is free of any sexual connotations or contexts.

DESCRIPTION OF THE STANDARD

This standard is detailed in the complaints and discipline procedures with respect to professional misconduct of a sexual nature/patient relations program, and is summarized in the College of Denturists of Ontario prevention plan previously distributed in June 1998 to all practitioners and as follows.

The Quality Assurance Committee formally acknowledges and recognizes the separate statutory Patient Relations Committee of the College of Denturists of Ontario.

SUMMARY AND CONCLUSION

Failure to comply with this standard may lead to the revoking of a member's certificate of registration.

COLLEGE OF DENTURISTS OF ONTARIO SEXUAL ABUSE PREVENTION PLAN

STATEMENT OF PHILOSOPHY

The College of Denturists views the matter of sexual impropriety and sexual abuse with the utmost seriousness and will not tolerate any actions of this kind on the part of Denturists of Ontario.

EVALUATION OF PRESENT PRACTICES

Although the College has traditionally demonstrated a prompt and thorough approach to the investigation of allegations of sexual abuse and/or impropriety, the approach to these investigations has largely been of an ad hoc nature rather than the result of following an established protocol. In general, the investigations of the past have incorporated many appropriate characteristics:

  1. the participation of a female member of the registrar staff;
  2. prompt follow-up, often involving an interview of the complainant, carried out in a supportive and sympathetic fashion;
  3. a prompt office visit with the Denturist alleged to have committed the offense in which he/she is confronted with the allegations.

Nevertheless the College now believes that the goal of eliminating sexual abuse/impropriety may be more efficiently reached by creating a sexual abuse protocol. This protocol would have the advantage of ensuring that all reported incidents will be dealt with by the College in a consistently appropriate fashion. The major components of the protocol will consist of the following:

SEXUAL ABUSE/IMPROPRIETY PROTOCOL

1. SEXUAL ABUSE OFFICER
The services of a Sexual Abuse Officer will be provided by appointment through the Patient Relations Committee.

Role of the Sexual Abuse Officer
The Sexual Abuse Officer will have primary responsibility for the investigation of complaints or reported incidents of sexual abuse/impropriety. The Sexual Abuse Officer's duties will include primary responsibility for:

  1. communication with the victims of sexual abuse/impropriety;
  2. follow-up office visits with the alleged perpetrator/denturist;
  3. assisting complainants in the compilation of required information or submissions necessary for the complainants or discipline process;
  4. the collection of data to facilitate reporting on trends, identification of solutions to problems, etc.;
  5. informing survivors of sexual abuse of effective treatment centres and counseling resources;
  6. such other duties as are outlined in the sexual abuse/impropriety protocol.
  7. facilitating training of staff and interested parties in matters concerning sexual abuse.
  8. liaising with other Colleges and with government regarding sexual abuse matters.

2. COMPLAINTS INVESTIGATION PROCESS

a. Initial Contact with the Complainant
In the vast majority of cases, the College's initial contact with the complainant of sexual abuse/impropriety occurs over the telephone. Whenever possible, all College employees will direct such telephone calls to the Sexual Abuse Officer. When the Sexual Abuse Officer is not available, the call will be directed to an available member of the registrar staff. However, this staff member will bring the matter to the attention of the Sexual Abuse Officer when he/she becomes available.

Whenever possible, any staff member dealing with such a call will extend an invitation to the complainant of sexual abuse/impropriety to meet with the Sexual Abuse Officer.

b. Meeting with the Sexual Abuse Officer
Should the complainant wish to meet the Sexual Abuse Officer, such meeting shall be arranged by the Sexual Abuse Officer and shall take place in accordance with the following criteria:

The meeting will take place in a setting in which the complainant's privacy may reasonably be expected to be respected (such meeting place need not necessarily be located at College headquarters).

The complainant will be advised prior to the meeting that he/she may bring other persons of her/his choosing to the meeting if he/she wishes, such as friends, relatives or other support figures, counselors (including legal counsel if desired) and interpreters.

The Sexual Abuse Officer will offer to assist the complainant to draft any submissions required by the College's complaint or discipline processes.

c. Follow-up Visit to Denturist Alleged to Have Committed the Sexual Abuse/Impropriety
Following the meeting with the complainant (or following the initial contact with the complainant should the complainant decline a meeting), the Sexual Abuse Officer will arrange to visit the office of the Denturist alleged to have committed the sexual abuse/impropriety. During this office visit, the Sexual Abuse Officer will present the Denturist with the allegations made by the complainant and will attempt to obtain any information which he/she feels is relevant to the matter. On completion of the office visit, the Sexual Abuse Officer will draft a report respecting the office visit which shall be provided to the appropriate College committee investigating the matter.

The office visit will be conducted as promptly as reasonably possible following the meeting with the complainant or the initial contact with the complainant if the complainant declines the offer to meet with the Sexual Abuse Officer.

