COURSE PRICE: $40.00
CONTACT HOURS: 4
This course is approved by the Physical Therapy Association of Georgia.
The planners and authors of this CE activity have disclosed no relevant financial relationships with any commercial companies pertaining to this activity.
This course meets the ethics and jurisprudence continuing competency requirement for PTs and PTAs in Georgia and is approved by the Physical Therapy Association of Georgia.
Persis Mary Hamilton has a rich background in nursing, nursing education, and writing. She has written fourteen nursing textbooks for two major publishers. Her doctoral dissertation investigated the relationship of learning to behavioral objectives and visual design in a textbook. Persis Hamilton works with Wild Iris Medical Education to ensure compliance with American Nurses Credentialing Center accreditation guidelines. She is involved with assessing needs, planning, implementing, and evaluating all nursing continuing education activities offered by the company. Over the years Hamilton has worked in most areas of nursing. She taught for more than 40 years in vocational, associate degree, baccalaureate degree, and graduate nursing programs, served as item writer for the League for Nursing, and was the principle speaker at numerous continuing education workshops. In addition, she has conducted research in Micronesia as well as Guam. Currently, Persis maintains a private practice in psychotherapy. Recently she completed a historical novel about the care of psychiatric patients in the 1930's, entitled Deportation Train.
Copyright © 2010 Wild Iris Medical Education, Inc. All Rights Reserved.
COURSE OBJECTIVE: The purpose of this course is to provide continuing competence in ethics and jurisprudence for physical therapists and physical therapist assistants in the state of Georgia.
Upon completion of this course, you will be able to:
Many people roll their eyes and change the subject when they hear the word ethics, viewing it as too controversial or too complex to discuss freely. Nonetheless, ethics is a significant concern of thinking, caring persons, especially healthcare providers such as physical therapists (PTs) and physical therapist assistants (PTAs).
Ethics is a branch of philosophy concerned with the rightness or wrongness of human behavior and the goodness or badness of its effects. Because ethics assumes that people have the ability to make choices about their behavior it has been the subject of philosophical discussion for centuries, generating an enormous body of literature. Students of ethics divide these writings into three general categories: descriptive, analytical, and prescriptive.
Descriptive ethics reports and describes the moral choices people make.
Analytical ethics scrutinize the language people use to discuss issues of right and wrong.
Prescriptive ethics offers advice about the way people decide what is good or bad behavior, doing so from two different perspectives: teleological and deontological.
Bioethics is the application of ethics to matters of human life. As scientific knowledge expands and healthcare providers achieve greater control over disease, pain, life, and death, it is important to address issues of right and wrong behavior. Although some authors use the term morals to refer to human behavior and ethics to refer to formalized codes of conduct, the words mean the same thing. Ethics comes from the Greek word ethos and morals from the Latin word mores (Lewis & Tamparo, 2007).
In recent years, some politicians have substituted the word values for morality; however the word values has a much broader meaning. Values are treasured ideals or attributes, such as creativity, achievement, adventure, power, friendship, and belief systems. Understanding one's values brings purpose and clarity to life. The desirability of such clarity was recognized by Socrates, who is credited with saying, "An unexamined life is not worth living." To help people examine their lives and clarify their values, Louis Raths (1979) suggested a seven-step process that he called "values clarification" (see box).
THE VALUING PROCESS
Choosing
Prizing
Acting
Source: Modified from Raths et al., 1979.
Belief systems are organized patterns of thought regarding the origin, purpose, and place of humans in the universe. These systems seek to explain the mysteries of life and death, good and evil, health and illness. Typically, belief systems include an ethical code of conduct about how people should relate to the world and its inhabitants.
Religions are patterns of thought and action that typically include belief systems, devotional rituals, organizational structures, and faith in a mystical power. Often, however, people develop their own belief systems, independent of organized religions.
Ethical principles are fundamental concepts by which people judge behavior. These principles help individuals make decisions and serve as criteria against which people gauge the rightness or wrongness of behavior. Laws are rules made by an authority with the power to enforce them. Although laws flow from ethical principles, they are limited to specific situations and codified by detailed language. Ethical principles, on the other hand, are guiding ideals of conduct that speak to the spirit of a law rather than its letter.
