ETHICS
GOALS
Course Description
“Ethics and Jurisprudence –
Georgia Physical Therapy” is an online home study continuing education program
for
Course Rationale
This course was developed to
promote and facilitate ethical behavior by
Course Goals & Objectives
At the end of this course, the participants will be
able to:
1.
define the meaning of Ethics and explain the various theories
that promote ethical behavior.
2.
apply a systemic approach to ethical decision-making.
3.
understand all of
the rights and responsibilities of physical therapy licensure as defined by the
GA Physical Therapy Practice Act (Georgia Laws 43-33), Rules of the GA State Board of
Physical Therapy (GA Rules 490-1 through 490-11), GA General Provisions 43-1-19
through 43-1-27, and GA Patient Record Laws (31-33).
4.
evaluate their current physical therapy practices to ensure
compliance with all relevant
5.
understand patients’ rights relating to privacy of information as
defined by the Federal HIPAA statutes
6.
analyze and interpret clinical situations to determine appropriate
professional legal and ethical behavior.
Course Instructor
Michael Niss DPT
Method of Instruction
Text based online home study
course.
Target Audience
Course Educational
Level
This
course is applicable for introductory learners.
Course Prerequisites
None
Criteria for Issuance of Continuing Education Credits
A documented score
of 70% or greater on the written post-test.
Determination of Contact Hours
“Ethics and Jurisprudence”
will require at least 4 hours to complete. This estimate is based on the accepted
standard for home study courses of approximately 10-12 pages of written text
(12 pt font) per hour. The complete text
of this course is 49 pages (excluding Bibliography and Post Test)
ETHICS
OUTLINE
page
Goals and Objectives 1 begin hour 1
Outline 2
Ethics 3
Overview 3
Ethics vs Morals 3
Ethical Questions 3
Ethics Theories 4-6
How to Make Right Decisions 6-8
Georgia Physical Therapy Practice Act 8-17 end hour 1
Rules of GA State Board of Physical Therapy 18-34 begin hour 2
Organization of Board 18
Licensure Requirements 18-19
Evaluation
of Examinations: Applicants 19-20
Renewal:
Continuing Ed Requirements 20-26
Board
Policy #7 23-25 end
hour 2
Supervision of Physical Therapist
Assistants 26-27 begin hour 3
Physical Therapy Aides 27-28
Code of Ethics 28-33
Preventative Services 33-34
Consultation 34
Georgia Patient Record Laws 34-37 end hour 3
General Provisions 37-39 begin hour 4
HIPAA 40-43
Ethical & Legal Considerations 43-49
Patient Rights 43-46
Confidentiality 43-44
Qualified
Care 44
Informed
Consent 44-45
Medical
Necessity 46
Billing and Coding 46-47
The Triad 46-47
Conflicts of Interest 47-48
Relationships 48-49
Referral sources 48-49
Bibliography 50
Post-Test 51-52 end hour 4
Ethics
Overview
The word
“ethics” is derived from the Greek word ethos (character), and from the
Latin word mores (customs). Together, they combine to define how
individuals choose to interact with one another. In philosophy, ethics defines
what is good for the individual and for society and establishes the nature of
duties that people owe themselves and one another. Ethics is also a field of human inquiry
(“science” according to some definitions) that examines the bases of human
goals and the foundations of “right” and “wrong” human actions that further or
hinder these goals.
Ethics are important on
several levels.
Ethics Versus Morals
Although the terms “ethics” and “morals” are often used
interchangeably, they are not identical. Morals usually refer to practices;
ethics refers to the rationale that may or may not support such practices.
Morals refer to actions, ethics to the reasoning behind such actions. Ethics is
an examined and carefully considered structure that includes both practice and
theory. Morals include ethically examined practices, but may also include
practices that have not been ethically analyzed, such as social customs, emotional
responses to breaches of socially accepted practices and social prejudices.
Ethics is usually at a higher intellectual level, more universal, and more
dispassionate than morals. Some philosophers, however, use the term “morals” to
describe a publicly agreed-upon set of rules for responding to ethical
problems.
Ethical Questions
Ethical questions involve 1) responsibilities to the
welfare of others or to the human community; or 2) conflicts among loyalties to
different persons or groups, among responsibilities associated with one’s role
(e.g. as consumer or provider), or among principles. Ethical questions include
(or imply) the words “ought” or “should”.
Throughout
history, mankind has attempted to determine the philosophical basis from which
to define right and wrong. Here are some
of the more commonly accepted theories that have been proposed.
Utilitarianism
This
philosophical theory develops from the work of Jeremy Bentham and John Stewart
Mill. Simply put, utilitarianism is the theory that right and wrong are
determined by the consequences. The basic tool of measurement is pleasure
(Bentham) or happiness (Mill).
A morally
correct rule was the one that provided the greatest good to the greatest number
of people.
Social
Contract Theory
Social
contract theory is attributed to Thomas Hobbes, John Locke, and from the twentieth
century, John Rawls. Social contract theories believe
that the moral code is created by the people who form societies. These people
come together to create society for the purpose of protection and gaining other
benefits of social cooperation. These persons agree to regulate and restrict
their conduct to achieve this end.
John
Rawls – Rawls’ theory is
more of a hypothetical contract than Hobbes’ theory. Rawls believes, like
Hobbes, that people are rationally, self-interested. Additionally, persons are
moral in that they have a sense of justice which is akin to Hume’s notion of
“fellow-feeling.” This sense is like an additional sense to taste, touch,
smell, etc. It allows persons to have a capacity of intuition regarding moral
principles and the ability to analyze and understand them. It allows people to
affirm and maintain relationships of love and friendship, further binding
people to duties that arise from social/political relationships. By being
rational, the persons have conceptions of their own good; they know what they
need for their own life based on their own abilities, interests, and desires.
These persons enter the original position which is analogous to Hobbes’ state
of nature being the situation prior to the creation of society. However, these
persons are behind a veil of ignorance which blinds them to the specific
details of their selves, who they are, what their rational plans of life are,
what their condition of life is. All the persons in the original position
behind the veil of ignorance know is general information about life itself. Not
knowing the specifics of their conditions, persons then can deliberate about
the principles which will govern their society. Rawls believes that all
rational self-interested persons will come to the same two general principles,
the principles of justice: (1) that all persons should have the same rights and
liberties compatible with the rights and liberties of others; (2) that whatever
social and economic inequalities there are should be the advantage of those who
may be disadvantaged by them, and that all positions and offices should be
available to everyone.
Under this
theory you determine if an act or rule is morally right or wrong if it meets a
moral standard. The morally important thing is not consequences but the way
choosers think while they make choices. One
famous philosopher who developed such a theory was Immanuel Kant (1724-1804).
Under this
view an act or rule is determined to be right or wrong by appeal to the common
intuition of a person. This intuition is sometimes referred to as your
conscience. Anyone with a normal conscience will know that it is wrong to kill
an innocent person.
This view is
based on the theory that each person should do whatever promotes their own best
interests; this becomes the basis for moral choices.
Natural
Law Theory
This is a
moral theory which claims that just as there are physical laws of nature, there
are moral laws of nature that are discoverable. This theory is largely
associated with Aristotle and Thomas Aquinas, who advocated that each thing has
its own inherent nature, i.e. characteristic ways of behavior that belong to
all members of its species and are appropriate to it. This nature determines
what is good or bad for that thing. In the case of human beings, the moral laws
of nature stem from our unique capacity for reason. When we act against our own
reason, we are violating our nature, and therefore acting immorally.
This ethics
theory proposes that ethical behavior is a result of developed or inherent
character traits or virtues. A person
will do what is morally right because they are a virtuous person. Aristotle
(384-322 B.C.) was a famous exponent of this view. Aristotle felt that virtue
ethics was the way to attain true happiness. These are some of the commonly
accepted virtues.
Autonomy: the duty to maximize the individual’s
right to make his or her own decisions.
Beneficence: the duty to do good.
Confidentiality: the duty to respect privacy of
information.
Finality: the duty to take action that may
override the demands of law, religion, and social customs.
Justice: the duty to treat all fairly,
distributing the risks and benefits equally.
Nonmaleficence: the duty to cause no harm.
Understanding/Tolerance: the duty to understand and to accept
other viewpoints if reason dictates.
Respect
for persons: the duty
to honor others, their rights, and their responsibilities.
Universality: the duty to take actions that hold
for everyone, regardless of time, place, or people involved.
Veracity: the duty to tell the truth.
The
foundation for making proper ethical decisions is rooted in an individual’s
ability to answer several fundamental questions concerning their actions.
Weighing
the legality of one’s actions is a prudent way to begin the decision-making
process. The laws of a geographic region are a written code of that region’s
accepted rules of conduct. This code of
conduct usually defines clearly which actions are considered acceptable and
which actions are unacceptable. However,
a legitimate argument can be made that sometimes what is legal is not always
moral, and that sometimes what is moral is not always legal. This idea is easily demonstrated by the
following situation.
It
is illegal for a pedestrian to cross a busy street anywhere other than at the
designated crosswalk (jaywalking). A man
is walking down a street and sees someone fall and injure themselves on the
other side of the street. He immediately
crosses the street outside of the crosswalk to attend to the injured
person. Are his actions legal? Are they moral? What if by stepping into the street he causes
a car to swerve and to strike another vehicle?
Admittedly,
with the exception of policemen and attorneys, most people do not know all of
the specific laws that govern their lives.
However, it is assumed that most people are familiar with the
fundamental virtues from which these laws are based, and that they will live
their lives in accordance with these virtues.
Professional
ethical behavior as it is defined in this context relates to actions that are
consistent with the normative standards established or practiced by others in
the same profession. For physical
therapists and physical therapist assistants, these ethical standards are
established in the APTA’s Code of Ethics.
All PT’s and
I
think most people would agree that the concept of fairness is often highly
subjective. However, for these purposes, we will define fairness as meaning
deserved, equitable and unbiased.
Fairness requires the decision-maker to have a complete understanding of
benefits and liabilities to all parties affected by the decision. Decisions that result in capricious harm or
arbitrary benefit cannot be considered fair.
The goal of every decision should be an outcome of relative equity that
reflects insightful thought and soundness of intent.
This
question presents as a true reflection of the other three. Legal, ethical, and fair are defined quite
differently by most people when judged in the comfort of anonymity versus when
it is examined before the forum of public opinion. Most often it is the incorrect assumption
that “no one will ever find out about this” that leads people to commit acts of
impropriety. How would your decisions
change, if prior to taking any actions, you assumed just the opposite; “other
people will definitely know what I have done”.
One sure sign of a poor decision is debating the possible exposure of an
action instead of examining the appropriateness of it.
TITLE 43. PROFESSIONS
CHAPTER 33. PHYSICAL THERAPISTS
§
43-33-1. Short title
This chapter shall be known and may be
cited as the "Georgia Physical Therapy Act."
§
43-33-2. Declaration of purpose
This chapter is enacted for the
purpose of safeguarding the public health, safety, and welfare by providing for
state administrative control, supervision, and regulation of the practice of
physical therapy. The practice of physical therapy is declared to be affected with
the public interest; and this chapter shall be liberally construed so as to
accomplish the purpose stated in this Code section.
§
43-33-3. Definitions
As used in this chapter, the term:
(1) "Board" means the State
Board of Physical Therapy.
