ETHICS AND
JURISPRUDENCE
GOALS AND OBJECTIVES
COURSE
DESCRIPTION
“Ethics and Jurisprudence” is a home study continuing education program
for
COURSE
RATIONALE
This course was developed to educate, promote and facilitate ethical and
legal behavior by
COURSE GOALS AND 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
Wisconsin Physical Therapy Practice Act (Chapter 448, Subchapter III) and the
Wisconsin Rules Governing the Practice of Physical Therapy
4.
evaluate their
current physical therapy practices to ensure compliance with all relevant
5.
understand the principles
of the APTA’s Code of Ethics and Guide for Professional Conduct
6.
incorporate the
principles of the APTA’s Code of Ethics and Guide for Professional conduct into
their professional practice activities
7.
understand
patients’ rights relating to privacy of information as defined by the Federal
HIPAA statutes
8.
analyze and
interpret clinical situations to determine appropriate professional ethical
behavior.
COURSE
INSTRUCTOR
Michael Niss, DPT
METHODS OF
INSTRUCTION
Home study course available via internet or written correspondence.
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 12 pages of written
text (12 pt font) per hour. The complete
text of this course is 49 pages (excluding Bibliography and Post Test)
OUTLINE
page
Goals and
Objectives 1 start
hour 1
Outline 2
Ethics
Overview 3
Why Ethics are Important 3
Ethics vs. Morals 3
Ethical Questions 3
Ethics
Theories 3-6
Utilitarianism 4
Social Contract Theory 4-5
Deontological Theory 5
Ethical Intuitionism 5
Ethical Egoism 5
Natural Law Theory 5
Virtue Ethics 5-6
How to Make
Right Decisions 6-7
Wisconsin
Board of PT Rules 14-27 start/end
hour 2
APTA Code of
Ethics 27-28 start
hour 3
APTA Guide
for Professional Conduct 28-39
Physical Therapist 28-37
Physical Therapist Assistant 37-40 end
hour 3
HIPAA 40-43 start
hour 4
Case Studies 43-49
Case Study #1 – Confidentiality 43
Case study #2 – Qualifications of
Practice 44
Case Study #3 – Informed Consent 44-45
Case Study #4 – Medical Necessity 45-46
Case Study #5 – Billing Coding 46-47
Case Study #6 – Conflict of Interest 47-48
Case Study #7 – Relationships with
Referral Sources 48-49
References 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.
Why Ethics are Important
Ethics
are important on several levels.
- People feel better about themselves and their
profession when they work in an ethical manner.
- Professions recognize that their credibility rests not only on
technical competence, but also on public trust.
- At the organizational level, ethics is good business. Several
studies have shown that over the long run ethical businesses perform
better than unethical businesses.
Ethics vs. 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”.
ETHICS THEORIES
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 is 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.
Thomas Hobbes – Hobbes believed that people were by nature
self-interested. Prior to the creation of society, these people live in the
state of nature which is a state of war. Every person is out for their own
purposes and good. There is no morality in the state of nature. Everyone in the
state of nature has the right of nature in which nothing is prohibited which
promotes your self-interest. Furthermore there is a law of nature which states
that all people act to preserve their own lives, therefore, it is acceptable to
do whatever is necessary to protect and defend their lives. This is why the
first law of nature is to leave the state of nature. The drive for
self-preservation dictates that persons need social relationships for the
purpose of protection. Rationally self-interested individuals realize that they
are more likely to be able to sustain and protect themselves if they have
arrangements with other individuals with whom they agree to share goods, as
well as cooperate and defend one another. So these people give up their right
of nature to establish society. Then they establish a sovereign who establishes
the rules governing conduct, making sure everyone abides by their agreements,
and enforces the rules and agreements so that everyone is able to live in
peace.
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.
Deontological or Duty Theory
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).
Ethical Intuitionism
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.
Ethical Egoism
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.
Virtue Ethics
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.
HOW TO MAKE RIGHT DECISIONS
The foundation for making proper ethical decisions is
rooted in an individual’s ability to answer several fundamental questions
concerning their actions.
- Is it legal?
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.
- Is it ethical?
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
documented in the APTA’s Code of Ethics.
All PT’s and PTA’s, even those who are not members of the APTA, are
bound to these guidelines. This is because The APTA Code of Ethics is the
accepted and de facto standard of practice throughout the profession.
- Is it fair?
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.
- Would you want others to know of your decision?
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.
Chapter
448, Subchapter III
(
448.50
Definitions.
448.50(1r)
”Diagnosis” means a judgment that is made after examining the
neuromusculoskeletal system or evaluating or studying its symptoms and that
utilizes the techniques and science of physical therapy for the purpose of
establishing a plan of therapeutic intervention, but does not include a
chiropractic or medical diagnosis.
448.50(3)
”Physical therapist” means an individual who has been graduated from a school
of physical therapy and holds a license to practice physical therapy granted by
the affiliated credentialing board.
448.50(3m)
”Physical therapist assistant” means an individual who holds a license as a
physical therapist assistant granted by the affiliated credentialing board.
448.50(4)(a)
(a) “Physical therapy” means any of the following:
1. Examining, evaluating, or testing individuals with mechanical,
physiological, or developmental impairments, functional limitations related to
physical movement and mobility, disabilities, or other movement-related health
conditions, in order to determine a diagnosis, prognosis, or plan of
therapeutic intervention or to assess the ongoing effects of
intervention. In this subdivision, “testing” means using standardized
methods or techniques for gathering data about a patient.
2. Alleviating impairments or functional limitations by instructing
patients or designing, implementing, or modifying therapeutic interventions.
3. Reducing the risk of injury, impairment, functional limitation, or
disability, including by promoting or maintaining fitness, health, or quality
of life in all age populations.
4. Engaging in administration, consultation, or research
448.50(4)(b)
(b) “Physical therapy” does not include using roentgen rays or radium for
any purpose, using electricity for surgical purposes, including cauterization,
or prescribing drugs or devices.
448.50(5)
”Sexual misconduct with a patient” means any of the following:
(a) Engaging in or soliciting a consensual or
nonconsensual sexual relationship with a patient.
(b) Making sexual advances toward, requesting
sexual favors from, or engaging in other verbal conduct or physical contact of
a sexual nature with a patient.
(c) Intentionally viewing a completely or partially disrobed patient
during the course of treatment if the viewing is not related to diagnosis or
treatment.
448.50(6)
”Therapeutic intervention” means the purposeful and skilled interaction between
a physical therapist, patient, and, if appropriate, individuals involved in the
patient’s care, using physical therapy procedures or techniques that are intended
to produce changes in the patient’s condition and that are consistent with
diagnosis and prognosis.
448.50 – ANNOT.
Physical therapists and massage therapists are
not prohibited from performing the activities that are within their respective
scopes of practice, even if those activities extend in some degree into the
field of chiropractic science. OAG 1-01.
448.51 License required.
(1) No person may practice physical therapy unless the person is
licensed as a physical therapist under this subchapter.
(1e) No person may designate himself or herself as a physical therapist
or use or assume the title “physical therapist,” “physiotherapist,” “physical
therapy technician,” “licensed physical therapist,” “registered physical
therapist,” “master of physical therapy,” “master of science in physical
therapy,” or “doctorate in physical therapy,” or append to the person’s name
the letters “P.T.,” “P.T.T.,” “L.P.T.,” “R.P.T.,” “M.P.T.,” “M.S.P.T.,” or “D.P.T.,”
or any other title, letters, or designation that represents or may tend to
represent the person as a physical therapist, unless the person is licensed as
a physical therapist under this subchapter.
(1s) No person may designate himself or herself as a physical therapist
assistant, use or assume the title “physical therapist assistant,” or append to
the person’s name the letters “P.T.A.” or any other title, letters, or
designation that represents or may tend to represent the person as a physical
therapist assistant unless the person is licensed as a physical therapist assistant
under this subchapter.
(a) In this subsection, “advertisement” includes advertisements that
appear on outdoor signs, in print or electronic media, and in material mailed
to a person other than a patient, client, or prospective patient or client who
has requested the material.
(b) No person may claim to render physical therapy or physiotherapy
services unless the person is licensed as a physical therapist under this
subchapter.
448.52 Applicability.
(1m) A license is not required under this subchapter for any of the
following, if the person does not claim to render physical therapy or
physiotherapy services:
(a) Any person lawfully practicing within the scope of a license, permit,
registration or certification granted by this state or the federal government.
(b) Any person assisting a physical therapist in practice under the
direct, on-premises supervision of the physical therapist.
(c) A physical therapy student assisting a physical therapist in the
practice of physical therapy or a physical therapist assistant student
assisting a physical therapist in performing physical therapy procedures and
related tasks, if the assistance is within the scope of the student’s education
or training.
(d) A physical therapist who is licensed to practice physical therapy in
another state or country and is providing a consultation or demonstration with
a physical therapist who is licensed under this subchapter.
(2m) A license is not required under this subchapter for any of the
following:
(a) Except as provided in par.
(b), a chiropractor licensed under ch.
446 claiming to render physical therapy, if the physical therapy is provided by
a physical therapist employed by the chiropractor.
(b) A chiropractor licensed under ch.
446 claiming to render physical therapy modality services.
448.522 Manipulation services. A physical therapist may not
claim that any manipulation service that he or she provides is in any manner a
chiropractic adjustment that is employed to correct a spinal subluxation.
448.527 Code of ethics. The affiliated credentialing board
shall promulgate rules establishing a code of ethics governing the professional
conduct of physical therapists and physical therapist assistants.
448.53 Licensure of physical therapists.
(1) The affiliated credentialing board shall grant a license as a
physical therapist to a person who does all of the following:
(a) Submits an application for the license to the department on a form
provided by the department.
(b) Pays the fee specified in s.