Throughout recorded history, leaders of world religions have taught an overarching ethical principle commonly called the Golden Rule: "Do unto others as you would they do unto you." Some philosophers emphasize certain principles over others. For example, Kant held that duty was the central issue; Mills, the interest of all; Fletcher, love; Thiroux, human dignity; Gilligan, care and justice; and Nodding, care (Thiroux, 2003). A single, global principle for exemplary behavior is an attractive approach, but when people face real-life situations, they seek more precise guidance.
Over the years, five ethical principles have emerged as especially applicable to healthcare providers. They are: respect for human life and dignity, beneficence, autonomy, honesty, and justice. The Code of Ethics of the American Physical Therapy Association, described below, applies all five principles to practice.
Respect for human life and dignity is one of the most basic of ethical principles. It requires that "individuals be treated as unique and equal to every other individual and that special justification is required for interference with an individual's own purposes, privacy, and behavior" (Rawls, 1971). This ethical principle elevates respect for the life, freedom, and privacy of all humans. Thiroux says this principle is necessary for any moral system because "there can be no human being, moral or immoral, if there is no human life" (1990). When applied to practice, respect for human life and dignity means that physical therapists:
Beneficence means doing good to benefit others. Although some writers separate beneficence (doing good) from nonmalfeasance (not doing harm), Franken (1973) suggested the ethical principle of beneficence is a continuum, from a neutral not harming to a positive doing good—that is, from not inflicting harm to preventing harm and promoting good. At a minimum, beneficence means maintaining professional competence. However, it also means acting in ways that demonstrate care and nurturance. When applied to practice, beneficence means that physical therapists:
Autonomy is the right of self-determination, independence, and freedom. It is the personal right of individuals to absorb information, comprehend it, make a choice, and carry out that choice. Physical therapists carry out the principle of autonomy by providing accurate, scientific information to clients, assisting them to understand the information and make decisions based on it. When applied to practice, autonomy means that physical therapists:
Honesty means truthfulness in word and deed. Even when conveying unwelcome information to clients about their illness or treatment options, a physical therapist does so truthfully and with compassion, only withholding information from clients when they are minor children or adults with legal guardians. Dishonesty and deceit are especially grievous when they involve theft of pain-relieving drugs or devices. Honesty means absolute truthfulness regarding professional credentials and financial matters, never charging for unearned services or accepting commissions, discounts, or gratuities for covert gain. It means obeying both the spirit and the letter of the law. When applied to practice, honesty means that physical therapists:
Justice implies fairness and equality. It requires impartial treatment of clients. Like other ethical principles, justice is based on respect for human life and dignity. The historic image of justice is a blindfolded woman with a scale, weighing an issue on the basis of objective evidence and judicial precepts. Justice means that scarce resources will be distributed equally, using the same criteria for everyone. When applied to practice, justice means that physical therapists:
A dilemma is a perplexing problem that requires a choice between conflicting alternatives. An ethical dilemma is a moral problem that requires a choice between two or more opposite actions, each of which is based on an ethical principle. For example, a physical therapist may need to decide whether to honor the ethical principle of honesty and disclose the unlikely value of a treatment to cure an illness or to honor the principle of beneficence and withhold the information in order to give the client hope.
Resolution of ethical dilemmas requires careful evaluation of all the facts of a case, including applicable laws, consultation with all concerned parties, and appraisal of the decision-makers' ethical stance (honoring end results or obeying fixed laws).
Nowadays, ethical dilemmas in healthcare facilities arise more frequently because modern medicine can keep hearts and lungs functioning much longer than thinking brains. To help resolve these perplexing issues, many institutions appoint ethics committees made up of healthcare professionals, ethicists, lawyers, and clergy. The task of ethics committees is to help decision-makers resolve ethical dilemmas. Often these committees use an ethical decision-making process such as the following:
To reduce the number and complexity of ethical dilemmas, and in support of the ethical principle of autonomy, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recommends that all adults discuss their wishes regarding extraordinary treatment measures with their families, sign a legal document called an advance healthcare directive, and appoint someone to make healthcare decisions in their stead if they should become incapacitated (JCAHO, 2009).
Codes of ethics are formal statements setting forth standards of ethical behavior for members of a group. In fact, one of the hallmarks of a profession is that its members subscribe to a code of ethics. Every member of a profession is expected to read, understand, and abide by the ethical standards of its occupation.
In order to make explicit the values and standards of professional physical therapists and their assistants, the American Physical Therapy Association publishes a Code of Ethics, Guide for Professional Conduct of Physical Therapists, Guide for Conduct of Physical Therapist Assistants, and Standards of Ethical Conduct for the Physical Therapist Assistant. These documents are regularly revised and updated, with the latest codes and standards effective July 2010.
