ADVISORY STATEMENTS

Registrants committed to the use of computerized clinical record keeping should ensure the security of such records. This should include an established protocol for each person who is given access to the computer system and records. It is recommended that the Registrant obtains necessary hardware and software enabling the inclusion of reports and other materials, within the computerized record, from third parties such as physicians, x-ray labs, etc. The following crucial elements should be attended to by a Registrant who uses a computerized clinical record keeping system:

a)    Entries should be chronological, including the date of each input.
b)    Patient confidentiality is paramount and therefore access should be prohibited to unauthorized personnel, utilizing codes or passwords.
c)    An audit trail should be maintained allowing the Registrant to make additions or corrections to the record. Original entries must not be modified and any additions or corrections should identify the date they were made and the identity of the individual who made them.
d)    Regular back-up copies should be retained, preferably off site. Safe storage is paramount.
e)    The system should be able to produce a hard copy promptly, when a patient requests same.

Repealed

The new Standards of Practice require Registrants to enter into a prior agreement with any other Registrant who might claim ownership of all or part of the patient record. The objective is to ensure that no patient is hindered in access to his/her patient record by reason of a dispute, which can arise on cessation of a business relationship between Registrants. Registrants should be familiar with s.16 of the Standards of Practice that requires a written agreement in any shared facility clarifying the ownership of all patient records created by each Registrant.
A dispute over the health care records should not arise. Every patient has the right to choose his/her massage therapist, and to follow a moving massage therapist or continue treatment with a new therapist at the same clinic. If the written agreement entitles the moving Registrant to ownership of the patient record, but the patient elects to remain at the same clinic under the care of a new massage therapist, the patient is entitled to have a copy of the original health care record remain at the clinic. Short-term disputes over immediate control of the patient’s records are avoidable, and adherence to the new standard of practice on this issue will assist in minimizing disputes on dissolution of associations or partnerships between Registrants.

The new Standards of Practice address patient confidentiality in s.9. The Registrant must maintain confidentiality concerning all patient information, except in very narrow circumstances. The Registrant’s responsibilities extend to ensuring that other persons with access to the patient’s information understand the importance of preserving patient confidentiality at all times, even after cessation of treatment or termination of the employment of non-registrant employees such as clerical staff.

Complaints about breach of patient confidentiality can arise from inadvertence on the part of a Registrant or employees. In small clinical settings, it is often more difficult to ensure patient confidentiality. The following steps will assist in preserving patient confidentiality in any clinic:

• Each patient record should be secured from public access or viewing at all times. A patient record should never be left on a counter or desktop vulnerable to casual viewing.
• Receptionists and others require frequent reminding that the name of a patient and the reason for any treatment required are confidential, and should not be audible to others during conversation or in the course of telephone communications.
• Communication with colleagues about difficult cases or issues is expected of professionals, but reference to patient names, or patient specific details which would enable one to identify the patient should not be disclosed in the hearing of others, such as in social settings, or on an elevator.

Patients sitting in your waiting room will recognize when appropriate procedures to ensure patient confidentiality are in place and being applied, and when they are not. Good practice in this area will avoid complaints and reassure your patients.

Registrants may be concerned about their professional responsibilities, in light of a recent media report that the Ministry of Health considers that Registered Massage Therapists have discretion to elect not to treat areas or sites determined by the referring physician to require massage therapy.

The Ministry of Health and the Medical Services Commission act under a mandate to pay on behalf of BCMSP insureds for necessary medical services. Neither body has jurisdiction over the professional responsibilities including ethical obligations of regulated health professionals. After obtaining the patient’s history and assessing the presenting condition, if the Registrant considers that the order requires reconsideration for any reason, the Registrant is required to contact the physician for clarification or revision. Registrants are not entitled to unilaterally proceed with a different massage therapy treatment from that prescribed by the physician.

Payment for massage therapy services by or through the BCMSP is within the mandate of the Ministry of Health and the Medical Services Commission. If a physician orders that a patient is to receive massage therapy services of a frequency and at sites not covered fully or in part by any applicable plan of insurance, it remains the responsibility of the Registrant to provide treatment in accordance with the treating physician’s referral, or seek a revision to the referral.

All Registered Massage Therapists should be aware of current acceptable clinical treatment records standards, or charting standards, which insure that clinical treatment records are maintained adequately. Adequate records should include a summary of findings, history, client goals, assessment, treatment plan procedures, progress notes and discharge summary.