440.05 (1)
(c) Submits evidence satisfactory to the affiliated credentialing board
that the applicant does not have an arrest or conviction record.
(d) Submits evidence satisfactory to the affiliated credentialing board
that the applicant is a graduate of a school of physical therapy approved by
the affiliated credentialing board, unless the affiliated credentialing
board waives this requirement under sub.
(3).
448.535 Licensure of physical therapist assistants.
(1) The affiliated credentialing board shall grant
a license as a physical therapist assistant to a person who does all of the
following:
(a) Submits an application for the license to the department on a form
provided by the department.
(b) Pays the fee specified in s.
440.05 (1).
(c) Submits evidence satisfactory to the affiliated credentialing board
that the applicant does not have an arrest or conviction record.
(d) Submits evidence satisfactory to the affiliated credentialing board
that the applicant is a graduate of a physical therapist assistant educational
program accredited by an agency that is approved by the affiliated
credentialing board.
(e) Passes an examination under s.
448.54.
(2) The affiliated credentialing board may waive a requirement under sub.
(1) (d) or (e),
or both, for an applicant who establishes to the satisfaction of the affiliated
credentialing board that he or she is licensed as a physical therapist
assistant by another licensing jurisdiction in the United States. The
affiliated credentialing board shall promulgate rules for granting a waiver
under this subsection. The rules may require an applicant to satisfy
additional requirements as a condition for granting a waiver.
448.54 Examination.
(1) The affiliated credentialing board shall conduct or arrange for
examinations for physical therapist and physical therapist assistant licensure
at least semiannually and at times and places determined by the affiliated
credentialing board.
(2)(a) Except as provided in sub.
(3) examinations for physical therapist licensure shall consist of written or
oral tests, or both, requiring applicants to demonstrate minimum competency in
subjects substantially related to the practice of physical therapy.
(b) Examinations for physical therapist assistant licensure shall consist
of written or oral tests, or both, requiring applicants to demonstrate minimum
competency in the technical application of physical therapy services.
(3) Notwithstanding s.
448.53 (1) (f), the affiliated credentialing board may not require an applicant
for physical therapist licensure to take an oral examination or an examination
to test proficiency in the English language for the sole reason that the
applicant was educated at a physical therapy school that is not in the United
States if the applicant establishes, to the satisfaction of the affiliated
credentialing board, that he or she satisfies the requirements under s.
448.53 (3).
448.55 Issuance of license; expiration and renewal.
(1) The department shall issue a certificate of licensure to each person
who is licensed under this subchapter.
(2) The renewal dates for licenses granted under this subchapter, other
than temporary licenses granted under rules promulgated under s.
448.53 (2), are specified under s.
440.08 (2) (a). Renewal applications shall be submitted to the department
on a form provided by the department and shall include the renewal fee
specified in s.
440.08 (2) (a) and proof of compliance with the requirements established in any
rules promulgated under sub.
(3).
(3) The affiliated credentialing board shall promulgate rules that
require an applicant for renewal of a license to demonstrate continued
competence as a physical therapist or physical therapist assistant.
448.56 Practice requirements.
(1) Written referral. Except as provided in this subsection
and s.
448.52, a person may practice physical therapy only upon the written referral
of a physician, chiropractor, dentist or podiatrist. Written referral is
not required if a physical therapist provides services in schools to children
with disabilities, as defined in s.
115.76 (5), provides services as part of a home health care agency; provides
services to a patient in a nursing home pursuant to the patient’s plan of care;
provides services related to athletic activities, conditioning or injury
prevention; or provides services to an individual for a previously diagnosed
medical condition after informing the individual’s physician, chiropractor,
dentist or podiatrist who made the diagnosis. The affiliated
credentialing board may promulgate rules establishing additional services that
are excepted from the written referral requirements of this subsection.
(1m)(a) Duty to refer.
(a) A physical therapist shall refer a patient to an appropriate health
care practitioner if the physical therapist has reasonable cause to believe
that symptoms or conditions are present that require services beyond the scope
of the practice of physical therapy.
(b) The affiliated credentialing board shall promulgate rules
establishing the requirements that a physical therapist must satisfy if a
physician, chiropractor, dentist, or podiatrist makes a written referral under sub.
(1). The purpose of the rules shall be to ensure continuity of care
between the physical therapist and the health care practitioner.
(2) Fee splitting. No licensee may give or receive,
directly or indirectly, to or from any other person any fee, commission, rebate
or other form of compensation or anything of value for sending, referring or
otherwise inducing a person to communicate with a licensee in a professional capacity,
or for any professional services not actually rendered personally by the
licensee or at the licensee’s direction.
(3) Billing by professional partnerships and corporations.
If 2 or more physical therapists have entered into a bona fide partnership or
have formed a service corporation for the practice of physical therapy, the
partnership or corporation may not render a single bill for physical therapy
services provided in the name of the partnership or corporation unless each
physical therapist who provided services that are identified on the bill is
identified on the bill as having rendered those services.
(4) Responsibility. A physical therapist is responsible for
managing all aspects of the physical therapy care of each patient under his or
her care.
(5) Patient records. A physical therapist shall create and
maintain a patient record for every patient the physical therapist examines or
treats.
(6) Physical therapist assistants. A physical therapist
assistant may assist a physical therapist in the practice of physical therapy
if the physical therapist provides direct or general supervision of the
physical therapist assistant. The affiliated credentialing board shall
promulgate rules defining “direct or general supervision” for purposes of this
subsection. Nothing in this subsection interferes with delegation
authority under any other provision of this chapter.
448.565 Complaints. The affiliated credentialing board
shall promulgate rules establishing procedures and requirements for filing
complaints against licensees and shall publicize the procedures and
requirements.
448.567 Performance audits. The affiliated credentialing
board shall promulgate rules that require the affiliated credentialing board on
a periodic basis to conduct performance self-audits of its activities under
this subchapter.
448.57 Disciplinary proceedings and actions.
(1) Subject to the rules promulgated under s.
440.03 (1), the affiliated credentialing board may make investigations and
conduct hearings to determine whether a violation of this subchapter or any
rule promulgated under this subchapter has occurred.
(2) Subject to the rules promulgated under s.
440.03 (1), the affiliated credentialing board may reprimand a licensee or may
deny, limit, suspend or revoke a license granted under this subchapter if it
finds that the applicant or licensee has done any of the following:
(a) Made a material misstatement in an
application for a license or for renewal of a license.
(am) Interfered with an investigation or disciplinary proceeding by using
threats, harassment, or intentional misrepresentation of facts.
(b) Been convicted of an offense the circumstances of which substantially
relate to the practice of physical therapy or assisting in the practice of
physical therapy.
(bm) Been adjudicated mentally incompetent by a court.
(c) Advertised in a manner that is false, deceptive or misleading.
(d) Advertised, practiced or attempted to practice under another’s name.
(e) Practiced or assisted in the practice of physical therapy while the
applicant’s or licensee’s ability to practice or assist was impaired by alcohol
or other drugs.
(f) Engaged in unprofessional or unethical conduct in violation of the
code of ethics established in the rules.
(fm) Engaged in sexual misconduct with a patient.
(g) Engaged in conduct while practicing or assisting in the practice of
physical therapy which evidences a lack of knowledge or ability to apply
professional principles or skills.
(h) Violated this subchapter or any rule promulgated under this
subchapter.
(3)(a) A licensee may
voluntarily surrender his or her license to the affiliated credentialing board,
which may refuse to accept the surrender if the affiliated credentialing board
has received allegations of unprofessional conduct against the licensee.
The affiliated credentialing board may negotiate stipulations in consideration
for accepting the surrender of licenses.
(b) The affiliated credentialing board may restore a license that has
been voluntarily surrendered under par.
(a) on such terms and conditions as it considers appropriate.
(4) The affiliated credentialing board shall prepare and disseminate to
the public an annual report that describes final disciplinary action taken
against licensees during the preceding year.
(5) The affiliated credentialing board may report final disciplinary
action taken against a licensee to any national database that includes
information about disciplinary action taken against health care professionals.
448.58 Injunctive relief. If the
affiliated credentialing board has reason to believe that any person is
violating this subchapter or any rule promulgated under this subchapter, the
affiliated credentialing board, the department, the attorney general or the
district attorney of the proper county may investigate and may, in addition to
any other remedies, bring an action in the name and on behalf of this state to
enjoin the person from the violation.
448.59 Penalties. Any person who violates this subchapter
or any rule promulgated under this subchapter may be fined not more than
$10,000 or imprisoned for not more than 9 months or both.
Board of Physical Therapy Rules
PT 1.01 Authority and purpose. The rules in
chs. PT 1 to 9
are adopted by the physical therapists affiliated credentialing board and
govern the issuance of licenses to physical therapists, the issuance of
licenses to physical therapist assistants, the referral for physical therapy
services, unprofessional conduct under, biennial license renewal, continuing
education requirements, continuity of care requirements, and conduct of board
self-audits.
PT 1.02 Definitions.
(1) "Board" means the physical therapists affiliated
credentialing board.
(2) "FSBPT" means the Federation of State Boards of Physical
Therapy.
(3) "License" means any license, permit, certificate or
registration issued by the board.
(4) "Licensee" means any person validly possessing any license
granted and issued to that person by the board.
(6) "Unlicensed personnel" means a person other than a
physical therapist or physical therapist assistant who performs patient related
tasks consistent with the unlicensed personnel's education, training and
expertise under the direct on-premises supervision of the physical therapist.
PT 1.03 Applications and credentials.
(1) Every person applying for any class of license to provide physical
therapy services shall make application on forms provided by the board, and
shall submit to the board all of the following:
(a) A completed and verified application form.
(c) Verified documentary evidence of graduation from a school of physical
therapy or a physical therapist assistant educational program approved by the
board.