Portions of these new documents are provided below for the convenience of practitioners. Complete and up-to-date versions can be accessed at http://www.apta.org/ethics.
CODE OF ETHICS FOR PHYSICAL THERAPISTS
Preamble
The Code of Ethics for the Physical Therapist delineates the ethical obligations of all physical therapists as determined by the House of Delegates of the American Physical Therapy Association. The purposes of this Code of Ethics are to:
No code of ethics is exhaustive nor can it address every situation. Physical therapists are encouraged to seek additional advice or consultation in instances where the guidance of the Code of Ethics may not be definitive.
This Code of Ethics is built upon the five roles of the physical therapist (management of patients/clients, consultation, education, research, and administration), the core values of the profession, and the multiple realms of ethical action (individual, organizational, and societal). Physical therapist practice is guided by a set of seven core values: accountability, altruism, compassion/caring, excellence, integrity, professional duty, and social responsibility. Throughout the document the primary core values that support specific principles are indicated in parentheses. Unless a specific role is indicated in the principle, the duties and obligations being delineated pertain to the five roles of the physical therapist. Fundamental to the Code of Ethics is the special obligation of physical therapists to empower, educate, and enable those with impairments, activity limitations, participation restrictions, and disabilities to facilitate greater independence, health, wellness, and enhanced quality of life.
Principles
Source: APTA, 2009a. Reprinted from APTA Code of Ethics, with permission of the American Physical Therapy Association. This material is copyrighted, and any further reproduction or distribution is prohibited.
STANDARDS OF ETHICAL CONDUCT FOR THE PHYSICAL
THERAPIST ASSISTANT
Preamble
The Standards of Ethical Conduct for the Physical Therapist Assistant delineate the ethical obligations of all physical therapist assistants as determined by the House of Delegates of the American Physical Therapy Association. The Standards of Ethical Conduct provide a foundation for conduct to which all physical therapist assistants shall adhere. Fundamental to the Standards of Ethical Conduct is the special obligation of physical therapist assistants to enable patients/clients to achieve greater independence, health, and wellness, and enhance quality of life.
No document that delineates ethical standards can address every situation. Physical therapist assistants are encouraged to seek additional advice or consultation in instances where the guidance of the Standards of Ethical Conduct may not be definitive.
Standards
Source: APTA, 2009b. Reprinted from APTA Standards of Ethical Conduct for the Physical Therapist Assistant, with permission of the American Physical Therapy Association. This material is copyrighted, and any further reproduction or distribution is prohibited.
Although those who provide physical therapy services gain professional certification from a recognized national organization, they practice within a society governed by state and federal law. For that reason, physical therapy professionals need to understand the basis of law (jurisprudence) in the United States, its sources and types, and the relationship of law to ethics in the practice of physical therapy.
Laws flow from ethical principles and are limited to specific situations and codified by detailed language. These rules of conduct are formulated by an authority with power to enforce them. As such, laws change with time and circumstances. In the United States, law is based on the old English system wherein the monarch held supreme power over the land and its people, acting according to "divine right." The ruler's decisions became the law of the land and eventually known as common, or case, law. These case-by-case decisions set precedent and shaped future laws.
In the United States, the U.S. Constitution is the supreme law of the land, filling the role once held by the monarch. The first ten amendments to the Constitution, the Bill of Rights, place restrictions on the power of government and establish specific individual freedoms, such as the right to free speech and assembly. When residents of the nation believe they have been denied any of these rights, they can seek redress in the courts.
The U.S. Constitution established three separate branches of government within the federal system—executive, legislative, and judicial—and granted specific powers to the federal government that are called express powers. Under the Tenth Amendment, all other powers are retained by the states, including licensure of healthcare professionals such as physical therapists and physical therapist assistants. As a result, both the federal government and the state governments create and enforce laws.
