The College of Registered Manual Osteopaths is a national association with members across Canada. Its Code of Ethics is based upon the acknowledgement that the social contract dictates the profession’s responsibilities to the patient, and the public; and upholds the fundamental principle that the paramount purpose of the registered manual osteopath’s professional services shall be to benefit the patient.
1. In all Canadian provinces, territories and any other jurisdiction where it is contrary to the applicable laws a registered manual osteopath (RMO) should refrain from rendering a medical diagnosis as it is a controlled act and outside their scope of practice unless they have a license in a health profession that permits them to offer medical diagnosis. An RMO is permitted to render a manual osteopathic diagnosis.
2. In all Canadian provinces, territories and any other jurisdiction where it is contrary to the applicable laws an RMO should refrain from performing high velocity low amplitude (HVLA) techniques as it is a controlled act and outside their scope of practice unless they have a license which permits them to perform joint manipulation.
3. In Canada and any other jurisdiction where it is contrary to the applicable laws an RMO should refrain from taking x-rays as it is a controlled act and outside their scope of practice unless they have a license that permits them to do so.
4. In Canada and any other jurisdiction where it is contrary to the applicable laws an RMO should refrain from performing any osteopathic manual therapy (OMT) techniques that requires putting a finger in anus or vagina as putting a finger inside these cavities is a controlled act and outside their scope of practice unless they have a license which permits them to do so.
5. An RMO should adhere to a commitment to the highest standards of excellence and should attend to their patients in accordance with established best practices.
6. An RMO should maintain the highest standards of professional and personal conduct and should comply with all governmental jurisdictional rules and regulations.
7. Practitioner-patient relationships should be built on mutual respect, trust and cooperation. In keeping with these principles, an RMO shall demonstrate absolute honesty with regard to the patient’s condition when communicating with the patient and/or representatives of the patient. An RMO shall not mislead patients into false or unjustified expectations of favorable results of treatment. In communications with a patient and/or representatives of a patient, a registered manual osteopath should never misrepresent their education, credentials, professional qualification or scope of clinical ability.
8. A registered manual osteopath should preserve and protect the patient’s confidential information, except as the patient directs or consents, or the law requires otherwise.
9. An RMO should employ their best good faith efforts to provide information and facilitate understanding to enable the patient to make an informed choice in regard to proposed treatment. The patient should make his or her own determination on such treatment.
10. The practitioner-patient relationship requires the registered manual osteopaths to exercise utmost care so that they do nothing to exploit the trust and dependency of the patients. Sexual misconduct is a form of behaviour that adversely affects the public welfare and harms patients individually and collectively. Sexual misconduct exploits the practitioner-patient relationship and is a violation of the public trust.
11. Registered manual osteopaths should willingly consult and seek the talents of other health care professionals, such as medical doctors when such consultation would benefit their patients or when their patients express a desire for such consultation.
12. Registered manual osteopaths should never neglect nor abandon a patient. Due notice should be afforded to the patient and/or representatives of the patient when care will be withdrawn so that appropriate alternatives for continuity of care may be arranged.
13. With the exception of emergencies, registered manual osteopaths are free to choose the patients they will serve, just as patients are free to choose who will provide healthcare services for them. However, decisions as to who will be served should not be based on race, religion, ethnicity, nationality, creed, gender, handicap or sexual preference.
14. RMOs should conduct themselves as members of a learned profession and as members of the greater healthcare community dedicated to the promotion of health, the prevention of illness and the alleviation of suffering. As such, RMOs should collaborate and cooperate with other health care professionals to protect and enhance the health of the public with the goals of reducing morbidity, increasing functional capacity, increasing the longevity of the population and reducing health care costs.
15. RMOs should exercise utmost care that advertising is truthful and accurate in representing their professional qualifications and degree of competence. Advertising should not exploit the vulnerability of patients, should not be misleading and should conform to all governmental jurisdictional rules and regulations in connection with professional advertising.
16. RMOs shall protect the public and the profession by reporting incidents of unprofessional, illegal, incompetent and unethical acts to appropriate authorities and organizations and should stand ready to testify in courts of law and in administrative hearings.