(d) In the case of a graduate of a foreign school of physical therapy or
physical therapist assistant educational program, verification of educational
equivalency to a board-approved school of physical therapy or physical
therapist assistant educational program, the verification shall be obtained
from a board-approved foreign graduate evaluation service, based upon
submission to the evaluation service of the following material:
1. A verified copy of transcripts from the schools from which secondary
education was obtained.
2. A verified copy of the diploma from the school or educational program
at which professional physical therapy or physical therapist assistant training
was completed.
3. A record of the number of class hours spent in each subject, for both
pre-professional and professional courses. For subjects which include
laboratory and discussion sections, the hours must be described in hours per
lecture, hours per laboratory and hours per discussion per week.
Information must include whether subjects have been taken at basic entry or
advanced levels.
4. A syllabus which describes the material covered in each subject
completed.
(2) If an applicant is a graduate of a school of physical therapy or a
physical therapist assistant educational program not approved by the board, the
board shall determine whether the applicant's educational training is
equivalent to that specified in sub.
(1) (c). In lieu of its own evaluations, the board may use evaluations
prepared by a board-approved evaluation service. The cost of an
evaluation shall be paid by the applicant.
(3) The board may waive the requirement under sub.
(1) (c). for an applicant who establishes, to the satisfaction of the board,
all of the following:
(a) That he or she is a graduate of a physical therapy school or a
physical therapist assistant educational program.
(b) That he or she is licensed as a physical therapist or physical
therapist assistant by another licensing jurisdiction in the
(c) That the jurisdiction in which he or she is licensed required the
licensee to be a graduate of a school or educational program approved by the
licensing jurisdiction or of a school or educational program that the licensing
jurisdiction evaluated for educational equivalency.
(d) That he or she has actively practiced as a physical therapist or
physical therapist assistant, under the license issued by the other licensing
jurisdiction in the
PT 1.04 Application deadline and fees. The completed
application and all required documents must be received by the board at its
office not less than 30 days prior to the date of the examination. The
required fees specified in s. 440.05
(1), Stats., shall accompany the application.
(1) All applicants shall complete written examinations. In
addition, an applicant may be required to complete an oral examination if the
applicant:
(a) Has a medical condition which in any way impairs or limits the
applicant's ability to practice physical therapy with reasonable skill and
safety.
(b) Uses chemical substances so as to impair in any
way the applicant's ability to practice physical therapy with reasonable skill
and safety.
(c) Has been diagnosed as suffering from pedophilia, exhibitionism or
voyeurism.
(d) Has within the past 2 years engaged in the illegal use of controlled
substances.
(e) Has been subject to adverse formal action during the course of
physical therapy education, postgraduate training, hospital practice, or other
physical therapy employment.
(f) Has been disciplined or had licensure denied by a licensing or
regulatory authority in
(g) Has been convicted of a crime the circumstances of which
substantially relate to the practice of physical therapy.
(h) Has not practiced as a physical therapist or physical therapist
assistant for a period of 3 years prior to application, unless the applicant
has been graduated from a school of physical therapy or a physical therapist
assistant educational program within that period.
(i) Has been graduated from a physical therapy school or a physical
therapist assistant educational program not approved by the board.
(2) An application filed under
s. PT 1.03 shall be reviewed by an application review panel consisting of at
least 2 board members designated by the chairperson of the board. The
panel shall determine whether the applicant is eligible for a regular license
without completing an oral examination.
(3) All examinations shall be conducted in the English language.
(4) Where both written and oral examinations are required, they shall be
scored separately and the applicant shall achieve a passing grade on both
examinations to qualify for a license.
(5) The board shall notify each applicant found eligible for examination
of the time and place scheduled for that applicant's examination. Failure
of an applicant to appear for examination as scheduled will void the
applicant's examination application and require the applicant to reapply for
examination unless prior scheduling arrangements have been made with the board
by the applicant.
(6)
(a) The score required to pass each written physical therapy or physical
therapist assistant examination shall be based on the board's determination of
the level of examination performance required for minimum acceptable competence
in the profession and on the reliability of the examination. The passing
grade shall be established prior to giving the examination.
(b) The passing scores for the national physical therapy examination and
the national physical therapist assistant examination are those scores
recommended by the Federation of State Boards of Physical Therapy.
(c) To pass the examination on statutes and rules, the applicant shall
receive a score determined by the board to represent minimum competence to
practice after consultation with subject matter experts who have received a
representative sample of the examination questions and available candidate
performance statistics.
(7) Members of the board shall conduct oral examinations of each
candidate and are scored as pass or fail.
(8) Any applicant who is a graduate of a school for physical therapists
or an educational program for physical therapist assistants in which English is
not the primary language of communication shall take and pass each of the
following in order to qualify for a license:
(a) The test of English as a foreign language as administered by the
educational testing service.
(b) The test of written English as administered by the educational
testing service.
(c) The test of spoken English as administered by the educational testing
service.
PT 2.02 Conduct of examinations. At the start of the
examinations, applicants shall be provided with the rules of conduct to be
followed during the course of the examinations. Any violation of these
rules of conduct by any applicant may be cause for the board to
withhold the applicant's grade and to find after a hearing that the applicant
has failed the examination.
PT 2.03 Failure and reexamination. An applicant who fails
to achieve passing grades on the examinations required under this chapter may
apply for reexamination on forms provided by the board. For each
reexamination, the application shall be accompanied by the reexamination
fee. If an applicant for reexamination fails to achieve passing grades on
the second reexamination, the applicant may not be admitted to further
examination until the applicant reapplies for licensure and presents to the
board evidence of further professional training or education as the board may
consider appropriate in the applicant's specific case.
PT 2.04 Examination waiver. An applicant for a license to
practice as a physical therapist assistant who applies prior to April 1, 2004,
shall not be required to complete the national physical therapist assistant
examination if the applicant does all of the following:
(1) Pays the fee specified in s. 440.05
(1), Stats.
(2) Submits evidence satisfactory to the board that the applicant does
not have an arrest or conviction record.
(3) Provides evidence satisfactory to the board that the applicant has
graduated from an accredited physical therapist assistant educational program.
(4) Provides evidence satisfactory to the board that during at least 2 years
of the 5 year period immediately preceding April 26, 2002, the applicant was a
physical therapist assistant, as defined by s. 448.52 (3), Stats., assisting a
physical therapist in practice under the general supervision of a physical
therapist as specified in s. PT 5.01.
(5) Passes an examination administered by the board on state laws and
administrative rules relating to physical therapy.
(6) Submits letters of recommendation from 2 physical therapists
licensed by the board who have personal knowledge of the applicant's activities
in assisting a physical therapist in practice.
PT 3.01
Temporary license to practice under supervision.
(1) An applicant for a regular license to practice as a physical
therapist or physical therapist assistant who is a graduate of an approved
school of physical therapy or a physical therapist assistant educational
program and has applied to take the national physical therapist examination or
the national physical therapist assistant examination or has taken the national
physical therapist examination and is awaiting results and is not required to
take an oral examination, may apply to the board for a temporary license to practice
as a physical therapist or physical therapist assistant under
supervision. The applications and required documents for a regular
license and for a temporary license may be reviewed by 2 members of the board,
and upon the finding by the 2 members that the applicant is qualified for
admission to examination for a regular license to practice as a physical
therapist or physical therapist assistant, the board, acting through the 2
members, may issue a temporary license to practice as a physical therapist or
physical therapist assistant under supervision to the applicant.
(2) The required fees specified in s. 440.05
(6), Stats., shall accompany the application for a temporary license to
practice under supervision.
(3) The holder of a temporary license to practice physical therapy under
supervision may practice physical therapy as defined in s. 448.50
(4), Stats., providing that the entire practice is under the supervision of a
person validly holding a regular license as a physical therapist. The
supervision shall be direct, immediate, and on premises.
(4) The holder of a temporary license to practice as a physical
therapist assistant under supervision may provide physical therapy services as
defined in s. 448.50
(4), Stats., providing that the entire practice is under the supervision of a
person validly holding a regular license as a physical therapist. The
supervision shall be direct, immediate, and on premises. No physical
therapist assistant holding a temporary license may provide physical therapy
services when the supervising physical therapist is not immediately available
to assist.
(5) The duration of a temporary license to practice physical therapy
under supervision granted under this section shall be for a period of 3 months
or until the holder receives failing examination results, whichever is shorter.
(6) A physical therapist may supervise no more than a combined total of
4 physical therapists and physical therapist assistants who hold temporary
licenses. This number shall be reduced by the number of physical
therapist assistants and physical therapy aides being supervised by the
physical therapist under
s. PT 5.02 (2) (k).
(7) A temporary license to practice as a physical therapist or physical
therapist assistant under supervision may not be renewed.
PT 4.01 Locum tenens license.
(1) A person who holds a valid license to practice physical therapy
issued by another licensing jurisdiction of the United States may apply to the
board for a locum tenens license to practice physical therapy and shall submit
to the board all of the following:
(a) A completed and verified application form.
(b) A letter of recommendation from a physician or supervisor or present
employer stating the applicant's professional capabilities.
(c) A verified photostatic copy of a license to practice physical therapy
issued to the applicant by another licensing jurisdiction of the
(d) A letter from a physical therapist licensed in this state requesting
the applicant's services, or a letter from an organization or facility in this
state requesting the applicant's services.
(e) The required fees specified in s. 440.05
(6), Stats.
(2) The application and documentary evidence submitted by the applicant
shall be reviewed by a member of the board, and upon the finding of the member
that the applicant is qualified, the board, acting through the member, may
issue a locum tenens license to practice physical therapy to the applicant.
(3) The holder of a locum tenens license to practice physical therapy
may practice physical therapy as defined in s. 448.56
(1), Stats., providing the practice is confined to the geographical area for
which the license is issued.