(2) "License" means a valid
and current certificate of registration issued by the board, which shall give
the person to whom it is issued authority to engage in the practice prescribed
thereon.
(3) "Licensee" means any
person holding a license under this chapter.
(4) "Person" means a human
being only, not a legal entity.
(5) "Physical therapist"
means a person licensed to practice physical therapy as defined in this chapter
and whose license is in good standing. A physical therapist shall be designated
by the initials "P.T."
(6) "Physical therapist
assistant" or "physical therapy assistant" means a person who is
licensed by the board to assist a physical therapist, whose activities are
supervised and directed by a physical therapist, and whose license is in
good standing. A physical therapist assistant shall be designated by the
initials "P.T.A."
(7) "Physical therapy" means
the examination, treatment, and instruction of human beings to detect, assess,
prevent, correct, alleviate, and limit physical disability, bodily malfunction
and pain from injury, disease, and any other bodily and mental conditions and
includes the administration, interpretation, documentation, and evaluation of
tests and measurements of bodily functions and structures; the planning,
administration, evaluation, and modification of treatment and instruction,
including the use of physical measures, activities, and devices, for
preventative and therapeutic purposes; and the provision of consultative, educational,
and other advisory services for the purpose of preventing or reducing the
incidence and severity of physical disability, bodily malfunction, and pain.
(8) "Physical therapy aide"
means a person who only performs designated and supervised physical therapy
tasks. The physical therapy aide must receive direct supervision and must be
directed on the premises at all times by a licensee. Physical therapy aides are
not licensed under this chapter.
(9) "Trainee" means an
individual who is approved for a traineeship.
(10) "Traineeship" means a
period of activity during which a trainee works under the direct supervision of
a licensed physical therapist who has practiced for
not less than one year prior to assuming the supervisory role.
(11) "Training permit" means
a valid and current certificate of registration issued by the board, which
gives the person to whom it is issued authority to engage in practice through a
traineeship prescribed thereon.
§
43-33-4. Creation of board
There is created a State Board of
Physical Therapy.
§
43-33-5. Appointment of board members; terms; vacancies; removal
The board shall consist of eight
members, as provided in Code Section 43-33-6, each of whom shall be appointed
by the Governor and confirmed by the Senate for a term of three years and until
a successor is appointed and qualified. Vacancies on the board shall be filled
by the Governor's appointment of a successor to serve out the unexpired term. The
Governor, after notice and opportunity for hearing, may remove any member of
the board for neglect of duty, incompetence, revocation or suspension of
license of those licensee members, or other dishonorable conduct. No person
shall serve consecutively
more than two full terms as a member of
the board.
§
43-33-6. Qualifications of board members
To be eligible for appointment to the
board, a person must be a resident of this state. Six members of the board
shall be licensed as physical therapists under this chapter who have practiced
or taught physical therapy for at least three years. At least one member shall
be licensed and practicing as a physical therapist assistant for at least three
years. The eighth member shall be appointed from the public at large and shall
have no business connection whatsoever with the practice or profession of
physical therapy.
§
43-33-7. Conduct of business by telephone
With the exception of hearings in
contested cases, the board may conduct business in conference by telephone,
provided that members of the board shall not receive compensation for business
conducted in conference by telephone.
§
43-33-8. Reimbursement of board members
Each member of the board shall be
reimbursed as provided for in subsection (f) of Code Section 43-1-2.
§
43-33-9. Division director as secretary of board; subpoena power; service of
process and documents; official records as prima- facie evidence
The division director shall be
secretary of the board and shall perform such other administrative duties as
may be prescribed by the board. In a contested case, the division director on
behalf of the board shall have the power to subpoena, throughout the state, witnesses,
designated documents, papers, books, accounts, letters, photographs, objects, or
other tangible things. All legal process and all documents required by law to
be served upon or filed with the board shall be served upon or filed with the
division director at his or her office in
§
43-33-10. General powers and duties of board
In carrying out the provisions of this
chapter, the board shall, in addition to the other powers conferred upon it
under this chapter, have the power to:
(1) Prepare or approve all
examinations or applicants for licenses;
(2) Determine
the qualifications of and authorize the issuance of licenses to qualified physical
therapists and physical therapist assistants;
(3) Determine
the qualifications for and approve educational programs that prepare physical
therapists and physical therapist assistants for the purpose of determining qualifications
of applicants for licensure;
(4) Initiate investigations of alleged
or suspected violations of the provisions of this chapter or other laws of this
state pertaining to physical therapy and any rules and regulations adopted by
the board. For this purpose, any board member or authorized agent of the board
shall have the power and right to enter and make reasonable inspection of any
place where physical therapy is practiced;
(5) Conduct
all hearings in contested cases according to Chapter 13 of Title 50, known as
the "Georgia Administrative Procedure Act";
(6) Discipline any person licensed
under this chapter, or refuse to grant, renew, or restore a license to any
person upon any ground specified in this chapter;
(7) Adopt a seal, the imprint of which
together with the authorized signature of either the division director or other
member authorized by the board shall be effective to evidence its official
acts;
(8) Establish licensing fees and
maintain in the office of the division director a register of all persons
holding a license and a record of all inspections made;
(9) Adopt and publish a code of
ethics;
(10) Issue training permits; and
(11) Adopt such rules and regulations
as shall be reasonably necessary for the enforcement and implementation of the
provisions and purposes of this chapter and other laws of this state insofar as
they relate to physical therapy.
§
43-33-11. License required for physical therapists or physical therapist
assistants; use of titles; limitation on scope of Code section
A physical therapist shall display
either the title "physical therapist" or the abbreviation "P.T."
on a name tag or other similar form of identification during times when such person
is providing direct patient care. A physical therapist assistant shall display
either the title "physical therapist assistant" or the abbreviation
"P.T.A." on a name tag or other similar form of identification during
times when such person is providing direct patient care. A physical therapy
aide shall be required to display the title "physical therapy aide" on
a name tag or other similar form of identification during times when such
person is assisting a licensee. No person shall practice as a physical
therapist or as a physical therapist assistant nor hold himself or herself out
as being able to practice as a physical therapist or as a physical therapist
assistant or as providing physical therapy or use the initials P.T. or P.T.A.
in conjunction therewith or use any word or title to induce the belief that he
or she is engaged in the practice of physical therapy unless he or she holds a license
and otherwise complies with the provisions of this chapter and the rules and regulations
adopted by the board. Nothing in this Code section shall be construed as preventing
or restricting the practice, services, or activities of:
(1) Any person licensed under any
other law of this state who is engaged in the professional or trade practices
properly conducted under the authority of such other licensing laws;
(2) Any person pursuing a course of
study leading to a degree or certificate as a physical therapist or as a
physical therapist assistant in an entry level educational program approved by
the board, if such person is designated by a title indicating student status,
is fulfilling work experiences required for the attainment of the degree or certificate,
and is under the supervision of a licensed physical therapist;
(3) Any person enrolled in a course of
study designed to develop advanced physical therapy skills when the physical
therapy activities are required as part of an educational program sponsored by
an educational institution approved by the board and are conducted under the
supervision of a physical therapist licensed under this chapter. If such person
provides physical therapy services outside the scope of the educational program,
he or she shall then be required to be licensed in accordance with this
chapter;
(4) A physical therapist licensed in
another state or country or employed by the
(5) Any person employed as a physical
therapist or as a physical therapist assistant by the
(6) A person currently licensed in
another state who is present in this state for treatment of a temporary
sojourner only, said treatment in this state not to exceed a total of 60 days during
any 12 month period.
§
43-33-12. Requirements for license to practice physical therapy
A license to practice physical therapy
shall be issued to any person who:
(1) Is a graduate of an educational
program that prepares physical therapists and which is accredited by a
recognized accrediting agency and approved by the board or, in the case of an
applicant who has graduated from an educational program which prepares physical
therapists conducted in a foreign country, has submitted, in a manner
prescribed by the board, credentials approved by the board and who has further
demonstrated the ability to speak, write, and understand the English language
and has satisfactorily completed a three- month board approved traineeship
under the supervision of a physical therapist licensed under this chapter;
(2) Has satisfactorily passed an
examination prepared or approved by the board; and
(3) Is not disqualified to receive a
license under the provisions of Code Section 43-33-18 or subsection (a) of Code
Section 43-1-19.
§
43-33-13. Requirements for license to practice as physical therapist assistant
A license to practice as a physical
therapist assistant shall be issued to any person who:
(1) Is a graduate of an educational
program that prepares physical therapist assistants and which is accredited by
a recognized accrediting agency and approved by the board or, in the case of an
applicant who has graduated from an educational program which prepares physical
therapist assistants conducted in a foreign country, has submitted, in a manner
prescribed by the board, credentials approved by the board and who has further demonstrated
the ability to speak, write, and understand the English language and has satisfactorily
completed a three- month board approved traineeship under the supervision of a
physical therapist licensed under this chapter;
(2) Has satisfactorily passed an
examination prepared or approved by the board; and
(3) Is not disqualified to receive a
license under the provisions of Code Section 43-33-18 or subsection (a) of Code
Section 43-1-19.
§
43-33-13.1. Physical therapy aide
A physical therapy aide is one, other
than a physical therapist or physical therapist assistant, who is employed to
assist a physical therapist or a physical therapist assistant by performing
only designated physical therapy tasks under direct supervision of a licensee
as approved by the board by rule or regulation.
.
§
43-33-14. Determining competence of applicants
The board shall determine the
competence of applicants to practice as physical therapists or as physical
therapist assistants by any method or procedure which the board deems necessary
to test the applicant's qualifications.
§
43-33-15. Reciprocity
The board may grant to a person
licensed in another state or territory of the
(1) That such person is properly
licensed under the laws of another state or territory or the
(2) That the requirements for
licensing in such other state or territory of the
§
43-33-16. Expiration, renewal, and restoration of licenses; canceled licenses;
continuing education
All licenses shall expire biennially
unless renewed. All applications for renewal of a license shall be filed with
the division director prior to the expiration date, accompanied by the biennial
renewal fee prescribed by the board. A license which has expired for failure of
the holder to renew may only be restored after application and payment of the prescribed
restoration fee within the time period established by the division director and
provided the applicant meets such requirements as the board may establish by
rule. Any license which has not been restored within such period following its
expiration may not be renewed, restored, or reissued thereafter. The holder of
such a canceled license may apply for and obtain a valid license only upon
compliance with all relevant requirements for issuance of a new license. The
board shall require no less than four hours of continuing education in order to
renew any license issued pursuant to this chapter.
§
43-33-17. Training permits
(a) The board may issue a training
permit to an applicant who is a graduate of an approved physical therapy
program who is approved to take the physical therapy licensing examination or
who has taken the examination but not yet received the examination results.
(b) The board may issue a training
permit to a foreign trained applicant who is a graduate from a physical therapy
program outside the
(c) The board may issue a training
permit to a reinstatement applicant whose license to practice as a physical
therapist or license to practice as a physical therapist assistant has been
expired for more than two years.
(d) The training permit shall allow
the holder thereof to work only under the direct supervision of a physical
therapist who has been approved by the board and has
practiced for not less than one year prior to assuming the supervisory role.
(e) Training permits are governed by
rules and regulations authorized under this chapter and approved by the board.
