In September, a California hospital agreed to pay $18.5 million to settle a lawsuit after seven women alleged they were sexually abused by a physical therapist during treatment. It’s among the most recent nuclear settlements, which are far more common than nuclear verdicts, excessive jury awards above $10 million. Most civil cases settle before reaching a courtroom.
While the case describes an extreme example of how one physical therapist used his medical role and position of trust to engage in inappropriate sexual contact during treatment, it remains a good reminder of boundaries and best practices every physical therapist should consider putting in place.
Beyond patient safety, the case would have been less likely to occur if the hospital’s physical therapists had established stronger professional boundaries and accountability.
Every physical therapist has a duty to protect patients from inappropriate conduct by intentionally using communication, consent and documentation practices that prevent misunderstandings during legitimate treatment.
Professional Boundaries Every Physical Therapist Must Establish
Physical therapy requires hands-on care, often in sensitive areas and with close physical contact. It’s not unusual to have lengthy conversations and get to know someone well throughout treatment. That’s why setting clear boundaries is a professional standard. These include: clear explanations of treatment, ongoing consent and careful attention to indicators of patient comfort.
As the PT, you’re responsible for explaining what you’re doing, why it’s necessary, and what the patient should expect. This should come with sensitivity to the power dynamics involved.
Patients come to physical therapy seeking pain relief, improved mobility or recovery from an injury. They may be physically vulnerable, unfamiliar with particular treatments or hesitant to question a healthcare professional.
5 Risk Management Strategies for Physical Therapists
Even when no misconduct occurs, preventing misunderstandings requires standards you should put in place before, during and after treatment sessions.
- Explain treatment before physical contact
Patients should never have to guess why a therapist is touching a particular area of their body.
Before performing manual therapy, explain what the technique involves, which anatomical areas will be treated and how the intervention supports the patient’s goals.
For example, a PT treating hip pain may need to assess muscles near the pelvis or upper thigh. Rather than beginning treatment without explanation, the therapist can describe the technique, clarify where contact will occur and ask whether the patient is comfortable proceeding.
Stop if a patient appears uncertain and address any concerns before continuing.
- Continuously obtain informed consent
A form your patients sign before an evaluation doesn’t mean they consent to every part of treatment. It’s the PT’s job to be sure patients understand the nature and purpose of treatment, relevant risks, reasonable alternatives and their ability to decline or stop an intervention.
Request additional verbal and even written consent whenever the treatment plan changes, particularly before techniques involving sensitive areas.
Physical therapists should:
- Explain the proposed technique before beginning
- Ask permission before any sensitive physical contact
- Offer clinically appropriate alternatives when available
- Document consent discussions according to established policies
Again, this requires verbal communication because a patient’s silence or lack of objection doesn’t necessarily mean consent.
- Use privacy curtains and chaperones
Patient privacy is especially important during treatments that require clothing adjustments, expose body areas or involve contact near sensitive anatomy.
Appropriate draping helps preserve patient dignity while allowing access to the area being treated.
Depending on the procedure, setting, patient preference and clinic policy, an appropriate chaperone can provide an additional safeguard.
Chaperones can support patient comfort and provide an additional person who observes a clinical interaction. However, their presence does not replace informed consent, professional judgment or proper documentation.
- Maintain clear professional boundaries
Strong therapeutic relationships often depend on empathy, trust and open communication. However, those relationships must remain professional.
In the Sonora lawsuit, the plaintiffs alleged that Elias developed personal connections with patients before engaging in abuse. According to the reporting, some patients described personal conversations and expressions of shared religious identity that contributed to their trust in him.
Those allegations illustrate why professional boundaries matter, especially when patients depend on clinicians for ongoing care.
Physical therapists should avoid sexualized comments, inappropriate personal disclosures, unnecessary intimate contact and relationships that exploit the therapeutic relationship.
They should also remain mindful of communication outside scheduled appointments, including personal text messages and social media interactions.
Professional warmth and compassion are important. But the therapeutic relationship must always serve the patient’s care.
- Document treatment thoroughly and accurately
Documentation records the clinical reasoning and care decisions made during treatment.
If a patient later questions an interaction, documentation helps establish what treatment was planned, why it was clinically appropriate and what information was communicated.
Be sure to include the following:
- The patient’s condition and treatment goals
- The rationale for manual therapy or sensitive techniques
- Relevant informed consent discussions
How to Handle Patient Complaints in Your PT Practice
One of the most significant aspects of the Adventist Health Sonora lawsuit was the allegation that the hospital failed to act promptly on multiple patient complaints. The lawsuit alleged that patient complaints and warning signs dating back to 2007 went unaddressed for years.
According to the plaintiffs’ attorneys, several hospital employees were aware of allegations involving the therapist before an internal investigation began. While the allegations are described in a civil case and aren’t independent findings about employee conduct, they reinforce the importance of having established policies for patient complaints.
No matter the circumstances, when a patient reports possible sexual misconduct, the concern should be documented and escalated through appropriate reporting channels.
Physical therapists, clinical supervisors and practice owners should understand:
- How patients can submit concerns
- Who’s responsible for reviewing and escalating complaints
- When incidents must be reported to a licensing board, employer, law enforcement and malpractice insurance
- How records and other evidence must be preserved
- What immediate measures may be necessary to protect patients
What Physical Therapists Should Do When a Patient Files a Complaint
Not every allegation results in disciplinary action or a finding of liability. However, they do often require significant time, documentation and legal guidance.
Seeking legal guidance from your malpractice insurance team early can help you understand applicable responsibilities, deadlines and rights and helps ensure you respond appropriately to the complaint.
Know that traditional malpractice insurance addresses covered professional negligence claims, like treatment errors or injuries that occur during clinical care. Some policies covre certain sexual misconduct allegations, but it depends on the specific circumstances, exclusions, legal findings and policy wording.
Importantly, insurance coverage for legal defense doesn’t necessarily mean an insurer will pay a settlement, judgment or damages arising from intentional sexual abuse. If a sexual misconduct complaint occurs in your PT practice, notify your malpractice insurer immediately.
Finally, patient trust built on clear communication is as essential to effective physical therapy as your clinical expertise. Every treatment explanation, consent discussion and professional interaction provides an opportunity to reinforce that trust.
Establishing basic safeguards from the start helps create a safer care environment for you and your PT patients.
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