As well as the patient’s full name, address, date of birth and insurance information, the written clinical treatment record or “chart” for each patient should include the following, unless circumstances justify the maintenance of less complete records.

Referral
1. If the referral is from a medical or dental practitioner:
a) A copy of the referral should be included in the clinical treatment record
b) Whether the referral is written or taken by telephone, all details should be recorded in the clinical treatment record. These should include the date, name and practitioner number of the referring doctor as well as the physical problem to be treated The number of referred areas specified by the doctor should also be included. .
c) The clinical treatment record should also contain copies of regular written follow up communication with the referring doctor.
2. If a patient self refers to a massage therapist, pays privately and does not use the MSP or any other third party insurer for partial payment, the clinical treatment record should still contain a summary of the relevant medical or dental information taken from the client’s history and assessment findings.
3. In all cases, the clinical treatment record should contain a statement regarding the patient’s expressed reasons for seeking massage therapy treatment.

Assessment Information
1. The clinical treatment record should contain an initial assessment of the patient including history, objective findings, subjective findings, as well as a statement of the patient’s chief complaint.
2. Contraindications and precautions should be noted where applicable.
3. The clinical treatment record should contain a brief treatment plan including treatment goals and health care objectives as well as any remedial exercises and home care prescribed.

Treatment and Progress Information
1. The clinical treatment record for each patient should contain a brief description of every treatment.
2. The clinical treatment record for each person should also contain a brief description of any change in the patient’s condition.
3. Any physical modalities used, such as a heat source or any type of hydrotherapy, should be listed. Any lubricants other than the standard use of oil, such as ointments or liniments should also be listed.

Discharge and follow up information
1. The condition of the patient at the time of discharge should be documented on the clinical treatment record. Such a discharge summary should include subjective and objective findings on discharge and a statement relating these findings to the treatment goals.
2. If applicable, the discharge summary should include a brief plan for follow up and be copied to the referring doctor.

On February 28, 2000 the Health Care (Consent) and Care Facility (Admission) Act (the "Consent Act") came into force. The new legislation applies to massage therapists and involves the clarification of the law in respect to obtaining consent from capable adults and for obtaining substitute health care consent for adults who are incapable of making health care decisions. The Consent Act also provides for an appeal and review mechanism in certain situations where substitute consent has been given and the incapable adult, or someone close to the adult, objects to the decision. This legislation amends the previous law primarily to protect the interests of incapable adult patients, their treatment providers, and their substitute decision makers. The Act does not apply to persons under 19 years of age, nor to persons undergoing psychiatric treatment involuntarily.

Massage therapists are entitled to proceed on the assumption that a person who presents for non-emergency treatment, and is to all appearances a competent adult, has the legal capacity to provide the necessary informed consent to the proposed massage treatment. But capacity must be determined before consent can be addressed.

How can an RMT determine capacity?
We are well aware that at any initial interview, the RMT must provide information that a reasonable person would require in order to understand the proposed treatment: information about the condition, the treatment, and the risks and benefits. The RMT must also give the patient an opportunity to ask questions and then provide answers about the proposed treatment. If the RMT is unable to communicate with the patient due to a language difference or physical disability, the RMT will have to make arrangements to communicate effectively before capacity can be determined.

If the RMT has determined that the patient understands all the elements of the treatment and voluntarily gives consent, then capacity of the patient has been established and the RMT can proceed with treatment. If the RMT is of the opinion that the adult needs the treatment and is incapable of giving consent, it must then be determined that the adult's substitute decision maker understands the elements of treatment and is capable of giving the required substitute consent. If there is doubt about the patient's capacity on a given treatment day, it is recommended that the RMT review the elements of treatment from the initial interview and determine whether the patient has the capacity to consent on that day or not.

Who can be a substitute decision maker?
The RMT must choose the first available substitute decision maker from: the spouse, an adult child, a parent, a sibling or anyone else related by birth or adoption to the adult. In order to qualify to give, refuse or revoke substitute consent to treatment for an adult, the prospective decision maker must be: at least 19 years old, have been in contact with the adult during the proceeding 12 months, have no dispute with the adult, be capable of giving, refusing, or revoking substitute consent, and be willing to comply with certain duties.

