Overview of Complaints Process

What types of concerns can the Regulator address?

The Regulator has the authority to address complaints about:

• Poor or inappropriate practice which does not meet the occupational therapy practice standards and competencies or violates ethical principles;
• Inappropriate conduct which reflects poorly on the profession;
• Occupational therapists who have a health condition which may impair their ability to practise safely; or
• Other concerns which may create a risk to public safety.

The Regulator can only address concerns about individuals who are currently licensed as an occupational therapist or were licensed at the time of the incident in question. We cannot address concerns about other healthcare professionals. We also generally do not address concerns about a workplace, a healthcare facility, or the healthcare system.

What other ways can I address my concerns?

If you are comfortable doing so, you can discuss your concern directly with the occupational therapist before filing a complaint. This may resolve the issue.

In some situations, it may be best to first raise a concern with an occupational therapist’s employer. You may consider this approach where the employer can address the issue directly and where public safety is not at risk.

However, if any of the following are true, you should consider submitting a complaint directly to the Regulator:

• It is not appropriate to report a concern to the employer for any reason;
• You have reported a concern to the employer but have not received a response within a reasonable time; or
• You think the occupational therapist may be endangering public safety.

When do I submit a complaint?

Although there is no specific time limit to file a complaint, it is more difficult to investigate incidents which occurred a long time ago. Also, in very serious cases, we may need to act quickly to restrict an occupational therapist’s practice until an investigation is complete. However, it is appropriate to take time to consider your concerns, review this information, and seek any additional details which you may need prior to filing a complaint.

Can I file a complaint for someone else?

Anyone may file a complaint about the care provided by an occupational therapist, including family members, friends, employers, other healthcare providers, and members of the public. If you are not the client who received care, you may not be entitled to details about that individual’s health or other personal information.

Who will know I made a complaint?

While there are confidentiality protections in the complaints process, the occupational therapist who the complaint is about will receive a copy of the complaint so they can respond to the concerns. It is generally not possible to remain “anonymous” in the complaint process. If you have a concern but do not wish to be identified as a complainant, please contact us to discuss potential alternatives to filing a complaint.

How long does the complaint process take?

While we try to deal with complaints quickly, it usually takes time to complete the process. The amount of time required depends on several factors, including the availability of information and the complexity of the issues. It is often in the public interest to take additional time to obtain relevant information in order to ensure that important factors are not overlooked.

Some complaints may be closed within three months. However, if a complaint is complicated or involves serious issues, it may take a year or longer to resolve.

If you would like an update during the complaints process, please reach out to us.

How do I submit a complaint?

To submit a complaint, please fill out our Complaint Form available here.

Alternatively, you may provide a written document describing your concerns. Please ensure that you include:

• Your full name and contact information;
• The full name of the occupational therapist you are making the complaint about, or as much information as you can provide to help us identify that individual (date, time, and location of the incident, relevant demographic details regarding the occupational therapist);
• Your relationship to the occupational therapist (e.g. client, colleague, relative of client, etc.);
• As many facts and details regarding the complaint as possible (including a description of the actions/behaviours which caused your concerns, when and where the incident occurred, and who else was present or may have relevant information about the incident);
• Confirmation whether you have raised the concerns with any other organization or whether any other investigations are ongoing (e.g. police involvement); and
• A description of how you think your concerns could be resolved.

If you have any documentation which is relevant to your concerns, you may also provide that information.

If you require support to file a complaint, including because of accessibility needs, please contact us so we can help.

There is no fee to file a complaint.

Once a complaint is filed, Regulator staff will review it to confirm that we have all the information we need. After reviewing your complaint, we will send you a letter acknowledging your complaint and providing additional details about the complaint process, generally within 5-10 business days.

The occupational therapist will also receive correspondence notifying them of the complaint and explaining the next steps at about the same time.

If we cannot process the complaint for any reason (e.g., the person you are complaining about is not registered with the Regulator, the complaint is about an issue we cannot address, etc.), we will tell you as soon as possible and suggest any potential alternatives you may have to address your issue.

