PROFESSIONAL PRACTICE FAQs

The Health Professions and Procedural Code (HPPC), Schedule 2 of the Regulated Health Professions Act, 1991 (RHPA) sets out mandatory reporting requirements for:

a) healthcare providers;
b) facility operators; and
c) employers.

a) Healthcare Providers

The Mandatory Reporting requirements for healthcare providers includes incidents or suspected cases of sexual abuse, child protection or abuse or neglect of elders.

Specifically, the HPPC states:
(1) A member shall file a report in accordance with section 85.3 if the member has reasonable grounds, obtained in the course of practising the profession, to believe that,
(a) another member of the same or a different College has sexually abused a patient; or
(b) a registrant of the Health and Supportive Care Providers Oversight Authority has sexually abused a patient who receives health care or supportive care services from the registrant. 2021, c. 27, Sched. 2, s. 70 (2).

The Child, Youth and Family Services Act, 2017, Section 125 sets out mandatory reporting requirements to a Children’s Aid Society when it is suspected that a child under the age of 16 years is in need of protection. Additionally, someone who is concerned that a 16-or 17-year-old may be in need of protection may, but is not required to make a report.

The Ministry of Children, Community and Social Services has helpful resources, including the Reporting Child Abuse and Neglect: It’s Your Duty brochure (PDF).

The Long-Term Care Homes Act, 2007 Section 24 and the Retirement Homes Act, 2010 Section 75 set out mandatory reporting requirements if it suspected that there is abuse or neglect in a retirement or Long-Term Care facility. The Ministry for Seniors and Accessibility, and the Elder Abuse Prevention Ontario for more information.

The Missing Persons Act, 2018 states that disclosure of personal health information may be required upon urgent demand.

b) Facility Operators

The Mandatory Reporting requirements for facility operators includes incident or suspected cases of sexual abuse, incompetence or incapacity. Specifically the HPPC states:

Reporting by facilities
85.2 (1) A person who operates a facility where one or more members practise shall file a report in accordance with section 85.3 if the person has reasonable grounds to believe that a member who practises at the facility is incompetent, incapacitated, or has sexually abused a patient.

Additionally, the Mandatory Gunshot Wounds Reporting Act, 2005 section 2(1) states: Every facility that treats a person for a gunshot wound shall disclose to the local police service or the local Ontario Provincial Police detachment the fact that a person is being treated for a gunshot wound, the person’s name, if known, and the name and location of the facility.

c) Employers

The Mandatory Reporting requirements for employers includes incidents of termination, revocation, suspension, imposition or dissolution of a partnership or association with a registrant for reasons of professional misconduct, incompetence or incapacity. Specifically the HPPC states:

Reporting by employers, etc.
85.5 (1) A person who terminates the employment or revokes, suspends or imposes restrictions on the privileges of a member or who dissolves a partnership, a health profession corporation or association with a member for reasons of professional misconduct, incompetence or incapacity shall file with the Registrar within thirty days after the termination, revocation, suspension, imposition or dissolution a written report setting out the reasons.

(2) Where a member resigns, or voluntarily relinquishes or restricts his or her privileges or practice, and the circumstances set out in paragraph 1 or 2 apply, a person referred to in subsection (3) shall act in accordance with those paragraphs:

1. Where a person referred to in subsection (3) has reasonable grounds to believe that the resignation, relinquishment or restriction, as the case may be, is related to the member’s professional misconduct, incompetence or incapacity, the person shall file with the Registrar within 30 days after the resignation, relinquishment or restriction a written report setting out the grounds upon which the person’s belief is based.

2. Where the resignation, relinquishment or restriction, as the case may be, takes place during the course of, or as a result of, an investigation conducted by or on behalf of a person referred to in subsection (3) into allegations related to professional misconduct, incompetence or incapacity on the part of the member, the person referred to in subsection (3) shall file with the Registrar within 30 days after the resignation, relinquishment or restriction a written report setting out the nature of the allegations being investigated. 2014, c. 14, Sched. 2, s. 12.

