Complaints of Sexual Abuse and Sexual Misconduct

As health care professionals, chiropractors hold a position of power and trust. A chiropractor is in a position of power over a patient by virtue of having professional knowledge and skill that a patient relies on for their care and well-being, with knowledge of a patient’s personal health information.

Chiropractors are responsible to maintain professional boundaries and not engage with patients in inappropriate relationships or blur the boundaries of the chiropractor-patient relationship. This includes unprofessional behaviours and conversations, and friendships with patients.
Chiropractors are responsible for managing boundary issues, and are therefore, accountable should boundary violations occur.
Chiropractors are aware it is against the law to engage in an unprofessional relationship with a patient of a sexual nature that includes sexual abuse and sexual misconduct. They are aware that there are serious penalties for findings of sexual abuse and misconduct, up to and including permanent revocation of their practice permit.
Chiropractors must adhere to the Health Professions Act and the College of Chiropractors of Alberta (CCOA or the College)’s Standards of Practice and Code of Ethics in their practice of chiropractic.

Defining a Patient – Our College has defined a patient as an individual who has had a clinical visit with a chiropractor within the last twelve months.

Who Can Submit a Complaint?

Any person can submit a complaint although the patient’s perspective is important in understanding the specific circumstances of the chiropractor’s conduct.

We recognize that coming forward can be incredibly difficult, but your safety matters and we want to hear about your experience. If you are able to report this conduct, it will help to:

Increase public protection and awareness: Incidents of sexual abuse are often not isolated. By coming forward, you help us act to ensure that what happened to you does not happen to someone else.
Make the College aware: As the regulator of chiropractors, we do not know unless it is reported to us. We rely on those persons involved to make us aware when a chiropractor’s conduct is sexually inappropriate.
Provide some closure: If you have been the victim of sexual abuse or sexual misconduct by a chiropractor, knowing that there is an investigation and potential serious consequences for the chiropractor may help in your healing process.

Defining Sexual Abuse and Sexual Misconduct

The Health Professions Act defines sexual abuse and sexual misconduct and provides direction to the College on managing these complaints.

Sexual Abuse is defined as the threatened, attempted or actual conduct of a regulated member towards a patient that is of a sexual nature.

Sexual abuse includes any of the following conduct:

Sexual intercourse between a regulated member and a patient of that regulated member;
Genital to genital, genital to anal, oral to genital or oral to anal contact between a regulated member and a patient of that regulated member;
Masturbation of a regulated member by, or in the presence of, a patient of that regulated member;
Masturbation of a regulated member’s patient by that regulated member;
Encouraging a regulated member’s patient to masturbate in the presence of that regulated member;
Touching of a sexual nature of a client’s genitals, anus, breasts or buttocks by a regulated member.

Sexual Misconduct is defined as any incident or repeated incidents of objectionable or unwelcome conduct, behaviour or remarks of a sexual nature by a regulated member towards a patient that the regulated member knows or ought reasonably to know will or would cause offence or humiliation to the patient or adversely affect the patient’s health and well-being but does not include sexual abuse.

Can a Patient Consent to a Relationship with a Chiropractor?

No. As there is an unequal balance of power and influence, a patient is in a vulnerable position making it impossible to give meaningful consent to any sexual involvement with a chiropractor.

It is never acceptable for a chiropractor to engage in an inappropriate or sexual relationship with a patient. It remains the ethical duty and responsibility of the chiropractor to maintain a professional clinical relationship, and the obligation remains with the chiropractor not to cross or blur any boundaries.

Blurring or Crossing Professional Boundaries

Professional boundaries are the parameters or limits between a chiropractor and a patient that ensures a therapeutic and safe clinical experience. Boundaries are necessary to keep the chiropractic visit a professional encounter and to serve the patient’s best interest.

A professional relationship is one of trust with communication by the chiropractor that should be focused on the clinical reason for the visit, assessment, examination and treatment of the patient. The interaction should be professional and communication should not be of a personal nature without relevance to the treatment being provided.

Behaviours and communication that may blur the boundaries of the patient relationship or behaviors defined in legislation as sexual abuse or sexual misconduct are never permitted.

Complaints of a Sexual Nature May Include

A lack of privacy and respect: This could include a chiropractor not providing enough privacy such as not offering a gown or a sheet to provide coverage during treatment.