What action can the Regulator take before investigating a complaint?

After a complaint is received and before investigating further, the Regulator has several options, including:

• Dismissing the complaint if:
  • the issue is not within the Regulator’s authority
  • it will not be possible to prove the complaint allegations
  • the reason for filing the complaint was not consistent with the purpose of the complaint process (i.e., public protection)
  • the alleged conduct is in fact consistent with expected professional requirements; or
  • proceeding with the complaint would otherwise not be in the public interest.

• Informally resolving the complaint if it is in the public interest to do so. When considering this option, the Regulator will assess whether the occupational therapist is willing and able to learn from and address the issues raised in the complaint. “Informal” means that the resolution does not involve a Committee process (described below). Nevertheless, informal resolution can be rigorous and specific, and include requirements such as education, treatment, monitoring, reflective exercises, and practice limitations.

• Referring the matter to another form of dispute resolution, which may include, for example, mediation.

• Authorizing the resignation of the occupational therapist’s registration and/or licence. An occupational therapist can only resign with the Regulator’s permission; it is not possible to resign simply to avoid the consequences of the complaints process.

• Referring the matter to the Fitness to Practise process if it appears that the occupational therapist is experiencing a health condition which impacts their ability to practise safely. Both the Regulator and the occupational therapist must agree to this option. More information is below: “Concerns about the Health of an Occupational Therapist”.

If the Regulator chooses one of these options, the person who made the complaint and the occupational therapist will be notified of this outcome in writing.

If the complaint is dismissed at this stage, the person who made the complaint will that decision reviewed by the Complaints Committee. When a complaint is dismissed, the Regulator may also provide written advice to you or another affected party.

The purpose of an investigation is to gather additional information about the complaint. The investigator, who may be Regulator staff or an external consultant, will attempt to obtain relevant information in a neutral and unbiased manner.

You may feel uneasy about participating in an investigation; however, cooperating with the process is important. The legislation which applies to the investigation process gives the investigator the power to require individuals and organizations to provide relevant information upon request.

If you are the person who filed the complaint (the “complainant”), it is likely that the investigator will contact you to clarify the information you provided in the complaint, which may include interviewing you.

If you are the occupational therapist who the complaint is about (the “respondent”), please consider the following:

• You have a legal obligation to cooperate with the investigation and respond to communications promptly and honestly.
• You will be expected to provide us with a written response to the complaint, which will give you an opportunity to provide your perspective on the issues under investigation.
• You should submit any information requested of you by the deadline provided.
• You have a right to be represented by a union representative, legal counsel, or another representative, at your own expense. You may wish to consult with your professional liability insurer about obtaining legal representation. The Regulator represents the public interest, not the interests of individual occupational therapists. Therefore, while we can provide you with general information about the complaints process, we cannot provide you with advice about how to proceed.
• In some circumstances, you may be asked for consent to participate in the following additional steps during an investigation:
  • A health assessment by a qualified healthcare professional;
  • A review or audit of your practice by a qualified reviewer; and/or
  • A competence assessment by a qualified assessor.
• The investigator may pursue other matters of potential concern which arise while investigating a complaint.

The investigator will determine what additional investigative steps are required, including interviewing individuals who have relevant information and obtaining health records or other documentation.

Once the investigator has obtained the relevant information, the occupational therapist will be provided with an investigation report and will be invited to respond to it prior to the Regulator making a decision about the next steps. Because the investigation may include confidential information about third parties, the person who made the complaint will not receive a copy of the investigation report; however, they will be advised of the decision made in the next step.

At the conclusion of the investigation, the Regulator decides how to proceed based on what is in the public interest. We consider a number of factors including:

• whether the information obtained supports the complaint,
• the seriousness of the issues raised, and
• whether the occupational therapist has acknowledged any elements of the complaint.

At this stage, the Regulator again has several options, as explained above (“What action can the Regulator take prior to investigating a complaint”):

• Dismiss the complaint (which may include written advice);
• Informally resolve the complaint;
• Refer the matter to another form of dispute resolution;
• Authorize the resignation of the occupational therapist’s registration and/or licence; or
• Refer the matter to the Fitness to Practise process.

