The scenarios in this article are based on recent complaints and reports received by CPSO regarding the delegation of controlled acts. The takeaways from these scenarios are intended to help physicians better understand their responsibilities under the Delegation of Controlled Acts policy.

Scenario 1: Delegation in a Cosmetic Clinic

A patient visited a cosmetic clinic for a consultation regarding a facial procedure. The procedure was performed on the same day by a nurse who was a delegate of the physician. Following the procedure, the patient experienced complications. A CPSO investigation found that the delegating physician had not assessed the patient prior to the procedure.

Scenario 2: Delegation in a Walk-in Clinic

Several patients were treated in a walk-in clinic by an Internationally Trained Physician (ITP) who was not registered with CPSO. The individual represented themselves as a doctor and performed certain controlled acts, such as administering injections and performing skin tests. The delegating physician did not assess the patients or establish a physician-patient relationship before delegating these controlled acts to the ITP. The ITP would connect with the delegating physician virtually, only if required, and was essentially operating the clinic independently, with no physician oversight.

Scenario 3: Delegation in a Virtual Clinic

A patient attended a virtual clinic and interacted with an individual they believed to be a physician. The individual did not introduce themselves or correct the patient when the patient referred to them as “doctor.” Following the online appointment, the patient received a prescription signed by a physician who had not assessed the patient nor contacted them after the appointment. The patient later discovered that the individual they spoke with was not a licensed physician in Ontario.

Key Takeaways for Physicians Delegating Controlled Acts:

• Delegate only when there is an established or anticipated physician-patient relationship. This means conducting the initial clinical assessment of the patient prior to delegation or, where this is not possible, within two business days of a new patient’s first encounter with the delegate (unless an exceptional circumstance permits delegation to occur in the absence of a physician-patient relationship – see provision 7 (a) to (f) of the policy).
• Do not permit delegates to operate clinics independently.
• Ensure delegates document the care they provide accurately and in a legible manner.
• Ensure delegates notify you promptly if complications arise.
• Ensure delegates introduce themselves accurately and explain their role to patients.
• Ensure delegates are not identifying or advertising themselves as physicians (e.g., on social media, office signage, business cards, etc.) with the protected titles of “physician,” “surgeon,” “doctor,” or an abbreviation or variation (e.g., “MD”).