17. Registered manual osteopaths have an obligation to the profession of manual osteopathy (also known as osteopathy, European style osteopathy and osteopathic manual practice) to endeavor to assure that their behaviour does not give the appearance of professional impropriety. Any actions which may benefit the practitioner to the detriment of the manual osteopathy profession must be avoided so as to not erode the public trust.
18. RMOs should recognize their obligation to help others acquire knowledge and skill in the practice of the manual osteopathy profession. They should maintain the highest standards of education and training in the accurate and full dissemination of information and ideas.
19. In Canada and any other jurisdiction where it is contrary to the applicable laws registered manual osteopaths should refrain from referring to themselves as osteopaths. In Ontario and other provinces except Quebec, the term osteopath is reserved for American trained osteopathic physicians who are registered with the College of Physicians and Surgeons of Ontario (CPSO) as doctors of osteopathy (DO) and for all legal purposes are considered medical doctors. Quebec is the only province in Canada where osteopathic manual practitioners may use the title of osteopath.
Fraud Prevention
Insurance fraud is any act committed with the intent to obtain a fraudulent outcome from an insurance process. Insurance fraud occurs when a person or entity makes false insurance claims in order to obtain compensation or benefits to which they are not entitled. Insurance fraud is committed in many forms, but regardless of the type, it is considered a serious crime in all jurisdictions.In Canada‚ this type of dishonest criminal act is classified among the most serious of crimes – it’s considered a felony under the criminal act. Those convicted of the insurance fraud face prison time‚ fines‚ legal fees and more – not to mention a wide range of negative personal and professional consequences.Health insurance fraud is the act of deceiving, misrepresenting information, or concealing information with the intent to receive benefits. Both patients and registered manual osteopaths can commit health insurance fraud. Registered manual osteopaths can commit health insurance fraud by making false claims, billing for services not provided or supplies not used, or altering existing claims. It is believed that most healthcare providers that commit health insurance fraud do so in order to receive greater compensation that they normally would from extended health plan insurers and other third party payers. This can be done in several ways, including:
Billing for procedures not actually performed. Billing for 1-hour of service when less time was spent. Billing under patient’s family member insurance when the patient has no insurance coverage. Scheduling unneeded follow-up visits for patients and providing treatments that are not medically necessary. Providing services for wellness purposes, to prevent injury and disease, to improve quality of life, and to improve athletic performances and billing Canadian extended health plan insurers for these services. Insurers in Canada do not cover these services. They only cover services that are medically necessary for a current medical condition. Offering Yoga, Pilates and other health classes and charging Ontario insurers for these classes as treatments. Issuing a paid in full receipt to patients without receiving payments for services rendered. Insurance in Canada generally reimburse treatment fees when a patient pays in full for services received. Offering tow tiered billing, charging cash paying patients less fess than those with extended health plan coverage. Accepting only what the extended health plan insurer pays as the full payment and not charging the patient if insurer pays only partial payment. If insurer pays 80% of the treatment cost, patient must pay the 20% remaining balance. The 20% balance in this case cannot be discounted.If CRMO members become aware of insurance fraud by a patient or a health care provider, they must report this criminal act to the appropriate authorities in the jurisdiction the act has been committed.