If you identify an immediate risk of harm, such as for child or elder abuse, you should file the report immediately.

The requirements for the timing of mandatory reporting is set out in Section 85 of the HPPC. If there is no immediate risk, generally you must file a report within 30 days of becoming aware of the situation.

Section 85.3 (2) states:
Timing of report
(2) The report must be filed within 30 days after the obligation to report arises unless the person who is required to file the report has reasonable grounds to believe that the member will continue to sexually abuse the patient or will sexually abuse other patients, or that the incompetence or the incapacity of the member is likely to expose a patient to harm or injury and there is urgent need for intervention, in which case the report must be filed forthwith. 2007, c. 10, Sched. M, s. 62 (1).

85.5 (1) A person who terminates the employment or revokes, suspends or imposes restrictions on the privileges of a member or who dissolves a partnership, a health profession corporation or association with a member for reasons of professional misconduct, incompetence or incapacity shall file with the Registrar within thirty days after the termination, revocation, suspension, imposition or dissolution a written report setting out the reasons. 1993, c. 37, s. 23; 2000, c. 42, Sched., s. 36.

A report must be filed in writing. Please use the College’s mandatory report form available on the College’s website. You may also write to the College directly through fax, mail or email.

You must report child abuse directly to a Children’s Aid Society.

Elder abuse must be reported to the Registrar of the Retirement Homes Regulatory Authority.

Outside of the situations described above (sexual abuse, child abuse, elder abuse), there is no requirement to report concerns that a client may pose a danger to themselves or others. That said, there may be situations that would warrant a provider to disclose confidential information if an individual may be at risk.

The Personal Health Information Protection Act, 2004 (PHIPA) sets out a registrant’s obligations for maintaining the confidentiality and privacy of personal health information. The legislation provides an exception to the duty of confidentiality where a registrant finds it necessary to notify someone of a serious risk to a person’s safety. PHIPA does not oblige registrants to disclose confidential information, but it permits one to do so “for the purpose of eliminating or reducing a significant risk of serious bodily harm”. Therefore, PHIPA reinforces a registrant’s need to use their knowledge of the client/patient and their professional judgement to determine the best, most appropriate, action to take.

PHIPA states:
40 (1) A health information custodian may disclose personal health information about an individual if the custodian believes on reasonable grounds that the disclosure is necessary for the purpose of eliminating or reducing a significant risk of serious bodily harm to a person or group of persons. 2004, c. 3, Sched. A, s. 40 (1).

If you are a registrant considering whether to breach confidentiality, you should first determine if there is "significant risk of serious bodily harm to a person or group of persons". You should also determine whether there is someone in a position to ‘eliminate or reduce a significant risk of serious bodily harm’. Registrants may elect to discuss with the client whether someone such as a family member or the Police should be called. The College recommends seeking legal advice before breaching client confidentiality.

Reflection Questions:
• What is the nature of the harm that may result, does it meet the threshold to be considered “serious bodily harm”?
• Is the risk posed significant?
• Is there a person or person(s) that may be able to reduce or eliminate the risk?
• What is the basis for the risk determination, do I have “reasonable grounds”?
• Would disclosing confidential information have the potential to place the client at more a risk?
• Has the appropriate risk assessment tool been used?
• Have I consulted with the College and/or sought legal advice?

While providing psychotherapy or any professional service to another regulated health professional you may be required to make a mandatory report for incidents or suspected cases of sexual abuse in accordance with Section 85. 1 of the HPPC. Your report should also contain your opinion, if you are able to form one, as to whether this registrant is likely to sexually abuse patients in the future.

If you have competence or capacity-related concerns about a colleague or a client who is a regulated professional and there is a significant risk of serious bodily harm to a person or groups of persons, registrants have ethical obligations to breach confidentiality and make a report to the professional’s College as per Section 40 of The Personal Health Information Protection Act, 2004.

