RMTAO Response to CMTO Standards of Practice

Download Bill 87, the Protecting Patient Act, was given Royal Assent on May 30, 2017. This act is meant to strengthen the prevention of, and response to, incidents of patient sexual abuse, increase supports for victims of sexual abuse by regulated health professionals and improve regulatory oversight and accountability of health regulatory colleges. All regulatory colleges for the health professions listed in the Regulated Health Professions Act were required to comply with this new legislation.

In response to this new legislation, the College of Massage Therapists’ of Ontario (CMTO) drafted new Standards of Practice relating to Maintaining Professional Boundaries and Preventing Sexual Abuse. The draft standards were released by the College on June 6, 2017 for feedback. The consultation included a survey of Registered Massage Therapists and an invitation for questions or clarification. The Board of Directors of the RMTAO provided a letter to the CMTO outlining specific concerns with the draft standards. These concerns included:

• The prohibition of the use of monitoring, video or photographic recording equipment in areas designated for clinical assessment of treatment;
• The removal of specific examples of non-verbal communication;
• The definition of professional attire appropriate to health professionals;
• The clarification of spousal touch within a loving relationship and clinical touch within a therapeutic relationship as it related to the treatment of spouses as sexual abuse;
• The requirement for the client to specifically request treatment of a sensitive area;
• The requirement of written confirmation by a physician prior to performing clinically-indicated breast massage;
• Written consent for the treatment of sensitive areas for each treatment.

The full letter to the CMTO from the RMTAO Board of Directors regarding the draft standards can be found here: Download RMTAO Letter to CMTO RE Consultation on Proposed New Standards for Maintaining Professional Boundaries and Preventing Sexual Abuse

As a result of the feedback received from the survey and the letter provided by the RTMAO, the CMTO amended the draft standards in all areas except the requirement for written consent prior to each treatment for certain sensitive areas.

The CMTO released the final version of the Standards of Practice for Maintaining Professional Boundaries and Preventing Sexual Abuse on September 21, 2017 with an effective date of September 11, 2017, which was the date of the CMTO council meeting when the new standards were approved.

The RMTAO Board of Directors have again written to the CMTO maintaining that the requirement to obtain consent for specific sensitive areas prior to every treatment is a barrier to care and undermines the therapist’s professionalism. The RMTAO believes and recommends that requiring written consent at the initial assessment, initial treatment within a treatment plan, or substantive change in the direction of that treatment plan is more than sufficient and has become the standard across other health care professions. The full letter to the CMTO regarding the new standards can be downloaded here: Download RMTAO Letter to CMTO RE New Standards for Maintaining Professional Boundaries and Preventing Sexual Abuse

We understand that with the implementation of these new standards, our members may be confused or upset. We know many of you have written to the RMTAO, the CMTO, and there is even a petition that has been created by an individual massage therapist. We will continue to seek clarification on these new standards and work to revoke the excessive consent requirement that we believe is a step backwards for this profession.

In the meantime, we would like to provide a practical outline of the requirements outlined in these new standards, specifically as they relate to the consent requirements for treating sensitive areas. 

For the treatment of a new client or an existing client with a new/adjusted treatment plan, you are required to discuss with the client:

• Nature of the treatment
• Expected benefits of treatment
• Material risks of the treatment
• Material side effects of the treatment
• Alternative courses of action
• Likely consequences of not having the treatment
• Draping and positioning
• Right to withdraw consent at any time

You are also required to obtain voluntary written informed consent, including a client signature and date prior to the commencement of a treatment plan or the treatment of sensitive areas.

For the treatment of the sensitive areas of the breast(s), the chest wall muscles, or the upper inner thigh, written consent is required before every treatment. This can be obtained through the client initials on a tracking form in the file. For the treatment of the buttocks(s) or gluteal muscles, written consent is required at the beginning of the treatment plan, and ongoing verbal consent is required for each individual treatment.

There are templates included in the standards that can be adapted for use in your practices. We have also had several members provide sample forms that they are using and we would be happy to forward on examples should you require.

We will continue to fight for the rights of RMTs. We believe that these current standards serve to undermine the professionalism of massage therapists and we hope to increase and encourage professional communication between massage therapists and clients without resorting to onerous consent requirements.

Tags: CMTO, Advocacy