What are a physiotherapist’s professional obligations?

The health, safety and care of the patient is the primary concern for health professionals in clinical practice.

In accordance with the Physiotherapy Board of Australia’s Code of Conduct, the Australian Physiotherapy Association’s Code of Conduct and the Health Practitioner Regulation National Law, physiotherapists have a duty to make the care of patients their first concern, to practise safely and effectively and to minimise any risks to a patient’s safety—specifically, to prevent, manage and mitigate risks of harm once they have been identified.

This is also the physiotherapist’s legal obligation under federal, state and territory legislation—physiotherapists are required to take precautions to avoid a risk of harm to patients for whom they are responsible.

If a physiotherapist fails to take appropriate precautions, they will likely be liable for any injury suffered by a patient at their clinic.

Clinical scenario

Larisa attends a consultation with a physiotherapist, Tanith, for treatment of a fractured hip after a fall.

Larisa is weaker on one side of her body due to her hip injury and is undergoing strengthening training.

Tanith directs Larisa to perform a particular strengthening exercise as part of the treatment.

Tanith looks away for a moment to speak with one of her colleagues.

Larisa falls during the strengthening exercise as the equipment was not secure.

Tanith’s colleague runs over to help Tanith lift Larisa back up.

Larisa reports feeling wrist pain and decides to drive herself home rather than continue with the treatment that day.

Tanith tells Larisa to ice her wrist.

In her notes of the day’s appointments, Tanith writes ‘RFA: hip. Tx: strengthening exercise, massage. NB—L fell, complained of wrist pain. Tx: ice. NV—1/52’.

Tanith calls Larisa a few days later to follow up and see how she is going.

Larisa tells Tanith that she went to her GP for the pain in her wrist and was referred for an X-ray, which confirmed that she had sustained a fracture.

Larisa blames Tanith for the fall and her wrist injury and makes a complaint against Tanith and the clinic.

Tanith has breached her professional obligations by:

• failing to be fully appraised of Larisa’s medical history and to consider the proper safety precautions to be provided before treatment, given Larisa’s original injury
• failing to ensure that there was a safe environment and equipment for Larisa’s treatment before and during the provision of treatment
• failing to properly assist, refer and ensure continuous and ongoing care of Larisa after her fall
• failing to adequately record the treatment and incident in Larisa’s clinical notes.

Learnings and safeguards

The scenario of Larisa and Tanith displays a number of common errors that occur before and after an incident in which a patient falls at a clinic.

Physiotherapists have a responsibility to take precautions to ensure that patients do not come to harm during the course of their treatment.

Below are some safeguards against breaching professional obligations regarding a patient’s safety and being found at fault if a patient falls:

• make sure that there is a safe environment when providing treatment to the patient
• follow proper safety procedures as outlined by the clinic and in accordance with your training
• make sure that any supportive equipment is stabilised and in proper working order
• do not leave the patient unsupervised during the course of treatment
• be aware of a patient’s medical history at all times
• if your patient does fall, follow appropriate procedures for rendering aid.

In order to limit your risk of being found to be fully responsible for any injury suffered if a patient falls, we suggest that you:

• offer ice or treatment to help the patient in the short term—but make sure that this is within the scope of your clinical expertise and it is appropriate to do so
• arrange transport for the patient, either to their home or to a hospital—making sure that someone comes to pick up the patient from the clinic
• refer the patient for examination with a GP or call an ambulance depending on the seriousness of the patient’s fall or injury
• ask the patient to update you on their progress
• make sure to record the incident in detail in your clinical notes
• notify your insurer in case the patient decides to make a claim.

If physiotherapists do have an incident in which a patient falls, they should seek assistance, including from a senior colleague, and make sure to notify their insurer as soon as possible.

Safeguards for clinics to ensure that all physiotherapists are practising effective risk management may include training for all new staff on clinic policies and professional obligations relating to patient safety and risk management.

Clinics can also organise regular meetings with staff to discuss case studies and ongoing training regarding risk management.

This article is part of the risk management series facilitated by APA’s insurance partner BMS and written by leading health law firm Barry Nilsson.

Disclaimer: Barry Nilsson communications are intended to provide commentary and general information. They should not be relied upon as legal advice. Formal legal advice should be sought in particular transactions or on matters of interest arising from this communication.

BMS Risk Solutions Pty Ltd (BMS) AFSL 461594 ABN 45 161 187 980 is the official and exclusive insurance broker for the APA member insurance program. BMS is part of the wider BMS group, which is dedicated to providing coverage and value-added services to associations and their members.