(4) A locum tenens license to practice physical therapy shall expire 90
days from the date of its issuance. For cause shown to its satisfaction,
the board, acting through a member of the board, may renew the locum tenens
license for additional periods of 90 days each, but the license may not be
renewed within 12 months of the date of its original issuance, nor again
renewed within 12 months of the date of any subsequent renewal.
PT 5.01 Practice and supervision of
physical therapist assistants.
(1) A physical therapist assistant, as
defined in s. 448.50
(3m), Stats., shall assist a physical therapist in the practice of physical
therapy under the general supervision of a physical therapist.
(2) In providing general supervision,
the physical therapist shall do all of the following:
(a) Have primary responsibility for physical therapy care rendered by the
physical therapist assistant.
(b) Have direct face-to-face contact with the physical therapist
assistant at least every 14 calendar days, unless the board approves another
type of contact.
(c) Remain accessible to telecommunications in the
interim between direct contacts while the physical therapist assistant is
providing patient care.
(d) Establish a written policy and procedure for written and oral
communication. This policy and procedure shall include a specific
description of the supervisory activities undertaken for the physical therapist
assistant as well as a description of the manner by which the physical
therapist shall manage all aspects of patient care. The amount of
supervision shall be appropriate to the setting and the services provided.
(e) Provide initial patient examination, evaluation and interpretation of
referrals and create the initial patient record for every patient the physical
therapist treats.
(f) Develop and revise as appropriate a written patient treatment plan
and program.
(g) Delegate appropriate portions of the treatment plan and program to
the physical therapist assistant consistent with the physical therapist
assistant's education, training and experience.
(h) Provide on-site assessment and reevaluation of each patient's
treatment at a minimum of one time per calendar month or every tenth treatment
day, whichever is sooner, and adjust the treatment plan as appropriate.
(i) Coordinate discharge plan decisions and the final assessment with the
physical therapist assistant.
(j) Limit the number of physical therapist assistants practicing under
general supervision to a number appropriate to the setting in which physical
therapy is administered, to ensure that all patients under the care of the
physical therapist receive services that are consistent with accepted standards
of care and consistent with all other requirements under this chapter. No
physical therapist may at any time supervise more than 2 physical therapist assistants
full-time equivalents practicing under general supervision.
PT 5.02
Supervision of unlicensed personnel.
(1) A physical therapist shall
provide direct on-premises supervision of unlicensed personnel at all
times. A physical therapist may not direct unlicensed personnel to
perform tasks which require the decision making or problem solving skills of a
physical therapist, including but not limited to patient examination,
evaluation, diagnosis, or determination of therapeutic intervention.
(2) In providing direct on-premises
supervision, the physical therapist shall do all of the following:
(a) Retain full professional responsibility for patient related tasks
performed.
(b) Be available at all times for direction and supervision with the
person performing related tasks.
(c) Evaluate the effectiveness of patient related tasks performed by
those under direct supervision by assessing persons for whom tasks have been
performed prior to and following performance of the tasks.
(d) Routinely evaluate the effectiveness of patient related tasks
performed by those under direct supervision by observing and monitoring persons
receiving such tasks.
(e) Determine the
competence of personnel to perform assigned tasks based upon his or her
education, training and experience.
(f) Verify the competence of unlicensed personnel with written
documentation of continued competence in the assigned tasks.
(g) Perform initial patient examination, evaluation, diagnosis and
prognosis, interpret referrals, develop and revise as appropriate a written
patient treatment plan and program for each patient and create and maintain a
patient record for every patient the physical therapist treats.
(h) Provide interpretation of objective tests, measurements and other
data in developing and revising a physical therapy diagnosis, assessment and
treatment plan.
(i) Direct unlicensed personnel to provide appropriate patient related
tasks consistent with the education, training, and experience of the person
supervised. Direction should list specific patient related tasks,
including dosage, magnitude, repetitions, settings, length of time, and any
other parameters necessary for the performance of the patient related tasks.
(j) Limit the number of unlicensed personnel providing patient related
tasks under direct supervision to a number appropriate to the setting in which
physical therapy is administered, to ensure that all patients under the care of
the physical therapist receive services that are consistent with accepted
standards of care and consistent with all other requirements under this
chapter.
(k) The total number of physical therapist assistants providing physical
therapy services and unlicensed personnel performing patient related tasks
under supervision may not exceed a combined total of 4. This number shall
be reduced by the number of physical therapists and physical therapist
assistants holding temporary licenses who are being supervised under
s. PT 3.01 (6).
PT 6.01 Referrals.
(1) In addition to the services excepted from written referral under s. 448.56,
Stats., a written referral is not required to provide the following services,
related to the work, home, leisure, recreational and educational environments:
(a) Conditioning.
(b) Injury prevention and application of biomechanics.
(c) Treatment of musculoskeletal injuries with the exception of acute
fractures or soft tissue avulsions.
(2) A physical therapist providing physical therapy services pursuant to
a referral under s. 448.56
(1), Stats., shall communicate with the referring physician, chiropractor,
dentist or podiatrist as necessary to ensure continuity of care.
(3) A physical therapist providing physical therapy services to a
patient shall refer the patient to a physician, chiropractor, dentist,
podiatrist or other health care practitioner under s. 448.56
(1m), Stats., to receive required health care services which are beyond the
scope of practice of physical therapy.
PT 7.01 Authority and purpose. The definitions of this
chapter are adopted by the board pursuant to the authority delegated by ss. 15.085
(5) (b) and 448.527,
Stats., to establish the standards of ethical conduct by physical therapists
and physical therapist assistants.
PT 7.02 Definitions. The term
"unprofessional conduct" is defined to mean and include but not be
limited to the following, or aiding or abetting the same:
(1) Violating or attempting to violate s. 448.57
(2) (a) to (g),
Stats., or any other applicable provision or term of
ch. 448, Stats., or of any valid rule of the board.
(2) Violating or attempting to violate any term, provision or condition
of any order of the board.
(3) Knowingly making or presenting or causing to be made or presented
any false, fraudulent or forged statement, writing, certificate, diploma, or
other thing in connection with any application for a license.
(4) Practicing fraud, forgery, deception, collusion or conspiracy in
connection with any examination for a license.
(5) Giving, selling, buying, bartering or attempting to give, sell, buy
or barter any license.
(6) Engaging or attempting to engage in practice under any license under
any given name or surname other than that under which originally licensed or
registered to practice in this or any other state. This subsection does
not apply to a change of name resulting from marriage, divorce or order by a
court of record. (7) Engaging or attempting to
engage in the unlawful practice of physical therapy.
(8) Any practice or conduct which tends to constitute a danger to the
health, welfare or safety of a patient or the public.
(9) Practicing or attempting to practice under any license when unable
to do so with reasonable skill and safety to patients.
(10) Practicing or attempting to practice under any license beyond the
scope of that license.
(11) Offering, undertaking or agreeing to treat or cure a disease or
condition by a secret means, method, device or instrumentality; or refusing to
divulge to the board upon demand the means, method, device or instrumentality
used in the treatment of a disease or condition.
(12) Representing that a manifestly incurable disease or condition can
be or will be permanently cured; or that a curable disease or condition can be
cured within a stated time, if it is not the fact.
(13)
Knowingly making any false statement, written or oral, in practicing under any
license, with fraudulent intent; or obtaining or attempting to obtain any
professional fee or compensation of any form by fraud or deceit.
(14) Willfully divulging a privileged communication or confidence
entrusted by a patient or deficiencies in the character of patients observed in
the course of professional attendance, unless lawfully required to do so.
(15) Engaging in uninvited, in-person solicitation of actual or
potential patients who, because of their particular circumstances, are
vulnerable to undue influence.
(16)
Engaging in false, misleading or deceptive advertising.
(17) Having a license, certificate, permit, registration or other
practice privilege granted by another state or by any agency of the federal
government to practice physical therapy limited, restricted, suspended or
revoked, or having been subject to other disciplinary action by the state
licensing authority or by any agency of the federal government.
(18) Conviction of any crime which may relate to practice under any
license, or of violation of any federal or state law regulating the possession,
distribution or use of controlled substances as defined in s. 961.01
(4), Stats. A certified copy of a judgment of a court of record showing
the conviction, within this state or without, shall be presumptive evidence of
the conviction.
(19) Engaging in inappropriate sexual contact, exposure, gratification,
or other sexual behavior with or in the presence of a patient. For the
purposes of this subsection, an adult receiving treatment shall continue to be
a patient until the time of final discharge from physical therapy.
(20) Failure to inform a patient or client of the
costs, benefits and risks of viable physical therapy intervention and treatment
alternatives.
(21) Failing to report to the board or to institutional supervisory
personnel any violation of this chapter by a licensee.
PT 7.03 Complaints. Procedures and
requirements for filing complaints with the board are set forth in
ch. RL 2.
PT 7.04 Self-audits. The board shall biennially review and
evaluate its performance in carrying out its responsibilities under this
chapter and in other areas over which the board exercises its independent
authority, as defined in s. 440.035,
Stats.
PT 8.01 Authority and purpose.
The rules in this chapter are adopted by the board pursuant to the authority
delegated by ss. 15.08
(5) (b), 227.11
(2) and 448.53,
Stats., and govern biennial renewal of licensees of the board.
PT 8.02 Renewal required; method of
renewal. Each licensee shall renew his or her license biennially with
the department. On or before October 1 of each odd-numbered year the
department shall mail to each licensee at his or her last known address as it
appears in the records of the board an application form for renewal. Each
licensee shall complete the application form and return it with the required
fee to the department prior to the next succeeding November 1. The
department shall notify the licensee within 30 business days of receipt of a
completed renewal form whether the application for renewal is approved or
denied.
