Sexual Misconduct and Boundary Violations

Sexual misconduct and boundary violations remain a critical challenge that threaten the
integrity of the physical therapy profession and the safety of patients. The patient-provider
relationship is built on trust, respect, and professionalism. Physical therapists and physical
therapist assistants in Washington state are responsible for understanding WAC 246-915-
182 (Unprofessional conduct - Sexual misconduct), WAC 246-16-100 (Sexual misconduct),
and Chapter 18.130 RCW (Uniform Disciplinary Act).

These laws apply inside and outside the clinical setting and recognize the power imbalance
in the patient-provider relationship. Washington law does not recognize patient consent as
a defense to sexual misconduct because of the inherent imbalance of power in the
therapeutic relationship. A patient's agreement or lack of objection does not make the
behavior acceptable or legal.

A therapeutic relationship between a patient or client and the provider is built on trust,
respect, sensitivity, duty, and power. You must constantly re-evaluate your professional
boundaries, be aware of the power imbalance between you and your patient or client and
repeatedly seek informed consent for procedures that involve touch.

Informed consent is the process in which you give patients important information about the
possible risks, benefits, and alternatives regarding their plan of care. This allows the patient
to decide if they want treatment. Consent is an ongoing process. As the patient's plan of
care evolves, you should continually ask for patient consent.

Engaging with patients on social media is another area of concern for physical therapists
and physical therapist assistants. You risk breaching patient-health care provider
boundaries by engaging with patients on social media, even when the patient initiates
contact. Maintain strict privacy settings on personal accounts, do not friend patients on
platforms like Facebook, and suggest secure alternatives.

If sexual misconduct is substantiated, the Board of Physical Therapy, the disciplining
authority under RCW 18.74.029, may impose sanctions that include:

• License suspension or revocation
• Practice limitations or monitoring
• Mandatory education and treatment
• Fines and administrative penalties
• Patient notification requirements

The goal of discipline is to protect public health and safety, not punish intent.

Things you can do to protect yourself:

• Be sensitive to the inherent power imbalance between you and your patient or
  client.
• Keep your relationship with the patient or client professional.
• Provide contact information through the clinic or business, not personal contacts.
• Review informed consent, the purpose of treatment, and receive ongoing consent.
• Give the patient or client permission to ask questions at any time.
• Be aware of workplace policies regarding the use of chaperones, patient or client
  contact outside of the care setting, and gift giving.
• Acknowledge your professional duty to report sexual misconduct and boundary
  violations.
• Review state rules and statutes regarding sexual misconduct.
• Be informed - understand the prevalence of sexual abuse and the impacts a history
  of sexual abuse may have on the patients or clients you treat.
• Be vigilant about potential perceived boundary crossings and make corrections.