In the states, the division of power mirrors that of the federal government:
| Source: Adapted from Hamilton, 1996. | |
| CONSTITUTIONAL LAW | |
|---|---|
| Source | U.S. Constitution, the supreme law of the nation |
| Functions | Establishes executive, legislative, judicial branches of government |
| Examples |
|
| STATUTORY LAW | |
| Source | Laws passed by legislative bodies of federal, state, and local governments |
| Functions | Protects and provides for the general welfare of society |
| Examples | Controlled Substances Act of 1970 created a schedule of controlled substances, ranking them according to their potential for abuse from high (I) to low (V). |
| ADMINISTRATIVE LAW | |
| Source | Executive power of federal, state, and local government, delegated by the legislative branch |
| Functions | Carries out special duties of various agencies |
| Examples |
|
| COMMON (CASE) LAW | |
| Source | Precedent, custom, tradition, court-made |
| Functions | Avoids duplication and unnecessary expense of litigating issues many times |
| Examples | Amendment 14 grants "equal protection of the law," but because of Plessy v. Fergson, an 1896 decision of the Supreme Court, several states continued to segregate children by race in public schools. In 1954, the Brown v. Board of Education decision said, "Separation of children in public schools solely on the basis of race deprives children of a minority group equal educational opportunities, even though physical facilities and other tangible factors may be equal." |
There are two major divisions of law: civil and criminal. The purpose of civil law is to make restitution for injury suffered by one or more individuals. Civil law is further divided into contract law and tort law. Contract law is concerned with legally binding agreements between two or more parties. Tort law is concerned with civil wrongs other than contracts, such as assault, battery, and professional negligence.
The purpose of criminal law is to protect society from actions that directly threaten the order of society. Because some crimes are more serious than others and children are considered less responsible than adults, there are three categories of criminal offenses: misdemeanor, felony, and juvenile.
| Source: Adapted from Hamilton, 1996. | |
| CIVIL LAW | |
|---|---|
| Function | To redress wrongs and injuries suffered by individuals |
| Categories |
|
| Proof | By a preponderance of the evidence; adjudicated by a judge or jury; a jury decision need not be unanimous |
| CRIMINAL LAW | |
| Function | To protect society from actions which directly threaten its orderly existence. Criminal acts, while aimed at individuals, are offenses against the state, thus perpetrators are punished by the state (imprisoned, fined, required to perform hours of work); victims usually are not compensated but may initiate civil action against perpetrators to make up for injury or loss. |
| Categories |
|
| Proof | Beyond a reasonable doubt; jury decision must be unanimous |
Criminal law is concerned with harm against society—that is, with action that directly threatens the orderly existence of society. Criminal acts, while causing harm to individuals, are offenses against the state. Thus, in criminal cases the government attorney, on behalf of the people, is the prosecutor. When a guilty verdict is returned, the victim usually does not receive redress (compensation) even though the person who commits the crime is punished in some way, such as being sentenced to jail, fined, or placed on probation. To receive compensation, the victim must bring a civil suit against the accused perpetrator.
Historically, healthcare regulation has been the province of the states, but in recent years the federal government has become increasingly involved. Of particular interest to the practice of physical therapy are three acts of Congress, namely, the Social Security Act of 1935, with the Amendments of 1965 establishing Medicare and Medicaid and the Amendments of 1997 and 2009 establishing and expanding the State Children's Health Insurance Program (SCHIP or CHIP); the Americans with Disabilities Act of 1995; and the Health Insurance Portability and Accountability Act of 1996.
For more detailed information about Medicare, Medicaid, and CHIP, go to the Centers for Medicare and Medicaid Services website at http://www.cms.hhs.gov.
The Americans with Disabilities Act (ADA) of 1990 is a broad-reaching civil rights statute. Amended in 2008 to broaden protections for disabled workers, it protects the rights of people with a variety of ailments, including persons infected with human immunodeficiency virus (HIV) and those with respiratory and musculoskeletal disorders. Its provisions include measures of special interest to physical therapists, such as access to public buildings, equal protection of disabled persons, and nondiscrimination in employment. For detailed information about the act and its provisions, see: http://www.ada.gov.
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 limits the extent to which health insurance plans may exclude care for pre-existing conditions and creates special programs to control fraud and abuse within the healthcare system. The most well-know provision of the Act is its standards regarding the electronic exchange of sensitive, private health information. Known as privacy standards, these rules (1) require the consent of clients to use and disclose protected health information, (2) grant clients the right to inspect and copy their medical records, and (3) give clients the right to amend or correct errors. Privacy standards require all hospitals and healthcare agencies to have specific policies and procedures in place to ensure compliance with the rules. For detailed information, see: http://www.cms.hhs.gov/hippaGenInfo.