§
43-33-18. Refusal to grant or restore licenses; discipline of licensees;
suspension, revocation, or restriction of licenses; immunity for violation
reporters
(a) The board shall have authority to
refuse to grant or restore a license to an applicant or to discipline a
physical therapist or physical therapist assistant licensed under this chapter
or any antecedent law upon a finding by the board that the licensee or
applicant has:
(1) (A) Implemented or continued a
program of physical therapy treatment without consultation with an appropriate
licensed practitioner of the healing arts; except that a physical therapist may
implement a program of physical therapy treatment without consultation with an
appropriately licensed practitioner of the healing arts when:
(i) Services are provided for the
purpose of fitness, wellness, or prevention that is not related to the
treatment of an injury or ailment; or
(ii) (I) The
patient was previously diagnosed and received treatment or services for that
diagnosis and the patient returns to physical therapy within 60 days of
discharge from physical therapy for problems and symptoms that are related to
the initial referral to the physical therapist. In such a situation the
physical therapist shall notify the original referral source of the return to
physical therapy within five business days; and
(II) The physical therapist holds a
master or doctorate degree from a professional physical therapy program that is
accredited by a national accreditation agency recognized by the United States
Department of Education and approved by the Georgia State Board of Physical
Therapy or the physical therapist has completed at least two years of practical
experience as a licensed physical therapist.
If after 90 days of initiating
physical therapy services the physical therapist determines that no substantial
progress has been made with respect to the primary complaints of the patient,
the physical therapist shall refer the patient to an appropriately licensed practitioner
of the healing arts. If at any time the physical therapist has reason to
believe that the patient has symptoms or conditions that require treatment or
services beyond the scope of practice of the physical therapist, the physical
therapist shall refer the patient to an appropriately licensed practitioner of
the healing arts; or
(B) In the case of practice as a
physical therapist assistant, practiced other than under the supervision and
direction of a licensed physical therapist;
(2) Displayed an inability or has
become unable to practice as a physical therapist or as a physical therapist
assistant with reasonable skill and safety to patients by reason of illness,
use of alcohol, drugs, narcotics, chemicals, or any other type of material, or
as a result of any mental or physical condition:
(A) In enforcing this paragraph the
board may, upon reasonable grounds, require a licensee or applicant to submit
to a mental or physical examination by an appropriate practitioner of the
healing arts designated by the board. The expense of such mental or physical
examination shall be borne by the licensee or applicant. The results of such examination
shall be admissible in any hearing before the board, notwithstanding any claim
of privilege under a contrary rule of law or statute, including, but not
limited to Code Section
(B) For the purposes of this
paragraph, the board may, upon reasonable grounds, obtain any and all records
relating to the mental or physical condition of a licensee or applicant,
including psychiatric records; and such records shall be admissible in any hearing
before the board, notwithstanding any privilege under a contrary rule of law or
statute, including, but not limited to, Code Section 24-9-21. Every person who
shall accept the privilege of practicing physical therapy in this state or who
shall file an application to practice physical therapy in this state shall be
deemed to have given his or her consent to the board's obtaining any such
records and to have waived all objections to the admissibility of such records
in any hearing before the board upon the grounds that the same constitute a
privileged communication; and
(C) If any licensee or applicant
could, in the absence of this paragraph, invoke a privilege to prevent the
disclosure of the results of the examination provided for in subparagraph (A)
of this paragraph or the records relating to the mental or physical condition
of such licensee or applicant obtained pursuant to subparagraph (B) of this paragraph,
all such information shall be received by the board in camera and shall not be disclosed
to the public, nor shall any part of the record containing such information be used
against any licensee or applicant in any other type of proceeding;
(3) Been convicted of a felony or
crime involving moral turpitude in the courts of this state, the
(4) Knowingly made misleading,
deceptive, untrue, or fraudulent representations to a patient, consumer, or
other person or entity in connection with the practice of physical therapy or
in any document connected therewith; practiced fraud or deceit or intentionally
made any false statement in obtaining or attempting to obtain a license to
practice physical therapy or as a physical therapist assistant; or made a false
or deceptive biennial registration with the board;
(5) Practiced physical therapy
contrary to this Code section or to the rules and regulations of the board;
knowingly aided, assisted, procured, or advised any person to practice physical
therapy contrary to this Code section or to the rules and regulations of the
board; or knowingly performed any act which in any way aids, assists, procures,
advises, or encourages any unlicensed person to practice physical therapy;
(6) Engaged in any unprofessional,
unethical, deceptive, or deleterious conduct or practice harmful to the public,
which conduct or practice need not have resulted in actual injury to any
person; unprofessional conduct shall also include any departure from, or the failure
to conform to, the minimal standards of acceptable and prevailing physical therapy
practice or the failure to comply with the code of ethics of the board;
(7) Failed to report to the board any
act or omission of a licensee or applicant or any other person which violates
the provisions of this subsection; or
(8) Divided fees or agreed to divide
fees received for professional services with any person, firm, association,
corporation, or other entity for bringing or referring a patient.
(b)(1) When the board finds that any
person is unqualified to be granted a license or finds that any person should
be disciplined pursuant to subsection (a) of this Code section, the board may
take any one or more of the following actions:
(A) Refuse to grant or restore a
license to an applicant;
(B) Administer a public or private
reprimand, but a private reprimand shall not be disclosed to any person except
the licensee;
(C) Suspend any license for a definite
period;
(D) Limit or restrict any license;
(E) Revoke any license;
(F) Condition the penalty or withhold
formal disposition, upon the physical therapist's, physical therapist
assistant's, or other person's submission to the care, counseling, or treatment
of physicians or other professional persons, and the completion of such care,
counseling, or treatment, as directed by the board; or
(G) Impose a fine not to exceed
$500.00 for each violation of law, rule, or regulation of the board.
(2) In addition to or in conjunction
with the actions enumerated pursuant to paragraph
(1) of this
subsection the board may make a finding adverse to the licensee or applicant but
withhold imposition of judgment and penalty, or it may impose the judgment and penalty
but suspend enforcement thereof and place the licensee or applicant on
probation, which probation may be vacated upon noncompliance with such
reasonable terms as the board may impose.
(c) In its discretion, the board may
restore and reissue a license issued under this chapter or any antecedent law
and, as a condition thereof, it may impose any disciplinary or corrective
measure provided in this chapter.
(d) A person, firm, corporation,
association, authority, or other entity shall be immune from civil and criminal
liability for reporting the acts or omissions of a licensee or applicant which
violate the provisions of subsection (a) of this Code section or any other provision
of law relating to a licensee's or applicant's fitness to practice as a
physical therapist or as a physical therapist assistant, if such report is made
in good faith without fraud or malice. Any person who testifies without fraud
or malice before the board in any proceeding involving a violation of the
provisions of subsection (a) of this Code section or any other law relating to
a licensee's or applicant's fitness to practice as a physical therapist or as a
physical therapist assistant shall be immune from civil and criminal liability
for so testifying.
§
43-33-19. Unlicensed practice as constituting public nuisance; injunctions
The practice of physical therapy is
declared to be an activity affecting the public interest and involving the
health, safety, and welfare of the public. Such practice when engaged in by a
person who is not licensed is declared to be harmful to the public health, safety,
and welfare. The board or the district attorney of the circuit where such
unlicensed practice exists, or any person or organization having an interest
therein, may bring a petition to restrain and enjoin such unlicensed practice
in the superior court of the county where such unlicensed person resides. It
shall not be necessary in order to obtain an injunction under this Code section
to allege or prove that there is no adequate remedy at law, or to allege or
prove any special injury.
§
43-33-20. Penalty
Any person convicted of violating this
chapter shall be guilty of a misdemeanor.
Rules of the
(Chapter 490)
The
following is an edited version of The Rules of Georgia State Board of Physical
Therapy (Chapter 490). To view the
chapter in its entirety, go to: http://sos.georgia.gov/acrobat/plb/rules/chapt490.pdf
Chapter 490-1 Organization
of the Board
490-1-.01
Organization of Board.
The Board of Physical Therapy
is composed of eight members who are appointed by the Governor. Members of the
public may obtain information from the Board and make submissions or requests
to the Board by contacting the Joint Secretary of the Professional Licensing
Boards Division,
Chapter 490-2 Licensure
Requirements
490-2-.01 Application For Licensure And Examination.
(1) A completed
application for examination must be submitted and approved prior to taking the
examination.
(2) Any physical therapist
or physical therapist assistant who plans to practice
as a physical therapist or physical therapist assistant in the State of
(3) Any applicant who does
not submit required documentation within one year of initial filing date will
not be given further consideration by the Board until submission of new application
and payment of appropriate fees.
(4) All applicants for
licensure and examination are also subject to the provisions of O.C.G.A.
§§43-1-19 and 43-33-18.
490-2-.02 Licensure:
Examination.
(1) All physical
therapists and physical therapist assistants are required to submit a completed
application, the appropriate fee, and pass an examination for licensure to practice
the profession in
(a) All applicants who are
graduates of Commission on Accreditation in Physical
Therapy Education (CAPTE)
accredited schools and are applying for licensure must submit:
1. passing
scores from the national licensing examination; and
2. passing scores from
examination on the laws governing the practice of physical therapy in Georgia
and the rules of the Georgia State Board of Physical Therapy; and
3. official
transcript from the institution granting the entry level degree in physical
therapy or physical therapist
assistant indicating the date of graduation.
(b) Verification of
licensure in all states in which the licensure candidate holds a license or has
ever held a license may be conducted by board staff.
490-2-.09 Licensure:
Endorsement.
(1) The Board may, in its
discretion register a physical therapist or physical therapist assistant
without an examination as set forth in Official Code of Georgia Annotated Section
43-33-15 upon payment of applicable fees. (Refer to fee schedule)
(2) Any applicant applying
for licensure pursuant to O.C.G.A. 43-33-15 and who is a graduate of a physical
therapy or physical therapist assistant program accredited by the Commission on
Accreditation of Physical Therapy Education (CAPTE) and approved by the Board, must provide:
(a) a
list of all states where the applicant holds an active license; and
(b) verification of
licensure in good standing from the state board of all states in which the
applicant has actively practiced in the two years immediately preceding the
date of this application; and
(c) official
transcript from the institution granting the entry level degree in physical
therapy or physical therapist
assistant indicating the date of graduation; and
(d) scores
from the national licensing examination.
(3) Any applicant applying
for licensure pursuant to O.C.G.A. 43-33-15 who is a
graduate of a physical therapy or
physical therapist assistant program not accredited by the Commission on
Accreditation of Physical Therapy Education (CAPTE) or approved by the Board,
must provide:
(a) a
list of all states where the applicant holds an active license; and
(b) verification of
licensure in good standing from the state board of all states in which the
applicant has actively practiced in the two years immediately preceding the
date of this application; and
(c) official
evaluation and transcript from a credential evaluation organization approved by
the State of
(d) scores
from the national licensing examination.
(4) Proper proof of
licensure in good standing from the state(s) where the applicant practiced in
the two years immediately preceding this application, proof of graduation from
an accredited physical therapy or physical therapist assistant program or
credential evaluations deemed substantially equivalent to the professional
degree, and satisfactory completion of the licensing examination shall be
deemed to be prima facie evidence of compliance with Code Section 43-33-15. The
Board, however, may request further verification of any credential submitted if
deemed necessary to evaluate the application.
