Disputes can arise in even the best professional relationships, whether the parties involved are employer and employee, colleagues, or health care provider and patient/client. Determining how best to address disputes requires consideration of various factors. The general information that follows lists several options. Keep in mind that no one option will work in all situations.
Note, too, that third-party involvement isn't always most effective or required. Depending on the situation, an examination of all of the options below may balance in favor of discussing the dispute with legal counsel and/or a trust colleague, employer, family member, or friend and seeking a workable solution with the party with whom you have a dispute.
Examine the Situation
If you believe that the matter may give rise to legal or ethical considerations and you are thinking about involving a third party, consider whether you know or can obtain all the facts. For example, key information relative to your analysis may lie in documents that are protected by privacy laws or may only be uncovered by contacting individuals with first-hand knowledge. Knowing all of the facts may impact how you proceed.
Review Applicable Laws, Rules, and Regulations
In considering whether you know the facts, examine these facts relative to applicable laws, rules, or regulations. Licensure is required in each state in which a physical therapist practices. Physical therapists must practice within the scope of their state physical therapy practice acts. Review state practice acts, along with the accompanying rules and regulations, to assist in assessing legal or ethical issues.
Look not only at state laws, but federal laws, rules, and regulations. For example, concern over whether privacy laws may have been violated may impact your decision in whether or not to file a complaint with the US Department of Health & Human Services.
In the event the matter may raise ethical issues, examine applicable state practice acts. Practice acts include language addressing adherence to ethical standards of the physical therapy profession. Depending upon the language in the practice acts, failure to adhere to the ethical standards of the physical therapy profession may be grounds for discipline under state law.
In addition, you may review APTA's Core Ethics Documents. These documents include the Code of Ethics for the Physical Therapist, the Standards of Conduct for the Physical Therapist Assistant, and their accompanying Guides for Conduct. These documents can be reviewed to determine ethical obligations.
If you are a physical therapist or physical therapist assistant and in need of further resources in order to better understand ethical obligations, you may review the Ethics and Judicial Committee Opinions and the numerous decision-making tools. These resources may guide physical therapists and physical therapist assistants in their ethical decision-making process.
Should I Contact a Third Party?
A challenging step is to determine what, if anything, to do. This determination is complex, particularly if you seek resolution from a third party. You may reach your own conclusions about whether something is legal or ethical, but a court, agency, or other authority will engage in their own analysis of the facts relative to applicable laws, rules, and regulations. It may be a challenge if not impossible to know what the third party's final analysis may be. Accordingly, consider the time and cost of obtaining a decision from a third party and whether such a decision will assist in achieving the resolution that you desire. The following further examines options that you may consider.
- Talk with the Physical Therapist or Physical Therapist Assistant:
One way to resolve a dispute is to talk with the physical therapist or physical therapist assistant about the issue of concern. Often two parties can resolve a dispute and reach a resolution without the need to involve a third party. In addition, by engaging in a dialogue you may learn information that better informs your understanding of why something may have occurred. Often this additional information and further discussions can resolve or adequately resolve the dispute.
- Advice of Counsel:
You may seek advice of counsel to assist in determining how to proceed. Counsel can examine the facts and provide guidance on applicable laws, rules, and regulations. In so doing, counsel can confidentially provide legal advice or guidance tailored to your unique set of facts.
- Additional Considerations Relative to Whether to Contact a Third Party:
To further assist in a determination of how to proceed, the Ethics and Judicial Committee has written an exhaustive opinion on this topic, entitled "Preserving Confidences; Physical Therapist's Reporting Obligation with Respect to Unethical, Incompetent, or Illegal Acts." In this opinion, the Ethics and Judicial Committee states that the Code of Ethics for the Physical Therapist and Standards of Ethical Conduct for the Physical Therapist Assistant do not require that a physical therapist, in every case in which he/she becomes aware of unethical, incompetent, or illegal conduct, make a report to the physical therapy licensing agency. Again, this decision depends on the facts and circumstances of your unique situation.
- Filing a Complaint - Contact the State Licensing Board:
To file a complaint against a physical therapist or physical therapist assistant contact the State Licensing Board Disciplinary Agency. A state licensing board has extensive investigative abilities including the ability to subpoena records. And it has the authority to take action against a physical therapist or physical therapist assistant's license. Additional resources on filing a complaint with the state licensing board can be found on the Federation of State Licensing Board's website. This website provides a list of what might constitute a possible violation punishable under a state practice act and provides further instructions on filing a complaint.
- Employer/Organizational Grievance Department:
You may choose to address the circumstances with the entity that employees the physical therapist or physical therapist assistant. In addition, many hospitals and other group practices have in place a grievance procedure.
- Insurance Related Issues:
If the issue deals with a fee dispute, in addition to the parties trying to privately resolve the situation, you may wish to contact the insurance company.
For disputes regarding payer/provider relationships, you may also contact the Insurance Commissioner or the Department of Health in your state. For patients, APTA's consumer website, moveforwardpt.com, provides links to information about resolving health insurance disputes.
- Other Third Party Agencies:
Other third party agencies may also provide assistance and information relative to your particular dispute. For example, you may wish to contact the Better Business Bureau. Or, if the situation warrants, you may seek the assistance of various law enforcement agencies or you may contact the Medicare fraud hotline or the Office of the Inspector General (OIG) Hotline to report fraud, waste, abuse, and mismanagement in the Department of Health and Human Services' programs. And, if the matter deals with a potential violation of Health Insurance Portability and Accountability Act of 1996 (HIPAA), you may consider whether to contact the US Department of Health & Human Services to file a complaint.
- APTA's Ethics Process:
APTA has a process to file an ethics complaint against an APTA member physical therapist or physical therapist assistant. The first step of this process is to send a signed written complaint to the president of the APTA chapter in your state. Email complaints are not accepted. Detailed information is required to allow the chapter president to make a discretionary decision about whether or not to issue charges. APTA can only take action if the physical therapist or physical therapist assistant is a member of APTA and if action (reprimand, probation, suspension, or expulsion) is taken, such action is limited to a person's membership in the association.
Resolving disputes or complaints is a complex matter. While the above provides some general information, it does not list every avenue or resource that might be available to you. Examine your situation and research options to determine how best to address your particular complaint or dispute.
Please note: The information provided is offered for general informational purposes only. It is not offered or intended, nor should it be relied upon, as legal advice. Legal doctrines, statutes, and case law vary from state to state. You should consult with your own attorney for specific legal advice on particular legal issues.