All fifty states and jurisdictions of the United States have physical therapy practice acts. Typically, these acts create an administrative body within the state to define the scope and regulate the practice of physical therapy. The administrative body, called a board, writes rules and regulations that give detailed requirements for educational institutions and practitioners regarding the scope of practice, licensure, competency, disciplinary sanctions, and supervision of physical therapist assistants and aides. The goal of these acts is to protect the public by setting standards for education and practice. It is the responsibility of practitioners to know and abide by the provisions of the physical therapy practice act (PTPA) and abide by the rules and regulations of the state in which they are licensed.
It is a criminal offense to violate provisions of a state physical therapy practice act. As an extension of the act's purpose, the physical therapy board makes rules and regulates such issues as licensure and scope of practice. When individuals or agencies believe a PT or PTA has violated a provision of the PTPA, they may complain to the administrative board. The board investigates the allegations, and if it finds evidence to support the complaint, state attorneys file a complaint against the licensee. Because a state license cannot be taken away without due process, licensees have the right to a public hearing before the board, to be represented by an attorney, and to present witnesses on their own behalf. Following such a hearing, the board (1) takes no action, (2) reprimands the licensee, (3) suspends or revokes the person's license, or (4) places the licensee on probation.
Although PTPAs vary from state to state, they contain similar grounds for complaints, including obtaining a license by fraud, practicing in a grossly incompetent or negligent manner, diverting controlled substances for personal use, and being convicted of a felony. It is the responsibility of license holders to know, understand, and obey the rules and regulations of the state in which they are licensed to practice. This information is generally readily available via the Internet.
In 1965, Georgia enacted a physical therapy practice act. Since then, the act has been revised from time to time. The current act and current rules and regulations resulting from that act are published online on the State of Georgia website. The Georgia Board of Physical Therapy website also provides links to the following information:
(Physical therapists, particularly those who are studying to take the Federation of State Boards of Physical Therapists [FSBPT] examination, are strongly urged to go to the State of Georgia website via the links provided above and read the information provided there.)
Civil law is concerned with harm against individuals, including breaches of contracts and torts. Its purpose is to make right the wrongs and injuries suffered by individuals, usually by assigning monetary compensation.
A contract is a legally binding agreement between two or more parties. Breaking such an agreement—such as exists between a healthcare agency and physical therapist—is called a breach of contract. Both parties to a contract must do exactly what they agreed to do or they risk being sued. For that reason, it is vital that each one clearly understand all the terms of an agreement.
A tort is any civil wrong other than a contract. Examples of intentional torts are battery, assault, false imprisonment, and defamation of character. Examples of unintentional torts are ordinary negligence and professional negligence (malpractice).
Assault is doing or saying anything that makes people fear they will be touched without their consent. The key element of assault is fear of being touched (for example, saying to a client, "If you don't let me give you this injection, I'll put you in restraints!").
Battery is touching a person without consent, whether or not the person is harmed. For battery to occur, unapproved touching must take place. The key element of battery is lack of consent. Therefore, if a man bares his arm for an injection, he cannot later charge battery, saying he did not give consent. If, however, he agreed to the injection because of a threat, the touching would be deemed battery, even if he benefited from the injection and it was properly prescribed.
Except in rare circumstances, clients have the right to refuse treatment. Other examples of assault and battery are:
False imprisonment is confining people against their will by physical or verbal means. Some examples of false imprisonment are:
Obviously, restraining clients with leather straps or locking them in a room is false imprisonment. However, removing their clothing to prevent them from leaving or threatening them if they try to leave are also acts of false imprisonment. If, for safety, clients need to be restrained, physical therapy providers should try to gain the person's cooperation. If this fails, a legal representative of the client must give permission. If these options are not available, therapists should document the need for restraints, consult with the physician, and follow agency policy.
Defamation of character is communication that is untrue and that injures the good name or reputation of another or that in any way brings that person into disrepute. This includes clients as well as other healthcare professionals. When the communication is oral, it is called slander; when it is written, it is called libel. Prudent healthcare professionals: (1) record only objective data about clients, such as data relate to treatment plans, and (2) follow agency policies and approved channels when the conduct of a colleague endangers client safety.
