Friday, February 7, 2014

Code of Ethics of College of Osteopathic Manual Practitioners of Ontario (COMPO)


This Code of Ethics is based upon the acknowledgement that the social contract dictates the osteopathic manual practice profession’s responsibilities to the patient, the public, and the profession; and upholds the fundamental principle that the paramount purpose of the osteopathic manual practitioner's professional services shall be to benefit the patient.

This code of ethics applies only to the registered members of the College of Osteopathic Manual Practitioners of Ontario (COMPO).  Failure to adhere to any of the COMPO code of ethics is cause for a disciplinary action by COMPO against member.

1. Osteopathic manual practitioners (OMP) should adhere to a commitment to the highest standards of excellence and should attend to their patients in accordance with established best practices.

2. Osteopathic manual practitioners should maintain the highest standards of professional and personal conduct, and should comply with all governmental jurisdictional rules and regulations.

3. OMP-patient relationships should be built on mutual respect, trust and cooperation. In keeping with these principles, osteopathic manual practitioners shall demonstrate absolute honesty with regard to the patient’s condition when communicating with the patient and/or representatives of the patient. Osteopathic manual practitioners shall not mislead patients into false or unjustified expectations of favourable results of treatment. In communications with a patient and/or representatives of a patient, osteopathic manual practitioners should never misrepresent their education, credentials, professional qualification or scope of clinical ability.

4. Osteopathic manual practitioners should preserve and protect the patient's confidential information, except as the patient directs or consents, or the law requires otherwise.

5. Osteopathic manual practitioners 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 osteopathic manual practice treatment. The patient should make his or her own determination on such treatment.

6. The OMP-patient relationship requires the osteopathic manual practitioners to exercise utmost care that he or she will do nothing to exploit the trust and dependency of the patient. Sexual misconduct is a form of behaviour that adversely affects the public welfare and harms patients individually and collectively. Sexual misconduct exploits the therapist-patient relationship and is a violation of the public trust.

7. Osteopathic manual practitioners should willingly consult and seek the talents of other health care professionals when such consultation would benefit their patients or when their patients express a desire for such consultation.

8. Osteopathic manual practitioners 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.

9. With the exception of emergencies, Osteopathic manual practitioners 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.

10. Osteopathic manual practitioners 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, Osteopathic manual practitioners 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.

11. Osteopathic manual practitioners should exercise utmost care that advertising is truthful and accurate in representing the OMP's 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.

12. Osteopathic manual practitioners 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.

13. Osteopathic manual practitioners have an obligation to the profession to endeavor to assure that their behavior does not give the appearance of professional impropriety. Any actions which may benefit the practitioner to the detriment of the profession must be avoided so as to not erode the public trust.

14. Osteopathic manual practitioners should recognize their obligation to help others acquire knowledge and skill in the practice of the profession. They should maintain the highest standards of scholarship, education and training in the accurate and full dissemination of information and ideas.

15. Osteopathic manual practitioners should not call themselves osteopath in Ontario as this title is reserved for American style osteopathic physicians who perform surgery and prescribe medications.

16. Osteopathic manual practitioners should not use the term “osteopathy” when referring to their profession in Ontario as the term “osteopathy” in Ontario means osteopathic medicine. Osteopathic manual practitioners should use the term “manual osteopathy” or “osteopathic manual practice” to refer to their profession.

All osteopathic manual practitioners should make sure the following guidelines are followed:

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, 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 an osteopathic manual practitioner’s practice must not contain:
(a) anything false or misleading;
(b) a guaranteed success of care;
(c) any comparison to another member’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) any reference to the member being an “osteopath” as this term in Ontario is reserved for osteopathic physicians who are under the law equal to a medical doctor. Members should call themselves “Osteopathic Manual Practitioner”;
(f) any reference to the member practicing “osteopathy” as this term in Ontario is protected by the College of Physicians and Surgeons of Ontario and is used only by osteopathic physicians. Members should use the term “manual osteopathy” or “osteopathic manual practice”;
(g) material that, having regard to all the circumstances, would reasonably be regarded as disgraceful, dishonourable or unprofessional.