Inappropriate communication or touching: This could include saying something sexually suggestive or seductive, commenting unnecessarily about sexual relationships, making sexually offensive comments or jokes, or giving unwanted attention.

It is not appropriate for a chiropractor to share their personal problems or their past relationships with a patient, offer to meet a patient in social situations, or compliment a patient’s appearance.

Unnecessary or improper physical examinations: This could mean more frequent breast, genital or pelvic examinations than would be considered necessary, touching you without your permission or explanation, or conducting a physical examination in a sexual rather than a medical way. This could also include a chiropractor unclasping your bra or moving your underwear without permission or necessity.

Sexual contact or assault: This encompasses everything from inappropriate touching to sexual assault. It also includes any sexual contact between a chiropractor and a patient.

Reflective Questions

Did the chiropractor do something to make you feel uncomfortable?
Were you touched in a way that was not necessary or felt uncomfortable during the chiropractic assessment or treatment?
Did the chiropractor say something sexually suggestive or ask you about personal information that has no relevance to chiropractic treatment?

Patient Relations Program - Funding for Counselling or Treatment Services for Patients

A patient who files a formal complaint alleging sexual abuse or sexual misconduct against a regulated chiropractor is eligible for support through the College’s Patient Relations Program.

Patients who qualify for the Patient Relations Program are offered access to funding for treatment or counselling services related to their complaint.

Funded treatment or counselling is confidential and voluntary. The College has no access to any of the patient’s personal information regarding the services received.

If you have submitted a complaint and qualify for funding through the Patient Relations Program, you will receive a letter from the Complaints Director outlining how to access services.

If your complaint is dismissed or the chiropractor is found not guilty, funding under the Patient Relations Program will end, either on the date the complaint is dismissed or the date on the hearing tribunal’s written decision (whichever is applicable).

Education about Sexual Abuse and Misconduct

All chiropractors must complete training on the prevention of sexual abuse and sexual misconduct and maintain appropriate boundaries every three years. In addition, staff and all Hearing Tribunal and Complaint Review Committee members must complete training on trauma-informed approaches to dealing with complaints of sexual abuse and sexual misconduct.

Complaint Process

If you are unsure about submitting a complaint or have questions, you are encouraged to contact the College’s Conduct Team at complaintsdirector@theccoa.ca or call 780-420-0932 ext. 116. Our Conduct Team will listen to your concern and will be able to let you know what you can expect during the process.

If you are ready to make a formal complaint, this must be submitted in writing and signed. See Complaints Process on how to submit a complaint. Recognizing it may feel challenging to participate in the process, we encourage you to have a support person with you if you choose.

Throughout the process, the needs of the complainant are balanced with procedural fairness to all parties, including the chiropractor. Legislation requires that we notify the chiropractor of the complaint so the chiropractor can provide their response.

Complaints of sexual abuse and sexual misconduct follow the complaints Process with these additional measures, as required in the Health Professions Act.

For complaints of sexual abuse or sexual misconduct, the Complaints Director will discuss the possibility of funding for treatment or counselling through the Patient Relations Program.
Resolution through a Complaint Resolution Agreement is not permitted.
If the complaint is referred to a hearing, the Hearings Director will try to ensure that at least one member of the Hearing Tribunal has the same gender identity as the patient.
All members of the Hearing Tribunal must receive trauma informed training and sexual violence training.
If the Hearing Tribunal finds the allegations of sexual abuse are proven, the health professional’s registration and practice permit will be permanently cancelled.
If the Hearing Tribunal finds allegations of sexual misconduct proven, the health professional will be suspended, and timelines imposed will depend on the circumstances of the case.
Any decision or order of the Hearing Tribunal that is based on a finding of sexual abuse or sexual misconduct will be published indefinitely on the College website. Decisions or orders may be redacted to protect the personal and health information of the patient or third parties.

In addition, if a complaint about sexual abuse or sexual misconduct is referred to a hearing and the complainant is required to attend as a witness, the complainant may bring a support person with them to the hearing.

We recognize that coming forward with a complaint about sexual abuse or misconduct can be very difficult. If you believe your chiropractor may have crossed a sexual boundary, we urge you to contact us at 780-420-0932 ext. 116 or complaintsdirector@theccoa.ca.