Practice standards are of great importance to regulators. They set out expected professional, ethical, and competent behaviour for regulated professionals, and are enforceable by the regulator which sets them. However, to be enforceable, regulators must ensure they use clear language when drafting standards. A recent case serves as a reminder to regulators to avoid ambiguity in practice standards. For example, if a standard only governs how a physician treats someone while they are a patient, does the standard also define when a person stops being a patient?
The case of Sefcik v. College of Podiatric Physicians of Alberta, 2025 ABCA 263 (CanLII), concerned a registrant-podiatrist who entered a sexual relationship with his employee “AA” from late May or early June 2019 to May 2020. The podiatrist had provided healthcare services or treatment to AA on two occasions; in February 2016 and in April 2019. About a month or so before the sexual relationship began, in April 2019, the podiatrist referred AA for an x-ray.
The Alberta Health Professions Act (“HPA”) defines “patient” for the purposes of a complaint made in respect of sexual abuse to mean “a patient as set out in the standards of practice of a council”, and defines “sexual abuse” to include “conduct of a regulated member towards a patient that is of a sexual nature and includes… (i) sexual intercourse between a regulated member and a patient of that regulated member”. The practice standard defines “patient” as a person currently receiving a health service or treatment. Based on the April 2019 services provided, the hearing tribunal found that when the sexual relationship began about a month or so later, AA was a “patient” of the podiatrist within the meaning of the practice standard, and accordingly, the podiatrist’s sexual relationship with AA was sexual abuse.
The hearing tribunal imposed the mandatory sanction the HPA requires for sexual abuse, being the cancellation of the podiatrist’s registration with no eligibility for reinstatement. The podiatrist unsuccessfully appealed the finding of sexual abuse to the Council of Podiatric Surgeons.
On appeal, the Alberta Court of Appeal noted that the central issue of whether the Council erred in upholding the hearing tribunal’s finding that, at the time of their sexual relationship, AA was the podiatrist’s patient, turned on the interpretation of the definition of “patient” in the practice standard.
As noted above, the practice standard defined “patient” as a person currently receiving a health service or treatment. The practice standard also included a glossary of defined terms, which included the term “minor healthcare services” defined as “a situation that requires discrete procedural or episodic care for which the regulated member has no determination in the ongoing care of the person receiving the service”.
The Court of Appeal found that the glossary definition had to be considered when interpreting the practice standard. In this regard, the court stated, at para. 25, “[t]he term “minor healthcare service” does not qualify or change the definition of patient but, as this case indicates, it logically informs the analysis of how that definition applies to the facts of a particular case, and in particular, how long the status of “patient” endures.” The court found that as the term indicates, not all health services and treatments are the same, noting that where a podiatrist sees someone for a non-recurring issue for which no follow-up care is required, that person may cease to be a patient as soon as they leave the appointment. On the facts of the case, the court found that the podiatrist provided a minor healthcare service to the patient in April 2019. In this regard, the only conclusion available on a proper interpretation and application of the practice standards is that AA ceased to be a patient by May 2019. AA was not the podiatrist’s “patient” when their sexual relationship began. As such, he did not commit “sexual abuse” as defined by the HPA. In this regard, the court quashed the finding of sexual abuse along with the cancellation of his registration.
While many professions have not set bright lines for when professional-patient relationships persist or end, this case illustrates that a regulator leaving a key concept undefined, and open to assessment based on a multitude of factors, may lead to interpretive conflicts that might be avoided by a bright-line rule. Notably, CPSA later modified its boundary standards to define an individual as a “patient” in specific circumstances both where a member-patient relationship “has not ended,” and “for a period of 1 year from the date the individual ceased to be the regulated member’s patient.”
Sefcik v. College of Podiatric Physicians of Alberta, 2025 ABCA 263 (CanLII)
Rachel Noble