Chapter 490-3 Evaluation
of Examinations: Applicants
490-3-.01
Evaluation of Examinations.
The passing level for the
physical therapist and the physical therapist assistant licensing examinations
shall be determined by the Board.
490-3-.02
Re-examination.
(1) An applicant who fails
the examination on the first attempt may submit a reexamination application to
the Board to be made eligible to test a second time.
(2) An applicant who fails
the examination on the second attempt must submit the following before being
made eligible to test a third time:
(a) A copy of his/her
“Examination Performance Feedback Report” obtained from the Federation of State
Boards of Physical Therapy (FSBPT), and pay all costs
associated with acquiring the report.
(b) A remediation plan
addressing each area of weakness/failure. Examination
preparation courses will be
considered provided that such course addresses the area(s) of weakness/failure.
The remediation plan must be developed in consultation with an appropriately
licensed physical therapist or physical therapy assistant, or by a faculty member
of a CAPTE-accredited program.
(c) Proof of satisfactory
completion of such remediation plan.
1. An applicant may be
approved administratively to take the examination a third time after the above
outlined procedure has been completed and approved.
(3) An applicant who fails
the examination three (3) or more times must submit a remediation plan as
outlined above in 490-3-.02(2)(a) and (b). The remediation plan must be approved
by the Board prior to the applicant’s beginning or initiating the plan. An
applicant may be approved to take the examination only after proof of
satisfactory completion of the approved plan has been submitted.
490-3-.03
Hearings.
An applicant to whom the
Board has refused examination may have a hearing before the Board.
Chapter 490-4 Renewal: Continuing
Competence Requirements, Disciplinary Sanctions
490-4-.01
Renewal of License and Penalties.
(1) Every licensed
physical therapist and physical therapist assistant shall biennially apply to
the Board for renewal of his/her license, submit proof of continuing competency
requirements and pay a renewal fee by October 31st of odd years. Refer to fee
schedule and 490-4-.02.
(2) A license that is not
renewed on or before October 31st shall be assessed a late fee. Refer to fee
schedule for penalty fee.
(3) A license that is not
renewed on or before December 31st of the renewal year shall lapse and be of no
force and effect and shall by operation of the law be revoked.
(4) A physical therapist
or physical therapist assistant who has been previously licensed in this State
who has allowed his/her license to become revoked due to failure to renew, shall
be required to submit an application for reinstatement, pay appropriate fee
(refer to fee schedule), and shall also be required to meet requirements as
provided below:
(a) An applicant who is
able to document that he/she has practiced as a physical therapist or physical
therapist assistant within 2 years shall be required to submit proof of continuing
competence requirements as established by the Board;
(b) An applicant, who is
unable to document that he/she has practiced as a physical therapist or
physical therapist assistant within 2 years but able to document such practice within
5 years, shall be required to submit proof of continuing competence (Refer to
490-4-.02), and shall be required to work under the supervision of a physical
therapist licensed in this state for 1,000 hours of continuous supervised
practice to be completed in no more than 1 year and no less than 6 months with
specific stipulations as deemed necessary by the Board; and shall be required to take and pass
the examination on the laws governing the practice of physical therapy in
Georgia and the rules of the Georgia State Board of Physical Therapy.;
(c) An applicant who is
unable to document that he/she has practiced as a physical therapist or
physical therapist assistant within 5 years shall be required to work under the
supervision of a physical therapist licensed in this state for 1,000 hours of
continuous supervised practice to be completed in no more than 1 year and no
less than 4 months with specific stipulations as deemed necessary by the Board
and shall be required to take and pass the
following examinations: the licensing examination, and the examination on the
laws governing the practice of physical therapy in Georgia and the rules of the
Georgia State Board of Physical Therapy.
(5) Applicants subject to
Rule 490-4-.01(4)(a) may in the discretion of
the Board be exempted from continuing competence requirements if such person
holds a current license in good standing in another state or if such person is
currently employed as a physical therapist or physical therapist assistant by
the United States Government if such person provides physical therapy services
under the direction or control of the employing organization.
490-4-.02
Continuing Competence Requirements.
(1) The Georgia State
Board of Physical Therapy requires each licensed physical therapist and
physical therapist assistant to participate in a minimum number of thirty (30)
clock hours of experience per licensure period to promote continuing
competence. The Board has defined the
requirements for competence as planned learning experiences which the licensee
can show is intended to increase their present skill level and that the content
is beyond the licensees’ present level of knowledge and competence, which may
be subject to audit by the board. Content of the experience must relate to
patient care in physical therapy whether the subject is research, treatment,
documentation, education, management, or some other content area. The purpose
of this requirement is to assist in assuring safe and effective practices in
the provision of physical therapy services to the citizens of
(a) Continuing competence
requirements may be met through the mechanisms identified in the categories,
Class I and Class II.
(b) The thirty (30) hours
of continuing competence requirements per biennium include a minimum of four
(4) contact hours specifically in ethics and jurisprudence as defined in the Georgia
Physical Therapy Act or by passage of the Georgia Jurisprudence Examination. Passage
of the examination is equivalent to the four (4) hour requirement.
(c) The total hours
required biennially for continuing competence may be distributed between Class
I and Class II activities. A maximum of 10 hours may be obtained through Class
II activities. All required hours may be met through Class I activities.
Competence credit is the clock hours spent in an activity except as noted
below. Any Class I activity without a stated maximum number of hours may be
used to accrue all required hours.
(d) A maximum of ten
(10) continuing competence credit hours will be accepted per calendar day.
(2) Class I and Class II
acceptable continuing competence credit shall be awarded to programs sponsored
by Continuing Competence providers as noted in the board by policy, provided
that the content is beyond the licensee’s present level of knowledge and
competence which may be subject to audit by the Board.
(3) Unacceptable
activities for continuing competence include, but are not limited to:
(a)
Orientation and in-service programs;
(b) Meetings for purposes
of policy decisions;
(c) Non-educational
meeting at annual association, chapter or organization meetings;
(d) Entertainment or
recreational meeting or activities;
(e) Committee meetings,
holdings of offices, serving as an organization delegate;
(f) Visiting exhibits;
(g) CPR.
(4) Continuing competence
requirements shall apply within the first biennium that a physical
therapist/physical therapist assistant is licensed in
(5) Individuals licensed
during the last six (6) months of a biennium renewal period will not be
required to meet continuing competence requirements for that biennium.
(6) Individuals who have
been reinstated within the last six (6) months of a biennium renewal period may
use the continuing competence coursework used for reinstatement, thereby making
them exempt from the requirement for that biennium renewal period.
(7) Those licensees
selected for audit shall submit the Verification of Continuing Competence form
and documentation of compliance upon receipt of notice. Acceptable documentation
shall include:
(a) An official program or
outline of the course attended or taught or a copy of the publication which
clearly shows that the objectives and content were related to patient care in
physical therapy and shows the number of contact hours, as appropriate. The
information also should clearly identify the licensee's responsibility in
teaching or authorship; and,
(b) A certificate or
verification of completion of home study which identifies the sponsoring entity
or maintain a copy of the final grade report in the case of a University credit
course(s), or specialization certificate, or proof of attendance with a copy of
the program for the other acceptable activities, or documentation of
self-instruction or reading professional literature; or,
(c) Verification of a peer
review of practice with verification of acceptable practice by a recognized
entity. An example of a recognized entity is the American Physical Therapy Association
Board Policy (See APTA Policy G03-05-15-40).
(8) Responsibilities of
the Licensee:
(a) To maintain the
documents identified in number (5) above for no less than three (3) years from
the beginning date of the licensure period. These records should be maintained
in the licensee’s personal files for no less than three (3) years from the
beginning date of the licensure period through the even numbered year after the
license is renewed.
(b) To complete all steps
necessary to meet the relicensure requirements on or before December 31st of
the odd numbered years.
(c) To provide the Board
with information requested during an audit.
(d) To keep a current
mailing address on file with the Licensing Board Office at all times.
Policy #7 - Continuing Competence
Policy
The Georgia State Board of Physical
Therapy requires each licensed physical therapist and physical therapist
assistant to participate in a minimum number of thirty (30) clock hours of
experience to promote continuing competence per licensure period. The Board
has defined the requirements for competence as planned learning experiences
which have content beyond the licensee’s present level of knowledge and competence
which may be subject to audit by the board. Content of the experience must
relate to patient care in physical therapy whether the subject is research, treatment,
documentation, education, management, or some other content area. The purpose
of this requirement is to assist in assuring safe and effective practices in
the provision of physical therapy services to the citizens of
The following programs may be
considered for Class I approval, but are not
limited to:
(a) Programs approved by the American
Physical Therapy Association and its affiliate components; or
(b) Programs approved by the Physical
Therapy Association of Georgia or any other state chapters; or
(c) Programs approved by the
Federation of State Boards of Physical Therapy; or
(d) Programs provided at
CAPTE-Accredited colleges and universities with programs in physical therapy
when the continuing competency course is held under the auspices of the school
of physical therapy; or
(e) Programs provided by the
(f) Programs approved by another state
board; or
(g) Programs provided at
JCAHO-accredited healthcare organizations; or
(h) Programs provided by the
(i) Programs provided by the National
Athletic Trainers Association; or
(j) Programs provided by the American
Dental Association; or
(k) Programs provided by the American
Association of Nurses; or
(l) Programs provided by the American
Occupational Therapy Association; or
(m) Fifteen
(15) hours for undergoing a peer review; or
(n) Ten (10)
hours for conducting a peer review when that activity is an adjunct responsibility
and not the primary employment; or
(o) Participation as a presenter for
continuing education courses, workshops, seminars or symposia which have been
approved by the approved list above; Continuing competence credit is based on
contact hours and may not exceed 10 hours per topic;
(p) Authorship of a presented
scientific poster, scientific platform presentation or published article;
Continuing competence credit is 10 hours per event and may not exceed 20 hours;
(q) Teaching a physical therapist or
physical therapist assistant credit course when that teaching is an adjunct
responsibility and not the primary employment; Continuing
competence credit is based on contact hours not to exceed 20 hours;
(r) Certification of clinical
specialization by the America Board of Physical Therapy Specialties. Continuing
competence credit is 30 hours and is recognized only in the biennium in which
certification or recertification is awarded.
The following programs may be
considered for Class II approval (limited to 10 hours):
(a) Self- instruction from reading
professional literature; Continuing competence credit is limited to a maximum
of five (5) hours; or
(b) Attendance at a scientific poster
session, lecture, panel, symposium or university course that does not meet the
criteria for Class I; Continuing competency credit is one hour per contact hour
of activity; or
(c) Acting as a clinical education
instructor for an accredited physical therapist or physical therapist assistant
educational program; Continuing competence credit is one (1) hour per eight (8)
contact hours; or
(d) Acting as a clinical instructor or
an intern for a formal, nonacademic, advanced clinical internship or as a
mentor or a learner for a formal, nonacademic mentorship.
Continuing competency hours obtained
between
490-4-.04
Inactive License.
(a) Any licensee who is no
longer practicing as a physical therapist or physical therapist assistant in
the State of
(1) An individual holding
inactive status may not practice as a physical therapist or work as a physical
therapist assistant within the State of Georgia.
