Responding to Complaints at the College of Occupational Therapists of Ontario: What Occupational Therapists Need to Know
At some point in their career, an occupational therapist (OT) may be subject to a formal complaint at the College of Occupational Therapists of Ontario (COTO). As the requirements of working through the complaint process can place a strain on the occupational therapist, we have prepared an introductory guide to responding to complaints at the COTO.
The COTO notifies the occupational therapist of the complaint process and provides a copy of the complaint itself. When applicable, the occupational therapist receives a summary of their prior complaint history. A panel of the COTO’s Inquiries, Complaints and Reports Committee (ICRC) reviews the matter following an investigation, and is responsible for addressing the occupational therapist’s conduct. The ICRC is entitled to order further investigation as required.
Generally, all complaints against occupational therapists are addressed by the ICRC. The occupational therapist’s opinion on the legitimacy of the complaint is irrelevant, and they typically are required to cooperate throughout the formal complaint process. This may entail participating in interviews conducted by the COTO.
The ICRC asks for written responses only, as complaint proceedings at the COTO proceed via the exchange and review of documents. Typically, hearings are not held for complaints, meaning the occupational therapist has no opportunity to directly explain their decisions and actions to the ICRC. Occupational therapists should address each of the complainant’s concerns prior to submitting their response.
Within 30 days of providing the occupational therapist with the complaint, the COTO expects a response. Writing the response is an essential part of the occupational therapist’s defence, and may take some time and effort. As professional consequences are a persistent concern throughout the process, occupational therapists may experience considerable stress. Contacting a lawyer who is familiar with professional regulation can assist occupational therapists with drafting the response and otherwise dealing with the COTO, which can ease some of the tension. When retained, legal counsel typically becomes the first point of contact with the COTO.
In crafting their response, occupational therapists should consider when the care was provided, the complexity of the care, and the possibility of a civil lawsuit arising in relation to the care. Organizing the response chronologically may assist occupational therapists in presenting a comprehensive narrative that includes all relevant events.
With more meritorious complaints, the occupational therapist may benefit from taking a conciliatory approach in their response. It is appropriate in some circumstances to acknowledge any lapses in care or professional standards, and describe how the occupational therapist has since improved their practice. When the ICRC is confident that the OT has taken responsibility, learned a lesson, and will adopt best practices going forward, it may require no further action.
In preparing a response for submission to the COTO, occupational therapists or their legal representatives should enclose any relevant records. Outside the context of the complaint process, occupational therapists are responsible for keeping their records in compliance with the Occupational Therapy Act, 1991 guidelines. Inadequate or faulty recordkeeping is an independent act of professional misconduct, and the ICRC may evaluate the quality of the occupational therapist’s records regardless of the outcome of the complaint.
Once the investigator receives the occupational therapist’s response and determines that no further investigation is necessary, the investigator forwards their report to the ICRC. When it is in possession of adequate information, the ICRC may do any of the following: take no further action; caution the occupational therapist in person before the ICRC; inquire into the occupational therapist’s professional capacity; refer the matter to the Discipline Committee; or take any other action within its power. Written reasons are generally provided for any decision, unless the occupational therapist is referred to discipline or to the Fitness to Practice Committee.
Regulatory findings at the COTO are becoming increasingly transparent, with the Public Register now including details of the following ICRC dispositions: Specified Continuing Education or Remediation Programs (SCERP); oral cautions; and referrals to discipline. Anyone accessing an occupational therapist’s public profile will generally be able to see if they have such dispositions.
In cases in which the complainant alleges serious misconduct, the ICRC may impose an interim order on the occupational therapist. Often when there are concerns that patients are likely exposed to potential harm, interim orders place terms, limitations, or conditions on the occupational therapist’s certificate of registration, and can last for the entirety of the investigation. Interim orders may even take the form of licence suspension. Outside of interim orders, the Registrar, under section 75 of the Health Professions Procedural Code, can also appoint a special investigator to address more serious complaints. Occupational therapists will find section 75 investigations much broader than standard investigations.
Occupational therapists and complainants are generally entitled to request reviews of ICRC decisions. These reviews are held before the Health Professions Appeal and Review Board (HPARB), which specifically looks at whether the COTO’s investigation into the OT was adequate, and whether the ICRC’s decision was reasonable. The HPARB panel, occupational therapist, and complainant typically all receive disclosure of any documents on which the ICRC relied.
Allegations of professional misconduct have the potential to impact an occupational therapist’s career, public image, and personal life, and typically require time and effort to adequately address. It is prudent for occupational therapists to consider retaining legal counsel familiar with professional regulation, as this may help with responding and working through the complaint process in general. When faced with a complaint, occupational therapists should respond with great care.
Josh Koziebrocki, is the principal lawyer and founder of Koziebrocki Law. He represents occupational therapists and has extensive experience dealing with regulatory issues. He can be reached at 416-925-5445.
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