Can I ask my patients if they have been vaccinated?

Members are expected to continue to screen patients based on the Ministry of Health COVID-19 Patient Screening Guidance Document. The document was updated on August 26, 2021, to include a background question (Q1) related to patients’ vaccination status, that is, “Did the person receive their final (or second) vaccination dose more than 14 days ago?”

• If the patient answers “No” to Q1 (or if they do not answer the question), practitioners must ask questions 3, 4, 5 and 6.
• If the client answers “Yes” to Q1, practitioners should only ask questions 3 and 4.

We encourage all members to review the updated COVID-19 Patient Screening Guidance Document.

Can practitioners refuse to treat patients who are not vaccinated for COVID-19?

At this time, we are not aware of any guidance that would permit members of the College (or other health care providers) to refuse care because of a patient’s vaccination status. We continue to monitor the situation and will provide updates as required. The rationale is that practitioners should be in a position to take steps to protect themselves, and their staff, and other patients, regardless of the patient’s vaccination status. The use of screening questionnaires, PPE, and masks will assist practitioners to provide TCM care in a safe manner.

If a practitioner believes that they are not able to provide in-person care for the patient (based on the risk assessment, and not their vaccination status), they would be expected to assist the patient by providing reasonable alternatives to their care needs and to ensure continuity of care. The College reminds members that discontinuing professional services that are needed can amount to professional misconduct in certain situations.

A patient asked if I have received the COVID-19 vaccine, am I required to tell them?*

Currently, members are not required to disclose their personal health information to patients.

However, considering the pandemic, members should be prepared for their patients to ask this question and how they will respond to their patients. If a member decides not to provide this information or if they advise their patient that they have not received the vaccine, the patient may decide to transfer their care to another member. It is important that the member respect this decision of the patient and ensure continuity of patient care (i.e., ensure that up-to-date patient records are transferred promptly in accordance with College expectations). It is also important that members respond to the original question and the patient’s response in a professional and respectful manner.

Members should be mindful that they are obligated to provide care in a safe and ethical manner and should comply with all Ministry directives and recommendations.

There may be situations where practitioners are required to disclose their immunization status. For example, they may be bound by specific employment obligations to disclose this information. Please note that the College cannot offer legal advice on these types of matters.

The College continues to encourage our members to take the vaccine to ensure that they, their staff, families and patients are protected from COVID-19.

Can TCM practitioners and acupuncturists discuss vaccines with patients?

Vaccination is outside of the TCM scope of practice¹. As such, practitioners should not be advising patients about vaccinations. For example, if a practitioner is asked about the efficacy of the COVID-19 vaccines or other vaccinations, they must tell the patient that they cannot provide this information and advise the patient to speak to a regulated health professional whose scope of practice allows them to provide the information (e.g., family physicians, nurses, etc.). 

Information that a practitioner provides in their professional capacity must be factual, accurate, easily verified, independent of personal opinion, and within their scope of practice.

Practitioners should not use their position as regulated health care providers to share their personal opinions with patients. For example, it is expected that in their professional capacity, practitioners not express or promote anti-vaccination sentiments or misinformation that contradicts evidence-based public health advice. It may be difficult for patients and the public to discern when the practitioner is representing themselves as a regulated health professional or not. Improper or ill-informed guidance may confuse patients and, in the interest of protecting the public, may be deemed unprofessional conduct.

When using social media, practitioners are advised to follow the same rules that would apply to any other forms of communication, that is, by maintaining professional boundaries and communicating respectfully, accurately, and professionally. Publicly communicating or making statements contrary to the information provided by public health authorities (e.g., promoting anti-vaccination sentiments, anti-masking, anti-lockdown and/or promoting unproven therapies for treating or preventing COVID-19) are inappropriate, potentially harmful, and could result in an investigation by the CTCMPAO and/or disciplinary action, where warranted.

Members are reminded that even when they are communicating on a personal or closed social media account, their comments and opinions may still be viewed as that of a regulated health professional.