What are the duties of a substitute decision maker?
A person chosen to give or refuse substitute consent must first consult as well as possible with the adult and comply with any instructions of wishes the adult expressed when capable. If the adult's wishes are not known, the person chosen must decide to give or refuse consent on the basis of the adult's known beliefs and values, or in the adult's best interest. The person chosen must consider things like the adult's current wishes, whether the benefit the adult is expected to obtain from the proposed treatment is greater than the risk of harm. The RMT should have a discussion in detail with the proposed substitute decision maker about the proposed treatment in order to determine his or her capacity prior to accepting that the person chosen is an acceptable decision maker. It is advisable to document that the person meets the requirements and is willing to give consent on behalf of the adult.

What if a substitute decision maker cannot be found?
If no family member is available or qualifies, the RMT must seek assistance from the office of the Public Trustee, whose phone number is 775-0847.

What is the duration of the substitute decision maker's authority?
The authority of the substitute decision maker to make decisions for the incapable adult is limited to 21 days. However, a renewal of the informed consent can be obtained through a discussion confirming the continuance of the treatment and the decision maker's consent. If the person chosen wishes to be relieved of the responsibility of giving or refusing consent, the RMT may then chose another person in accordance with the criteria specified.

Body Substance Precautions, formerly known as Universal Precautions, are procedures employed to minimize exposure to infectious agents in human body fluids and protect from infections. Infectious agents include bacteria, parasites, viruses and fungi. Bodily fluids of concern include blood, urine, feces, vomit and saliva. Infectious agents of the greatest concern include Hepatitis A, B, and C, which can cause serious liver disease, and HIV, which causes AIDS. As RMT’s, however, it is still very important to minimize the likelihood that either ourselves or our patients will contract parasitic infections such as scabies or lice, fungal infections such as tinea, bacterial infections such as staph or strep, and viruses that cause colds or flu.

The same simple precautions will provide protection for all infections. As a health professional, you should assume all body fluids are infectious. You can’’t tell by looking at someone whether or not they are infected.

1. Before providing treatments, make sure the skin of your hands is intact. If it isn’t, cover it with a protective glove such as latex or plastic. If available, liquid Band-Aid or an occlusive dressing are also suitable barriers to protect your hands. If you cannot use a barrier, don’t provide treatments until your lesions are well healed.

2. Before and after treatment, wash your hands thoroughly with soap and water. If this is not available always use a waterless hand rub, like an alcohol rub. Wash all linen after each treatment in hot soapy water. Wipe down your table using a cloth or sponge wrung out in a solution of 1 tablespoon of bleach to 4 cups of water. It is handy to keep a solution of this made up for this purpose.

3. Use a squeeze or pump bottle to dispense lubricants to avoid contamination. Never refill the dispenser without cleaning the bottle first.

4. If called upon to administer emergency first aid, protect your face from being splashed by bodily fluids if there is a likelihood of this happening. Carry a resuscitation device with you in case you are called upon to administer CPR.

5. If you are exposed to bodily fluids, wash the area immediately with soap and water. If this is not available, use antiseptic towelletes. It is also a good idea to be in the habit of carrying these with you. If the exposure was to your unprotected face, flush your eyes and mucous membranes with water for fifteen minutes. Seek medical follow up immediately. Sometimes medicines will be prescribed as a preventive measure. Sometimes testing and monitoring will be recommended.

It is important never to expose yourself nor your patients to infection of any sort by assuming that there is no danger of infection.

Registrants are reminded of the importance of ascertaining through adequate history taking whether patients are consuming any type of medication which may alter any of the body’s systems and make massage therapy treatment potentially harmful.

Certain medications prescribed by an MD, certain “over the counter” preparations, or perhaps even herbal preparations that are taken by patients could have potentially dangerous effects when combined with massage treatment if the therapist is unaware of the effect the preparation may have on any of the body systems.

Registrants are encouraged to continually update their patient histories to be aware of and include in the patient record any new preparations their patients may be taking. In addition to this, reference books, which list the effects of medications and herbal medications, are useful. The Compendium of Pharmaceuticals, or CPS, lists the effects on the body systems of all prescription medications. Some non-prescription medications are also listed. The Physicians Desk Reference ( PDR) for Herbal Medicines lists most of the popular herbal medicines. These are two of many sources available.