Abuse Prevention
The College of Registered Manual Osteopaths (CRMO) follows a zero tolerance on sexual relationship between practitioners and patients. It is never appropriate to have a sexual relationship with a patient who is receiving manual osteopathic care. • There is a minimum recommended waiting period of one year following the termination of the professional relationship, before any sexual relationship may begin between a registered manual osteopath and a former patient. • Following terminating the professional relationship CRMO members shall refer the patient to another osteopathic manual practitioner and document these actions on the patient’s chart (it is recommended the referral be in writing and a copy of such correspondence be given to the patient and a second copy placed in the file). • With the patient’s consent, the CRMO member shall transfer patient records to the new attending osteopathic manual practitioner. • In some cases, it may never be appropriate for an RMO to have a sexual relationship with a former patient. For example, if there is a continued power imbalance between the member and the patient, or the patient is vulnerable. • Remarks of a sexual nature are a common form of sexual abuse of patients. Always speak in words that patients can understand. Pay attention to the way you convey information and to the words youselect when speaking to patients by employing the correct vocabulary for body parts and procedures & being particularly sensitive to words that could cause misunderstandings. • Many patients may have language or conceptual difficulties. Realize that the use of charts and diagrams enhances the communication process. Because how registered manual osteopaths say something is as important as the choice of vocabulary, they need to use tact and consideration when explaining procedures to patients to avoid causing anxiety, and not talk about themselves or their problems to patients, this being considered unprofessional. • RMOs shall provide patients with an opportunity to ask questions & provide patients with answers within the scope of manual osteopathy practice. • Body language, the non-verbal component of language, will convey as much or more to patients as words. Patients may distrust the message if body language contradicts what is being said. Always remember the importance of maintaining appropriate eye contact, adopting an appropriate facial expression to convey concern and proficiency, being careful in your use of physical gestures; and respecting your patient’s personal sense of space. Careful use of body language can greatly enhance communication, leading to better understanding and trust between therapist and patient. Since the main goal of communication is mutual understanding, listening is just as important as speaking. CRMO members must learn to communicate with their entire being, to listen and carefully observe patients. By learning to listen effectively, you can learn to modify your speech to match the needs of the patient. The benefits of listening and observing include enriched communication and patients who are dignified partners in their own care.
Touching
Obtain the patient’s consent before touching patient. • Acknowledge that patients have the right to change their minds about consenting to manual osteopathic care. • Avoid causing unnecessary distress or embarrassment to the patient by inappropriate touching. • Show respect by maintaining the patient’s dignity. • Respect, as much as possible, the patient’s personal sense of space. • Use firm and gentle pressure when touching the patient to give reassurance and produce a relaxed response.• Avoid hesitant movements by being deliberate and efficient. Members of the College of Registered Manual Osteopaths (Canada) must recognize the patient controls consent. • The patient is entitled to know why, where and when he/she is to be touched. • Consent may be withdrawn at any time during a procedure. • Agreement, acquired verbally or non-verbally, is required before a patient may be touched. • Special situations must be identified and possible options anticipated. • Patient concerns must be addressed first. • Make patients, who must necessarily be partially unclothed, as comfortable as possible. • Give patients clear instructions about how to wear the gown if a gown has to be used. • Allow patients independence, and enough time and privacy while disrobing. • Touch only those areas needed to facilitate removal of clothing when providing assistance to disrobe, and preferably, if the patient is female, have a female assistant attend to the matter. • Request the patient’s permission for staff to observe. To avoid perceptions of sexual abuse, registered manual osteopaths shall make touching an acceptable encounter by providing reassurance and explanations throughout the procedure; and involving patients in some aspects of procedures, such as moving themselves in response to clear instructions; and encouraging patients to identify affected areas or landmarks when possible; and constantly checking for the level of understanding and consent by the patient. Procedures requiring touching of patients are open to misinterpretation. Ensuring that patients understand at all times what is being done and why will greatly reduce the risk of offense. Considerate touching will encourage the patient to relax and cooperate in ways that will save time and produce better results.
