Workplace Practices: Friend or Foe of Ethics

Transcription

1 Workplace Practices: Friend or Foe of Ethics Board of Ethics November, 2011

2 Session Learning Outcomes Describe the Board of Ethics and its role in ethics education and adjudication of cases Identify common ethical inquiries to the ASHA national office Review the use of and purpose for a Code of Ethics Describe the basic steps used to file an ethical complaint Introduce a model for ethical decision making Apply this model to scenarios which highlight ethical dilemmas

3 Members of the Board of Ethics: 2011 Stephanie Davidson, Chair (Audiology) Nicholas Bankson (SLP) Susan Brannen (Audiology) Fred Britten (Audiology) Gerard Caracciolo (SLP) Diane Eger (Audiology) Sumalai Maroonroge (Audiology) Sharon Moss (SLP) Wren Newman (SLP) Mary Porter (SLP) Diane Scott (Audiology) Diane Yeager (Public Member)

4 National Office Staff/Board of Directors National Office Heather Bupp, Esq Director of Ethics Linda D Aloisio, Administrative Support Monitoring Vice Presidents Allan Diefendorf, VP for Standards and Ethics: Aud. Jennifer Watson, VP for Standards and Ethics: SLP

5 Charge to the Board of Ethics The Board of Ethics is charged by Bylaws of the Association (2008) to: Formulate, publish and from time to time amend a Code of Ethics Develop educational programs and materials for members Adjudicate complaints alleging violations of the Code of Ethics

6 Trends of Inquiries to BOE Ethical dilemmas are a common and difficult part of the practice of speech-language pathology and audiology (Anderson and Chabon, 2007) Approximately 3,000 ethics inquiries per year (Denton, 2007)

7 Common Themes of Inquiries Employer demands Use and supervision of support personnel Impaired practitioner/professional Reimbursement for services Professional [vs] business ethics Clinical fellowship supervision

8 Adjudication Workload: Complaints ICH FCH

9 Employer Demands Pressure to: Provide services without adequate training Increase caseload Adhere to treatment eligibility criteria or program placement recommendations which may be in conflict with your clinical judgment Use old or poorly maintained equipment/ technology Provide services which, in your clinical judgment, are not warranted.

10 Use and Supervision of Support Personnel Inappropriate delegation of responsibilities to support personnel Inadequate documentation of supervision Billing for services by unsupervised students/assistants Inadequate supervision

11 Reimbursement of Services Misrepresenting information to obtain reimbursement Billing for services provided by an SLP who is not certified and/or does not receive the necessary supervision (Intentionally) misusing incorrect code numbers or diagnostic labels on billing forms for purpose of qualifying for payment Billing for services not provided or not necessary

12 Professional vs Business Ethics Solicitation of cases for private practice from your caseload Acceptance of gifts or incentives from manufacturers or other individuals Client abandonment and/or disruption of services Failure to report unethical behavior Misuse of professional credentials

13 Clinical Fellowship Supervision Inadequate or inappropriate supervision of clinical fellows Inadequate time to meet supervisory responsibilities Inadequate documentation of supervision and CF s performance Failure to maintain one s own competence Misuse of power over the CF

14 Impaired Practitioner Impairments which may affect the provision of services to consumer Use and abuse of drugs Use and abuse of alcohol Mental health issues The professional not knowing when the delivery of service should be ceased

15 Where to Obtain Assistance Code of Ethics [2010] Issues in Ethics Statements Articles from the Director of Ethics Website: asha.org/practice/ethics Contact the Director of Ethics Heather Bupp, Esq. Director of Ethics

16 Principles within Code of Ethics The four Principles of Ethics forms the moral basis for the code. The Principles are: Principle I Responsibilities to persons served professionally Principle II Responsibility for one s professional competence Principle III Responsibility to the public Principle IV Responsibilities involving inter-and intraprofessional relationships

17 Difficulties Applying the Code of Ethics Most Codes are broadly written; it is sometimes difficult to apply general rules to specific cases Ethical questions are complex and may not be completely addressed by a code of ethics An ethical code may conflict with institutional policies and practices We may be required to practice within a framework of numerous codes of conduct (Huffman, 2003)

18 The decision-making process begins with the question, Am I facing an ethical dilemma? If the situation is one in which personal and professional integrity are being challenged, the answer will likely be Yes. (Morris & Chabon, 2005)

19 Once it is established that an ethical dilemma exists, the questions addressed include: What possible courses of action are permissible, impermissible or necessary? and What are the effects (benefits and burdens) of each action? (Chabon & Morris, 2006)

20 Ethical Decision Making Model Am I facing an ethical dilemma here? What are the relevant facts, values & beliefs? Who are the key people involved?