If a patient is taking a preparation of any sort and you are unsure of how his preparation may impact on the body, find out before treatment. If you don’t have reference books, or the prescribing physician is not available, consult with a pharmacist.

CMTBC members are reminded that section 3(a) of the Code of Ethical Conduct includes the obligation to “…comply with all Federal, Provincial and Municipal laws and regulations pertaining to the business and practice of massage therapy”. Active Registrants engaged in the practice of massage therapy must ensure compliance with the complicated GST requirements set out in the federal Excise Tax Act.

The treatment of massage therapy services under this tax legislation is complicated by the fact that massage therapy is regulated by provincial statute only in Ontario and British Columbia. Furthermore, British Columbia is the only province in Canada that includes massage therapy as an insured service under its universal medical insurance plan. The result is that some massage therapy services are specifically exempted from GST under the tax legislation and others are not. Although most “health” services, including physiotherapy, chiropractic, optometry and podiatry, are specifically exempted under the Excise Tax Act, massage therapy is not an exempt health service. Accordingly, GST is payable for certain services rendered by some Registered Massage Therapists.

Some of the issues for your accountant’s consideration are:

1. The amount of income you receive through the provincial government under certain plans such as MSP and the Workers’ Compensation Board, and whether it is GST exempt; 
2. Whether your GST payable income generates less than $30,000, such that you qualify as a “small supplier”, and may not be obligated to remit GST; 
3. Whether your practice constitutes a partnership for tax purposes, such that the income of the partnership as a whole must be included in resolving issues 1 and 2;

It is the responsibility of each RMT to determine annually whether he or she should be collecting and remitting the Goods and Services Tax.

Due to the complicated nature of all GST related matters, members are urged to seek professional advice annually, from a tax lawyer or accountant, in determining their GST status and liability. An adverse ruling could trigger liability for past GST not collected by the RMT, as well as interest and penalties.

The CMTBC has clarified the December, 2001 ICBC Claims Handling Procedure and Service Provider Supplier documentation with ICBC.  This Advisory may assist Registrants who must balance their contractual obligations to ICBC with their professional responsibility to patients.

Confidentiality

Registrants must be vigilant in ensuring that patient information remains confidential, as required within the therapist/patient relationship, and as set out in section 9 of the Standards of Practice (Schedule D, CMTBC Bylaws).  Every patient is entitled to waive confidentiality and authorize access to all or a portion of the patient’s treatment or billing records, for any reason including payment by a third party insurer such as ICBC.  By requesting payment by ICBC for a service, the patient is deemed to consent to disclosing the billing record for that service, and the Registrant must produce the billing record on ICBC’s request. No written authorization is required.  A third party insurer, including ICBC, is entitled to ensure that there is no duplication of request for payment, or other error.  If in doubt, the Registrant should clarify the obligation of disclosure with the patient before the Registrant bills ICBC for the service.

Access by ICBC to the patient’s treatment records for the services paid or to be paid by ICBC does require a written authorization.  If inspection or release of a copy of a particular record is authorized by the patient, the Registrant must still preserve the confidentiality of the balance of the patient’s treatment or billing records.

A patient authorization or Court Order may permit access to all of a patient’s billing and/or treatment records.  A Registrant concerned about the proper limits to an authorization or Court Order should clarify matters with the patient, the CMTBC Registrar, or her own lawyer.  A patient’s consent can be modified or revoked by the patient at any time.

Service Provider Supplier Application

ICBC has clarified that it is not mandating that each Registrant have a driver’s and business license.  If the Registrant is not required by law to have a Driver’s or a Business License, ICBC requires adequate documentation with her application. If you do not have a valid Driver’s License and do not drive in the course of work, you must attach a letter to this effect to your application.  If you are not required to have a Business License within the area in which you practice, you must attach a letter from your local authority (City, Village, Town, District) confirming this. 

It is open to ICBC to decline to enter into contracts with Registrants who are driving, or operating their business, without the necessary licenses.

Repealed

This advisory is intended to give members of the CMTBC an introduction to the Personal Information Protection Act of British Columbia (PIPA). It is not intended to be, and cannot be relied upon, as legal advice.  All CMTBC members must further investigate the PIPA legislation and know how it applies to their practices.  For complete information, refer to the PIPA website at http://www.oipc.bc.ca/sector_private/resources/index.htm

On January 1, 2004, the Personal Information Protection Act (PIPA or "The Act") came into effect. PIPA regulates the way private sector organizations (such as massage therapy clinics) collect, use, keep secure and disclose personal information.  