If the Regulator chooses one of these options, the person who made the complaint and the occupational therapist will be notified of this outcome in writing. If the complaint isdismissed at this stage, the person who made the complaint will be advised of their right to have that decision reviewed by the Complaints Committee.

If none of these options are appropriate or available at this stage, the Regulator will refer the complaint to the Complaints Committee.

If the Regulator determines that the complaint requires further review and action, it may refer the matter to the Complaints Committee. When a complaint is referred to the Complaints Committee, a panel is appointed which usually includes two occupational therapists and one public representative. The panel will carefully review the investigation results. They will decide whether additional information is required to make a decision, which may include:

• Further witness interviews, documents, or responses; and/or
• Requiring the occupational therapist to participate in a health assessment, practice review/audit, or competence assessment.

Unless the Committee dismisses the complaint, it will invite the occupational therapist to attend a Committee meeting to answer questions and make comments if they wish. The Committee may also invite other people to appear before it. Complaints Committee meetings are not open to the public.

When the Complaints Committee is satisfied that it has reviewed all of the relevant information that it needs, it will make one of the following decisions:

• Dismiss the complaint (which may include guidance);
• Informally resolve the complaint;
• Refer the matter to another form of dispute resolution;
• Caution the occupational therapist (where the Committee determines that the occupational therapist may have breached the expected professional requirements, but in circumstances where a more serious sanction is not warranted, considering all the circumstances );
• Reprimand the occupational therapist, with their consent (where the Committee determines that the occupational therapist may have breached the expected professional requirements in circumstances where a more serious sanction is warranted );
• Impose conditions or restrictions on the occupational therapist’s registration or licence, with their consent (where the Committee determines that the occupational therapist may have breached the expected professional requirements in circumstances where a more serious sanction is warranted, and specific remedial action [e.g., education or treatment] or practice limitations are required to protect the public );
• Refer the matter to the Fitness to Practise process, where the occupational therapist and the Regulator agree. Further detail regarding this process is described below (“Concerns about the Health of an Occupational Therapist”).

If none of these options are appropriate or available at this stage (because a more formal process is necessary), the Complaints Committee will refer the complaint to the Professional Conduct Committee.

The Complaints Committee will provide reasons for their decision in writing. The written decision will be provided to the occupational therapist. The complainant will also receive a summary or copy of the decision.

In certain circumstances, information about the decision may also be shared with other individuals. If the outcome is a more serious sanction (with the consent of the occupational therapist), a summary of the outcome will be published on the Regulator’s website.

Complaints Committee decisions are final and there is no internal review or appeal process. If you wish to consider legal options, you may wish to seek legal advice.

What is the role of the Professional Conduct Committee?

Complaints may be referred to the Professional Conduct Committee when the allegations are serious or when a more formal hearing process is required to consider the evidence. When a matter is referred to the Professional Conduct Committee, a panel of at least three people will be appointed consisting of occupational therapists and at least one public representative.

The Professional Conduct Committee’s procedure is more formal than the Complaints Committee and is similar to an administrative tribunal or court. If a complaint is referred to the Professional Conduct Committee, an occupational therapist is encouraged to retain legal counsel at their own expense, if they have not already done so earlier in the process.

The Professional Conduct Committee will address a complaint in one of two ways:

• Settlement Agreement: When the facts and/or outcome are agreed upon by the Regulator and the occupational therapist, an agreement may be presented to the Committee, which may accept or reject the agreement.
• Hearing: If there is no Settlement Agreement, the complaint will proceed to a hearing. A hearing is similar to a trial, where witnesses may be called to give evidence and documents are submitted. Hearings are generally open to the public.