Ordinary negligence is failure to act as an ordinary, reasonable person, resulting in injury or damage to people and/or property. When negligence is alleged, the conduct of the accused is measured by what a "reasonable, prudent individual would have done in the same or similar circumstances." This provision seeks to ensure that an objective standard is used to determine whether negligence occurred. When individuals sustain injuries or suffer damages from some unfortunate event, they may seek compensation (usually money) from the one they believe is responsible. To win such a suit, four elements must be proven:
For example, a patient slipped on the wet floor in the hall of the medical clinic and fractures his hip. He sued the clinic to recover medical costs. To win his suit, the man must prove: (1) the clinic had a duty to protect its patients from slippery, dangerous walkways, (2) the floor was wet and slippery, (3) the condition of the floor was the cause of the fall, and (4) actual damages were sustained by the fall.
Professional negligence (malpractice) is the improper discharge of professional duties or failure to meet standards of care resulting in harm to another person. Four important principles affect malpractice actions: individual responsibility, respondeat superior, res ipso loquitor, and standard of care.
Because today's healthcare consumers are more involved in their personal care, more likely to question the quality of medical care, and more apt to take legal action against providers, physical therapists must guard against such action. Here are some suggested actions to prevent malpractice claims:
Delegate duties cautiously. PTs are responsible for subordinates, equipment, and supplies. When they assign a task to a PT assistant or aide, physical therapists should make sure the task is not beyond the ability or scope of practice of the subordinate because, if an error occurs, the PT is responsible. When a subordinate is incompetent, physical therapists should follow performance evaluation procedures of the agency.
Develop self-awareness. PTs need to recognize their strengths and weaknesses and use continuing education to expand their knowledge and skill. They should not be afraid to admit lack of knowledge in some area and should refuse assignments where they lack critical skills.
Follow agency policies and procedures. These documents are designed to prevent errors, injuries, and accidents. If a mistake occurs and legal action results, the courts will want to know if the practitioner followed accepted procedures.
Document actions accurately. Legally, if an action is not documented, it did not happen. Notes should be written accurately, objectively, and without subjective judgments that could be construed as libelous.
Write detailed incident reports. However unpleasant the task, all errors, injuries, and accidents need to be described in detail. Because long periods of time may elapse between an incident and a court action, an incident report may be the only detailed account of what happened.
Recognize suit-prone clients and intervene. When people feel frightened and powerless, they may become critical and demanding. By reacting defensively or avoiding such clients, PTs may confirm the fear of clients and foster their anger. When PTs listen actively, discuss treatment plans openly, and involve clients in decision making, they foster trust and respect and clients are less inclined to pursue legal action.
Prevent accidents. Be alert for hazards that cause injury. Spilled water, broken equipment, protruding apparatus, exposed electrical wires, and cluttered hallways are accidents waiting to happen. When they do, people are more likely to suffer injuries and healthcare professionals be held liable.
Become informed consumers of professional liability insurance. The likelihood of being sued is real. Lawsuits are costly and awards may be in the millions of dollars. Even when you are vindicated, the price of defending yourself may be immense. Given these realities, PTs and PTAs need to become informed consumers of liability insurance (see box).
FEATURES OF PROFESSIONAL LIABILITY INSURANCE
Definition
Professional liability insurance shifts the cost of a suit and its settlement from a person to an insurance company. Such insurance covers acts committed by an individual when he or she is functioning in a professional capacity.
Types of Coverage
Coverage Limits
No policy is limitless. Some important limitations are:
Duration of Coverage
Liability insurance policies are contracts that are renewed or canceled each year. The policy usually states how it is to be canceled and how many days notice must be given.
Employer and Individual Policies
Employer policies cover physical therapists only while they are on the job working for that employer within the scope of the employer's job description. Individual policies give named holders more power to control decisions than if they are insured only under the policy of the employer.
Exclusions
Many policies exclude coverage of criminal acts, such as intentional torts (assault, battery, false imprisonment, etc.) and disciplinary actions brought by licensing boards against physical therapists and physical therapist assistants.
Right to Decide about Settlements
Physical therapists and physical therapist assistants need to know if an insurance policy gives them the right to decide about the settlement of a case or if the insurance company has that right. This is an important issue because settlements become matters of public record and may adversely affect future opportunities.
Scope of Practice
Physical therapists in independent practice need to know if an insurance policy covers them as independent practitioners or if they are only covered when they are employed by a healthcare agency.
Cautions
A liability insurance policy is a legal contract between an insurance company and a policyholder. False information on the application may void the policy. Liability insurance does not cover acts outside the scope of practice of licensure or intentional torts such as assault, battery, false imprisonment, and defamation of character.