PIPA ensures that organizations that hold information about individuals handle that personal information responsibly. It also gives individuals control over the way information about them is handled and a right to request access to, and correction of, their personal information.  Organizations covered by PIPA need to consider how they will comply with and implement PIPA's privacy protection provisions.  

The Standards of Practice (Schedule "D" of the CMTBC Bylaws) sets out a number of requirements regarding the recording and preservation of patient information.  The PIPA legislation further restricts the way therapists (and their office staff) collect, disclose and use personal information.  

Developing a Privacy Plan  
Developing a Privacy Plan is a good place to start. While not an exhaustive list, a privacy plan usually includes the following ten steps:  

1. Designate a Privacy Officer Each office must have a privacy officer who is responsible for ensuring that the office follows the PIPA guidelines for the use and storage of patient files.  This officer can be a therapist, clinic owner or member of the office staff.  If you're a sole proprietor of a clinic, you are the privacy officer.
2. Become familiar with the Act The privacy officer, therapists and all employees must become familiar with the Act.  The Act itself and other resources are available from the PIPA website.
3. Understand what is defined by Personal Information Some examples of personal information to be safeguarded are
   • home address, phone number, home email address
   • Personal Health Number (PHN) 
   • Date of Birth, age 
   • Employment information 
   • Medical information 
   • Treatment History 
   • Financial information – credit card number, bank account number, salary 
4. Review how your practice handles personal information The first question to ask is "What personal information do we collect and how does our practice currently manage it?"
   
   The privacy officer needs to conduct an internal review that:
   1. Inventories the personal information the practice currently collects/maintains 
   2. Determines what personal information the practice requires to operate 
   3. Identifies your current information practices (including how and why your organization collects, uses and discloses personal information)  
5. Put your practice to the test Consider whether your information handling practices meet PIPA obligations.  If you are currently applying the well-established ethical and professional principles to the management of patient information, it is unlikely that significant changes are needed. Develop a plan to overcome any deficiencies, starting with the most problematic areas. These include your handling of the most sensitive personal information collected or of the information most vulnerable to improper use or disclosure.   A helpful tool to assess your practice's current policies is on the PIPA website at http://www.oipc.bc.ca/pdfs/private/a-_GUIDE_TO_PIPA(3rd_ed).pdf 
6. Implement Change If you determine your information handling practices to be deficient, you will need to implement changes to your information practices and systems (technological or otherwise). Regardless of the size of your company, any person who collects, uses or discloses personal information should be involved in the implementation of your privacy program.  Compliance with the privacy principles may require a change to some of your computer systems or how your practice physically stores information.  
   
   Staff working in medical offices where patient records are kept should: 
   • shut and lock doors and cabinets as required 
   • control access to fax machines and not leave records unattended there 
   • prevent unauthorized access to patient records 
   • log out of computer systems or applications when leaving them unattended (for a few minutes or at the end of the day) 

   Paper records should be: 

   • stored closed when not in use so contents are not seen accidentally
   • inaccessible to members of the public and not left where they might be looked at by unauthorized persons, even for a short time 
   • held in secure storage with clear labeling 
   • returned to the filing location as soon as possible after completion of treatment 
   • stored securely within the clinic or office , arranged so that the record can be found easily if needed urgently.
   • disposed of in an appropriate manner once the mandatory record retention ends (as defined in the Code of Conduct).   

   With electronic records, staff should: 