4. An osteopathic manual practitioner may advertise his/her fee for osteopathic manual practice services 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 osteopathic manual practitioner does not bill a third-party payer for the complimentary portion of the treatment service;
(d) the advertisement expressly states the timeframe to be honoured for any complimentary or discounted treatment service;
(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 treatment service;
(g) the advertisement is presented in a professional manner that maintains the dignity of the osteopathic manual practice profession.

An osteopathic manual practitioner 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 service.

2) The financial record shall contain; date of service, services billed, payments 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 osteopathic manual practitioner, on each separate page, and name(s) of relevant referring health professionals, if appropriate. The patient health record shall contain a history of the patient, 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 osteopathic manual practice, the osteopathic manual practitioner 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) An osteopathic manual practitioner 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 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) An osteopathic manual practitioner is 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) A member 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 osteopathic manual practice care to that patient.

10) A member 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) A member 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 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 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.

Every member of the College of Osteopathic Manual Practitioners of Ontario (COMPO) is required to ensure that patient consent to any 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.

Osteopathic manual practitioners 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 osteopathic manual practitioner 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 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, 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. 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.

• It is never appropriate to have a sexual relationship with a patient who is receiving active treatment. The professional relationship must be terminated.

• There is a history of complaints against health professionals of all disciplines who have had sexual relationships with their patients/former patients. Complaints have been made by patients, significant others (including spouses of both members and patients) and former significant others. Therefore, there is a minimum recommended waiting period of one year following the termination of the professional relationship, before beginning any sexual relationship.

• 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, transfer patient records to the new attending osteopathic manual practitioner.

• In some cases, it may never be appropriate for a member 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 you select when speaking to patients by employing the correct vocabulary for body parts and procedures & being particularly sensitive to words that could cause misunderstandings; and

• Many patients may have language or conceptual difficulties. Realize that the use of charts and diagrams enhances the communication process. Because how osteopathic manual practitioners 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;

• Osteopathic manual practitioners shall provide patients with an opportunity to ask questions & provide patients with answers within the scope of osteopathic manual 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.

You must learn to communicate with your 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.

• Obtain the patient’s consent.
• Acknowledge that patients have the right to change their minds about consenting to procedures.
• 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.

Osteopathic manual practitioners must recognize the patient controls consent and:
• 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; and
• 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.
• 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, make touching an acceptable encounter by:
• providing reassurance and explanations throughout the procedure;
• involving patients in some aspects of procedures, such as moving themselves in response to clear instructions;
• 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.

The following are considered acts of professional misconduct. Any COMPO member who is found to be guilty of misconduct is referred to the disciplinary committee. 

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 osteopathic manual practice 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 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 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 osteopathic manual practice services for the patient or fees for such services.

9. Failing to reveal the nature of a remedy or treatment used by the osteopathic manual practitioner following a patient's request to do so.

10. Failing to advise a patient to consult with another health professional when the osteopathic manual practitioner knows or ought to know that; the patient’s condition is beyond the scope of practice and competence for the member; or the patient requires the care of another health professional; or the 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 international certificate of registration, in the course of providing or offering to provide osteopathic manual practice services within the scope of practice of the osteopathic manual practice 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 osteopathic manual 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.

22. Using the term “osteopath” in the province of Ontario instead of “Osteopathic Manual Practitioner”.

23. Using the term “osteopathy” in the province of Ontario instead of “Manual Osteopathy” or “Osteopathic Manual Practice”.

The Financial Services Commission of Ontario (FSCO) has produced a brochure that addresses reducing abuse and fraud in health care services for auto insurance. Osteopathic manual practitioner members of the College of Osteopathic Manual Practitioners of Ontario (COMPO) should consult this brochure to learn about the role of health professionals in this area.

Reducing Abuse and Fraud in Health Care Services for Auto Insurance: Everyone has a Role to Play – English (

Reducing Abuse and Fraud in Health Care Services for Auto Insurance: Everyone has a Role to Play – French (

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