Advertising Guidelines
Registered manual osteopaths should ensure their advertising meets the following CRMO guidelines: 1. An advertisement must be accurate, factual and contain information that is verifiable. It should readily be comprehensible by the persons to whom it is directed. 2. An advertisement may:(a) name a specific service, manual osteopathy technique and/or product but cannot claim superiority or endorse the exclusive use of such services, techniques or products; (b) offer an initial complimentary consultation. 3. Any advertisement with respect to a registered manual osteopath’s practice must not contain: (a) anything false or misleading; (b) a guaranteed success of care or cure; (c) any comparison to another osteopathic manual practitioner’s or other health care provider’s practice, qualifications or expertise; (d) any expressed or implied endorsement or recommendation for the exclusive use of a product or brand of equipment used to provide services; (e) material that, having regard to all the circumstances, would reasonably be regarded as disgraceful, dishonorable or unprofessional.4. Registered manual osteopaths may advertise their fee for manual osteopathic care provided: (a) the advertisement contains accurate, complete and clear disclosure of what is and what is not included in the fee; (b) there are no hidden fees/costs; (c) the registered manual osteopath does not bill a third-party payor such as extended health plan insurers for the complimentary portion of the osteopathic service; (d) the advertisement expressly states the timeframe to be honored for any complimentary or discounted manual osteopathic care; (e) the advertisement does not limit the offer to a certain number of participants; (f) no obligation is placed on the patient for follow-up appointments as a result of the complimentary or discounted osteopathic service; (g) the advertisement is presented in a professional manner that maintains the dignity of the osteopathic profession.
Record Keeping
Registered manual osteopaths shall keep a daily appointment record, financial record and patient health record. All records shall be accurate, legible and comprehensive. 1) The daily appointment record shall set out the surname and initials of each patient the member examines or treats or to whom the member renders any manual osteopathic service. 2) The financial record shall contain; date of service, services billed, payment received; and balance of account. 3) The patient health record shall contain; patient’s name, address, birth date and gender, dates of each of the patient’s visits to the member, a reference identifying the patient, and the name/address of the primary treating registered manual osteopath on each separate page, and name(s) of relevant referring health professionals, if appropriate. The patient health record shall contain a history of thepatient, including; patient’s chief complaint(s)/concern(s) and supporting data, & relevant past health history. 4) Every patient health record, including every financial record shall be retained for at least seven years following the patient’s last visit, or, if the patient was less than 18 years old at the time of his/her last visit, the day the patient became or would have become 18 years old. Destruction of patient health records shall be done in a secure fashion to ensure that the records cannot be reproduced or identified in any form. 5) As part of the resignation process from active manual osteopathy practice, the registered manual osteopath shall take reasonable steps to ensure with regard to each patient health record for which the member has primary responsibility: • the record is transferred to another member and reasonable efforts are made to obtain the patient’s consent; • the patient is notified that the member intends to resign and the patient can obtain copies of the patient health record; and • if the record transferred is not the original patient health record, the original record is stored in a secure location for seven years following the patient’s last visit, or, if the patient was less than 18 years old at the time of his/her last visit, the day the patient became or would have become 18 years old. 6) Registered manual osteopaths shall not allow any person to examine a patient health record or give any information, copy or thing from a patient health record to any person except as required by law or as required or allowed by this section. 7) A CRMO member with primary responsibility for a patient health record shall provide, on request, copies of or access to a patient health record to any of the following persons, or any person authorized by the following persons: • the patient; • a personal representative authorized by the patient to obtain copies from or access to the record; • if the patient is deceased, the patient’s legal representative; • if the patient lacks capacity to give an authorization, a committee of the patient appointed under the Mental Incompetency Act. 8) Registered manual osteopaths are not required to provide copies from or access to a patient health record if the member is of the opinion that disclosure of the health record would likely result in serious harm to the care of the patient or serious physical or emotional harm to the patient or another person. 9) An RMO shall, upon receiving written authorization from the patient or a duly authorized person, provide a copy of the patient health record in a timely manner. The member shall maintain the original patient health record even if he/she is no longer providing manual osteopathic care to that patient.10) An RMO may charge a reasonable fee prior to providing copies of a patient health record to reflect the cost, time and effort required to provide copies of the patient health record. 11) RMOs may provide copies of or access to a patient health record to his/her legal counsel or insurer where the patient health record is relevant to advice being sought by the member or required by the policy of insurance. 12) A College of Registered Manual Osteopaths member may, for the purpose of providing health care or assisting in the provision of health care to a patient, allow a health professional to examine the patient health record or give a health professional any information, copy or thing from the record. 13) A CRMO member may maintain an electronic record keeping system. The member shall take reasonable steps to ensure the electronic record keeping system is so designed and operated that patient health records are secure from loss, tampering, interference or unauthorized use or access.