   • log out of computer systems or applications when not in use 
   • not leave a terminal unattended and turned on 
   • keep computers away from public view and access 
   • not share user IDs with other people 
   • change passwords at regular intervals to prevent unauthorized use 
   • revoke user IDs and passwords as soon as authorized users resign or are dismissed
   • always clear the screen of a previous patient’s information before seeing another
   • As is outlined in the CMTBC Bylaws, neither paper nor electronic records should be shared between a licenced practitioner and an unlicenced one who operates from the same facility and is treating the same client/patient.  
7. Develop a privacy policy PIPA requires you to prepare and follow a privacy policy, which has to be available for review by patients and employees. Consult the staff who handle personal information in your medical practice when developing your policy. Consider policies and practices in the following areas: 
   • How information will be safeguarded by physical, technological, and organizational security measures How to ensure personal information is collected accurately and disposed of properly
   • How to give patients notice of why you are collecting information about them and how to obtain and record consents and handle withdrawals of consent 
   • How you will maintain the privacy of your employee’s personal information including patient charts, electronic medical records, computer information, conversations, phone calls, e-mails, faxes, photocopiers, courier deliveries, and other media  
8. Train staff The way an organization's staff handle personal information is just as important as the technology the organization has in place to manage and secure the information. A privacy plan should include a program to train staff about privacy procedures and the organization's privacy policy.  Your staff will need to understand that there has been legislative requirements placed on your organization in 2004 and that these requirements may necessitate changes in some of their jobs, tasks and responsibilities.  For example, your office is required to respond within 30 days of receiving a request for access to personal information, but you are entitled to reimbursement of reasonable photocopying charges.   No matter how good your privacy policy and practices are on paper, or how secure your technology is, it is your staff who will be responsible for consistently complying with the privacy principles on a transaction-by-transaction basis. Therefore, staff training will be essential to your success in this area.  
9. Develop or revise forms and communications materialsReview and revise as necessary your organizations forms, brochures, websites, etc. to comply with, and inform your patients/clients about, your privacy policy and information practices. If your organization collects personal information by forms, or online, you will need to include notices that inform individuals of the collection purposes.  Your patients/clients should also be told the identity of the clinic's Privacy Officer in case of complaints.   Your patient case history form should be amended to include a privacy statement.  Consent should also be obtained to use their personal information to contact them by phone, mail or email for purposes not directly associated with their treatment.  i.e. clinic newsletters, welcome cards, email or phone notifications must be authorized by the patient.  The sample case history form available on the CMTBC website at http://www.cmtbc.bc.ca includes these changes and demonstrates how your own case history form can be amended to accommodate the PIPA requirements.  
10. Develop an effective complaints handling process A privacy plan should include a process for handling privacy complaints.  It is always more efficient for an organization to resolve complaints directly than to involve an outside regulator such as the CMTBC or the Office of the BC Information and Privacy Commissioner.  Having an effective complaints handling process is an important part of managing privacy risks within an organization. It helps an organization to:
    • address complaints quickly and effectively 
    • identify (and address) any systemic or ongoing compliance problems 
    • increase patient/client confidence in the organization's privacy procedures 
    • avoid an investigation by the Information and Privacy Commissioner.  

For further information, tips and tools, please visit the PIPA website.

The Inquiry Committee has seen a significant increase in the number of complaints about the unauthorized practice of massage therapy using the billing particulars of a Registered Massage Therapist.  Registrants are advised to ensure that non RMTs neither provide massage therapy services, nor bill for massage therapy services.  RMTs are expected to be vigilant in ensuring that other persons do not use the RMT’s name or registration number.  RMTs are expected to report to the Registrar the unauthorized practice of massage therapy by anyone.

RMTs are not permitted to facilitate the practice of massage therapy or billing for massage therapy services by persons who have not yet achieved the status of Active Registrant, whether or not those persons are currently enrolled in massage therapy schools.  The only exception to this prohibition is with respect to massage therapy services being provided by students under contract with a BC massage therapy school during an internship session.  Once that session has ended, RMTs are prohibited from billing or facilitating billing for massage therapy services rendered by non RMTs, even if those non RMTs are still enrolled at school, or have graduated and await registration as an RMT.

 
Registered Massage Therapists are sometimes asked by lawyers to consent to an interview relating to a patient or former patient involved in litigation. The interview can concern both factual and expert opinion evidence in the possession of the health professional.

With your patient’s consent, you should cooperate with an interview, whether by your patient’s lawyer or a lawyer adverse to your patient’s position in the litigation (opposing counsel), subject to negotiating reasonable terms, including payment for your services and a convenient date and time.

Recent legal decisions in B.C. clarify your duties when you are asked to submit to an interview by opposing counsel: 

•  Once your patient has commenced an action or damages for personal injury, your patient is deemed to have waived confidentiality with respect to all relevant health information and cannot prevent the interview. 
• Opposing counsel is entitled to request that a health professional attend for an interview, without a Court Order, once the litigation has been commenced, as long as opposing counsel delivers a general notice of intention to do so to your patient’s lawyer. 
• You are not required to cooperate with an interview with opposing counsel, but usually will wish to do so, on acceptable conditions. These include insisting that your patient’s lawyer be made aware of the time and place for the interview, and be entitled to attend; requiring payment of a reasonable fee in advance; and obtaining clarification in advance from your patient’s lawyer of any health issues or information which is considered irrelevant to the litigation and which should, therefore, remain confidential.

