Draft Regulation R-013: Spousal Exemption to Sexual Abuse Provisions and Draft Standard of Practice S-032: Providing Chiropractic Care to a Spouse

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1 ONTARIO CHIROPRACTIC ASSOCIATION ASSOCIATION CHIROPRATIQUE DE L ONTARIO March 26, 2015 Joel Friedman, Director, Policy and Research College of Chiropractors of Ontario 130 Bloor St. West, Suite 902 Toronto, ON M5S 1N5 RE: OCA Response to February Consultation Dear Mr. Friedman: This communication constitutes the feedback from the Ontario Chiropractic Association (OCA) to the various documents circulated by the College of Chiropractors of Ontario (CCO) for consultation purposes in February By Laws The proposed by-law changes are appropriate and the OCA supports them with one suggestion. By-law 17.6(e) makes reference to the member s business . There may not always be both a business and a personal . In circumstances where there is only what the registrant considers to be a personal , we suggest that the publication of this be at the discretion of the practitioner. Perhaps replacing member s business with an address used exclusively by the member for business purposes would avoid confusion. Draft Regulation R-013: Spousal Exemption to Sexual Abuse Provisions and Draft Standard of Practice S-032: Providing Chiropractic Care to a Spouse The OCA is strongly supportive of these proposed changes. We advocated to the Health Professions Regulatory Advisory Council (HPRAC) and the government for the CCO to have the option of creating this exemption. We applaud the CCO for taking action to do so by way of Draft Regulation R-013. Some additional clarity might be helpful in the Setting of Care section. This section requires that care to a spousal patient be provided in a proper setting suitable to provide the care required. It is very clear that all CCO Standards of Practice will apply to spousal care situations. It is not clear whether a proper setting suitable to provide the care required is necessarily the same for a spousal patient as for a nonspousal patient. For example, it is not unusual for a chiropractor to provide care in a patient s home (a house call) so we would assume that the marital home could be considered a suitable setting Victoria St., Toronto ON M5C 2N Toll-free Fax:

2 P a g e 2 Draft Standard of Practice S-016: Advertising and Guideline G-016: Advertising Testimonials We are aware from a number of OCA members that there is some opposition to the proposed ban on the use of testimonials in advertising. Testimonials can be a very effective form of advertising. We also understand that this proposed ban is in accordance with the Ministry s Template. With respect to advertising by members of themselves or their services, testimonials may not be aligned with the Intent section of S-016, and we support the proposed change based on the explanation in the draft Guideline that testimonials may be subjective, misleading and unverifiable Online Coupons, Contests and Giveaways We applaud the proposed change to G-016; 4(g) to add the following: Although discounted fees may be offered, online coupons, contests and giveaways are inappropriate, demean the integrity of the profession, and should be avoided. This is a position strongly endorsed by the OCA. The wording is clear, and we believe it is important for this statement to be this clear. We suggest changing the phrase should be avoided to must be avoided. The OCA agrees with the CCO s identification of these advertising techniques as inappropriate and demeaning to the integrity of the profession. We believe they should be prohibited, and urge the CCO to consider this for both the Guideline and the Standard of Practice. The Exclusion of Websites from the Advertising Standard We are concerned that the new Standard will not be applicable to members websites. We refer you to our detailed letter and appendices of April 25, 2014 in which we made the following points and provided considerable evidence: We have been unable to find any other chiropractic regulatory college in Canada that expressly excludes a member s website from its Advertising Standard Other Ontario Colleges under the Regulated Health Professions Act do not treat advertising on a website differently than other media. The exclusion of websites from the reach of the Advertising Standard leaves the profession vulnerable to reputational injury caused by website content that is undignified and unprofessional. The current rationale which is that a website is considered an extension of the member s office that the public must choose to enter does not reflect current reality of the internet. The Standard defines advertising as a message that is: communicated outside a member s office through a public medium that can be seen or heard by the public at large with the intent of influencing a person s choice of service or service provider