PT 8.05 Requirements for reinstatement. A license shall
expire if it is not renewed by November 1 of odd-numbered years. A
licensee who allows the license to lapse may apply to the board for reinstatement
of the license as follows:
(1) If the licensee applies for renewal of the
license less than 5 years after its expiration, the license shall be renewed
upon payment of the renewal fee.
(2) If the licensee applies for renewal of the license more than 5 years
after its expiration, the board shall make inquiry as it finds necessary to
determine whether the applicant is competent to practice under the license in
this state, and shall impose any reasonable conditions on reinstatement of the
license, including oral examination, as the board deems appropriate. All
applicants under this paragraph shall be required to pass the open book
examination on statutes and rules, which is the same examination given to
initial applicants.
PT 9.01 Authority and purpose. The rules in
this chapter are adopted by the board pursuant to the authority delegated by
ss. 15.085
(5) (b), 227.11
(2) and 448.55
(3), Stats., and govern required biennial continuing education of licensees of
the board.
PT 9.02 Definitions.
(1) "Contact hour" means not less than 50 minutes a licensee
spends in actual attendance at or completion of acceptable continuing
education.
(2) "Continuing education" means planned, organized learning
activities designed to maintain, improve, or expand a licensee's knowledge and
skills relevant to the enhancement of practice, education, or theory
development to improve the safety and welfare of the public.
(4) "Licensee" means a person licensed to practice as a physical
therapist or physical therapist assistant in this state.
PT 9.03 Continuing
Education Requirements.
(1) Unless granted a postponement or waiver under sub. (8), every
physical therapist shall complete at least 30 hours of board-approved continuing
education in each biennial registration period, as specified in s. 448.55 (3),
Stats. Four of the required 30 hours shall be in the area of ethics and
jurisprudence.
(2) Unless granted a postponement or waiver under sub. (8), every
physical therapist assistant shall complete at least 20 hours of board-approved
continuing education in each biennial registration period, as specified in s.
448.55 (3), Stats. Four of the required 20 hours shall be in the area of ethics
and jurisprudence.
(3) Continuing education hours may apply only to the registration period
in which the hours are acquired. If a license has lapsed, the board may grant
permission to apply continuing education hours acquired after lapse of the
license to a previous biennial period of licensure during which required
continuing education was not acquired. In no case may continuing education
hours be applied to more than one biennial period.
(4) Unless granted a postponement or waiver under sub. (8), a licensee
who fails to meet the continuing education requirements by the renewal deadline
shall cease and desist from practice.
(5) During the time between initial licensure and commencement of a full
2-year licensure period new licensees shall not be required to meet continuing
education requirements.
(6) Applicants from other states applying for a license to practice as a
physical therapist under s. 448.53 (3), Stats., shall submit proof of
completion of at least 30 hours of continuing education approved by the board
within 2 years prior to application.
(7) Applicants from other states applying for a license to practice as a
physical therapist assistant under s. 448.53 (3), Stats., shall submit proof of
completion of at least 20 hours of continuing education approved by the board
within 2 years prior to application.
(8) A licensee may apply to the board for a postponement or waiver of
the requirements of this section on grounds of prolonged illness or disability,
or on other grounds constituting extreme hardship. The board shall consider
each application individually on its merits, and the board may grant a
postponement, partial waiver or total waiver as deemed appropriate.
PT 9.04
Standards for Approval.
(1) To be approved for credit, a continuing education program shall meet
all of the following criteria:
(a) The program constitutes an
organized program of learning which contributes
directly to the professional competency of the licensee.
(b) The program pertains to
subject matters which integrally relate to the practice
of the profession.
(c) The program is conducted
by individuals who have specialized education,
training or experience by reason of which the individuals should be considered qualified concerning
the subject matter of the activity or program.
(d) The program fulfills pre-established
goals and objectives.
(e) The program provides proof
of attendance by licensees.
(2) The continuing education activities described in table PT 9.04
qualify for continuing education hours.
|
|
|
|
ACTIVITY |
CONTACT HOUR LIMITS |
|
|
|
|
(a) Successful completion of relevant academic
coursework. |
No limit. [10 contact hours = one semester credit;
6.6 contact hours = quarter credit] |
|
(b) Attendance at seminars, workshops, lectures,
symposia, and professional conferences which are sponsored or approved by
acceptable health-related or other organizations including the American
Physical Therapy Association and the Wisconsin Physical Therapy Association. |
No limit. |
|
(c) Successful completion of a self-study course or
courses offered via electronic or other means which are sponsored or approved
by acceptable health-related or other organizations including the American
Physical Therapy Association and the Wisconsin Physical Therapy Association. |
No limit. |
|
(d) Earning a clinical specialization from the
American Board of Physical Therapy Specialties or other recognized clinical
specialization certifying organizations. |
Up to 12 contact hours for initial certification or
for recertification. |
|
(e) Authorship of a book about physical therapy or a
related professional area. |
Up to 12 contact hours for each book. |
|
(f) Authorship of one or more chapters of a book
about physical therapy or a related professional area. |
Up to 6 contact hours for each chapter. |
|
(g) Authorship of a presented scientific poster,
scientific platform presentation, or published article. |
Up to 6 contact hours for each poster, platform
presentation, or refereed article. |
|
(h) Presenting seminars, continuing education
courses, workshops, lectures, or symposia which have been approved by
recognized health-related organizations including the American Physical
Therapy Association and the Wisconsin Physical Therapy Association.Note: No
additional hours are given for subsequent presentations of the same content.
Substantive course revisions may be counted but are limited to the extent of
the revision. |
No limit. |
|
(i) Teaching in an academic course in physical
therapy as a guest lecturer.Note: No additional hours are given for
subsequent presentations of the same content. Substantive course revisions
may be counted but are limited to the extent of the revision. |
No limit. [10 contact hours = one semester credit;
6.6 contact hours = one quarter credit] |
|
(j) Teaching in an academic course in physical
therapy.Note: No additional hours are given for subsequent presentations of
the same content. Substantive course revisions may be counted but are not
limited to the extent of the revision. |
No limit. [10 contact hours = one semester credit;
6.6. contact hours = one quarter credit] |
|
(k) Successful completion in a clinical residency
program credentialed by the American Physical Therapy Association or other
recognized credentialing organization. |
No limit. |
|
(l) Attending employer-provided continuing education,
including video and non-interactive on-line courses. |
Up to 15 contact hours for physical therapists. Up to
10 contact hours for physical therapist assistants. |
|
(m) Authoring an article in a non-refereed
publication. |
Up to 5 contact hours. |
|
(n) Developing alternative media materials, including
computer software, programs, and video instructional material. |
1 contact hour per product. Up to 5 contact hours. |
|
(o) Serving as a clinical instructor for internships
with an accredited physical therapist or physical therapist assistant educational
program. |
Up to 15 contact hours for physical therapists. Up to
10 contact hours for physical therapist assistants. |
|
(p) Serving as a supervisor for students fulfilling
clinical observation requirements. |
1 contact hour per contact hour with students, up to
5 contact hours. |
|
(q) Participating in a physical therapy study group
of 2 or more physical therapists or physical therapist assistants or in an
interdisciplinary study group of members of at least 2 disciplines meeting on
a topic relevant to the participants' work. |
Up to 2 contact hours per study group. |
|
(s) Attending a scientific poster session, lecture
panel, or a symposium. |
Up to 2 contact hours. |
|
(t) Serving as a delegate to the American Physical
Therapy Association House of Delegates, on a professional committee, board,
or task force. |
Up to 5 contact hours. |
(3) The following activities shall not be awarded
continuing activity credit:
(a) Meetings for the
purpose of policy decisions.
(b) Non-educational meetings at annual association, chapter or
organization meetings.
(c) Entertainment or recreational meetings or activities.
(d) Visiting exhibits.
PT 9.05 Proof of attendance at continuing
education programs. Applicants for renewal shall be required to
certify their attendance at required continuing education programs. The
board may conduct a random audit of all licensees on a biennial basis for
compliance with continuing education requirements, and shall audit any licensee
who is under investigation by the board for alleged misconduct.
APTA CODE OF
ETHICS
Preamble
This Code of Ethics of the American Physical Therapy Association sets forth
principles for the ethical practice of physical therapy. All physical
therapists are responsible for maintaining and promoting ethical practice. To
this end, the physical therapist shall act in the best interest of the
patient/client. This Code of Ethics shall be binding on all physical
therapists.
Principle 1
A physical therapist shall respect the rights and dignity of all individuals
and shall provide compassionate care.
Principle 2
A physical therapist shall act in a trustworthy manner towards
patients/clients, and in all other aspects of physical therapy practice.
Principle 3
A physical therapist shall comply with laws and regulations governing physical
therapy and shall strive to effect changes that benefit patients/clients.
Principle 4
A physical therapist shall exercise sound professional judgment.
Principle 5
A physical therapist shall achieve and maintain professional competence.
Principle 6
A physical therapist shall maintain and promote high standards for physical
therapy practice, education and research.
Principle 7
A physical therapist shall seek only such remuneration as is deserved and
reasonable for physical therapy services.
Principle 8
A physical therapist shall provide and make available accurate and relevant
information to patients/clients about their care and to the public about
physical therapy services.
Principle 9
A physical therapist shall protect the public and the profession from
unethical, incompetent, and illegal acts.
Principle 10
A physical therapist shall endeavor to address the health needs of society.
Principle 11
A physical therapist shall respect the rights, knowledge, and skills of
colleagues and other health care professionals.
THE
GUIDE FOR PROFESSIONAL CONDUCT
Purpose
This
Guide for Professional Conduct (Guide) is intended to serve physical
therapists in interpreting the Code of Ethics (Code) of the American
Physical Therapy Association (Association), in matters of professional conduct.