It is expected that as regulated health care providers, members follow the directives and guidance from the Ministry of Health and Public Health Ontario on issues related to COVID-19, immunization and public health in general. Members who are found to be practising contrary to College expectations and public health directives may face consequences, such as a College investigation that may result in a referral to the discipline committee.

We continue to expect that our members are following the information provided by the proper health authorities to ensure that safe and ethical care is provided to the public.

What is required for members to provide in-person care?

There are 3 conditions that members must consider before providing in-person care. The conditions are:

1. Members must comply with the requirements set out in COVID-19 Operational Requirements: Health Sector Restart. This is a Ministry document that covers requirements for risk assessments, hierarchy of hazard controls, screening, health human resources, critical supplies and equipment, infection control and other important issues.
2. Members should use telemedicine or virtual care where possible to avoid having patients physically come to the clinic. Health Care Providers must consider which services should be provided remotely and which services can safely resume in-person with appropriate hazard controls and sufficient PPE.
3. Members should be sourcing personal protective equipment (PPE) through their regular supply chain. If you are experiencing difficulty sourcing PPE, the Government has made available a directory of PPE suppliers.

With respect to condition #2, members are in the best position to determine which services should resume in person, and which should resume virtually. However, members should consider the following when making this determination

1. Your own ability to resume services at this time.
2. The need to minimize harm to patients.
3. The need to treat all patients with the same clinical needs equally unless relevant differences exist.
4. The need to ensure that those who continue to be burdened by the limited capacity of the health care system have their health monitored, receive appropriate care, and be re-evaluated for emergent activities should they require them.

Again, members must first read the following documents before providing in-person care to ensure that they are able to do so safely:

• COVID-19 Operational Requirements: Health Sector Restart
• Return to Practice Guidance

How can I ensure safe practice while conducting telepractice?

Members must read the College’s Telepractice Position Statement to understand the risks and responsibilities associated with telepractice and virtual care.

How should a practitioner determine whether it is safe to provide in-person care?

After reviewing all of the required information and considering the necessary issues, members should only provide in-person care if they can do so safely and the anticipated benefits of providing that treatment (that the practitioner has determined the patient needs) clearly outweighs the risks of contracting COVID-19 to the patient, practitioner and/or clinic staff.

What are some scenarios where I as a practitioner should be cautious

• If the practitioner does not have the necessary PPEs in place,
• Consideration for patients (and/or the practitioner) that may have a compromised immune system,
• Insufficient infection control policies in place at their clinic (particularly if it is a multi-discipline clinic),
• Consideration of the practitioner themselves in whether they are comfortable to provide in-person care, etc...

What PPE Should I wear in my practice to mitigate the risk of COVID-19?

Notice: This guide is based on the assumptions that patients have been pre-screened and do not exhibit any signs or symptoms of COVID-19. The Ministry’s COVID-19 Operational Requirements: Health Sector Restart must be adhered to.

The College expects members to use their training and professional judgement to determine which personal protection equipment is appropriate to wear depending on the situation as it presents itself in your place of practice. Members may only begin providing in-person care only if all necessary precautions and protocols are in place to protect patients and themselves. This will include the necessary PPE provisions. The Provincial Government has produced guidance documents to help health care professionals to make this decision. To assist members, we have provided a summary of what would apply to members of this College. Review of this document is ongoing and the information will be amended as necessary.

The recommendations below are a starting point for PPE usage at this time, and members can increase their level of PPE as necessary:

Masks
Members are required to wear surgical, procedure, or medical masks at all times when they are in their place of practice. (As indicated in the Ministry’s COVID-19 Operational Requirements: Health Sector Restart) As per the guidance from Health Canada, our Members should, where possible, be using a surgical, procedural or medical mask that fall within one of the three classifications indicated.

Members are not required to change masks (between patients) unless any of the following apply:

• The mask becomes visibly soiled
• The mask makes contact with another person or their droplets or secretions (i.e. is coughed on)
• The mask becomes damaged or compromised in any way
• The mask becomes very moist to the point that the integrity becomes compromised

Please carefully assess your individual situation by reviewing the document “Routine Practices and Additional Precautions” prior to exercising your discretion.