(2) Any individual holding
inactive status is not subject to the biennual renewal fees or continuing
competence requirements.
(3) An individual whose
license is under any sanction may not transfer to inactive status while
sanctions are in effect.
(4) Any individual holding
inactive status may return to active status by meeting all requirements for
reinstatement as outlined herein.
(b) A physical therapist
or physical therapist assistant who has been granted
an Inactive
License may reinstate the
license by submitting an application for reinstatement, pay appropriate fee
(refer to fee schedule), and shall also be required to meet requirements as provided
below:
(1) An applicant who is
able to document that he/she has practiced as a physical therapist or physical
therapist assistant within 2 years shall be required to submit proof of continuing
competence requirements as established by the Board;
(2) An applicant, who is
unable to document that he/she has practiced as a physical therapist or
physical therapist assistant within 2 years but able to document such practice within
5 years, shall be required to submit proof of continuing competence (Refer to
490- 4-.02), and shall be required to work under the supervision of a physical
therapist licensed in this state for 1,000 hours of continuous supervised practice
to be completed in no more than 1 year and no less than 4 months with specific
stipulations as deemed necessary by the Board; or
(3) An applicant who is
unable to document that he/she has practiced as a physical therapist or
physical therapist assistant within 5 years shall be required to work under the
supervision of a physical therapist licensed in this state for 1,000 hours of
continuous supervised practice to be completed in no more than 1 year and no
less than 4 months with specific stipulations as deemed necessary by the Board
and shall be required to take and pass the next licensing examination.
(c) Applicants subject to
Rule 490-4-.04(b) may in the discretion of the Board be exempted from
continuing competence and supervision requirements if such person holds a
current license in good standing in another state or if such person is
currently employed as a physical therapist or physical therapist assistant by
the United States Government if such person provides physical therapy services
under the direction or control of the employing organization.
Chapter 490-5 Supervision
& Direction of Physical Therapist Assistant
490-5-.01
Responsibility of the Licensed Physical Therapist in Supervision and Direction
of the Physical Therapy Assistant. Amended.
(1) A licensed physical
therapist shall at all time be responsible for providing adequate supervision
of the assistant supervised by him, as defined in Rule 490-5-.02.
(2) The licensed physical
therapist shall be present in the same institutional setting, as defined in
paragraph (3) of this section, 50 percent of any work week or portion thereof that
the assistant is on duty, and shall be readily available to the assistant at
all other times for advice, assistance and instruction.
(3) "Institutional setting"
means any nursing home, acute hospital, convalescent hospital, rehabilitation center, other in-patient facility by any
other name and out-patient clinic which would include private office.
(4) The licensed physical
therapist in the home health setting responsible for the patient shall
supervise the physical therapist assistant working with the patient and shall:
(a) perform
the initial patient evaluation to establish a physical therapy diagnosis, treatment
goals, frequency, duration, and plan of care;
(b) meet
with the assistant no less than once weekly to review all patients being
treated;
(c) document
all meetings with the assistant and subsequent decisions;
(d) make
an on-site visit to each patient being treated by the assistant as appropriate based
on the need to alter the treatment plan and no less than every sixth visit;
(e) document
the on-site visit, changes in the treatment plan, and communication to the assistant;
(f) be
available to the assistant at all times for advice, assistance, and instructions.
(5) A licensed physical
therapist shall be designated as the physical therapist assistant's supervisor
in the school setting and shall:
(a) perform
all physical therapy evaluations to develop or amend physical therapy
interventions stated on the student's
Individual Educational Plan (IEP) for the purpose of assisting with the
achievement of educational goals and objectives, including frequency and
duration of physical therapy services.
(b) make an on-site visit
to each student scheduled for direct weekly services from the physical
therapist assistant no less than every fourth scheduled week, and no less than once
every three months for students who are scheduled with the physical therapist assistant
once monthly or less. The on-site visit shall include, but not be limited to, a
case review, reassessment of the program and physical therapy services and
review of documentation prepared by the physical therapist assistant.
(c) document
the on-site visit including status of case(s), program or services status or change
and indicate instructions given to the physical therapist assistant.
(d) interact
with the physical therapist assistant in appropriate ways specific to the goals
and objectives stated in the IEP of the student who is scheduled for sessions
with the physical therapist assistant.
(e) be
available to the physical therapist assistant at all times for advice,
assistance and instructions.
490-5-.02 Adequate
Supervision Defined. Amended.
Adequate supervision by a
licensed physical therapist shall include the following:
(a) evaluate
each patient and interpret the results to determine and document a physical
therapy diagnosis;
(b) plan
each patient's treatment program and determine which elements thereof can be delegated
to the assistant;
(c) provide
periodic reevaluation of the treatment program and of the assistant's performance
in relation to the patient;
(d) perform
and record an evaluation of the patient and his response to treatment at the termination
thereof;
(e) Interact with the
assistant in appropriate ways specific to the plan of care of the patients
being treated by the assistant.
Chapter 490-8 Physical
Therapy Aides: Definition & Requirements
490-8-.01
Definition.
A physical therapy aide,
or anyone who holds himself out as being a physical therapy aide, is an
individual other than a licensee under O.C.G.A. 43-33 who aids the licensed physical
therapist or physical therapist assistant in the licensee's provision of
physical therapy services and whose activities do not require technical training
through a formal course of study.
490-8-.02
Supervision.
The physical therapy aide
must have direct supervision on the premises at all times when providing
supportive activities for the physical therapist or the physical therapist assistant.
(a) For purposes of this
rule, "direct supervision" shall mean on the premises and immediately
available at all times.
(b) For purposes of this
rule, "on the premises" shall mean the immediate area of the patient.
(c) A licensee of this
chapter may supervise a maximum of two (2) physical therapy aides when they are
aiding the licensee's provision of patient evaluation and intervention.
490-8-.03
Duties.
For purposes of this Rule,
the term, "designated physical therapy tasks," as referenced in O.C.G.A.
43-33-13.1, shall be limited to the following:
(a) Physical therapy aides
may perform the following tasks independent of supervision by a licensed
physical therapist or licensed physical therapist assistant:
1. Clerical tasks
excluding treatment documentation.
(i)"Treatment
Documentation" is defined for purposes of this Rule as the creation, generation,
composition of any patient care report and shall include but not be limited to patient
evaluations, assessment, plans of care, goals, progress notes, consultation reports,
discharge summaries and any other written materials related to patient
management.
(ii) Nothing in this Rule
shall preclude a physical therapy aide from transcribing, recording or copying
treatment documentation generated by a licensee of this chapter. Any treatment
documentation prepared in this or any manner, however, must be signed by the
supervising licensed physical therapist or physical therapist assistant and by signing
the treatment documentation, the licensee is representing that he or she either
prepared the treatment documentation or supervised a physical therapy aide in
the preparation of the treatment documentation consistent with the Laws and
Rules Governing the Practice of Physical Therapy in the State of Georgia.
2. transporting
patients;
3. assembling
and disassembling equipment in treatment areas;
4. housekeeping
activities
(b) The physical therapy
aide, at the discretion of the licensee, may provide supportive activities to
patient care when specifically meeting the criteria as set forth in 490-8-.02. Supportive
activities or patient care tasks do not include the direct provision of any patient
intervention, but do include only assisting a patient in preparation for
treatment by a licensee, assisting a patient after cessation of treatment by a
licensee, or assisting the licensee during treatment provided by that licensee.
Licensed physical therapists and physical therapist assistants are the only
providers of physical therapy.
Chapter 490-9 Code of
Ethics
490-9-.01
Purpose.
This code shall apply to
all licensed physical therapists, physical therapists assistants, and all
individuals recognized in the delivery of patient care under Chapter 33 of
Title 43 in the State of
490-9-.02
Principles of Conduct for Licensed Physical Therapists.
Any individual who is
licensed as a physical therapist shall abide by the following ethical standard:
(1) Act with
consideration, within the scope of physical therapy, for the rights and dignity
of all individuals.
(a) The physical therapist
shall hold as confidential information obtained while acting in a professional
capacity.
(b) The physical therapist
shall provide optimal physical therapy care for all patients regardless of
patient race, gender, age, religion, disability or sexual preference.
(c) The physical therapist
should balance considerations of the patient’s physical,
psychological and socioeconomic welfare
in professional decisions and actions and document these considerations in the
patient’s record of care.
(d) The physical therapist
shall communicate and interact with patients and all persons encountered in a
professional capacity with courteous regard and timeliness.
(e) The physical therapist
shall not engage in any behavior that constitutes harassment or abuse of a
patient, professional colleague or associate.
(2) Comply with the laws
and regulations governing the practice of physical therapy in the State of
(a) Physical therapists
are to practice (consultation, evaluations, treatment, research, education,
administration and preventive care) in accordance with the state practice act.
(3) Accept responsibility
for the exercise of sound judgment.
(a) When implementing
treatment, physical therapists shall assume the responsibility for evaluating
that individual; planning, implementing, and supervising the therapeutic program;
reevaluating and changing the program; and maintaining adequate records of the
case, including progress reports.
(b) When performing
wellness and preventative services, physical therapists shall assume
responsibility for providing optimal patient care.
(c) When the individual’s
needs are beyond the scope of the physical therapist’s
expertise, the physical therapist
shall so inform and assist the individual in identifying a qualified person to
provide the necessary services.
(d) When the physical
therapists judge that benefit can no longer be obtained from their services,
they shall so inform the individual receiving the services. It is unethical to initiate
or continue services that, in the therapist’s judgment, either cannot result in
beneficial outcome or are contraindicated.
(e) The physical
therapist’s ability to make independent judgment must not be limited or
compromised by professional affiliations, including employment relationships.
(f) Physical therapists
are not to delegate to a less qualified person any activity which requires the
unique skills, knowledge, and judgment of a physical therapist.
(g) The primary
responsibility for physical therapy care assisted by supportive personnel rests
with the supervising physical therapist. Adequate supervision requires, at a
minimum, that a supervising physical therapist perform the following
activities:
1. Establish effective
channels of written and oral communication;
2. Interpret and
communicate critical information about the patient to the supportive personnel;
3. Perform an initial
evaluation of the patient;
4. Develop a plan of care,
including short and long-term goals;
5. Delegate appropriate
tasks to supportive personnel;
6. Assess the supportive
personnel’s competence to perform assigned tasks;
7. Provide supervision in
accordance with the law, the patient’s condition, and the specific situation;
8. Identify and document
precautions, special programs, contraindications, goals, anticipated progress,
and plans for re-evaluation;
9. Re-evaluate the
patient, modify the plan of care when necessary, perform the final evaluation,
and establish a follow-up plan.
(h) Physical therapists
are obligated to advise their employer(s) of any practice which causes a
physical therapist to be in conflict with the ethical principles of this
section.
Physical therapists are to
attempt to rectify any aspect(s) of their employment which is in conflict with
the principles of this section.
(4) Seek remuneration for
their services that is deserved and reasonable.
(a) Fees for physical
therapy services should be reasonable for the service performed, considering
the setting in which it is provided, practice costs in
the geographic area, judgment of other organizations, and other relevant
factors.