The Guide provides guidelines by which physical therapists may determine the
propriety of their conduct. It is also intended to guide the professional
development of physical therapist students. The Code and the Guide apply to all
physical therapists. These guidelines are subject to changes as the dynamics of
the profession change and as new patterns of health care delivery are developed
and accepted by the professional community and the public.
Guide
for Conduct of the Physical Therapist
Principle
1
A physical therapist shall respect the rights and
dignity of all individuals and shall provide compassionate care.
1.1 Attitudes of a Physical Therapist
A. A physical therapist
shall recognize individual differences and shall respect and be responsive to
those differences.
B. A physical therapist
shall be guided by concern for the physical, psychological, and socioeconomic
welfare of patients/clients.
C. A physical therapist
shall not harass, abuse, or discriminate against others.
D. A physical therapist
shall be aware of the patient’s health-related needs and act in a manner that
facilitates meeting those needs.
Principle
2
A physical therapist shall act in a trustworthy
manner towards patients/clients, and in all other aspects of physical therapy
practice.
2.1 Patient/Physical Therapist Relationship
A. To act in a
trustworthy manner the physical therapist shall act in the patient/client’s
best interest. Working in the patient/client’s best interest requires knowledge
of the patient/client’s needs from the patient/client’s perspective.
Patients/clients often come to the physical therapist in a vulnerable state and
normally will rely on the physical therapist’s advice, which they perceive to
be based on superior knowledge, skill, and experience. The trustworthy physical
therapist acts to ameliorate the patient’s/client’s vulnerability, not to
exploit it.
B. A physical therapist
shall not exploit any aspect of the physical therapist/patient relationship.
C. A physical therapist
shall not engage in any sexual relationship or activity, whether consensual or
nonconsensual, with any patient while a physical therapist/patient relationship
exists.
D. The physical
therapist shall create an environment that encourages an open dialogue with the
patient/client.
E. In the event the
physical therapist or patient terminates the physical therapist/patient
relationship while the patient continues to need physical therapy services, the
physical therapist should take steps to transfer the care of the patient to
another provider.
2.2 Truthfulness
A physical therapist
shall not make statements that he/she knows or should know are false,
deceptive, fraudulent, or unfair. See Section 8.2.D.
2.3 Confidential Information
A. Information relating
to the physical therapist/patient relationship is confidential and may not be
communicated to a third party not involved in that patient’s care without the
prior consent of the patient, subject to applicable law.
B. Information derived
from peer review shall be held confidential by the reviewer unless the physical
therapist who was reviewed consents to the release of the information.
C. A physical therapist
may disclose information to appropriate authorities when it is necessary to
protect the welfare of an individual or the community or when required by law.
Such disclosure shall be in accordance with applicable law.
2.4 Patient Autonomy and Consent
A. A physical therapist
shall not restrict patients’ freedom to select their provider of physical therapy.
B. A physical therapist
shall communicate to the patient/client the findings of his/her examination,
evaluation, diagnosis, and prognosis.
C. A physical therapist
shall collaborate with the patient/client to establish the goals of treatment
and the plan of care.
D. A physical therapist
shall inform the patient/client of the benefits, costs, and substantial risks
(if any) of the recommended intervention and treatment alternatives.
E. A physical therapist
shall respect the patient’s/client’s right to make decisions regarding the
recommended plan of care, including consent, modification, or refusal.
Principle
3
A physical therapist shall comply with laws and
regulations governing physical therapy and shall strive to effect changes that
benefit patients/clients.
3.1 Professional Practice
A physical therapist
shall provide examination, evaluation, diagnosis, prognosis, and intervention.
A physical therapist shall not engage in any unlawful activity that
substantially relates to the qualifications, functions, or duties of a physical
therapist.
3.2 Just Laws and Regulations
A physical therapist
shall advocate the adoption of laws, regulations, and policies by providers,
employers, third party payers, legislatures, and regulatory agencies to provide
and improve access to necessary health care services for all individuals.
3.3 Unjust Laws and Regulations
A physical therapist
shall endeavor to change unjust laws, regulations, and policies that govern the
practice of physical therapy. See Section 10.2.
Principle
4
A physical therapist shall exercise sound
professional judgment.
4.1 Professional Responsibility
A. A physical therapist
shall make professional judgments that are in the patient/client’s best
interests.
B. Regardless of
practice setting, a physical therapist has primary responsibility for the
physical therapy care of a patient and shall make independent judgments
regarding that care consistent with accepted professional standards. See
Section 2.4.
C. A physical therapist
shall not provide physical therapy services to a patient/client while his/her
ability to do so safely is impaired.
D. A physical therapist
shall exercise sound professional judgment based upon his/her knowledge, skill,
education, training, and experience.
E. Upon accepting a
patient/client for physical therapy services, a physical therapist shall be
responsible for: the examination, evaluation, and diagnosis of that individual;
the prognosis and intervention; re-examination and modification of the plan of
care; and the maintenance of adequate records, including progress reports. A
physical therapist shall establish the plan of care and shall provide and/or
supervise and direct the appropriate interventions. See Section 2.4.
F. If the diagnostic
process reveals findings that are outside the scope of the physical therapist’s
knowledge, experience, or expertise, the physical therapist shall so inform the
patient/client and refer to an appropriate practitioner.
G. When the patient has
been referred from another practitioner, the physical therapist shall
communicate the findings of the examination and evaluation, the diagnosis, the
proposed intervention, and re-examination findings (as indicated) to the
referring practitioner.
H. A physical therapist
shall determine when a patient/client will no longer benefit from physical
therapy services.
4.2 Direction and Supervision
A. The supervising
physical therapist has primary responsibility for the physical therapy care
rendered to a patient/client.
B. A physical therapist
shall not delegate to a less qualified person any activity that requires the
unique skill, knowledge, and judgment of the physical therapist.
4.3 Practice
Arrangements
A. Participation in a
business, partnership, corporation, or other entity does not exempt physical
therapists, whether employers, partners, or stockholders, either individually
or collectively, from the obligation to promote, maintain and comply with the
ethical principles of the Association.
B. A physical therapist
shall advise his/her employer(s) of any employer practice that causes a
physical therapist to be in conflict with the ethical principles of the
Association. A physical therapist shall seek to eliminate aspects of his/her
employment that are in conflict with the ethical principles of the Association.
4.4 Gifts
and Other Consideration
A physical therapist
shall not accept or offer gifts or other considerations that affect or give an
appearance of affecting his/her professional judgment.
Principle
5
A physical therapist shall achieve and maintain
professional competence.
5.1 Scope of Competence
A physical therapist
shall practice within the scope of his/her competence and commensurate with
his/her level of education, training and experience.
5.2 Self-assessment
A physical therapist
shall engage in self-assessment, which is a lifelong professional
responsibility for maintaining competence.
5.3 Professional Development
A physical therapist
shall participate in educational activities that enhance his/her basic
knowledge and skills.
Principle
6
A physical therapist shall maintain and promote high
standards for physical therapy practice, education and research.
6.1 Professional Standards
A physical therapist
shall know the accepted professional standards when engaging in physical
therapy practice, education and/or research. A physical therapist shall
continuously engage in assessment activities to determine compliance with these
standards. If a physical therapist is not in compliance with these standards,
he/she shall engage in activities designed to reach compliance with the
standards. When a physical therapist is in compliance with these standards,
he/she shall engage in activities designed to maintain such compliance.
6.2 Practice
A. A physical therapist
shall achieve and maintain professional competence. See Section 5.
B. A physical therapist
shall demonstrate his/her commitment to quality improvement by engaging in peer
and utilization review and other self-assessment activities.
6.3 Professional Education
A. A physical therapist
shall support high-quality education in academic and clinical settings.
B. A physical therapist
participating in the educational process is responsible to the students, the
academic institutions, and the clinical settings for promoting ethical conduct.
A physical therapist shall model ethical behavior and provide the student with
information about the Code of Ethics, opportunities to discuss ethical
conflicts, and procedures for reporting unresolved ethical conflicts. See
Section 9.
6.4 Continuing Education
A. A physical therapist
providing continuing education must be competent in the content area.
B. When a physical
therapist provides continuing education, he/she shall ensure that course
content, objectives, faculty credentials, and responsibilities of the
instructional staff are accurately stated in the promotional and instructional
course materials.
C. A physical therapist
shall evaluate the efficacy and effectiveness of information and techniques
presented in continuing education programs before integrating them into his or
her practice.
6.5 Research
A. A physical therapist
shall support research activities that contribute knowledge for improved
patient care.
B. A physical therapist
shall report to appropriate authorities any acts in the conduct or presentation
of research that appear unethical or illegal. See Section 9.
Principle
7
A physical therapist shall seek only such
remuneration as is deserved and reasonable for physical therapy services.
7.1 Business and Employment Practices
A. A physical
therapist’s business/employment practices shall be consistent with the ethical
principles of the Association.
B. A physical therapist
shall never place her/his own financial interest above the welfare of
individuals under his/her care.
C. A physical therapist
shall recognize that third-party payer contracts may limit, in one form or
another, the provision of physical therapy services. Third-party limitations do
not absolve the physical therapist from making sound professional judgments
that are in the patient’s best interest. A physical therapist shall avoid
underutilization of physical therapy services.
D. When a physical
therapist’s judgment is that a patient will receive negligible benefit from
physical therapy services, the physical therapist shall not provide or continue
to provide such services if the primary reason for doing so is to further the
financial self-interest of the physical therapist or his/her employer. A
physical therapist shall avoid overutilization of physical therapy services.
E. 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.
F. A physical therapist
shall not directly or indirectly request, receive, or participate in the
dividing, transferring, assigning, or rebating of an unearned fee.