Patients attending for treatment
In addition, it is the College’s recommendation that Members also have all patients wear masks when arriving for, or receiving treatment (including while patients are in a designated waiting area or room), as it becomes more difficult to maintain social distancing. Members should advise patients in advance (for example, at the time of booking an appointment), of the recommendation that they wear a mask when attending for treatment. Advise them that this is for the protection of the practitioner and the patient themselves. If the patient arrives without a mask, the member can provide a disposable mask for the patient to wear. If the patient is uncomfortable with wearing a mask, members may ask if the patient would be comfortable to wear some other form of face covering. If the patient remains uncomfortable with wearing a mask, a member would have to decide as to whether the anticipated benefits of treatment (to the patient) clearly outweigh the risks of COVID-19 to the patient and the practitioner.

Gloves
Practitioners may but are not required, to wear examination or surgical gloves for patient treatments. When used, gloves must be discarded after each treatment regardless of the condition of the glove. Members must also wash their hands before and after each treatment. It is important that members maintain hand hygiene even when using gloves.

A clear procedure for donning and removing PPE safely may be found here.

Gowns/Lab Coats
Members should be using regular lab coats or gowns that are often worn in TCM practice. Similar to masks, these do not need to be changed after each patient unless:

• The lab coat becomes visibly soiled
• The lab coat makes contact with the patient’s droplets or secretions
• The lab coat becomes damaged or compromised in any way

In addition to aprons, gowns, and lab coats, the use of scrubs is a suitable alternative for practitioners to wear. As long as they are removed before leaving the clinic environment and can be laundered appropriately, practitioners may choose to wear scrubs at their discretion. The same consideration would apply if the scrubs become visibly soiled, make contact with the patient’s droplets or secretions, or become damaged or compromised in any way.

Please carefully assess your individual situation by reviewing the document “Routine Practices and Additional Precautions” prior to exercising your discretion.

Face shields or eye protection
Members of the College are not recommended to be treating COVID-19 patients, and so face shields or eye protection may not be required for daily practice but should be considered. Members are encouraged to maintain a small supply of eye protection or face shields available at their practice. Practitioners should ensure to consider situations where patients may not call in advance to book. Practitioners should carefully consider how to handle this situation and have policies in place at the clinic to ensure the safety of staff and practitioners.

Members are expected to use their professional judgement and conduct ongoing risk assessments to determine if additional PPE is required.

If you are having difficulty finding PPE supplies, please visit the Directory of PPE Suppliers for alternative options.

This reference guide has adapted the following information released from the Ministry. We recommend that you review each document carefully prior to exercising your discretion.

(These documents are curated to assist you on preparation and is not meant to be relied upon as independent of information provided by the various levels of public health and other authoritative sources. This guide does not replace the need for Members to keep aware of the latest developments, updates and changes to government materials which is subject and open to change from time to time.)

Additional information for clinics:

• COVID-19 Operational Requirements: Health Sector Restart
• Guidance for Essential Workplaces
• Routine Practices and Additional Precautions

What happens if a member is found to be practicing contrary to government directives or College standards?

Contravening an order of the Chief Medical Officer of Health is a contravention of the Health Protection and Promotion Act. This can result in a provincial prosecution and significant financial penalties.

In addition, the College could commence an investigation that may result in a referral to the discipline committee.

If the member has created an unsafe working environment for their staff, they are subject to a complaint to the Ministry of Labour and a prosecution and/or fine under the Occupational Health and Safety Act. Further, if any employee died as a result of unsafe working conditions, the member could be subject to a charge under the Criminal Code.

If the member has transmitted, or abetted the transmission of COVID-19 to their patients, staff or anyone who comes to their clinic, the member could be the subject of a civil law suit or possibly a criminal charge under the Criminal Code.