(b) Physical therapists
shall not:
1. directly
or indirectly request, receive, or participate in the dividing, transferring, assigning,
or rebating of an unearned fee;
2. profit
by means of a credit or other valuable consideration, such as an unearned commission,
discount, or gratuity in connection with furnishing of physical therapy services;
3. use
influence upon individuals, or families of individuals under their care for utilization
of any product or service based upon the direct or indirect financial interest
of the physical therapist.
(5) Provide accurate
information to the consumer about the profession and the services provided.
(a) Physical therapists
are not to use, or participate in the use of, any form of communication
containing false, plagiarized, fraudulent, misleading, deceptive, or unfair statements.
(6) Accept the
responsibility to protect the public and the profession from unethical, incompetent,
or illegal acts.
(a) Physical therapists
shall report any activity which appears to be unethical, incompetent, or
illegal to the proper authorities.
(b) Physical therapists
shall not participate in any arrangement in which patients are exploited due to
the referring sources enhancing their personal incomes as a result of referring,
prescribing, or recommending physical therapy or a specific physical therapy practice.
(c) If a physical
therapist is involved in an arrangement with a referring source in which income
is derived from the services, the physical therapist has an obligation to
disclose to the patient, within the scope of the state law, the nature of the
income.
490-9-.03
Principles of Conduct for Licensed Physical Therapist Assistants.
Any individual who is
licensed as a physical therapist assistant shall abide by the
following ethical standards:
(1) Act with
consideration, within the scope of physical therapy, for the rights and dignity
of all individuals.
(a) The physical therapist
assistant shall hold as confidential information obtained while functioning as
a physical therapist assistant.
(b) The physical therapist
assistant shall provide optimal physical therapy care for all patients
delegated by the physical therapist regardless of patient race, gender, age, religion,
disability or sexual preference.
(c) The physical therapist
assistant should be aware of the patient's physical,
psychological and socioeconomic welfare
in decisions and actions taken while rendering treatment.
(d) The physical therapist
assistant shall communicate and interact with patients and all persons
encountered with courteous regard and timeliness.
(e) The physical therapist
assistant shall not engage in any behavior that constitutes harassment or abuse
of a patient, professional colleague or associate.
(2) Comply with the laws
and regulations governing the practice of physical therapy in the State of
(a) Physical therapist
assistants are to practice only under the supervision of a licensed physical
therapist.
(3) Accept responsibility
for the exercise of sound judgment.
(a) Upon accepting
delegation from a physical therapist, the physical therapist assistant shall
provide services within the plan of care established by the physical therapist.
(b) When the individual's
needs are beyond the scope of the physical therapist assistant's expertise, the
physical therapist assistant shall inform the supervising physical therapist.
(c) When the physical
therapist assistant determines that a change in the plan of care is needed, the
assistant will contact the supervising physical therapist and request reevaluation
of the patient's status.
(d) When the physical
therapist assistant determines that the patient has received maximum benefits
from physical therapy, he/she shall so inform the supervising physical therapist.
(e) Physical therapist
assistants are not to delegate to a less qualified person any activity which
requires the unique skills, knowledge, and judgment of a physical therapist assistant.
(f) The primary
responsibility for physical therapy care assisted by supportive personnel rests
with the supervising physical therapist. Adequate supervision is the
responsibility of both the physical therapist and the physical therapist
assistant. To insure appropriate supervision, the physical therapist assistant
is expected to:
1. Maintain effective
channels of written and oral communication.
2. Communicate critical
information about the patient to the supervising physical therapist in a timely
manner.
3. Function within the
established plan of care.
4. Identify and document
treatment activities and all special occurrences.
5. Request re-evaluation
of the patient and/or modification of the plan of care when necessary.
(g) Physical therapist
assistants are obligated to advise their employer(s) of any practice which
causes a physical therapist or a physical therapist assistant to be in conflict
with the ethical principles of this section. Physical therapist assistants are
to attempt to rectify any aspect(s) of their employment which is in conflict
with the principles of this section.
4. Seek remuneration for
their services that is deserved and reasonable.
(a) Physical therapist
assistants shall not:
1. Directly or indirectly
request, receive, or participate in the dividing, transferring, assigning, or
rebating of an unearned fee;
2. Profit by means of a
credit or other valuable consideration, such as an unearned commission,
discount, or gratuity in connection with furnishing of physical therapy services;
3. Use influence upon
individuals, or families of individuals under their care for utilization of any
product or service based upon the direct or indirect financial interest of the
physical therapist assistant;
(5) Provide accurate
information to the consumer about the profession and the services provided.
(a) Physical therapist
assistants are not to use, or participate in the use of, any form of communication
containing false, plagiarized, fraudulent, misleading, deceptive, or unfair statements.
(6) Accept the
responsibility to protect the public and the profession from unethical, incompetent,
or illegal acts.
(a) Physical therapist
assistants shall report any activity which appears to be unethical, incompetent,
or illegal to the proper authorities.
(b) Physical therapist
assistants shall not participate in any arrangement in which patients are
exploited due to the referring sources enhancing their personal incomes as a
result of referring, prescribing, or recommending physical therapy or a
specific physical therapy practice.
(c) If a physical
therapist assistant is involved in an arrangement with a referring source in
which income is derived from the services, the physical therapist assistant has
an obligation to disclose to the patient, within the scope of the State Law,
the nature of the income.
490-9-.04
Disciplinary Sanctions.
When providing physical
therapy treatment following appropriate consultation, unprofessional and
unethical conduct shall include but is not limited to the following:
(a) Failing to adhere to
the Code of Ethics for Physical Therapists and Physical
Therapists Assistants, as
codified in Rules 490-9-.01 through 490-9-.03.
(b) Delegating to an aide
or unlicensed person any physical therapy task other than those codified in
Chapter 490-8.
(c) Failing to provide
continuous, immediate and physically present supervision of the aide or
unlicensed person when designated tasks are performed.
(d) Failing to provide an
evaluation on each patient and establishing a physical therapy diagnosis.
(e) Failing to formulate
and record in the patient’s record a treatment program based upon the
evaluation and any other information available.
(f) Failing to perform
periodic evaluation of the patient and documenting the evaluations in the
patient’s record and to make adjustments to the patient’s treatment program as
progress warrants.
(g) Failing to formulate
and record a patient’s discharge plan.
(h) Directly or indirectly
requesting, receiving or participating in the division, transferring,
assigning, rebating or refunding of fees or remuneration earned, in cash or kind,
for bringing or referring a patient. For purposes of this Rule:
1. No physical therapist,
physical therapy assistant, employee or agent thereof acting on his behalf,
shall enter into or engage in any agreement or arrangement with any individual,
entity, or an employee or agent thereof acting on his behalf, for the payment or
acceptance or compensation in any form for the referral or recommending of the professional
services of either. This prohibition includes any form of fee division or charging
of fees solely for referral of a patient.
2. This prohibition shall
include a rebate or percentage of rental agreement or any arrangement or
agreement whereby the amount received in payment for furnishing space, facilities,
equipment or personnel services.
3. Provided further, that
this Rule shall not preclude a discount, waiver of co-payment or other
reduction in price of services by a physical therapist if the reduction in
price is properly disclosed to the consumer and third party payers and
appropriately reflected in the costs claimed or charges made.
Chapter 490-10 Preventive
Services
490-10-.01 Preventative Services.
A licensed physical
therapist or a licensed physical therapist assistant under the supervision of
an appropriately licensed physical therapist may perform Preventative services
that are not considered “implementing a program of physical therapy treatment without
consultation.” For purposes of this rule, “Preventative services” is defined as
the use of physical therapy knowledge and skills by a physical therapist or physical
therapist assistant to provide education or activities in a wellness or
community setting for the purpose of injury prevention, reduction of stress and
or the promotion of fitness, but does not include administration of physical
therapy treatment.
Chapter 490-11 Consultation
490-11-.01
Consultation.
(1) For purposes of
Official Code of Georgia Annotated, Section 43-33-18(a)(1):
(a)
"Consultation" shall mean provision of professional advice;
(b) "Appropriate
Licensed Practitioner of the Healing Arts" shall include properly licensed
practitioners in this or another state, whose consultation falls within the practitioner’s
legally authorized scope of practice;
(c) For purposes of
determining whether a licensed practitioner is appropriate, the physical therapist
shall consider, but not be limited to, the following factors:
1. Physical condition of
the patient;
2. Nature of ailment;
3. Extent to which the
consulting practitioner has knowledge of the patient’s history and condition
such that an informed judgment can be made concerning course of treatment.
(b) Physical therapists
shall document the consultation with the appropriate licensed practitioner of
the healing arts prior to implementing a program of physical therapy treatment.
Georgia
Patient Record Laws
31-33-1.
As used in this chapter, the term:
(1) 'Patient' means any person who has
received health care services from a provider.
(2) 'Provider' means all hospitals,
including public, private, osteopathic, and tuberculosis hospitals; other
special care units, including podiatric facilities, skilled nursing facilities,
and kidney disease treatment centers, including freestanding hemodialysis
units; intermediate care facilities; ambulatory surgical or obstetrical
facilities; health maintenance organizations; and home health agencies. It
shall also mean any person licensed to practice under Chapter 9, 11, 26, 34,
35, or 39 of Title 43.
(3) 'Record' means a patient´s health
record, including, but not limited to, evaluations, diagnoses, prognoses,
laboratory reports, X-rays, prescriptions, and other technical information used
in assessing the patient´s condition, or the pertinent portion of the record
relating to a specific condition or a summary of the record.
31-33-2.
(a)(1)(A) A provider having custody and
control of any evaluation, diagnosis, prognosis, laboratory report, or biopsy
slide in a patient´s record shall retain such item for a period of not less
than ten years from the date such item was created.
(B) The requirements of subparagraph
(A) of this paragraph shall not apply to:
(i) An individual provider who has
retired from or sold his or her professional practice if such provider has
notified the patient of such retirement or sale and offered to provide such
items in the patient´s record or copies thereof to another provider of the
patient´s choice and, if the patient so requests, to the patient; or
(ii) A hospital which is an
institution as defined in subparagraph (B) of paragraph
(1) of Code
Section
rules and regulations for hospitals as
issued by the department pursuant to Code
Section
(2) Upon written request from the
patient or a person authorized to have access to the patient´s record under a
health care power of attorney for such patient, the provider having custody and
control of the patient´s record shall furnish a complete and current copy of
that record, in accordance with the provisions of this Code section. If the
patient is deceased, such request may be made by a person authorized
immediately prior to the decedent´s death to have access to the patient´s
record under a health care power of attorney for such patient; the executor,
temporary executor, administrator, or temporary administrator for the
decedent´s estate; or any survivor, as defined by Code Sections 51-4-2, 51-4-4,
and 51-4-5.
(b) Any record requested under
subsection (a) of this Code section shall be furnished within a reasonable
period of time to the patient, any other provider designated by the patient, any
person authorized by paragraph (2) of subsection
(a)
of this Code section to request a patient´s or
deceased patient´s medical records, or any other person designated by the
patient.
(c) If the provider reasonably
determines that disclosure of the record to the patient will be detrimental to
the physical or mental health of the patient, the provider may refuse to
furnish the record; however, upon such refusal, the patient´s record shall,
upon written request by the patient, be furnished to any other provider
designated by the patient.