In most cases, your patient’s lawyer will wish to attend the interview by opposing counsel. In some cases, your patient’s lawyer may take no interest at all in the interview. In any event, you should contact your patient’s lawyer before responding to opposing counsel’s request for an interview, and you should require a letter from your patient’s lawyer, setting out his or her position. You should confirm verbal communications from your patient’s lawyer with a letter to him or her, specifying your understanding of their response on behalf of your patient to the interview request.

Your patient and his or her lawyer are not entitled in law to instruct you to refuse to attend the interview requested by opposing counsel. If a health professional unreasonably refuses to attend an interview, opposing counsel can obtain a Court Order mandating the attendance of the health professional.

Our Courts recognize that claims often settle after all parties have the information directly from the health professionals involved. By attending the interview, the health professional avoids a subpoena mandating attendance at trial and contributes to pre-trial settlements.

In most cases, the health professional should obtain advice from his or her own lawyer and may wish to have that lawyer attend the interview as well.

The leading authorities are Swirski v. Hatchey (1995), 16 B.C.L.R. (3d) 281, and MacEchern v. Rennie, 2009 BCSC 939.

The CMTBC Inquiry Committee has received several questions regarding internet coupon marketing through sites like Groupon.com, Swarmjam.com, Twongo.com and others. After reviewing applicable bylaws, the Committee has concluded that this form of advertising and discounting of rates does not contravene the applicable CMTBC Bylaws. In particular, RMTs are entitled to set their own rates and offer discounts. However, all of the CMTBC advertising legislation applies equally to this form of internet discount advertising.

The Inquiry Committee reminds registrants that all massage therapy advertisements must adhere to the CMTBC Bylaws, Part F.1: Advertising and Other Marketing Activities. Registrants are ultimately responsible for the wording and appropriateness of their advertisements, even if the advertisement text was created by the internet marketing website. Please review the applicable CMTBC Bylaws before advertising in any medium, and please contact the CMTBC office if any questions arise as to appropriate advertising.

Note that registrants can only issue receipts with their practitioner number to patients who pay for and receive massage therapy treatments. Some internet coupons can be purchased by someone other than the person receiving massage therapy treatments. When receiving payment by coupons or vouchers of this type, registrants should clearly mark on the receipt that payment was received via the particular internet coupon or voucher. Registrants should also advise patients that the insurer decides whether to reimburse payment for any treatment, and is entitled to accurate and precise billing information from the RMT so it can properly process each claim. Whether or not an insurer will reimburse for a payment made through an internet coupon discount site is for the insurer to decide, and RMTs must avoid being a party to efforts to mislead or even defraud insurers.

Another issue with these internet coupon discount sites is the frequency of unauthorized practitioners using our protected titles. The Unauthorized Practice Committee asks registrants for increased diligence in monitoring these sites for use by unauthorized practitioners using our protected titles. Please report any abuse of our protected titles immediately to the Unauthorized Practice Committee or the CMTBC office.

Recently registrants have been requesting an update on the ability of RMTs to utilize certain forms of light therapy, including Low Level or Low Intensity Laser Therapy.   It remains the status quo that these therapies are not within the current Scope of Practice for BC RMTs. 

Be advised that the BC Ministry of Health prohibits use of all forms of laser therapy by BC RMTs, and has not agreed to include laser therapy within the scope of practice of BC RMTs.

Registrants may not perform any type of laser therapy treatment in conjunction with their massage therapy treatments. 

Please refer to CMTBC Bylaws Code of Ethical Conduct (Schedule C) and Section 78 for more information on performing treatments and advertising of massage therapy services in BC.   An RMT involved in any level of laser therapy is vulnerable to an allegation of serious professional misconduct in contravening the legislation governing massage therapy.

The Scope of Practice Committee intends to work with the MTA towards obtaining a fresh review by the Ministry of Health of the current status of this prohibition. 

Please direct any inquiries to the Registrar at the CMTBC office.