Clarification on Principles and Standards

APTA's revised Code of Ethics for the Physical Therapist and Standards of Practice for the Physical Therapist Assistant went into effect July 1, 2010. Here are answers to some clarifications on specific Principles and Standards.

Additional Examination of Principle/Standard 4C

Principle/Standard 4C states: "Physical Therapists (and PTAs) shall discourage misconduct by healthcare professionals and report illegal or unethical acts to the relevant authority, when appropriate."

What are my reporting obligations under Principle/Standard 4C, and more specifically, what does "when appropriate" mean? 

The language "when appropriate" under Principle/Standard 4C means that not all allegedly illegal or unethical acts should be reported immediately to an agency/authority. Instead, you are encouraged to communicate with the individuals involved and see if the action is corrected and in that case, no reporting is appropriate. Moreover, whether something is or is not ethical is subject to interpretation. And, the ability to interpret will depend upon knowing all of the facts. An agency/authority will engage in fact finding to facilitate their interpretation. Accordingly, you may conclude that something is unethical, but an agency/authority can reach a different conclusion after completion of a fact finding investigation. For further guidance on the complexities of reporting, you may wish to read the following EJC Opinion.

Additional Examination of Principle/Standard 4E

Principle/Standard 4E states: "Physical therapists (and PTAs) shall not engage in any sexual relationship with any of their patient/clients, supervisees or students."

Does Principle/Standard 4E mean what it says? 

Yes. This sentence means what it states. It means that a PT/PTA shall not exploit their patients/clients, supervisees or students by engaging in a sexual relationship.

You may also read this Principle/Standard in conjunction with Principle/Standard 4B, which states: "Physical therapists (and PTAs) shall not exploit persons over who they have supervisory, evaluative or other authority (e.g. patients/clients, students, supervisees, research participants, or employees)."

Next, please consider further what is stated in the following EJC Opinion: "A physical therapist stands in a relationship of trust to each patient and has an ethical obligation to act in the patient's best interest and to avoid any exploitation or abuse of the patient. Thus, if a physical therapist has natural feelings of attraction toward a patient, he/she must sublimate those feelings in order to avoid sexual exploitation of the patient."

One's ethical decision making process should focus on whether the patient/client, supervisee or student is being exploited. In this context, questions have been asked about whether one can have a sexual relationship once the patient/client relationship ends.

To this question, the EJC has opined as follows: "The Committee does not believe it feasible to establish any bright-line rule for when, if ever, initiation of a romantic/sexual relationship with a former patient would be ethically permissible. The Committee imagines that in some cases a romantic/sexual relationship would not offend ... if initiated with a former patient soon after the termination of treatment, while in others such a relationship might never be appropriate."

Additional Examination of Principles/Standards 5D and 5E

Principle/Standard 5D states: "Physical therapists (and PTAs) shall encourage colleagues with physical, psychological, or substance related impairments that may adversely impact their professional responsibilities to seek assistance or counsel."

Principle/Standard 5E states: "Physical therapists (and PTAs) who have knowledge that a colleague is unable to perform their professional responsibilities with reasonable skill and safety shall report the information to the appropriate authority."

What am I obligated to do under Principle/Standard 5D and 5E? 

The central focus of Principle/Standard 5D and 5E is to state that a PT/PTA cannot do nothing when faced with circumstances set forth in 5D and 5E. Principle/Standard 5D states that a PT/PTA shall encourage seeking assistance or counsel and Principle/Standard 5E addresses reporting information to the appropriate authority. For further guidance on the complexities of reporting, you may wish to read the following EJC Opinion.

Additional Examination of Principle 7E

Principle 7E states: "Physical therapists shall be aware of charges and shall ensure that documentation and coding for physical therapy services accurately reflect the nature and extent of the services provided."

Principle/Standard 5E states: "Physical therapists (and PTAs) who have knowledge that a colleague is unable to perform their professional responsibilities with reasonable skill and safety shall report the information to the appropriate authority."

Can you further explain Principle 7E and provide me with some resources that can assist me in my documentation and coding? 

Principle 7E states that physical therapists shall be aware of charges for physical therapy services to ensure that documentation and coding reflect those services. In other words, the physical therapist must make sure that the process of documentation and coding accurately captures the charges. In this context, where charges cannot be determined because of payment methodology you can review the House of Delegates policy entitled Professional Fees for Physical Therapy Services. The policy states that "in cases where the fee for service cannot be determined because of the payment methodology, the physical therapist should be aware of the payment methodology." In addition, you may wish to review the House of Delegates policy entitled Documentation Authority for Physical Therapy Services.

Additional Examination of Principle 7F and Standard 7E

Principle 7F and Standard 7E state: "Physical Therapists (and PTAs) shall refrain from employment arrangements, or other arrangements, that prevent physical therapists (and PTAs) from fulfilling professional obligations to patients/clients."

\ Has a PT/PTA violated Principle 7F and Standard 7E by working in a referral-for-profit setting? 

No. A PT/PTA has not violated the Principle/Standard by working in a referral-for-profit setting. If a PT/PTA is able to fulfill their ethical obligations, they are complying with the Principle/Standard, irrespective of practice setting. For further information about referral-for-profit, please review the resources on the APTA Web site.

Additional Examination of Principle 8A

Principle 8A states: "Physical Therapists shall provide pro bono physical therapy services or support organizations that meet the health needs of people who are economically disadvantaged, uninsured, and underinsured."

Is it a violation of Principle 8A if a PT does not provide pro bono physical therapy services? 

No. It is not a violation. Principle 8A states that a PT shall provide pro bono physical therapy services OR support organizations that meet the health needs of people who are economically disadvantaged, uninsured, and underinsured. The key word in this sentence is "or." If a PT is unable to provide pro bono services they can still fulfill their ethical obligations by supporting organizations that meet the health needs of people who are economically disadvantaged, uninsured, and underinsured. In addition, PTs may wish to review the House of Delegates Guidelines: Pro Bono Physical Therapy Services.

Additional Examination of Principle 8A and Standard 8A

Standard 8A states: "Physical therapist assistants shall support organizations that meet the health needs of people who are economically disadvantaged, uninsured, and underinsured."

Does Standard 8A differ from Principle 8A? 

Yes. Standard 8A does not include language on pro bono services.

  • Last Updated: 12/15/2010
  • Contact: ejc@apta.org
  • Members Only = Members Only
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