G. A physical therapist
shall not profit by means of a credit or other valuable consideration, such as
an unearned commission, discount, or gratuity, in connection with the
furnishing of physical therapy services.
H. Unless laws impose
restrictions to the contrary, physical therapists who provide physical therapy
services within a business entity may pool fees and monies received. Physical
therapists may divide or apportion these fees and monies in accordance with the
business agreement.
I. A physical therapist
may enter into agreements with organizations to provide physical therapy
services if such agreements do not violate the ethical principles of the Association
or applicable laws.
7.2 Endorsement of Products or Services
A. A physical therapist
shall not exert influence on individuals under his/her care or their families
to use products or services based on the direct or indirect financial interest
of the physical therapist in such products or services. Realizing that these
individuals will normally rely on the physical therapist’s advice, their best
interest must always be maintained, as must their right of free choice relating
to the use of any product or service. Although it cannot be considered
unethical for physical therapists to own or have a financial interest in the
production, sale, or distribution of products/services, they must act in
accordance with law and make full disclosure of their interest whenever
individuals under their care use such products/services.
B. A physical therapist
may receive remuneration for endorsement or advertisement of products or
services to the public, physical therapists, or other health professionals
provided he/she discloses any financial interest in the production, sale, or
distribution of said products or services.
C. When endorsing or
advertising products or services, a physical therapist shall use sound
professional judgment and shall not give the appearance of Association
endorsement unless the Association has formally endorsed the products or
services.
7.3 Disclosure
A physical therapist
shall disclose to the patient if the referring practitioner derives
compensation from the provision of physical therapy.
Principle
8
A physical therapist shall provide and make
available accurate and relevant information to patients/clients about their
care and to the public about physical therapy services.
8.1 Accurate and Relevant Information to the Patient
A. A physical therapist
shall provide the patient/client information about his/her condition and plan
of care. See Section 2.4.
B. Upon the request of
the patient, the physical therapist shall provide, or make available, the
medical record to the patient or a patient-designated third party.
C. A physical therapist
shall inform patients of any known financial limitations that may affect their
care.
D. A physical therapist
shall inform the patient when, in his/her judgment, the patient will receive
negligible benefit from further care. See Section 7.1.C.
8.2 Accurate and Relevant Information to the Public
A. A physical therapist
shall inform the public about the societal benefits of the profession and who
is qualified to provide physical therapy services.
B. Information given to
the public shall emphasize that individual problems cannot be treated without
individualized examination and plans/programs of care.
C. A physical therapist
may advertise his/her services to the public.
D. A physical therapist
shall not use, or participate in the use of, any form of communication
containing a false, plagiarized, fraudulent, deceptive, unfair, or sensational
statement or claim.
E. A physical therapist
who places a paid advertisement shall identify it as such unless it is apparent
from the context that it is a paid advertisement.
Principle
9
A physical therapist shall protect the public and
the profession from unethical, incompetent, and illegal acts.
9.1 Consumer Protection
A. A physical therapist
shall provide care that is within the scope of practice as defined by the state
practice act.
B. A physical therapist
shall not engage in any conduct that is unethical, incompetent or illegal.
C. A physical therapist
shall report any conduct that appears to be unethical, incompetent, or illegal.
D. A physical therapist
may not participate in any arrangements in which patients are exploited due to
the referring sources’ enhancing their personal incomes as a result of
referring for, prescribing, or recommending physical therapy.
Principle
10
A physical therapist shall endeavor to address the
health needs of society.
10.1 Pro Bono Service
A physical therapist
shall render pro bono publico (reduced or no fee) services to patients lacking
the ability to pay for services, as each physical therapist’s practice permits.
10.2 Community Health
A physical therapist
shall endeavor to support activities that benefit the health status of the
community. See Section 3.
Principle
11
A physical therapist shall respect the rights,
knowledge, and skills of colleagues and other healthcare professionals.
11.1 Consultation
A physical therapist
shall seek consultation whenever the welfare of the patient will be safeguarded
or advanced by consulting those who have special skills, knowledge, and
experience.
11.2 Patient/Provider Relationships
A physical therapist
shall not undermine the relationship(s) between his/her patient and other
healthcare professionals.
11.3 Disparagement
Physical therapists
shall not disparage colleagues and other health care professionals. See Section
9 and Section 2.4.A.
Guide
for Conduct of the Physical Therapist Assistant
Standard
1
A physical therapist assistant shall respect the
rights and dignity of all individuals and shall provide compassionate care.
1.1 Attitude of a physical therapist assistant
A. A physical therapist
assistant shall demonstrate sensitivity to individual and cultural differences.
B. A physical therapist
assistant shall be guided at all times by concern for the physical and
psychological welfare of patients/clients.
C. A physical therapist
assistant shall not harass, abuse, or discriminate against others.
Standard
2
A physical therapist assistant shall act in a
trustworthy manner towards patients/clients.
2.1 Trustworthiness
A. To act in a
trustworthy manner a physical therapist assistant shall act in the
patient’s/client’s best interest. Working in the patient’s/client’s best
interest requires sensitivity to the patient’s/client’s vulnerability and an
effective working relationship between the physical therapist and the physical
therapist assistant.
B. A physical therapist
assistant shall act to ameliorate the patient’s/client’s vulnerability, not to
exploit it.
C. A physical therapist
assistant shall clearly identify him/herself as a physical therapist assistant
to patients/clients.
D. A physical therapist
assistant shall conduct him/herself in a manner that supports the physical
therapist/patient relationship.
E. A physical therapist
assistant shall not engage in any sexual relationship or activity, whether
consensual or nonconsensual, with any patient entrusted to his/her care.
F. A physical therapist
assistant shall not invite, accept, or offer gifts or other considerations that
affect or give an appearance of affecting his/her provision of physical therapy
interventions.
2.2 Exploitation of Patients
A physical therapist
assistant shall not participate in any arrangements in which patients/clients
are exploited. Such arrangements include situations where referring sources
enhance their personal incomes as a result of referring for, delegating,
prescribing, or recommending physical therapy services.
2.3 Truthfulness
A. A physical therapist
assistant shall not make statements that he/she knows or should know are false,
deceptive, fraudulent, or unfair.
B. Although it cannot be
considered unethical for a physical therapist assistant to own or have a
financial interest in the production, sale, or distribution of
products/services, he/she must act in accordance with law and make full
disclosure of his/her interest to patients/clients.
2.4 Confidential Information
A. Information relating
to the patient/client is confidential and may not be communicated to a third
party not involved in that patient’s care without the prior consent of the
patient, subject to applicable law.
B. A physical therapist
assistant shall refer all requests for release of confidential information to
the supervising physical therapist.
Standard
3
A physical therapist assistant shall provide
selected physical therapy interventions only under the supervision and
direction of a physical therapist.
3.1 Supervisory Relationship
A. A physical therapist
assistant shall provide services only under the supervision and direction of a
physical therapist.
B. A physical therapist
assistant shall provide only those physical therapy interventions that have
been selected by the physical therapist.
C. A physical therapist
assistant shall not carry out any selected physical therapy interventions that
are outside his/her education, training, experience, or skill and shall notify
the physical therapist.
D. A physical therapist
assistant may adjust specific interventions within the plan of care established
by the physical therapist in response to changes in the patient’s/client’s
status.
E. A physical therapist
assistant shall not perform examinations or evaluations, interpret data,
determine diagnosis or prognosis, or establish or alter a plan of care.
F. Consistent with the
physical therapist assistant’s education, training, knowledge, and experience,
he/she may respond to the patient’s/client’s inquiries regarding interventions
that are within the established plan of care.
G. A physical therapist
assistant shall have regular and ongoing communication with the physical
therapist regarding the patient’s/client’s status.
Standard
4
A physical therapist assistant shall comply with
laws and regulations governing physical therapy.
4.1 Supervision
A physical therapist
assistant shall know and comply with applicable law. Regardless of the content
of any law, a physical therapist assistant shall provide services only under
the supervision and direction of a physical therapist.
4.2 Representation
A physical therapist
assistant shall not hold him/herself out as a physical therapist.
Standard
5
A physical therapist assistant shall achieve and
maintain competence in the provision of selected physical therapy
interventions.
5.1 Competence
A physical therapist
assistant shall provide interventions consistent with his/her level of
education, training, experience, and skill.
5.2 Self-assessment
A physical therapist
assistant shall engage in self-assessment in order to maintain competence.
5.3 Development
A physical therapist
assistant shall participate in educational activities that enhance his/her
basic knowledge and skills.
Standard
6
A physical therapist assistant shall make judgments
that are commensurate with their educational and legal qualifications as a
physical therapist assistant.
6.1 Patient Safety
A. A physical therapist
assistant shall discontinue immediately any components of interventions that,
in his/her judgment, appear to be harmful to the patient and shall discuss
his/her concerns with the physical therapist.
B. A physical therapist
assistant shall not carry out any selected physical therapy interventions that
are outside his/her education, training, experience, or skill and shall notify
the physical therapist.
C. A physical therapist
assistant shall not perform interventions while his/her ability to do so safely
is impaired.
6.2 Patient Status Judgments
A physical therapist
assistant participates in patient status judgments by reporting changes to the
physical therapist and requesting patient re-examination or revision of the
plan of care. See Section 3.1.
6.3 Gifts and Other Considerations
A physical therapist
assistant shall not invite, accept, or offer gifts or other considerations that
affect or give the appearance of affecting his/her provision of physical
therapy interventions or that exploit the patient in any way. See Section
2.1(B).
Standard
7
A
physical therapist assistant shall protect the public and the profession from
unethical, incompetent, and illegal acts.
7.1 Consumer Protection
A physical therapist
assistant shall report any conduct that appears to be unethical or illegal.