This expectation is also outlined for psychologists in the Canadian Code of Ethics for Psychologists which states:

II.43 Act to stop or offset the consequences of seriously harmful activities being carried out by another psychologist or member of another discipline, when there is objective information about the activities and the harm. This may include reporting to the appropriate regulatory body, authority, or committee for action, depending on the psychologist’s judgment about the person(s) or body(ies) best suited to stop or offset the harm, and would be consistent with the privacy and confidentiality rights and limitations of the individuals and groups involved. (See Standards I.45 and IV.17.)

and for Registered Behaviour Analysts in the BACB Ethics Code for Behaviour Analysts, which states:

2.04 Disclosing Confidential Information Behavior analysts only share confidential information about clients, stakeholders, supervisees, trainees, or research participants: (1) when informed consent is obtained; (2) when attempting to protect the client or others from harm; (3) when attempting to resolve contractual issues; (4) when attempting to prevent a crime that is reasonably likely to cause physical, mental, or financial harm to another; or (5) when compelled to do so by law or court order. When behavior analysts are authorized to discuss confidential information with a third party, they only share information critical to the purpose of the communication.

A: There is no mandatory reporting requirement for IPV outside of the requirements in the Child, Youth and Family Services Act, 2017 when it is suspected that a child is at risk and in need of protection. That said, there may be situations that would warrant a provider to disclose confidential information if an individual may be at risk. See FAQ: Must I report suspected harm to self or others? for more information on how to determine whether to breach confidentiality in cases of suspected harm.

The Office of the Information and Privacy Commissioner of Ontario (IPC) has developed a guidance document to assist professionals to make informed decisions about privacy, confidentiality, and public safety, particularly around assessing and reducing IPV risk.

If you determine there is no significant risk of serious bodily harm, you should the consider risk of recurrence by assessing the presenting risk factors and/or using the appropriate risk assessment tool(s). Your findings that inform decision-making on next steps should be documented.

Standard 9.2 - Individual Client Records states:
Registrants must keep a record regarding the services they provide to each client. Each record must contain...
d. Relevant information about every material service activity that is carried out by the registrant or under the responsibility of the registrant, including, but not limited to: assessment procedures; assessment findings; diagnoses; goals or plans of service; reviews of progress with respect to goals and/or of the continued relevance of the plan of service; activities related to crises or critical incidents; and interventions carried out or advice given;
... and
l. Any other documents that provide information relevant and material to service that is not included elsewhere in file, and which is relevant to the opinions, recommendations and decision making with respect to client service.

All registrants are required to self-report certain information to the College as set out in sections 85.6.1 through 85.6.4 of the Health Professions Procedural Code, being Schedule 2 to the Regulated Health Professions Act, 1991.

Registrants must self-report to the College, as soon as reasonably practicable:

1. Finding of guilt or conviction for any offence (Section 85.6.1 of the Code and section 4(1) of O.Reg. 193/23)
2. Charge for an offence (Section 85.6.4 of the Code)
3. Finding of professional negligence or malpractice in relation to any profession (Section 85.6.2 of the Code and section 4(4) of O.Reg. 193/23)
4. Finding of professional misconduct or incompetence by another body that governs a profession inside or outside of Ontario (Section 85.6.3 of the Code and section 4(2) of O.Reg. 193/23)
5. Finding of incapacity in relation to any health profession (section 4(2) of O.Reg. 193/23)
6. A proceeding for professional misconduct, incompetency or incapacity in relation to any health profession (Section 4(3) of O.Reg. 193/23)
7. A proceeding in any jurisdiction in which the member is alleged to have committed professional negligence or malpractice that is in relation to the practice of a health profession (section 4(5) of O.Reg. 193/23)

Details of the above such as bail conditions or restrictions must also be reported through the online self-reporting form.

Registrants must also report in their annual renewal form if they are a member of any other body that governs a profession, in any jurisdiction, e.g., nursing, law, psychotherapy, etc.