If a patient arrives to an appointment without a mask, do I cancel the appointment?

It is recommended that members have patients wear a mask to their appointment. Members should advise patients in advance (for example, at the time of making the appointment). If the patient arrives without a mask, the member can provide a disposable mask for the patient to wear. If the patient is uncomfortable with wearing a mask, a Member would have to decide as to whether the anticipated benefits of treatment (to the patient) clearly outweigh the risks of COVID-19 to the patient and the practitioner.

What should I be doing to screen patients for COVID-19?

The Ministry of Health has provided a Patient Screening Guidance Document for health care providers to use in their practice. Members are required to use the screening questions in the guidance document to screen their patients for COVID-19. This screening should take place over the phone prior to the appointment, and when the patient arrives for the appointment.

If the patient screens positive for COVID-19, the member should not proceed with the appointment, and follow the steps outlined in the Return to Practice Guidance to have the patient tested for COVID-19.

Does the College require mandatory education on Infection Prevention and Control (IPAC) procedures?

Our expectation is that our members are knowledgeable about existing IPAC procedures, however, if members, their staff or their clinic partners (in a multidiscipline setting) are looking for a refresher to remind them of key fundamentals, you will find helpful information prepared by Public Health Ontario here. The information gathered provides helpful videos as well as step by step guides that practitioners could review for themselves and/or direct their staff to review prior to providing in-person care.

What should I do if a patient’s chronic symptoms overlap with the symptoms listed on the COVID-19 screening?

If patients answer yes to any of the screening questions, it would be considered a positive screening. Based on the ministry guidance, patients who screen positive are recommended to complete the self-assessment tool. Based on how they respond, the tool will advise them if further testing is required. The Ministry’s Guidance on Testing and Clearance provides additional information on testing and clearance for individuals suspected or confirmed to have COVID-19.

The College’s guidance is that patients with signs and symptoms consistent with COVID-19 should not be seen in-person for clinical services during this time to minimize the risk for potential infection. However, TCM practitioners and acupuncturists are expected to use their professional judgment when making treatment decisions and to determine if the anticipated benefits of treatment outweigh the risks to the patient and the practitioner.

At this time, all practitioners are encouraged to implement a system for virtual and/or telephone consultations when and where possible. Members are in the best position to determine which services should resume in person, which should resume virtually. If, after careful assessment of risks and resources, a practitioner decides to provide in-person treatment, they must comply with the requirements set out in COVID-19 Operational Requirements: Health Sector Restart.

What can a practitioner do if a patient finds wearing a face mask uncomfortable?

Practitioners should instruct their patients to wear masks when for example, they arrive for, or receive treatment. If the patient cannot wear a mask (e.g., due to a medical condition or perhaps have difficulty breathing), the practitioner would be expected to ask if the patient would be comfortable to wear some other form of face covering, e.g., a face shield, if appropriate. However, if the patient remains uncomfortable, the member will have to use their professional judgment when making treatment decisions and to determine if the anticipated benefits of treatment outweigh the risks of COVID-19 to the patient and the practitioner. If the patient is exhibiting signs and symptoms consistent with COVID-19, they should not be seen in-person for clinical services during this time to minimize the risk for potential infection. The practitioner should also consider whether virtual care may be more appropriate to this patient at this time.

The College is mindful that this is a difficult time for R. TCMP’s and R. Ac’s. We know that individuals and businesses are impacted during this time. For more information on how the governments may assist you, your practice or your employees during this time, please see the following resources:

• Canada's COVID-19 Economic Response Plan
• Ontario's COVID-19 Support for Workers

Members must screen patients based on the current case definition and determine if they fit the definition for a Probable Case for COVID-19. All members should undertake active screening and passive screening:

• Active screening over the phone before scheduling appointments, when possible and upon entry to the clinic. Staff conducting screening should ideally be behind a barrier to protect from droplet/contact spread. A plexiglass barrier can protect reception staff from sneezing/ coughing patients.
• Passive screening including signage at points of entry of the facility and at reception, using the latest case definition for COVID-19. Similar messaging can be communicated on voicemails and websites

Members must screen patients based on the current Screening Guidance.