(d) A provider shall not be required
to release records in accordance with this
Code section unless and until the
requesting person has furnished the provider with a signed written
authorization indicating that he or she is authorized to have access to the
patient´s records by paragraph (2) of subsection (a) of this Code section. Any
provider shall be justified in relying upon such written authorization.
(e) Any provider or person who in good
faith releases copies of medical records in accordance with this Code section
shall not be found to have violated any criminal law or to be civilly liable to
the patient, the deceased patient´s estate, or to any other person.
31-33-3.
(a) The party requesting the patient´s
records shall be responsible to the provider for the costs of copying and
mailing the patient´s record. A charge of up to
$20.00 may be collected for search,
retrieval, and other direct administrative costs related to compliance with the
request under this chapter. A fee for certifying the medical records may also
be charged not to exceed $7.50 for each record certified. The actual cost of
postage incurred in mailing the requested records may also be charged. In
addition, copying costs for a record which is in paper form shall not exceed
$.75 per page for the first 20 pages of the patient´s records which are copied;
$.65 per page for pages 21 through 100; and $.50 for each page copied in excess
of 100 pages. All of the fees allowed by this Code section may be adjusted annually
in accordance with the medical component of the consumer price index. The
Office of Planning and Budget shall be responsible for calculating this annual
adjustment, which will become effective on July 1 of each year. To the extent
the request for medical records includes portions of records which are not in
paper form, including but not limited to radiology films, models, or fetal
monitoring strips, the provider shall be entitled to recover the full
reasonable cost of such reproduction. Payment of such costs may be required by
the provider prior to the records being furnished. This subsection shall not
apply to records requested in order to make or complete an application for a
disability benefits program.
(b) The rights granted to a patient or
other person under this chapter are in addition to any other rights such
patient or person may have relating to access to a patient´s records; however,
nothing in this chapter shall be construed as granting to a patient or person
any right of ownership in the records, as such records are owned by and are the
property of the provider.
31-33-4.
The provisions of this chapter shall
not apply to psychiatric, psychological, or other mental health records of a
patient.
31-33-5.
Any provider releasing information in
good faith pursuant to the provisions of this chapter shall not be civilly or
criminally liable to the patient, guardian, parent, or any other person for
such release.
31-33-6.
Nothing in this chapter shall be
construed as destroying or diminishing the privileged or confidential nature of
any communication now or hereafter recognized by law.
31-33-7.
(a) Notwithstanding the provisions of
Code Section 31-33-4, if a law enforcement officer employed by a governmental
entity is required to submit to a psychological or psychiatric examination for
the purpose of assessing the law enforcement officer´s fitness for duty,
employment status, or assignment of duties, then, upon the written request of
the law enforcement officer, the employer shall furnish to the law enforcement
officer a complete copy of the evaluation or report.
(b) Any employer or health care
provider furnishing or making a report or evaluation in good faith pursuant to
the provisions of this Code section shall not be civilly or criminally liable
to the law enforcement officer or any other person for furnishing or making
such report or evaluation.
(c) If an employer reasonably
determines that disclosure of the evaluation or report to the law enforcement
officer will be detrimental to the mental health of the law enforcement
officer, would present a risk of harm to other persons, would involve the
disclosure of confidential information or would violate the privacy of a third
party, then the employer may refuse to furnish the record of evaluation;
provided, however, that upon such refusal the evaluation or report shall, upon
written request by the law enforcement officer, be furnished by the employer to
a psychiatrist or psychologist treating the law enforcement officer.
Title
43, Chapter 1 General Provisions
§
43-1-19.1. Waiver
of deductibles or copayments in health insurance plans; deceptive or misleading
advertising
(a) For the purposes of applicable provisions of Code Section 43-1-19, it
shall be considered a deceptive or misleading practice for any person duly
licensed and authorized to provide any type of health care services to
advertise, as an inducement to attract patients, the waiver of a deductible or
copayment required to be made to such person under the patient's health
insurance policy or plan.
(b) This Code section shall not apply to nonprofit community health
centers which primarily serve indigent patients.
(c) Notwithstanding the provisions of any other law of this Code to the
contrary, it shall not be considered a misleading, fraudulent, or deceptive act
for a provider to waive occasionally such a deductible or copayment required to
be made under the patient's health insurance contract, policy, or plan if the
waiver is authorized by the insurer or if the waiver is based on an evaluation
of the individual patient and is not a regular business practice of the person
providing the health care services.
§
43-1-19.2. License
applications to include questions on prior revocation or denial of license
Each application for a license to practice a profession or business to be
issued by a professional licensing board or any agency of the state shall
include a question as to whether the applicant for such license:
(1) Has had revoked or suspended or otherwise sanctioned any license
issued to the applicant by any board or agency in Georgia or any other state;
or
(2) Was denied issuance of or, pursuant to disciplinary proceedings,
refused renewal of a license by any board or agency in Georgia or any other
state.
The question shall be answered under oath and the answer shall include the name
of the board or agency which revoked, suspended, denied, refused renewal of, or
otherwise sanctioned the license.
§ 43-1-20. Actions to enjoin
unlicensed practice
A professional licensing board, the division director,
or the appropriate prosecuting attorney may bring an action to enjoin the
unlicensed practice by any person of a profession or business required to be
licensed by a professional licensing board. The action to restrain and enjoin
such unlicensed practice shall be brought in the superior court of the county
where the unlicensed person resides. It shall not be necessary to allege or
prove that there is no adequate remedy at law to obtain an injunction under
this Code section.
§ 43-1-20.1. Cease and desist orders
against persons practicing without a license; fine for violating order
(a) Notwithstanding any other provisions of the law to the contrary, after
notice and hearing, a professional licensing board may issue a cease and desist
order prohibiting any person from violating the provisions of this title by
engaging in the practice of a business or profession without a license.
(b) The violation of any cease and desist order of a professional
licensing board issued under subsection (a) of this Code section shall subject
the person violating the order to further proceedings before the board, and the
board shall be authorized to impose a fine not to exceed $500.00 for each
transaction constituting a violation thereof. Each day that a person practices
in violation of this title shall constitute a separate violation.
(c) Initial judicial review of the decision of the board entered pursuant
to this Code section shall be available solely in the superior court of the
county of domicile of the board.
(d) Nothing in this Code section shall be construed to prohibit a
professional licensing board from seeking remedies otherwise available by
statute without first seeking a cease and desist order
in accordance with the provisions of this Code section.
§ 43-1-21. Release of information
regarding investigations
The division director is authorized to provide to any lawful licensing
authority of this or any other state, upon inquiry by such authority,
information regarding a past or pending investigation of or disciplinary
sanction against any applicant for licensure by that board or licensee of that
board notwithstanding the provisions of subsection (h) of Code Section 43-1-19
or any other law to the contrary regarding the confidentiality of that
information. Nothing in this Code section or chapter shall be construed to
prohibit or limit the authority of that director to disclose to any person or
entity information concerning the existence of any investigation for unlicensed
practice being conducted against any person who is neither licensed nor an
applicant for licensure by a professional licensing board.
§ 43-1-22. Inactive status licenses
The division director may provide for inactive status
licenses for the various professional licensing boards.
§ 43-1-23. Exemption
of licensees of professional licensing boards from filing with clerk of
superior court.
No licensee of a professional licensing board shall be required to file or
record his license with the clerk of the superior court, and no clerk shall be
required to report the filing or recordation of any such license.
§ 43-1-24. Licensed professionals
subject to regulation by professional licensing board
Any person licensed by a professional licensing board and who practices a
"profession," as defined in Chapter 7 of Title 14, the "Georgia
Professional Corporation Act," or who renders "professional
services," as defined in Chapter 10 of Title 14, "The Georgia
Professional Association Act," whether such person is practicing or
rendering services as a proprietorship, partnership, professional corporation,
professional association, other corporation, limited liability company, or any
other business entity, shall remain subject to regulation by that professional
licensing board, and such practice or rendering of services in that business
entity shall not change the law or existing standards applicable to the
relationship between that person rendering a professional service and the
person receiving such service, including but not limited to the rules of
privileged communication and the contract, tort, and other legal liabilities
and professional relationships between such persons.
§ 43-1-25. Authority of professional
licensing boards to promulgate rules and regulations
Except as provided in subsection (o) of Code Section 43-1-19, Code Sections
43-1-16 through 43-1-24 shall apply to all professional licensing boards and
licenses thereunder, except the Georgia Real Estate Commission and its
licensees, notwithstanding any other law to the contrary, and each such
professional licensing board may promulgate rules and regulations to implement
the authority provided by the applicability of said provisions to said boards.
§
43-1-26. Exemption
of credentialed persons from licensure, registration, or certification in the
state in connection with the Olympic and Paralympic Games; conditions and
limitations; consent for certain medical services; automatic repeal
Repealed by Ga. L. 1994, p. 480, § 1, effective
§
43-1-27. Licensee
required to notify licensing authority of felony conviction
Any licensed individual who is convicted under the laws of this state, the
United States, or any other state, territory, or country of a felony as defined
in paragraph (3) of subsection (a) of Code Section 43-1-19 shall be required to
notify the appropriate licensing authority of the conviction within ten days of
the conviction. The failure of a licensed individual to notify the appropriate
licensing authority of a conviction shall be considered grounds for revocation
of his or her license, permit, registration, certification, or other
authorization to conduct a licensed profession.
HIPAA
In April 2001, at the direction of President Bush and
Congress
required
Covered Entities
As required by HIPAA, the final regulation covers health plans, health care
clearinghouses, and those health care providers who conduct certain financial
and administrative transactions (e.g., enrollment, billing and eligibility
verification) electronically.
Information Protected
Medical records and other individually identifiable health information used or
disclosed by a covered entity in any form, whether electronically, on paper, or
orally, are covered by the final rule.
Consumer Control Over
Health Information
Under the final rule, patients have significant new rights to understand and
control how their health information is used.
Boundaries on Medical
Record Use and Release
With few exceptions, an individual’s health information may only be used for
their health care and related purposes unless the individual specifically
authorizes its use for another purpose.
Safeguards for Personal
Health Information
The final rule establishes the privacy safeguard standards that covered
entities must meet. The requirements are flexible and scalable to account for
the nature of each entity’s business, and its size and resources. Covered
entities generally will have to:
Accountability for Medical
Records Use and Release
In HIPAA, Congress provided penalties for covered entities that misuse personal
health information.
Balancing
Public Responsibility with Privacy Protections
In limited circumstances, the final rule permits – but does not require –
covered entities to continue certain existing disclosures of health information
without individual authorization for specific public responsibilities.
These permitted disclosures
include: emergency circumstances; identification of the body of a deceased
person, or the cause of death; public health needs; research, generally limited
to when a waiver of authorization is independently approved by a privacy board
or Institutional Review Board; oversight of the health care system; judicial
and administrative proceedings; limited law enforcement activities; and
activities related to national defense and security.
The privacy rule generally
establishes new safeguards and limits on these disclosures. If there is no
other law requiring that information be disclosed, covered entities will use
their professional judgments to decide whether to disclose any information,
reflecting their own policies and ethical principles.
Equivalent Requirements
for Government Entities
The provisions of the final rule generally apply equally to private sector and
public sector entities that are covered by the law. For example, both private
hospitals and government medical units have to comply with the full range of
requirements, such as providing notice, access rights and designation of a
privacy officer.