3. COLLECTION OF SEXUAL ABUSE/IMPROPRIETY DATA

The Sexual Abuse Officer shall maintain in a systematic fashion a record of all complaints or reports of sexual abuse and/or impropriety which come to the attention of the College, including:

  1. The names and addresses of all complainants or reporters of sexual abuse and/or impropriety.
  2. The names and registration numbers of all Denturists alleged to have committed the sexual abuse impropriety.
  3. A description of all reported incidents, including the date and location.
  4. The disposition of the complaint or report of sexual abuse/impropriety, including the steps taken in the investigation, the outcome of the investigation and any disciplinary activity which ensued, including penalties assigned to the Denturist.

4. GUIDELINES FOR PROFESSIONAL BEHAVIOUR

The following document will be distributed to all members of the profession: Guidelines for the Prevention of Sexual Abuse/Impropriety in the Denturist Office.

This document has been drafted in accordance with legislation which calls for the development of a sexual abuse plan by the College. The primary objective of this plan is to eliminate incidents of sexual abuse and/or sexual impropriety in the Denturist office.

Professionalism in the Sexual Context
The College takes the position that professional conduct requires a Denturist to conduct a Denturist practice observing the following principle:

PATIENTS HAVE THE RIGHT TO EXPECT DENTURIST CARE WHICH PLACES NO SEXUAL DEMANDS UPON THEM.

Blatant types of sexual demands (often referred to as sexual abuse or sexual violation) usually include some form of overt sexual physical contact with the patient. There is no place in a Denturist practice for such physical contact.

However, more subtle types of sexual demands are often unrecognized and occasionally may occur inadvertently. These more subtle sexual demands include the following:

  1. Behavior, gestures, or expressions that are seductive or sexually demeaning to a patient
  2. Inappropriate draping practices which reflects a lack of respect for the patient's privacy
  3. The placement of dental instruments upon the patient's chest.
  4. Making sexual comments about a patient's body or underclothing.
  5. Making sexually demeaning comments to a patient.
  6. Criticism of the patient's sexual orientation.
  7. Initiation of conversations regarding sexual problems, preferences or fantasies.
  8. Inappropriately affectionate behavior involving hugging and kissing.

5. PROFESSIONAL EDUCATION PROGRAM

The College recognizes the importance of ongoing professional education respecting the issue of sexual abuse and/or impropriety. Accordingly, the following initiatives will be incorporated into the College's professional education program:

The distribution of the above Guidelines for Professional Behavior to all Denturists practising in the province.

The underwriting of seminars and lectures concerning the subject of sexual abuse and/or impropriety in the Denturist office. These seminars and lectures will be made available to local denturist societies.

The encouragement of the Faculties of Denturism to incorporate appropriate training respecting sexual abuse and/or impropriety in their undergraduate and graduate programs.

6. STAFF EDUCATION

The College is committed to the development of an education program for appropriate members who have contact with individuals who complain of sexual abuse or who are involved in investigating and adjudicating cases of this nature.

This education program will include the following:

  1. The nature of sexual abuse, the magnitude of the problem, the consequences to victims and issues of race, gender and class related to abuse.
  2. The range of ways the victim of sexual abuse may initiate a complaint and how to facilitate and handle complaints in an appropriate, empathetic and supportive manner.
  3. How to fully and appropriately explain the complaints and discipline process of the College to potential or actual complainants.
  4. The options available to a complainant to lodge a complaint of sexual abuse through the criminal and civil justice systems.
  5. How to address victims of sexual abuse and those making inquiries with sensitivity and respect (for example, not implying that the problem is the victim's fault).
  6. The characteristics of sexual impropriety and sexual abuse and/or sexual violation.
  7. How to inform survivors of sexual abuse of effective treatment centers and counseling resources.

7. PUBLIC EDUCATION

The College is committed to a public education process designed to improve communication with the public and increase awareness of the College's regulatory role. The issues of sexual abuse and impropriety including public awareness constitutes a substantive part of the College's overall public communication program.

GUIDELINES

THE PROFESSIONAL BEHAVIOUR REGARDING THE PREVENTION OF SEXUAL ABUSE IN THE DENTURIST OFFICE

College Guidelines contain practice parameters and standards that should be considered by all Ontario Denturists in the care of their patients. It is important to note the following guidelines may be used by the College or other bodies in determining whether appropriate standards of practice and professional responsibilities have been maintained.

INTRODUCTION

Ontario government legislation now requires all health regulatory colleges to have in place a patient relations program that includes measures for preventing and dealing with "sexual abuse" of patients. These mandated measures under the Regulated Health Professions Act, 1991, RHPA include the publishing of guidelines regarding the conduct of members of the College toward their patients. This bulletin outlines and explains these Guidelines.

Sexual impropriety with patients is considered an extremely serious matter. The College previously approved a policy of zero tolerance in this regard. The sanctions mandated by the RHPA against members who are found guilty of professional misconduct in connection with sexually abusing patients are very severe. (These penalties are detailed below.) All members are well advised to read and understand the following Guidelines and to keep them for frequent reference. If you have any questions or concerns, you are encouraged to contact the College office (416) 925-6331.

WHAT IS "SEXUAL ABUSE?"

