● Relevant information : Professional competence and scope of physical therapy practice. Both language development and reading remediation skills are out of the scope of practice for physical therapy unless the practitioner has additional specialized education or training or is assisting another professional with expertise in developing an intervention plan. A speech-language pathologist should handle language skills, and a teacher or reading specialist should handle reading skills. ● Type of ethical problem : Ethical distress. Juan knows the right thing to do, but there is a barrier. ● Ethics theories and approaches : ○ Procedural Justice: APTA Code, Principle 3C (“Physical therapists shall demonstrate professional judgment within their scope of practice and level of expertise”). ○ Deontological theory. ● Practical alternatives: The school district can contract for services. The professionals under contract would create an intervention plan. ● Complete action: Juan can monitor progress and report changes and progress to the contracting professionals. ● Evaluate process and outcome: Juan can assist the school district to develop a list of potential resources (local, regional, statewide), which can be used to obtain services not available within the school district. Veracity Dana is the therapy manager in a large rehabilitation facility. She discovers that Carmen has not renewed her license, which expired 8 months ago. If Dana tells the rehabilitation facility’s chief financial officer about the lapsed license, the facility may be forced to return several thousand dollars to Medicare for payments received for therapy services during the time the therapist’s license was expired, and, in addition, may receive a fine for submitting false reimbursement forms to Medicare. Furthermore, the chief financial officer will reduce the budget for the physical therapy department by the amount of money returned to Medicare, which will mean fewer dollars to hire additional therapists or to buy new equipment and supplies. ● Relevant information: State license is expired. Neither Carmen nor Dana can bill for physical therapy services legally because Carmen does not have a current license. Moral duty requires following the applicable rules and regulations. ● Type of ethical problem: This is an ethical problem that has legal ramifications. The ethical principles that apply are the following: ○ Veracity/Integrity: APTA Code, Principle 7E (“Physical therapists shall be aware of charges and shall ensure that documentation and coding for physical therapy services accurately reflect the nature and extent of the services provided”). ○ Procedural Justice: APTA Code, Principle 5A (“Physical therapists shall comply with applicable local, state, and federal laws and regulations”).
● Ethics theories and approaches : ○ Deontological/duty theory: State and federal regulations must be followed. Health insurance policy rules and regulations may be involved as well if some clients have other insurance in addition to Medicare. ● Practical alternative: Hoping not to get caught or fined is irresponsible (and morally wrong). An alternative for the therapist would be to first reinstate her license and report the unauthorized treatments to billing sources. ● Complete action: Carmen must not treat any more clients until her license is renewed. Carmen must renew her license immediately and inform Dana of the date on which the license was reactivated. Carmen may also receive sanctions from the state licensure board, such as a monetary fine or a requirement to perform a specified number of hours of community service. ● Evaluate process and outcome: In the future, a database can be created that includes the dates of employees’ license expirations and completed renewals. The facility has a vested financial interest in making sure credentials are current on all personnel. Clients have a right to treatment by therapists with current credentials. Fidelity A representative from a local equipment company has approached Francine with a proposition: For every piece of equipment Francine orders for her clients, the company will award her points toward a free trip to Cancun, Mexico. Francine would love to go to Cancun. ● Relevant information: This scenario describes a “kickback” scheme. Favor (money, points, tokens, gifts) is given for directing client dollars (via the therapist) to a particular business. In return, the therapist receives a reward, the kickback. ● Type of ethical problem: None, unless Francine accepts the kickback, which is illegal. ● Ethics theories and approaches: ○ Fidelity – APTA Code, Principle 7E (“Physical therapists shall not accept gifts or other considerations that influence or give an appearance of influencing their professional judgment”). ○ Integrity – APTA Code, Principle 3D (“Physical therapists shall not engage in conflicts of interest that interfere with professional judgment”). ○ Accountability and Professional Duty – APTA Code, Principle 5A (“Physical therapists shall comply with applicable local, state, and federal laws”). ● Practical alternative: None. Kickback schemes are unethical and illegal while performing professional duties. The duty is to the client and facility, not to outside interests, such as a vendor, seller, or company. ● Complete action: Francine should refuse to participate and may have a legal responsibility to report the person and company to her employer and to a state agency, such as a state regulatory (licensure) board. ● Evaluate process and outcome: Continue to monitor for any situations that appear to be kickback schemes.
ANALYZING ETHICAL ISSUES: CASE VIGNETTES
● Professional behavior. ● Organizational and management issues. ● Competency. ● Documentation. ● Student education. ● Licensing. ● Scope of practice. ● Continuing education. ● Supervision of physical therapy assistants.
The following vignettes address various ethical issues. They primarily address the APTA Code of Ethics for the Physical Therapist (2010b) applications, with occasional brief statements about legal issues or ethical theories. In a real ethics situation, the six-step process and ethical principles and theories previously mentioned in this course should also be applied to resolve the dilemma. The following categories are examples of the types of ethical situations that may arise in physical therapy
practice and include: ● Social boundaries.
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Book Code: PTNJ0824
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