Informed Consent
Every member of the College of Registered Manual Osteopaths (CRMO) is required to ensure that patient consent to any manual osteopathic treatment and that the consent is fully informed, voluntarily given, related to the patient’s condition and circumstances, not obtained through fraud or misrepresentations; and it is evidenced in a written form signed by the patient or otherwise documented in the patient record. Registered Manual Osteopaths shall recognize that consent is an ongoing and evolving process involving ongoing discussions with a patient and not a single event of a patient’s signature on a consent form. If the registered manual osteopath recommends a new treatment, there are significant changes in a patient’s condition, or there are significant changes in the material risks to a patient, the CRMO member shall continue to dialogue with the patient about the material risks, benefits and side-effects of the recommended treatment, including potential risks that may be of a special or unusual nature, and shall document those discussions in the patient’s chart. During discussions, CRMO members shall provide patients with an opportunity to ask questions concerning the proposed treatment and shall answer questions prior to the commencement of the treatment. Patients may withdraw their consent to any treatment at any time. The Health Care Consent Act does not identify an age at which minors may exercise independent consent for health care because it is accepted that the capacity to exercise independent judgment for health care decisions varies according to the individual and the complexity of the decision at hand. CRMO members are encouraged to seek consent from the appropriate parent or guardian to treat children who do not clearly have the capacity to consent to a treatment.
Misconduct
The College of Registered Manual Osteopaths considers the following acts of professional misconduct. Registered manual osteopaths are prohibited from engaging in any of the below activities. 1. Doing anything to a patient for therapeutic, preventative, palliative or other health-related purposes in a situation in which consent is required by law, without such consent. 2. Abusing a patient verbally, physically, psychologically or emotionally. 3. Practicing the manual osteopathy profession while the member’s ability to do so is impaired by any substance (such as alcohol & narcotics). 4. Discontinuing needed professional services unless, the patient requests the discontinuation; or alternative services are arranged; or the patient is given a reasonable opportunity to arrange alternative services. 5. Discontinuing professional services contrary to the terms of an agreement between the CRMO member and a health facility or clinic that provides health services to the public unless; the discontinuation is requested by the health facility or clinic; or alternative services are arranged; or a reasonable opportunity to arrange alternative services is provided. 6. Practicing the manual osteopathy profession while the member is in conflict of interest. 7. Giving information about a patient to a person other than the patient, his/her authorized representative, or the member’s legal counsel or insurer, except with the consent of the patient or his/her authorized representative or as required or allowed by law. 8. Breaching an agreement with a patient relating to professional manual osteopathic care for the patient or fees for such services. 9. Failing to reveal the nature of a remedy or treatment used by the CRMO member following a patient’s request to do so. 10. Failing to advise a patient to consult with another health professional when the registered manual osteopath knows or ought to know that; the patient’s condition is beyond the scope of practice and competence for the CRMO member; or the patient requires the care of another health professional; orthe patient would be most appropriately treated by another health professional. 11. Providing a therapeutic service that is not necessary. 12. Failing to maintain the member’s practice premises in a safe and sanitary manner. 13. Using a term, title or designation in respect of a member’s practice that is not true. 14. Using a term, title or designation indicating a specialization in the profession that is not true. 15. Using a name, other than the member’s name as set out in the College of Registered Manual Osteopaths certificate of registration, in the course of providing or offering to provide manual osteopathic care within the scope of practice of the manual osteopathy profession. 16. Failing to keep records for a period of seven years after the date of last patient visit. 17. Falsifying a record relating to the member’s manual osteopathy practice. 18. Failing, without reasonable cause, to provide a report or certificate relating to a treatment performed by the member within a reasonable time of 30 days after a patient has requested such a report or certificate. 19. Signing or issuing, in the member’s professional capacity, a document the member knows contains a false or misleading statement. 20. Submitting an account or charge for services the member knows is false or misleading. 21. Failing to disclose to a patient the fee for a service before the service is provided, including a fee not payable by the patient.