"Sexual abuse" is very broadly defined in the legislation, to include not only physical actions but also behaviour or remarks. Here is how "sexual abuse of a patient" is defined under the RHPA's Health Professions Procedural Code:

sexual intercourse or other forms of physical sexual relations between the member and the patient;
touching, of a sexual nature, of the patient by the member; or
Behaviour or remarks of a sexual nature by the member towards the patient.
The Code does allow touching, behaviour and remarks that are of a clinical nature and that are appropriate to the services rendered.

Although, the RHPA requires that these Guidelines relate to the "sexual abuse" of patients, the College takes equally seriously the sexual abuse or sexual harassment of dental office staff. There are other provisions set out in the professional misconduct Regulations that deal with this type of behaviour.

GUIDELINES FOR PROFESSIONAL BEHAVIOUR

As a general guiding principle, you, as a member of the College, are required to ensure that your patients receive dental care in an atmosphere that places no sexual demands upon them and is free of any sexual connotation or context.

Blatant types of sexual misconduct (often referred to as sexual abuse or sexual violation) usually include some form of overt sexual physical contact with the patient or touching of sexual nature. Section 1(4) of the Health Professions Procedural Code (RHPA, 1991) states that "sexual nature" does not include touching, behaviour or remarks of a clinical nature that are appropriate to the services provided.

In the context of the practice of Denturism, clinical touching of a patient that is related to the examination, assessment and treatment of conditions of the oro-facial complex is appropriate.

In most cases, if touching must involve areas beyond the oro-facial complex, you should explain beforehand to the patient the context of the treatment and/or investigation in order to avoid any misinterpretation or misunderstanding. As with all phases of dental examination, assessment and treatment, the principles of "informed consent" should be followed at all times.

DOS AND DON'TS

More subtle types of sexually inappropriate behaviour are often unrecognised and occasionally maybe committed inadvertently. While the College recognises that these Guidelines do not cover all eventualities, most sexually demeaning conduct could be prevented by the following:

DO:

  • BE aware that recent publicity about sexual abuse of patients, the proclamation of the RHPA, the issuing of these Guidelines and their availability to the public have changed the climate of practise of Denturism in Ontario. Behaviour engaged in without consequence in the past may now leave you vulnerable to patient complaints and possible prosecution.
  • RESPECT cultural differences and be aware of sensitivities of individual patients.
  • ENSURE that any and all conversations between you and your office staff would not be found offensive by a patient.
  • USE appropriate draping practices that respect a patient's privacy and ensure that the placement of patient bibs or drapes is carried out in a professional manner.
  • ENSURE or attempt to ensure that a third party is present when treatment is rendered outside of regular office hours.
  • DOCUMENT on the patient record any and all comments or concerns made by a patient relative to alleged sexual abuse and any other unusual incident that may have occurred during the course of or after an appointment. These chart entries should be made as soon as possible after the incident occurred and should contain statements from you and the office staff who were present.

DON'T:

  • USE gestures or expressions or engage in any other behaviour that may be interpreted as seductive or sexually demeaning to a patient or as sexual abuse.
  • PLACE dental instruments or supplies upon a patient's chest or lap.
  • MAKE sexual comments about a patient's body or clothing.
  • TELL jokes or stories of a sexual nature to a patient.
  • COMMENT on patient's sexual orientation.
  • INITIATE conversations with patients regarding sexual problems, preferences or fantasies and refuse to participate if such discussions are initiated by a patient.
  • ENGAGE in inappropriate "affectionate" behaviour with a patient such as hugging and kissing.

DATING PATIENTS

Because of the very broad definition of "sexual abuse" in the legislation, it is unacceptable for you to date a current patient. Even the most casual dating relationship may lead to forms of affectionate behaviour that would fall under this definition and could leave you open to possible accusations.

If you intend to date a patient, the denturist/patient relationship should first be terminated, the account settled and the patient information and/or duplicate records transferred to another practitioner according to the College's Guidelines Respecting the Release and Transfer of Patient Records.

PENALTIES

The legislation says that when a panel of the Discipline Committee finds a member guilty of committing an act of professional misconduct by "sexually abusing" a patient, as a minimum, it must:

  • Reprimand the member.
  • Revoke the member's certificate of registration if the sexual abuse consisted of, or included any of the following:
    • sexual intercourse;
    • genital to genital, genital to anal, oral to genital, or oral to anal contact;
    • masturbation of the member by, or in the presence of, the patient;
    • masturbation of the patient by the member;
    • encouragement of the patient by the member to masturbate in the presence of the member;
  • As required by the RHPA, 1991, the member may also be ordered to reimburse the College for funding provided for therapy and counselling for the patients who were "sexually abused" by the member, to the maximum of $10,000.00 per patient.

These Guidelines have been developed by the College as part of the "College's Sexual Abuse Prevention Plan" and in accordance with the legislated requirements under the Regulated Health Professions Act 1991. They are not intended to interfere with the traditional denturist/patient relationship, that of providing appropriate dental treatment in a professional and caring manner.