7.2 Organizational Employment
A. A physical therapist
assistant shall inform his/her employer(s) and/or appropriate physical
therapist of any employer practice that causes him or her to be in conflict
with the Standards of Ethical Conduct for the Physical Therapist Assistant.
B.
A physical therapist assistant shall not engage in any activity that puts him
or her in conflict with the Standards of Ethical Conduct for the Physical
Therapist Assistant, regardless of directives from a physical therapist or
employer.
HIPAA AND PATIENT PRIVACY
In
April 2001, at the direction of President Bush and HHS Secretary Tommy G.
Thompson, the first-ever federal privacy standards to protect patients’ medical
records and other health information provided to health plans, doctors, hospitals
and other health care providers went into effect. These standards provide
patients with access to their medical records and more control over how their
personal health information is used and disclosed.
Covered Entities
HIPAA regulations include 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.
Patient Protections
The
new privacy regulations ensure a national floor of privacy protections for
patients by limiting the ways that health plans, pharmacies, hospitals and
other covered entities can use patients' personal medical information. The
regulations protect medical records and other individually identifiable health
information, whether it is on paper, in computers or communicated orally. Key
provisions of these new standards include:
·
Access
To Medical Records.
Patients generally should be able to see and obtain copies of their medical
records and request corrections if they identify errors and mistakes. Health
plans, doctors, hospitals, clinics, nursing homes and other covered entities
generally should provide access to these records within 30 days and may charge
patients for the cost of copying and sending the records.
·
Notice
of Privacy Practices.
Covered health plans, doctors and other health care providers must provide a
notice to their patients how they may use personal medical information and
their rights under the new privacy regulation. Doctors, hospitals and other
direct-care providers generally will provide the notice on the patient's first
visit and upon request. Patients generally will be asked to sign, initial or
otherwise acknowledge that they received this notice. Patients also may ask
covered entities to restrict the use or disclosure of their information beyond
the practices included in the notice, but the covered entities would not have
to agree to the changes.
·
Limits
on Use of Personal Medical Information. The privacy rule sets limits on how health plans and covered
providers may use individually identifiable health information. To promote the
best quality care for patients, the rule does not restrict the ability of
doctors, nurses and other providers to share information needed to treat their
patients. In other situations, though, personal health information generally
may not be used for purposes not related to health care, and covered entities
may use or share only the minimum amount of protected information needed for a
particular purpose. In addition, patients would have to sign a specific
authorization before a covered entity could release their medical information
to a life insurer, a bank, a marketing firm or another outside business for
purposes not related to their health care.
·
Prohibition
on Marketing. The final
privacy rule sets new restrictions and limits on the use of patient information
for marketing purposes. Pharmacies, health plans and other covered entities
must first obtain an individual's specific authorization before disclosing
their patient information for marketing. At the same time, the rule permits
doctors and other covered entities to communicate freely with patients about
treatment options and other health-related information, including
disease-management programs.
·
Stronger
State Laws. The new
federal privacy standards do not affect state laws that provide additional
privacy protections for patients. The confidentiality protections are
cumulative; the privacy rule will set a national "floor" of privacy
standards that protect all Americans, and any state law providing additional
protections would continue to apply. When a state law requires a certain
disclosure -- such as reporting an infectious disease outbreak to the public
health authorities -- the federal privacy regulations would not preempt the
state law.
·
Confidential
communications. Under
the privacy rule, patients can request that their doctors, health plans and
other covered entities take reasonable steps to ensure that their
communications with the patient are confidential. For example, a patient could
ask a doctor to call his or her office rather than home, and the doctor's
office should comply with that request if it can be reasonably accommodated.
·
Complaints. Consumers may file a formal complaint
regarding the privacy practices of a covered health plan or provider. Such
complaints can be made directly to the covered provider or health plan or to
HHS' Office for Civil Rights (OCR), which is charged with investigating
complaints and enforcing the privacy regulation. Information about filing
complaints should be included in each covered entity's notice of privacy
practices.
Health Plans and Providers
The
privacy rule requires health plans, pharmacies, doctors and other covered
entities to establish policies and procedures to protect the confidentiality of
protected health information about their patients. These requirements are
flexible and scalable to allow different covered entities to implement them as
appropriate for their businesses or practices. Covered entities must provide
all the protections for patients cited above, such as providing a notice of
their privacy practices and limiting the use and disclosure of information as
required under the rule. In addition, covered entities must take some
additional steps to protect patient privacy:
·
Written
Privacy Procedures. The
rule requires covered entities to have written privacy procedures, including a
description of staff that has access to protected information, how it will be
used and when it may be disclosed. Covered entities generally must take steps
to ensure that any business associates who have access to protected information
agree to the same limitations on the use and disclosure of that information.
·
Employee
Training and Privacy Officer. Covered entities must train their employees in their privacy
procedures and must designate an individual to be responsible for ensuring the
procedures are followed. If covered entities learn an employee failed to follow
these procedures, they must take appropriate disciplinary action.
·
Public
Responsibilities. In
limited circumstances, the final rule permits -- but does not require --covered
entities to continue certain existing disclosures of health information 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 that involves limited data or
has been independently approved by an Institutional Review Board or privacy
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. Where no other law requires
disclosures in these situations, covered entities may continue to use their
professional judgment to decide whether to make such disclosures based on their
own policies and ethical principles.
·
Equivalent
Requirements For Government. The provisions of the final rule generally apply equally to
private sector and public sector covered entities. For example, private
hospitals and government-run hospitals covered by the rule have to comply with
the full range of requirements.
ETHICS AND JURISPRUDENCE CASE STUDIES
Case Study #1 - Confidentiality
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 MRI report, it looks like he is going to need surgery.”
Is
this a breach in 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.
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.
(APTA’s Guide for Professional Conduct,
Principle 2.3)
Case Study #2 –
Qualifications of Practice
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 PTA.
The patients always give her compliments, and frequently request her to
treat them. She demonstrates exceptional
skills and achieves outstanding outcomes.
Is the clinic providing ethical care to its patients?
The practice of physical therapy is closely regulated throughout the
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 PTA.”. The “should” in this case must not be
interpreted as merely a casual suggestion but rather a legal definition
regulated by the state’s Physical Therapy Practice Act. Any treatment or procedure that should
be performed by a licensed professional, must be performed by a licensed
professional. (APTA’s Guide for
Professional Conduct, Principle 4.2.B)
Case Study #3 – Informed Consent
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?
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.
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). (APTA’s Guide for Professional Conduct,
Principle 2.4)
Case Study #4- Medical Necessity
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?
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.
In this instance, the decision to limit care is not ethical. 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. (APTA’s Guide
for Professional Conduct, Principles 7.1.C and 8.1.C)
Case Study #5 – Billing and Coding
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?
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 committing a crime by conspiring with the patient to defraud their
insurance company. The question
frequently asked 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 patients, who have no financial responsibility associated with their
healthcare, are more likely to utilize a greater number of services (and
subsequently have higher total bills) than those who must contribute directly
for their care.
Billing
accuracy is another important area of ethical conduct relating to billing and
coding for rehab services. It is crucial that therapists take great care
to ensure that the following billing criteria is met: What was performed = What was documented =
What was billed. All three components of
this equation 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. (APTA’s Guide for Professional Conduct, Principle 9.1.C)
Case Study #6 – Conflicts of Interest
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.
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. (APTA’s Guide for Professional Conduct, Principles 7.2.A 7.2.B)
Case Study #7 – Relationships with Referral Sources
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.
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. (APTA’s Guide for Professional
Conduct, Principle 9.1.D)
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http://folio.legis.state.wi.us/cgi-bin/om_isapi.dll?clientID=93587&infobase=code.nfo&softpage=Browse_Frame_Pg
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POST-TEST
- The ethics theory that proposes that right and
wrong are determined by the consequences is called
- Utilitarianism
- Social Contract Theory
- Ethical Intuitionism
- Virtue Ethics
- The duty to tell the truth is also known as
- Autonomy
- Beneficence
- Nonmaleficence
- Veracity
- According to 448.56 of the
- In schools to children with disabilities
- To a patient in a nursing home pursuant to the
patient’s plan of care.
- Care relating to athletic activities,
conditioning, or injury prevention
- All of the above
- Which of the following statements is FALSE
concerning PTA supervision requirements?
- The supervising PT must meet face to face with
the PTA at least once every 14 days
- The supervising PT must provide on-site
assessment and reevaluation of each patient’s treatment at least once per
month or every 10th treatment day, whichever is sooner.
- The supervising PT must review all PTA
treatment notes weekly.
- A physical Therapist may not supervise more
than 2 full-time PTA’s practicing under general supervision.
- Unprofessional conduct by a physical therapist
is defined in which of the following?
- Rule PT 4.01 of the
- Rule PT 7.02 of the
- Chapter 448.54 of the
- Principle 10 of the APTA Code of Ethics
- The licenses of all
- November 1 of odd years
- November 1 of even years
- January 1 of even years
- October 1 of odd years
- Each biennial registration period,
- 30, 20, 2
- 30, 30, 4
- 30, 20, 4
- 20, 20, 4
- Which principle of The APTA’s
Guide of Professional Conduct prohibits consensual sexual activity between
a therapist and a patient?
- Principle 8.2 (B)
- Principle 7.1 (D)
- Principle 4.2 (A)
- Principle 2.1 (C)
- Which of the following is NOT a
provision under HIPAA?
- All patients shall receive
copies of all of their medical records within 60 days of completion of
their care.
- Providers must give patients a
clear written explanation about how their health information will be
used.
- An individual’s specific
authorization is required in order to use their patient information for
marketing purposes.
- Providers and other covered
entities must train their employees in privacy procedures.
- The “Trust Test” is used to
determine
- Informed Consent
- Medical Necessity
- Conflict of Interest
- Fair Market Value