At the conclusion of its process, the Professional Conduct Committee may make one of the following decisions:

• Determine that the allegations have not been proven; or
• Determine that the allegations have beenproven, and:
  • Revoke the occupational therapist’s registration and/or licence;
  • Authorize the occupational therapist to resign their registration;
  • Suspend the occupational therapist’s licence for a period of time and/or until certain conditions have been met;
  • Impose conditions or restrictions on the occupational therapist’s registration or licence;
  • Reprimand the occupational therapist;
  • Direct the occupational therapist to complete additional educational or training requirements;
  • Direct the occupational therapist to obtain medical treatment or counselling;
  • Impose a fine (in certain circumstances); and/or
  • Make another order that the Committee determines is appropriate under the circumstances.

The Professional Conduct Committee may also order that the occupational therapist pay some of the Regulator’s costs in resolving the matter.

The Professional Conduct Committee will provide reasons for their decision in writing. In most cases, the written decision will be provided to the occupational therapist. The person who made the complaint may also receive a summary or copy of the decision. A copy of the decision or a summary of the decision may also be published on the Regulator’s website.

There is no internal review or appeal process for Professional Conduct Committee decisions. These decisions may only be appealed on the basis of certain legal issues to the Nova Scotia Court of Appeal. If you wish to consider legal options, you may wish to seek legal advice.

What if there is an urgent public safety concern?

At any point after a complaint is received and until the matter is resolved, the Regulator will assess whether it is necessary to temporarily intervene in the occupational therapist’s practice. If intervention is necessary to protect the public, we may:

• prevent the occupational therapist from continuing to practise, or
• impose conditions, limitations or restrictions on their practice while the matter is under investigation.

The occupational therapist may voluntarily agree to these measures (an “Undertaking”), or where warranted, they can be imposed by the Complaints Committee.

This type of intervention is considered extraordinary and is used when it is in the public interest, based on factors such as the seriousness of the allegations and the likelihood and consequences of alleged actions being repeated. These measures are temporary and only remain in effect until there is a final decision in the matter or the Regulator determines that the intervention is no longer required. This type of intervention does not mean that the allegations against the occupational therapist have been proven.

Complaints or reports relating to a physical or mental health condition which affects an occupational therapist’s ability to practise safely (“capacity”) may be referred to the non-disciplinary Fitness to Practise process.

The Fitness to Practise process may be initiated because

• of a complaint or a report from an employer, colleague or member of the public;
• of information received during another process; or because
• the occupational therapist self-reported a capacity issue to the Regulator.

The goal of the Fitness to Practise process is to support occupational therapists to return to practice once it is safe to do so. Participation in the Fitness to Practise process is voluntary.

The occupational therapist must meet certain eligibility criteria to participate in the Fitness to Practise process, including confirmation that a health concern has impacted on their professional practice, often based on an assessment by a qualified healthcare professional.

If an occupational therapist is experiencing a health issue which warrants intervention but does not necessarily impact their ability to practise safely, the Regulator may use informal resolution rather than the Fitness to Practise process.

What is the Fitness to Practise process?

The Fitness to Practise process usually involves at least two stages:

• First stage: the occupational therapist will enter into an agreement to remedy their health condition by participating in specific treatment. Often during this stage, the occupational therapist agrees not to practise or, in some cases (with Fitness to Practise Committee approval) to restrict or limit their practice. This both protects the public until the health condition improves and allows the occupational therapist to focus on their wellness.
• Second stage: the Regulator will confirm that the occupational therapist has recovered enough from their health condition that they can practise safely with appropriate support. The occupational therapist agrees to comply with certain requirements which create supportive conditions for them to return to practise in a safe and controlled manner. This plan may include ongoing treatment, monitoring, limitations on working conditions, and retraining. The Fitness to Practise Committee must approve this plan.

A failure to comply with the requirements at any stage of the Fitness to Practise process may result in additional conditions, a requirement to repeat an earlier stage, or removal from the process.

Because the Fitness to Practise process relates to the health of an occupational therapist, information shared with other individuals is limited to respect confidentiality.

The complaints process is confidential and anyone who receives or has knowledge of information because of their participation in this process must keep that information confidential except in very specific circumstances. This includes a person who makes a complaint, and the occupational therapist who the complaint is about.

When can I disclose information?