Source: Adapted from Hamilton, 1996.
If you are served with a summons and complaint, you will need to act right away. If you do nothing—fail to answer the complaint—a default judgment could result. Here are some suggestions for what to do and what not to do when served.
Do (if personally insured):
Do (if not personally insured):
Do not (whether you are insured or not):
CASE 1
The neighbor of Molly Soft, PTA, repeatedly complains about her painful neck and asks Molly to treat her. At first Molly refuses, but eventually she gives in and performs four manual therapy treatments on the neighbor's cervical spine. At first the treatments help, but after the fourth one the neighbor complains of increased neck pain.
Molly has violated a specific standard of professional conduct, the one that requires a PTA to work under the direct supervision of a PT (Standards of Ethical Conduct, 3E).
Discussion
What action should Molly take?
Suggested Answer
Molly should refer her neighbor to a physician for examination and treatment. She needs to tell the neighbor that Molly, as PTA, should not be treating her without supervision. Molly has put both her neighbor and herself in jeopardy.
CASE 2
Joe Peal, PT, an employee of the local home health agency, feels a strong sexual attraction for the daughter of one of his clients. He is considering asking her for a date and shares his thoughts and feelings with a colleague.
If Joe pursues his sexual interest, he will violate principle 4E of the Code of Ethics, which prohibits a PT from engaging in any sexual relationship with any client.
Discussion
If you were Joe's colleague, what would you advise him to do?
Suggested Answer
Joe should ask his supervisor to assign another PT to the client and to terminate his PT/client relationship before pursuing an association with the daughter.
CASE 3
A PT just started her own business and is heavily in debt. She does not have a full caseload, but says she does not want to "start a precedent" by providing pro bono services to clients.
A specific principle speaks to this issue (Code of Ethics, 8A), recommending PTs provide reduced- or no-fee services when possible.
Discussion
What ethical principle could you use to appeal to your colleague?
Suggested Answer
The ethical principle of beneficence, which means taking action to benefit others.
CASE 4
Pam Newsom, a new PT graduate, is placed in a wound-care rotation in a nursing home, alternating with a group of experienced PTs. A 33-year-old client is admitted who has severe systemic cellulitis with weeping sores covering her legs and lower torso. Pam has never done wound care and does not feel she has the experience or competence to treat this client.
Principle 6B of the Code of Ethics requires that PTs "take responsibility for their professional development based on critical self-assessment." Principle 3C states that PTs "shall make judgments within their scope of practice and level of expertise."
Discussion
What should Pam do?
Suggested Answer
Pam should not perform procedures that are outside the scope of practice of a PT, nor should she perform procedures she does not know how to do. She should discuss the problem with her supervisor at once, preferably asking to observe a demonstration of wound care by a competent colleague; after which, she should give a satisfactory return demonstration.
CASE 5
Diana Learner, PTA, has just taken a position with a healthcare agency in town. On her fourth day at work, a client phones to say she must cancel her mid-morning appointment. Diana's immediate supervisor tells her to document the treatment as if it had taken place, because "we reserved the time and that counts as an appointment." Diana does not feel right about recording something that is not true.
Indeed, Diana should feel uncomfortable about such deceit. To do so would be a clear violation of Standards of Ethical Conduct, namely 7D, requiring that "documentation for their interventions accurately reflect the nature and extent of the services provided."
Discussion
What should Diana do?
Suggested Answer
Diana is a new employee and especially vulnerable. Pleasantly but honestly, she should explain to her supervisor that such an act violates ethical standards and that she does not want to taint the reputation of the agency. If the supervisor insists on false documentation, Diana should consult with the local APTA branch, follow their advice, and seek other employment.
Georgia Board of Physical Therapy
http://sos.georgia.gov/plb/pt/
American Physical Therapy Association
http://www.apta.org
American Physical Therapy Association (APTA). (2009a). Code of Ethics. Retrieved October 15, 2009, from: http://www.apta.org.
American Physical Therapy Association (APTA). (2009b). Standards of Ethical Conduct for the Physical Therapist Assistant. Retrieved October 15, 2009, from http://www.apta.org.
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Lewis, M. A., Tamparo, C. D. (2007). Medical law, ethics, & bioethics for the health professions (6th ed.). Philadelphia: F. A. Davis.
Raths, L. E., Harmin, M., Simons, S. B. (1979). Values and teaching (2nd ed.). Columbus, OH: Merrill.
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