On January 30, 2025 the Hearing Tribunal released a decision finding John Walker [Registrant] guilty of unprofessional conduct.
The Facts
The facts underlying the Tribunal’s decision can be summarised as follows:
The Registrant provided occupational therapy services to a child at a Head Start program operating out of a community resource centre. The child was referred to him for fine motor assessment, in advance of the child beginning the Head Start Program. The child then remained on the Registrant’s case load for a period of time while enrolled in the Head Start program. The child’s mother also accessed services from various programs at the same resource centre. The Registrant and the Complainant began a relationship after the child had been discharged from the Registrant’s case load and was no longer attending the Head Start Program. However, when the relationship began, the Complainant was still accessing services at the resource centre.
The Decision
In its decision, the Hearing Tribunal found that the Registrant had exploited a previous client-therapist relationship with a minor client in order to pursue a personal, intimate, and sexual relationship with the client’s mother (the Complainant). The Tribunal noted that the Registrant’s actions:
“clearly harmed the integrity of the profession in the eyes of the public, were inconsistent with the position of trust that an occupational therapist occupies and were extremely troubling in terms of the exploitation of an existing power imbalance between himself and [the Complainant].”
The Tribunal observed that although the Complainant was never the Registrant’s client, there was a significant power imbalance between them. The Tribunal noted that the Complainant trusted the Registrant for his specialized knowledge and skills and relied on his advice as an occupational therapist to support her in addressing her child’s challenges. The Tribunal explained that the Complainant’s many ongoing stresses in her life contributed to the significant power imbalance. These stressors including being the single parent of two young children, one of whom required formal supports, and experiencing financial pressures.
The Tribunal agreed with the proposition that a power imbalance can exist between a client’s caregiver and the occupational therapist, and that such a power imbalance can remain even after the end of direct service provision to the caregiver’s child. The Tribunal states:
“an occupational therapist must be cognizant and actively avoid pursuing relationships with caregivers where the power differential persists, particularly where the said caregiver is in a highly vulnerable state.”
The Tribunal found that the power imbalance between the Registrant and Complainant persisted after the Complainant’s child was discharged by the Registrant. The following factors were observed by the Tribunal to have contributed to the continuing power imbalance:
- The Complainant was highly vulnerable to exploitation given her circumstances and desire to treat her child’s developmental challenges.
- The Complainant continued to seek occupational therapy services for her child.
- The Complainant continued to access services for herself from the resource centre that ran the Head Start program.
- The personal relationship between the Registrant and Complainant included discussions about the Complainant’s child and occupational therapist strategies to support the child, where the line between professional and personal was often blurred.
The Tribunal held that the Registrant’s conduct breached Standard of Practice (SoP) 1.2, Code of Ethics (CoE) indicator 2.1 and harmed the integrity of the regulated profession. As a result, they found that his conduct constituted unprofessional conduct as defined in section 1.1(pp)(ii) and (xii) of the Health Professions Act [HPA]. It is important to note that the Registrant was not alleged to have engaged in sexual abuse or misconduct (as defined in the HPA), as the Complainant was not the Registrant’s patient as defined in ACOT’s Standards of Practice.
Please note that references to the SoP and CoE in the Walker Hearing Tribunal Decision refer to the versions of these documents in force at the time that the conduct occurred (i.e. the 2003 SoP and 2005 CoE versions). Current and past versions of the Standards and Code are available on the ACOT website: https://acot.ca/practice-resources/
Lessons Learned
Three central themes were emphasized by the Hearing Tribunal. These themes are discussed here with reference to ACOT’s current SoP and CoE:
- OTs occupy a position of trust.
The Hearing Tribunal noted that the conduct at issue was inconsistent with the position of trust that an occupational therapist occupies. Exploiting a client-therapist relationship in order to pursue a personal, intimate, or sexual relationship with a client’s parent (or anyone with whom the client has a significant interdependent relationship) is inconsistent with this position of trust and inconsistent with a registrant’s ethical responsibilities to the public and the profession (CoE D.1(a) and D.1(b)).
- It is the OT’s responsibility to establish and maintain boundaries.
SoP G requires OTs to maintain appropriate boundaries between professional and personal relationships and to avoid or manage conflicts of interest. CoE B.6 establishes an OT’s ethical responsibility to recognize that power imbalances can exist between the OT and a person with whom a client has a significant interdependent relationship (such as the relationship between the Complainant and her child in the current case), and to determine and communicate boundaries appropriate to the situation.
SoP H.3 specifically prohibits OTs from engaging in sexual conduct with a person with whom a patient has a significant interdependent relationship. Although such conduct is not considered sexual abuse or sexual misconduct, a hearing tribunal may still consider it to be unprofessional conduct.
- A power imbalance can continue to exist even after a client has been discharged.
Factors to consider in determining whether there is a risk of a continuing power imbalance between the OT and the care partner of a former client include:
- whether there is a continuing significant interdependent (or dependent) relationship between the care partner and the client.
- whether the OT is still providing services to the client.
- if the former client or OT have the expectation of an ongoing professional relationship (i.e., likelihood of future occupational therapy services).
- the length and intensity of the therapist-client relationship, as well as length of time since the therapist-client relationship ended.
- the vulnerability of the care partner.
Where there is more than a minimal risk of a continuing power imbalance between an OT and a care partner, beginning a personal relationship may constitute unprofessional conduct.
For queries related to the complaint process or this article, please email complaints.director@acot.ca
For queries related to the application of the SoP or CoE, please email info@acot.ca
For more guidance on ACOT’s expectations with respect to boundaries, please see Practice Guideline: Maintaining Appropriate Boundaries