3 P a g e 3 The Association believes not only that a website fits within this definition, but that this definition outlines the specific, core intent of most websites. Members of the public wander onto websites in a way that does not apply to entering a physical office space, and the portion of the public that relies on the internet for their information and buying decisions is large and growing. The analogy of entering a website being akin to entering a physical office is not viable. By circumscribing its own authority in this way, the College sends the message that members need not be as careful with the content of their websites as they are in all other forms of advertising. It also creates potential confusion for both the public and members of the College if different standards apply to websites than to other communications. We respectfully suggest that the College revisit this issue, and dialogue with the profession about a potential shift in position. Draft Standard of Practice S-003 Professional Portfolio We note the proposed change to a requirement from a recommendation for a minimum of five hours of CE that consists of interactive, hands-on learning related to spinal adjustment or manipulation. We support this change. Spinal manipulation or adjustment is very closely associated with chiropractic. Our recognized position as highly skilled in manual therapy, primarily manipulation or adjustment, is extremely important for the profession and is an integral part of the OCA s efforts to differentiate and promote the profession through advocacy. There are a number of factors we believe should be taken into consideration in finalizing S-003. Self -Directed Nature of CE The premise of the Professional Portfolio is one of self-assessment and self-directed, lifelong learning. In this context direction is given to members that CE activities must relate to a member s clinical practice and/or professional activities, with the goal of enhancing a member s professional knowledge and skill. We agree with and support this principle. The proposed requirement could be seen to reduce the value of the self-assessment and infringe on the principle of self-directed learning. It would interfere to some extent with the practitioner s ability to choose the CE which he or she has identified as most valuable for him or her. Diversity within the Profession It is important that we all accept and respect the diversity within the profession. Part of the diversity in chiropractic today is the wide variety of activities and interventions used in practice.

4 P a g e 4 These include, for example: A variety of diagnostic methods including conventional and chiropractic or technique specific methods A variety of adjustment or manipulation techniques A variety of mechanical adjusting including the activator and pro-adjustor A variety of soft tissue techniques, including ART, mobilization, and muscle energy techniques A variety of physical and electrotherapies A variety of diagnostic testing tools including imaging and electromyography, Acupuncture Exercise and rehabilitation programs Patient activation and counseling using, for example, Brief Action Planning Cognitive Behavioural Therapy Lifestyle counseling Etc. As clinical practice expands, some chiropractors may rely on other techniques as much as they rely on adjustment or manipulation. We should respect their decision. Other CE requirements In addition to adjustment or manipulation there are other important skills where competency is important for public safety. For the protection of the public, competence and skill in the controlled act of diagnosis is perhaps as important as competence and skill in adjustment/manipulation. Chiropractors in Non-treating Careers There are more and more chiropractors performing work that is not traditional practice. This includes: chiropractors in corporate positions, government employees, researchers, those in assessment and education positons, such as the ISAEC practitioners, and, those in health care but not practicing as chiropractors, such as a program director at a FHT or a WSIB employee. So there are chiropractors for whom the proposed mandatory adjustment/manipulation CE requirement may not be appropriate. Exemptions could be put in place for these members. Draft Standard of Practice S-021: Assistive Devices In our letter of October 11, 2011, at the request of the Ministry of Health and Long Term Care, we asked the CCO to confirm that the prescription of a short list of assistive devices was within the scope of practice of a chiropractor. This was necessary for our advocacy efforts to secure prescription rights in the Ontario Assistive Devices program so that patients could be reimbursed for devices prescribed by a chiropractor. Dr. Amlinger responded with some questions on July 16, 2012, and we responded on July 20, 2012 suggesting that the CCO and OCA meet to move this opportunity forward. There have been no

5 P a g e 5 subsequent communications from the CCO on this topic. It is not clear whether this draft Standard of Practice is intended to respond to that request. We would appreciate understanding whether this is the case or whether the CCO is able to address the specific questions raised in our October 2011 letter. If so, we will attempt to restart interest at the Ministry. Regardless, we offer the following comments and suggestions on the proposed draft Standard of Practice S-021: In the Intent section we suggest amendment of the sentence Assistive devices may be used by chiropractors as an adjunctive therapy to patient care for managing certain conditions within the chiropractic scope of practice to read Assistive devices may be prescribed and/or dispensed by chiropractors for managing conditions within the chiropractic scope of practice. o Prescribed and/or dispensed is a more clear description of the activity than used. o The word certain is unnecessary. In the Protocol Section we suggest amending if, in the member s clinical judgment or opinion, an assistive device is intended to improve the patient s health, to read if, in the member s clinical judgment or opinion, an assistive device is reasonably expected to improve the patient s health o Intent of the device seems unclear. In the Billing Section we suggest amending The cost of the assistive device must reasonably relate to the time and expertise of, and cost to, the member. to read The cost of any assistive device dispensed by the member must reasonably relate to the time and expertise of, and cost to, the member. o This would help delineate the two functions of prescribing and dispensing. Thank you for this opportunity to provide feedback on these important documents. The OCA wishes to express our appreciation for the dedicated work of the CCO Council and staff in your important role of regulating the profession. We look forward to your response to the question posed in the Assistive Devices section. Sincerely, Dr. Bob Haig, DC Chief Executive Officer