Examples of the limited circumstances in which information may be disclosed includes:

If you are:	You can disclose information to:
The Occupational therapist who the complaint is about:	your own legal counsel, union representative, or healthcare provider
The person who made the complaint or another type of participant, such as a witness:	your own legal counsel or healthcare provider, legal counsel for the Regulator, or legal counsel or another representative for the occupational therapist

All participants in the complaints process may tell their employer that they are participating in the complaints process.

You can also disclose information with the consent of the person to whom the information relates; or as otherwise permitted or required by law.

What information will the Regulator disclose?

It is important to understand that if you make a complaint, the occupational therapist will be provided with a copy of the complaint. They will also generally receive a copy of any relevant information obtained during the investigation of the complaint.

It may be necessary for the Regulator to disclose information during the complaints process. For example:

• Information may be shared with Regulator staff, legal counsel, agents, and committee members in order to administer the complaints process.
• Specific information may be provided to witnesses in order to conduct an investigation.
• Information may be shared with employers when necessary to manage professional practice issues.

Individuals who receive information in these circumstances are themselves required to use confidential information only for the purpose for which it was disclosed to them.

In certain circumstances, in order to address public safety issues or as required by law, the Regulator may disclose or publish information about an occupational therapist involved in the complaints process. Generally, such information will be limited to that which is required under the circumstances. Most complaints are resolved without publication.

As noted above, most Professional Conduct Committee hearings are open to the public.

The mandate of the Regulator is to:

• Protect the public from harm;
• Serve and promote the public interest;
• Subject to the public interest, preserve the integrity of the occupational therapy profession; and
• Maintain public confidence in the ability of the Regulator to regulate the profession.

We do not represent or advocate for occupational therapists in the complaints process. We are also unable to act as advocates or representatives for any other participant in the complaints process, including the person who files a complaint. The principles of natural justice require us to conduct investigations and resolve complaints in a procedurally fair and unbiased manner.

We treat all participants in the complaints process with respect and expect the same in return.

If you have made a complaint or are considering doing so and you need support or information, please reach out to us. For example:

• You require assistance filing a complaint due to accessibility needs or a language barrier;
• You are unsure whether filing a complaint with the Regulator is the best way to address your concern;
• You are unsure whether what you experienced is acceptable occupational therapy practice; or
• You are unclear on any aspect of the complaints process.

You are not required to retain legal counsel if you file a complaint. However, if you wish to obtain legal advice, you may consult with a lawyer at your own cost. The Regulator will not be able to advise you on your legal rights or the availability of remedies in court.

If you are an occupational therapist who has received a complaint, you may contact us to clarify any aspect of the complaints process or your professional responsibilities. Please note that Regulator staff cannot provide you with legal advice or provide specific guidance on how to respond to a complaint. All occupational therapists in Nova Scotia are required to carry personal professional liability insurance which provides defence costs in regulatory proceedings. Your insurer will be able to advise you whether and to what extent your policy will cover the cost of legal representation in the event of a complaint. Support may also be available through your union representative.

We recognize that the complaints process can be stressful for all participants. You are permitted to disclose your participation in the complaints process to your own healthcare provider to seek support, treatment and guidance.

In fulfilling its public protection mandate, the Regulator considers many factors during the complaints process, and not all possible actions, decisions and outcomes are described in this overview. This is general information only and is not legal advice. For more detailed information, you may wish to consult the following resources. Please reach out to us if you have any questions about the process which have not been addressed in these materials.

If you require legal advice or have questions about the interpretation or application of specific laws, please consult with your own legal counsel.

• The Regulated Health Professions Act, the Regulated Health Professions General Regulations, and the Occupational Therapy Regulations.
• The Nova Scotia Occupational Therapy Regulator By-Laws
• The Nova Scotia Occupational Therapy Regulator Practice Standards, Code of Ethics, and Competencies for Occupational Therapists

Contact information for the regulatory bodies for other healthcare professions in Nova Scotia may be accessed through the Nova Scotia Regulated Health Professions Network.

If you need to reach us, our contact information is available here.