21 Ethical Decision Making Model State the dilemma clearly Analysis

22 Ethical Decision Making Model Am I facing an Ethical dilemma here? What are the relevant facts, values & beliefs? Who are the key people involved? State the dilemma clearly. Evaluate: 1) Ethical Principles 2) Code of Ethics 3) Social Roles 4) Self-Interests Does your proposed course of action lead to CONSENSUS? If YES then proceed If NO Analysis PROPOSED COURSE OF ACTION What are the conflicts that arise from each action? What are the possible courses of action one could take? (Morris & Chabon, 2005)

23 Professional Codes Provide Guidance [Chabon and Dunham, 2007] Provide helpful guidance to members Establish and embrace the common, core values reflecting consensus among members Promote public trust by stating what is to be expected of professionals Promote high standards of practice Define acceptable/unacceptable conduct within the profession

24 Filing an Ethics Complaint Complaints must be filed in writing the required form and instructions are available on the Ethics area of the ASHA website Complaint attachments should provide the facts on which the complaint is based and evidence that corroborates and supports the allegations Do not refer the BOE to a site or have the BOE contact you for further information. Submit everything at the time it is filed. The complaint must be signed ASHA does not accept anonymous complaints Pay attention to the instructions and seek guidance from the Director of Ethics when preparing a complaint!!!!

25 Board of Ethics Jurisdiction ASHA members who hold ASHA certification Non-members who hold ASHA certification Applicants for ASHA certification

26 Responding to an Ethics Complaint A copy of the signed complaint is forwarded to the respondent, who has an opportunity to provide a statement refuting the allegations A response should be made to each allegation (stated or implied) in the complaint The response should provide facts which refute the allegations and evidence that corroborates and supports information provided in the response Seek guidance from the Director of Ethics when responding to a complaint!!!!

27 Initial Determination The Board of Ethics reviews each case, considering only the information presented in the complaint and the response Based on the information provided, the Board renders an Initial Determination May find that there is insufficient evidence to support a violation May find that there is a violation of the Code of Ethics (the board will indicate the portions of the Code that have been violated) May spend several hours adjudicating a case. The Board does not have investigative powers!!!

28 Sanctions If the individual has been found to be in violation of the Code of Ethics, one of the following sanctions will be applied as part of the Initial Determination Reprimand (private between complainant and respondent) Censure (public: published in ASHA Leader) Withholding (for clinical fellows) Suspension of Membership and/or Certification for a period of time (public: published in ASHA Leader) Revocation of Membership and/or Certification for a period of time (public: published in ASHA Leader)

29 Further Consideration Hearing Individuals found to be in violation of the Code of Ethics in the Initial Determination may request a Further Consideration Hearing Additional written evidence in defense Ability to appear before the Board of Ethics to present a defense At the conclusion of the process, a Final Decision is rendered A final appeal can be made to ASHA s Board of Directors

30 Motions to Reach Decisions: N=144 Cases No Violations Violation ICH Sanctions FCH 20 0 Unanimous Split Vote

31 Situation: Example Case New owner of company informs you that if you are to keep the salary you have been receiving, you need to increase your caseload. Under this pressure and since you are unable to see the cases during the summer months, and they are on your caseload during a school year, you submit billing slips which reflect that you are seeing the clients 3 times per week. You had intended that once school beins, you would make up these sessions that are being billed in advance. One of the parents receive an insurance claim and notices there are sessions on the insurance billing which do not match the days you actually saw the child. Upon checking, the employer finds $ of billing for services not rendered for several clients. Your employer files a complaint with the State Licensure Board and the ASHA Board or Ethics

32 Findings of the Board of Ethics Principle of Ethics I, Rule O: Individuals shall not charge for services not rendered Principle of Ethics III, Rule D: Individual shall not misrepresent services rendered Principle of Ethics III, Rule E: Individuals shall not defraud or engage in a scheme to defraud. Principle of Ethics IV, Rule C: Individuals shall not engage in dishonesty and fraud

33 Sanction Imposed Revocation of Membership and Certification for Life

34 Ethical Delimmas: Cases Presented

35 Sanctions to Consider for Deliberations Reprimand (private): Between complainant and Respondent\ Censure (public): Published in the Leader Withholding (for clinical fellows) Suspension of Membership and/or Certification for a period of time: Published in Leader Revocation of Membership and/or Certification for a period of time: Published in Leader