There are many things to consider when a Member is in the process of joining a practice. Some are business related, such as the rental agreement with the clinic owner, and some are regulatory-related such as who owns the patient records. This blog highlights some issues that Members often encounter and steps that can be taken to avoid them.

First and foremost it is recommended that you have an agreement or a contract with the clinic owner and do not rely on a verbal agreement. Secondly, it is usually money well spent to hire a lawyer who is familiar with the College's regulations and standards of practice to review the contract before you sign it.

From the regulatory perspective, there are numerous issues that can arise when a Member joins a new practice; however, two of the most frequent issues we see for Members have to do with:
  • the ownership of patient files, and
  • how patients are notified when a Member is leaving a clinic.

Understanding the College's requirements and having a written contract or agreement in place can avoid disagreements with the clinic owner later and reduce disruption to patient care and access to files.

Ownership of patient files

The Standard of Practice for Record Keeping states:
          "if a Member relocates a practice he/she takes the patient records to the new location."

Members are responsible for all patient records they have created and must maintain and store them in accordance with the record keeping standard. It is recommended that the contract or agreement clearly states that the naturopath owns the patient health records and consequently keeps the original files when the naturopath leaves the clinic.

If the clinic owner will not abide by the requirements set by the College and allow the Member to take the original files when they leave, it is the responsibility of all parties to act professionally and come to an agreement to ensure records are retained according the Standard of Practice for Record Keeping. This includes addressing issues around patient access to the records and who will act as the Health Information Custodian as required by the Personal Health Information Protection Act, 2004.

Keep in mind that the patient file is a separate issue from whom the patient chooses to provide their health care. The original patient record may be stored in one location while the patient may see a practitioner somewhere else. The clinic where the patient first saw the naturopath does not and cannot "own" the patient. This can also be a point of contention when a naturopath decides to leave a clinic.

Notifying patients

The Code of Ethics states that "reasonable notice of termination of care is to be provided to the patient". The Standard of Practice for Record Keeping also indicates that when a Member relocates a practice "patients are notified in writing as to how they can obtain access to their patient records."

Depending on where the Member is moving to, patients may choose to continue care with them or remain at the clinic if a new naturopath is taking over. Either way, it is the Member's responsibility to ensure that patients are notified in writing that the ND is leaving and where the patient's records will be located.

The Member however, may designate someone to notify patients on their behalf. This should be discussed, agreed upon, and included in the agreement or contract. How far in advance patients are to be notified is not dictated by the College. This depends on how far ahead of time the Member knows they will be leaving. In some cases notification can be months ahead or sometimes weeks.

While it may seem inconvenient or awkward to ask that a clinic owners put an agreement or contract in place, all parties - including your patients - will be better protected in the long run.



For additional guidance, email (maryellen.mckenna@collegeofnaturopaths.on.ca) or phone (416-583-6020) our Regulatory Education Specialist, Dr. Mary-Ellen McKenna ND (Inactive).