If a patient screens positive over the phone, you must advise them to call their local public health unit, and/or contact Telehealth Ontario at 1-866-797-0000. Patients should not show up to hospitals unannounced.

A patient who screens positive at a member’s practice must be separated from other visitors and staff so that they are at least 2 metres apart (use a separate room where available) and given a surgical/procedure mask while health workers call their local public health unit and a plan for travel and further COVID-19 assessment is made.

It is important to note that the College’s code of ethics for members states that:

COVID-19 Infection Prevention and Control for Regulated Health Professionals Webinar
A recording of the June 25, 2020 COVID-19: Infection Prevention and Control (IPAC) for Regulated Health Professionals webinar is now available. The webinar was a joint presentation from the College of Kinesiologists, Massage Therapists, Occupational Therapists and Physiotherapists. The webinar was led by representatives from Public Health Ontario and focuses on IPAC in the context of COVID-19.

Access materials from the webinar here :

• Slide deck
• FAQs
• Links and resources

Ontario Matching Portal

       Additional Resources

• Healthcare Provider Information Sheet
• Ontario Health Workforce Matching Portal Training Guide
• Matching Portal FAQ

Members are currently able to provide in-person treatment to their patients after a careful assessment of risks and resources. It is expected that health care providers will provide in-person care (when all the considerations have been addressed) once it has been determined that the measures put in place are keeping patients, staff and the health care provider safe.

The Chief Medical Officer of Health set 3 conditions that members must consider before providing in-person care. The conditions are:

1. Members must comply with the requirements set out in COVID-19 Operational Requirements: Health Sector Restart. This is a Ministry document that covers requirements for risk assessments, hierarchy of hazard controls, screening, health human resources, critical supplies and equipment, infection control and other important issues.
2. Members should use telemedicine or virtual care where possible to avoid having patients physically come to the clinic. Health Care Providers must consider which services should be provided remotely and which services can be safely provided in-person with appropriate hazard controls and sufficient PPE.
3. Members should be sourcing personal protective equipment (PPE) through their regular supply chain. If you are experiencing difficulty sourcing PPE, the Government has made available a directory of PPE suppliers.

With respect to condition #2, members are in the best position to determine which services should be provided in-person, and which should be provided virtually. However, members should consider the following when making this determination

1. Your own ability to provide in-person services at this time.
2. The need to minimize harm to patients.
3. The need to treat all patients with the same clinical needs equally unless relevant differences exist.
4. The need to ensure that those who continue to be burdened by the limited capacity of the health care system have their health monitored, receive appropriate care, and be re-evaluated for emergent activities should they require them.

Below are College documents members are required to read before providing in-person care.

In-Person Practice and Telepractice Guidance

Return to Practice Guidance

Telepractice Position Statement

Return to Practice Guidance – One Page Summary

Archived COVID-19 Information and Resources

Chief Medical Officer of Health Memo: Health Worker Illness and Return to Work

COVID-19 Guidance for Independent Health Facilities

COVID-19 Guidance for Prioritization of Phase 2 Populations for COVID-19 Vaccination

Directive #2 for Health Care Providers

Directive #2 Questions and Answers

Directive #6

Directive #6 Resource Guide

Enhanced Public Health Measures for COVID-19

FAQs on Access to Personal Protective Equipment for All Settings

Updated Infection Prevention and Control Measures for COVID-19

COVID-19 Vaccine Update: Directive 6, Expansion of eligibility to those born in 2009, and Third Doses of COVID-19 Vaccines – August 17, 2021

Revocation of Chief Medical Officer of Health Directive #2 and the Resumption of non-urgent and non-emergent surgeries and procedures – May 19, 2021

Supporting Health Care Workers and Hospitals with Authority for Enhanced Practice Scope within Alternate Models of Care and Staff Redeployment from Independent Health Facilities – April 22, 2021