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Professionalism and Professional Obligations for Registered Dietitians
- Mandatory Reporting For Dietitians
- Key Elements of a Mandatory Report
- Mandatory Report of Sexual Abuse
- Mandatory Report of Child Abuse
- Duty to Warn
- Mandatory Reports about the Conduct of Another Dietitian
- The Formal Investigation
- Protection from Retaliation
Mandatory Reporting for Dietitians
A special duty under the Regulated Health Professions Act, and indeed other statutes, is to make mandatory reports to the proper authority when certain events occur, such as sexual abuse of a client, child abuse, abuse of an elderly person in a nursing home, or unprofessional behavior of another dietitian. If it appears that one of these situations exists, a dietitian should obtain specific advice.
- Generally, failing to make a mandatory report is considered professional misconduct and carries significant consequences. In some cases, dietitians can be prosecuted and fined up to $50,000 in Provincial Offences Court.
- A dietitian could also be sued for any harm that results from a failure to report. Some years ago, a physician was successfully sued for more than half a million dollars for failing to report a client who was a danger to others, and who then harmed someone in a motor vehicle accident.
- A mandatory report is not a breach of confidentiality, even where a client does not want a report to be made. A dietitian's duty of confidentiality is subject to other requirements or authority of law.
Key Elements of a Mandatory Report
A report should either be made or confirmed in writing within 30 days to the appropriate authorities. Here are some key elements:
- Provide a summary of the concern. Be clear about the concern. Do not make the reader guess, particularly if the matter is technical or clinical.
- Provide details. This will assist the recipient to respond appropriately. It may also reduce your subsequent involvement in answering obvious questions. It is usually acceptable to attach pertinent documents.
- Include a list of witnesses the authority may wish to contact. Remember, for reports of sexual abuse under the Regulated Health Professions Act , the identity of the client cannot be included unless he or she consents in writing.
- Include any response or explanation from the subject of the report. Fairness would suggest that it be mentioned in the report. This demonstrates good faith. In addition, including the response helps everyone understand the complete situation. You are not taking sides by making a report, but providing important information to an authority.
- Outline any action that has been taken to date on the allegation. It is important for the authority to know, for example, that the person has been placed on workplace suspension.
Mandatory Report of Sexual Abuse
When dealing with revelations of sexual abuse of clients, it is important for dietitians to manage them sensitively and not cause further harm. In addition, dietitians need to be aware of their legal obligations. According to law:
- A report of sexual abuse under the Regulated Health Professions Act must be made if a dietitian has reasonable grounds, obtained in the course of practising dietetics, to believe that a regulated health professional has sexually abused a patient.
- A report of sexual abuse under the Regulated Health Professions Act cannot include the identity of the client unless the client gives written consent to including his or her name.
- A report of sexual abuse under the Regulated Health Professions Act must be made within 30 days unless there are reasonable grounds to believe that additional abuse may occur, in which case the report must be made immediately.
Mandatory Report of Child Abuse
Any person who has a reasonable suspicion that a child is in need of protection needs to report that suspicion to the local Children's Aid Society. While everyone has this duty, it is an offence for a dietitian not to make a report when the information is obtained in the course of practising dietetics.
For a report under the Child and Family Services Act, only reasonable grounds to "suspect", not "believe", is needed. This means that the degree of information suggesting that a child is in need of protection can be quite low. As the definition of a child in need of protection, under the Child and Family Services Act , is quite lengthy and complex, when faced with potential child abuse where the health or safety of a child is threatened, dietitians are urged to get advice on reporting. You may get advice either from the Practice Advisor at the College, legal counsel or your organization's risk manager.
Many of the mandatory reporting criteria refer to "reasonable grounds to believe". That phrase has two components:
- Reasonable grounds refer to objective information, not personal belief. If the facts are present, a report must be made even though you might not believe the facts to be true. A dietitian does not have to make a detailed evaluation of whether the person providing the information is credible - - so long as there is some objective basis for making the report.
- Reasonable grounds describe the type of information needed to make a report. Mere rumour or gossip does not constitute reasonable grounds; for example, a nurse saying over coffee that everyone knows that a certain doctor in the hospital sleeps with his patients. However, hard evidence or clear proof is not needed either. Information from someone who did not personally observe the event is fine, so long as it contains some specifics.
Duty to Warn
Health professionals have a duty to warn appropriate authority if they have reasonable grounds to believe that an identifiable person or group is at substantial risk of serious harm or death from another person. The Personal Health Information Protection Act, 2004 provides legislative support for making a report without client consent in order to protect a third party from serious bodily harm.
Mandatory Reports About the Conduct of Another Dietitian
Cases of professional misconduct, incompetence or incapacity observed in another dietitian must be reported to the College in the interest of ensuring safe and competent dietetic services to the public. A dietitian should make a mandatory report about the conduct of another dietitian when:
- terminating an employee;
- terminating an association (e.g., partnership, contract, professional corporation) with another registered health practitioner for professional misconduct, incompetence or incapacity;
- ending a group practice because you could no longer tolerate a practitioner's conduct or incompetence, e.g., drinking or repetitive rudeness to clients;
- intending to terminate an employee or associate but that person resigned or voluntarily relinquished their privileges.
The Formal Investigation
Once a mandatory report or complaint is made, the authority will first consider if there is enough information to conduct a formal investigation. If there is any doubt, the reporting dietitian will probably be contacted again. If a formal investigation is initiated, the investigator will focus on locating and interviewing firsthand witnesses of the actual events, and obtaining documents that might bear on the allegations. Most authorities try not to reveal the name of the person making a mandatory report. However, it sometimes is necessary to disclose the name in order to properly investigate or prosecute the matter.
Should dietitians conduct their own investigation when a mandatory report is going to be or has been made? Some worry that this could interfere with or even jeopardize the official investigation. Nonetheless, proceed with great caution and consider the following factors:
- In every case, try not to disturb the evidence. Make sure that documents are not altered by your inquiries. Ensure that the recollection of witnesses is not affected by asking leading questions, or interviewing them in the presence of other witnesses or people who may, by their mere presence, influence the answers.
- Only make inquiries if there is an important reason for doing so, for example, to ensure that sufficient facts have been collected in order to make the report, establish whether anyone is at immediate risk, or take necessary internal disciplinary action.
- If it is reasonably possible, wait until the authorities have completed their inquiries.
Protection from Retaliation
The Regulated Health Professions Act protects people who submit reports from retaliation. Unless acting in bad faith, the reporting dietitian cannot be successfully sued for making a mandatory report. Making a false report in order to get someone into trouble would be an illustration of bad faith. A dietitian making a report that later turns out to be groundless would still be protected from retaliation if there was information to support the report. Some statutes provide additional protection as well.