Preserving
Existing,
Ethical & Legal
Considerations
1. Confidentiality
The
information contained in each patient’s medical record must be safeguarded
against disclosure or exposure to nonproprietary individuals. The right to know any medical information
about another is always predicated on a sound demonstration of need. Frequently, many individuals require access
to information contained in a patient’s medical record. Their right to access
this information is limited to only that information which is deemed necessary
for them perform their job in a safe, effective, and responsible manner.
Case Study
John Jones PT, Sue Brown (therapy receptionist),
and Mary Smith (Therapy managed care contracting), are in a private PT office
discussing the fact that they are treating Biff Simpson, a star NFL
quarterback. John says, “I can’t believe
that I’m actually treating Biff Simpson.”
Mary asks, “How bad do you think his injury is?” John replies, “I saw his
Is this a breach in confidentiality?
The
first questions we must ask are “What information is being disclosed and do the
three individuals engaged in the conversation have a need to know this
information?”
John’s
first statement discloses the name of person receiving care, and his second
statement reveals private patient medical information. Certainly, as the primary therapist, John
would need to know the patient’s name and therapy related diagnosis in order to
provide care. Sue, the receptionist, may
also need this information to schedule appointments and perform other essential
clerical tasks. Mary, whose job it is to contract with managed care
organizations, most likely has no compelling reason to know either the
patient’s identity or any of his medical information. Therefore, the disclosure
to Mary of the patient’s identity and medical information is a breach of
patient confidentiality.
2. Care Provided By Qualified Individuals
The
practice of physical therapy is closely regulated throughout the
Case Study
You work in very busy outpatient rehab clinic. One of your coworkers is a physical therapy
aide who has worked in rehabilitation for more than 20 years. Frequently, she is called upon to perform
treatments that should be done by a PT or
Is the clinic providing ethical care to its
patients?
The
answer is no. In this situation, the
aide’s abilities and outcomes are considered irrelevant. The key sentence in the paragraph is:
“perform treatments that should be done by a PT or
3. Informed Consent
Informed
consent is the process by which a fully informed patient can participate in
choices about their health care. It originates from the legal and ethical right
the patient has to direct what happens to their body and from the ethical duty
of the therapist to involve the patient in her health care.
The
most important goal of informed consent is that the patient has an opportunity
to be an informed participant in their health care decisions. It is generally
accepted that complete informed consent includes a discussion of the following
elements:
·
the
nature of the decision/procedure
·
reasonable
alternatives to the proposed intervention
·
the
relevant risks, benefits, and uncertainties related to each alternative
·
the
consequences on non-treatment
·
the
goals of treatment
·
the
prognosis for achieving the goals
·
assessment
of patient understanding
·
the
acceptance of the intervention by the patient
In
order for the patient’s consent to be valid, they must be considered competent to
make the decision at hand and their consent must be voluntary. It is easy for
coercive situations to arise in medicine. Patients often feel powerless and
vulnerable. The therapist should make clear to the patient that they are
participating in a decision, not merely signing a form. With this
understanding, the informed consent process should be seen as an invitation for
them to participate in their health care decisions. The therapist is also
generally obligated to provide a recommendation and share their reasoning
process with the patient. Comprehension on the part of the patient is equally
as important as the information provided. Consequently, the discussion should
be carried on in layperson’s terms and the patient’s understanding should be
assessed along the way.
Case Study
Sam is a PT who has just received orders to begin
ambulation with a 75-year-old woman who is s/p right hip ORIF. He goes to her hospital room to evaluate her
and begin ambulation. She says she does
not want therapy today because she is in too much pain. Sam explains to her that the doctor has left
orders for her to begin walking. The
patient refuses. Sam leaves and returns
the next day to try again. Again, she
declines treatment and he leaves.
Under the guidelines of informed consent, were the
therapist’s actions adequate?
The
therapist’s actions were not sufficient.
None of the required information was offered to the patient. The most
important thing the therapist failed to explain to the patient was the
consequences of non-treatment. The
patient cannot make an informed decision regarding therapy without this
information. It could be argued that her
decision to refuse therapy may have changed had she known that one of the
consequences of this decision could be the development of secondary
complications. (i.e. increased risk of morbidity or
mortality)
4. Care Based on Medical Necessity
Therapists
are obligated to propose and provide care that is based on sound medical
rationale, patient medical necessity, and treatment efficacy and
efficiency. It is unethical to either
alter or withhold care based on other extraneous factors without the patient’s
knowledge and consent.
Case Study
Steve is a physical therapist and owns his own
therapy clinic. He recently signed a
contract with an HMO to provide physical therapy services. The contract stipulates that Steve will be
compensated on a case rate basis. (A
fixed amount of money per patient, based on diagnosis) Steve has performed a thorough cost analysis
on this contract and has determined that the financial “breakeven” point
(revenue equals expenses) on each of these patients is 5 visits. He informs his staff that all patients
covered by this insurance must be discharged by their fourth visit.
Is limiting care in this manner ethical?
No,
it is not ethical. In this instance, the
quantity of care is not being determined by the medical necessity of the
patient. A therapist must be able to
justify all of their professional decisions (such as the discharging of a
patient from clinical care) based on sound clinical rationale and
practices. This principle is clearly
defined in the APTA’s Guide for Professional Conduct, Principle 7.1c
Billing & Coding
The Triad
Ethical conduct as it relates to billing and coding for
rehab services, revolves around one ideological triad. The triad being: What was performed = What
was documented = What was billed. All
three components of the triad must always be identical. A clinician must be sure never to perform one
service, and then document it or bill it as something different. To do so, represents a fraud and it subjects
the therapist to possible prosecution.
Case Study
A Physical Therapy office began offering free massages.
Everyday the facility was overflowing with patients. Everyone enjoyed the free
massages and visited frequently. The therapists were able to provide this service
to all of the patients for “free” because they waived the massage recipient’s mandatory
co-pay and deductible, and then billed the patient’s insurance.
Is it legal to waive a patient’s co-pay/deductible and
bill only the insurance company?
No, it is not legal. All co-payments and deductibles must
be collected. In most instances, the
decision on whether or not to collect this money cannot be made by the provider. The reason for this is quite simple. When a patient purchases a health insurance
policy, (either as an individual or through a group plan), they are signing a
legal contract that contains specific terms and stipulations. Typically, the cost of the policyholder’s
monthly premiums is based on the amount of coverage they have purchased and
also the amount of co-payment and deductible.
A high co-payment/deductible results in a lower monthly premium. Conversely, a low co-payment/deductible will
result in a higher monthly premium. By
not collecting the co-payment/deductible, the therapist is effectively
conspiring with the patient to defraud their insurance company. (After all, doesn’t the insurance company
have a legitimate argument that the patient should be paying a higher monthly
premium if they don’t have to pay a co-payment or deductible?) The common response given by providers is
“Why should the insurance company care, I’m the one who is not getting paid?” That is true; however, ultimately, the
insurance company ends up paying out more because the patient, without any
financial responsibility, will usually attend more therapy sessions.
Conflicts of Interest
A conflict of interest is a situation in which a person
has a private or personal interest that influences the objective exercise of
his or her professional duties. As a professional you take on certain
responsibilities and obligations to patients, employers, and others. These
obligations must take precedence over a therapist’s private or personal
interests.
In addition to avoiding all real instances of conflict of
interest, therapists must also avoid any apparent or potential conflicts as
well.
An apparent conflict of interest is one in which a
reasonable person would think that the professional’s judgment is likely to be
compromised, and a potential conflict of interest involves a situation that may
develop into an actual conflict of interest.
How do you determine if you are in a conflict of
interest, whether actual, apparent, or potential? The key is to determine
whether the situation you are in interferes or is likely to interfere with your
independent judgment. A good test is the ‘trust test’: Would relevant others
[my employer, my patients, professional colleagues, or the general public]
trust my judgment if they knew I was in this situation. Trust is at the ethical
heart or core of this issue. Conflicts of interest involve the abuse, actual or
potential, of the trust people have placed in professionals. This is why
conflicts of interest not only injure particular patients and employers, but
they also damage the whole profession by reducing the trust people generally
have in therapists.
Case Study
Debi Jones PT
works in an acute care hospital. She is
meeting with a vendor whose company is introducing a new brace onto the
market. He offers her 3 free braces to
“try out” on patients. The vendor states
that if Debi continues to order more braces, she will qualify to receive
compensation from his company by automatically becoming a member of its
National Clinical Assessment Panel.
Does this
represent a conflict of interest?
Yes, there exists a conflict of interest in this
situation. Debi has two primary
obligations to fulfill. The first is to
her patient. It is her professional duty to recommend to her patient a brace
that, in her judgment, will benefit them the most. The second obligation is to her employer, the
hospital. As an employee of the hospital
it is her responsibility to manage expenses by thoroughly and objectively seeking
effective products that also demonstrate economic efficiency. The conflict of interest occurs when she
begins to accept compensation from the vendor in direct or indirect response
for her brace orders. Even if she truly
believes it is the best brace for her patient, and it is the most cost
effective brace the hospital could purchase, by accepting the money she has
established at least an apparent conflict of interest. Under this situation she is obligated to disclose
to all parties her financial interest in ordering the braces. This disclosure
is necessitated because the potential for personal gain would make others
rightfully question whether her objectivity was being influenced.
Relationships
Referral Sources
It is unethical for a physical therapist to offer anything of value to physicians or any
other referral source in direct
response for the referral of patients or services. This includes
cash, rebates, gifts, discounts, reduced rent, services, equipment, employees,
or marketing. Many mistakenly believe
that it is a normal acceptable business practice to offer these things to
referral sources. It is not. In most states, the practice is not only
unethical, but it is also illegal. Exchanges
of valued items or services between therapists and referral sources must never have any relationship to the
referral of patients.
Goodwill gifts of nominal value are acceptable provided that no
correlation can be made between the magnitude or
frequency of the gift giving and referral patterns. All business agreements and transactions
should always be well documented and most importantly, reflect fair market value.
Case Study
Larry Jones PT
owns a private practice. Business has
been poor. He decides to sublease half of his space to an orthopedic surgeon. Larry’s current lease is at $20/sq ft. The
doctor wants to pay $15/sq ft. They come to a compromise of $17/sq ft. Larry
also agrees that if the doctor is his top referral source after 3 months, he’ll
make him the Medical Director of the facility and pay him a salary of
$500/month.
Is this an ethical arrangement?
No, this agreement is not ethical. The most notable infraction involves offering
to designate the physician as Medical Director contingent
upon the number of referrals he sends.
This is undeniably a direct offer of cash for patients. Another area of concern is the rent. At first glance, the rent amount of $17/sq ft
seems fair because it was a compromise between the two parties. However, closer scrutiny reveals this to be
unethical. The fair market value for
rent has been established as $20/ft.
(Larry’s current rental agreement with his landlord) By discounting the doctor $3/sq ft on his
rent, Larry is giving a referral source something of value.
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ETHICS
& JURISPRUDENCE –
POST-TEST
10. Which of the
following is NOT generally considered to be a required element of Informed
Consent?
A. Discussion of consequences of
non-treatment
B. Consensus of family members
C. Assessment of patient understanding
D. Acceptance of the intervention by the
patient (or legal custodian)