Identifying a Conflict of Interest
Identifying a Conflict of Interest
The Conflict of Interest regulation (O. Reg. 596/94) outlines the situations where an RT might find themselves in an actual, potential or perceived conflict of interest [s.3 (1)]. The likelihood of a conflict of interest increases when:
The magnitude of the benefit is substantial (e.g., a full course meal with drinks at an expensive restaurant vs. muffins & coffee);
The benefit is personal (e.g., a cash donation given to a specific individual vs. the entire RT department);
There is no educational component (e.g., a department being offered lunch during RT week without any educational session vs. a lunch & learn); and
It involves a patient/client (or their family) where there is an ongoing professional relationship (e.g., a current home care patient/client offers their RT a piece of antique china vs. the family of a deceased patient/client offering the same gift in gratitude for the RT’s past services).
Three Key Factors to Consider when Identifying a Conflict of Interest
1. Why is this benefit being offered to me? (i.e., what advantage does this transaction provide to the person/organization proposing the benefit?)
2. Are there factors in this situation that influence, or might influence, my professional judgement and/or objectivity?
An RT working in an asthma clinic has been approached by the owner of a local health food store to see if they would consider offering a line of herbal asthma remedies in their clinic. The RT believes that these products would be beneficial to some of their patients/clients and, in addition, the RT would also receive a percentage of the profit from the sales.
What do you do?
There are several issues involved with the above scenario. The first is the fact that such an arrangement clearly places the RT in a conflict of interest, and should not be undertaken. The other concern is that the use of these herbal products is not likely part of the current medically accepted guidelines for the treatment of asthma.
3. Is it possible that others might perceive that my professional judgement and/or objectivity is impaired?
An RT has been asked by the family of a patient/client in the pulmonary rehab clinic where they work if they can sublet the RT’s apartment while they are travelling during the summer.
What do you do?
This could be a conflict of interest as it may alter how the RT provides care to the patient/client in the future because the relationship is no longer purely professional in nature.
1. Is my relationship with this patient/client purely professional?
Treatment of a Spouse*
The sexual abuse provision in the Regulated Health Professions Act (RHPA) [Schedule 2 s. 1(3)] prohibits healthcare professionals from treating their spouses in a professional capacity. In the RHPA, sexual abuse is defined by an action, not by the intent. In addition, under the RHPA’s definition of sexual abuse, only a patient can be sexually abused. As such, regulated health professionals who provide treatment to their spouse, which then makes them their patient, fall within this definition. In other words, if a health professional is found to be treating their spouse (with whom they inherently have established a sexual relationship) they too would be subject to the mandatory revocation provisions of the RHPA. Therefore, a CRTO Member must not provide respiratory therapy services to their spouse.
* “spouse”, in relation to a Member, has been defined in the RHPA as:
(a) a person who is the member’s spouse as defined in section 1 of the Family Law Act, or
(b) a person who has lived with the member in a conjugal relationship outside of marriage continuously for a period of not less than three years.
Treating a sexual partner who does not meet the definition of a spouse under the RHPA will continue to be considered sexual abuse.
In addition, it is the view of the CRTO that RTs should avoid treating other family members as well. In providing treatment to a family member who is not a spouse, the Member risks not only being in an actual, potential or perceived conflict of interest, but they also risk a lack of objectivity that may affect their professional judgement. However, the CRTO recognizes that there may be circumstances where the RT is the only practitioner available to provide the necessary care, as is the case in sole-charge practice settings. In situations where it is in the patient’s best interest for the RT to treat a family member who is not their spouse, this may be permissible until such time as alternative care arrangements can be made. Emergency care of family members where no one else is available is acceptable because the benefits outweigh the “challenges posed by the personal relationship”. In such circumstances, the RT is encouraged to transfer care to an appropriate provider as soon as possible.
For more information on what constitutes sexual abuse, please see the CRTO’s Abuse Awareness & Prevention PPG.
An RT works both for a home care company and the local hospital. While working at a hospital, they are required to arrange home oxygen for a patient/client who wants to be set up with one particular company. However, it is the RT’s professional opinion that the patient/client would receive better services if they went with the company the RT works for.
What do you do?
Whether this is an actual or potential conflict of interest situation depends on if the RT will benefit in any way from adding this patient/client to their home care company’s roster. Also, there is a chance the patient may perceive this to be a conflict once they find out that the RT works for the company they are recommending. The best way for the RT to deal with this is to declare their relationship with the home care company up front, before offering his professional opinion.
2. Have I (or do I plan to) offer or receive a benefit (financial or nonfinancial) related to the referral of this patient/client to my practice or to the services that I provide?
Example… The RT Manager of a Sleep Lab enters into an exclusive service agreement with the manufacturer of a particular CPAP device because they’re able to offer an incentive that the other companies cannot.
3. Have I (or do I plan to) enter into an agreement (including related to my employment) that influences/appears to influence my professional judgement?
An RT owns a sleep lab and rents some of the office space to a home care company. The RT receives a percentage of the profits of the home care company; meaning that the more patients/clients the RT sends to the home care company, the greater their share.
What do you do?
To avoid a conflict of interest in this situation, the RT must disclose the income sharing arrangement to their patients/clients in advance of any referral to the home care company, and assure them that their care will not be affected if they choose another company.
4. Have I (or do I plan to) engage in any form of revenue, fee or income sharing agreement that influences/appears to influence my professional judgement (O. reg. 596/94) s. 3(1)(g)?
Agreement: a revenue, fee or income sharing arrangement.
Fiduciary: a relationship based on trust and confidence
Member: refers to a Respiratory Therapist (RT) who is registered with the CRTO as either a Registered Respiratory Therapists (RRT), Practical (limited) Respiratory Therapist (PRT) or Graduate Respiratory Therapists (GRT).
Professional misconduct: as defined in the Professional Misconduct Regulation (O. Reg. 753/93), which was established under the Respiratory Therapy Act.
Reasonable person: an individual who is neutral and informed
Relationship: in the course of their practice, RTs engage in therapeutic (patient/client) and professional relationships (students, colleagues, coworkers) .
Related person: means any person connected with a member by blood relationship, marriage, common-law or adoption, and
- persons are connected by blood relationship if one is the child or other descendant of the other or one is the brother or sister of the other;
- persons are connected by marriage if one is married to the other or to a person who is connected by blood relationship to the other;
- persons are connected by common-law if the persons have, for a period of not less than three years, cohabited in a relationship of some permanence; and
- persons are connected by adoption if one has been adopted, either legally or in fact, as the child of the other or as the child of a person who is so connected by blood relationship.
Related company: means a company, corporation or business partnership or entity that is owned or controlled, in whole or in part, directly or indirectly, by a person or another person related to the person.
- College of Nurses of Ontario. Professional Conduct (2019). Retrieved from: https://www.cno.org/globalassets/docs/ih/42007_misconduct.pdf
- College of Physicians and Surgeons of Ontario. Physicians’ Relationship with Industry: Practice, Education and Research (2014). Retrieved from: https://www.cpso.on.ca/en/Physicians/Policies-Guidance/Policies/Physicians-Relationships-with-Industry-Practice
- General, O Reg 596/94, retrieved on October 20, 2021. Retrieved from https://canlii.ca/t/527jh
- Institute of Medicine (US) Committee on Conflict of Interest in Medical Research, Education, and Practice; Lo B, Field MJ, editors. Conflict of Interest in Medical Research, Education, and Practice. Washington (DC): National Academies Press (US); 2009. Summary. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK22926