Can I? Should I? New rules in ASHA’s recently revised Code of Ethics provide guidance to clinicians in a variety of situations. On the Pulse
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On the Pulse  |   July 01, 2016
Can I? Should I?
Author Notes
  • Janet Brown, MA, CCC-SLP, is ASHA director of health care services in speech-language pathology. jbrown@asha.org
    Janet Brown, MA, CCC-SLP, is ASHA director of health care services in speech-language pathology. jbrown@asha.org×
  • Heather Bupp, Esq., is ASHA director of ethics. hbupp@asha.org
    Heather Bupp, Esq., is ASHA director of ethics. hbupp@asha.org×
Article Information
Practice Management / Professional Issues & Training / ASHA News & Member Stories / On the Pulse
On the Pulse   |   July 01, 2016
Can I? Should I?
The ASHA Leader, July 2016, Vol. 21, 36-37. doi:10.1044/leader.OTP.21072016.36
The ASHA Leader, July 2016, Vol. 21, 36-37. doi:10.1044/leader.OTP.21072016.36
Fifteen new rules in the Code of Ethics, which became effective March 1, provide guidance about appropriate actions in difficult clinical situations. The following scenarios illustrate situations in which some of the new rules—as well as previously established rules—apply.
Impaired provider
Patricia’s co-worker Marie confided that she is stressed due to an impending divorce and issues with her teenage children. Marie has told Patricia that she is taking medication for anxiety and that she needs several drinks to sleep at night. For the past week Patricia has seen that Marie is unsteady and slightly disoriented at work—they are both speech-language pathologists in a hospital—and has expressed her concerns to Marie. The following week Patricia sees Marie fall while escorting a child to the therapy department. She reports her concerns about Marie to her supervisor, who in turn reports internally to Human Resources to activate its policy on impaired employees.
Is Patricia obligated under the code to do anything? Yes.
Principle I, Rule S: Individuals who have knowledge that a colleague is unable to provide professional skills with reasonable skill and safety shall report this information to the appropriate authority, internally if a mechanism exists and, otherwise, externally. (Rule I-R may also apply; see the list of related rules below.)
Practicing without certification
Paul just graduated with his master’s degree in speech-language pathology and passed the Praxis exam. He is recruited for a position in a rural hospital in a neighboring state, but then learns that the state does not provide provisional licensure for clinical fellows. Paul declines the position because he knows that Medicare providers must be licensed.
Should Paul take the job? No. Does Paul need a provisional state license? Yes.
Principle II, Rule B: Members who do not hold the Certificate of Clinical Competence may not engage in the provision of clinical services; however, individuals who are in the certification application process may engage in the provision of clinical services consistent with current local and state laws and regulations and with ASHA certification requirements. (Rule IV-R may also apply.)

A skilled nursing facility can perform screenings but cannot bill for an evaluation if there is no indication in the patient’s medical record or staff reports of speech, language, cognitive or swallowing problems.

Independent judgment
The administrator of a skilled nursing facility tells Cynthia, the speech-language pathology director, that her staff must complete full evaluations on all Medicare Part B patients admitted to the facility. Cynthia tells the administrator that they can perform screenings but cannot bill for an evaluation if there is no indication in the patient’s medical record or staff reports of speech, language, cognitive or swallowing problems. If any patient fails a screen, she explains to him, they can then request a physician order and perform and bill for a full evaluation.
Should Cynthia follow the supervisor’s directive? No.
Principle II, Rule F: Individuals in administrative or supervisory roles shall not require or permit their professional staff to provide services or conduct clinical activities that compromise the staff member’s independent and objective professional judgment. (Related rules may include I-K, III-D, IV-B.)
Reporting other professionals
Teresa, an SLP, has observed an occupational therapy assistant treating patients independently while the occupational therapist works out of another location. She is concerned when she sees the assistant performing evaluations and signing the therapist’s name, even when the therapist was not present. When Teresa asks about this, the assistant tells her to mind her own business and that he has been working in the office long enough to know what the patients need. The therapist says that she talks to the assistant by phone periodically and is comfortable with his judgment. Teresa contacts the state licensure board for occupational therapy to report the therapist and the assistant.
Could Teresa report what she knows? Yes.
Principle IV, Rule N: Individuals shall report members of other professions who they know have violated standards of care to the appropriate professional licensing authority or board, other professional regulatory body, or professional association when such violation compromises the welfare of persons served… (“Know” is defined in the code terminology as “having or reflecting knowledge.”)
Related Ethics Rules

Although not new, the following Code of Ethics rules may be related to the scenarios outlined in this article.

Impaired provider

I-R: Individuals whose professional practice is adversely affected by substance abuse, addiction, or other health-related conditions are impaired practitioners and shall seek professional assistance and, where appropriate, withdraw from the affected areas of practice.

Practicing without certification

IV-R: Individuals shall comply with local, state, and federal laws and regulations applicable to professional practice, research ethics, and the responsible conduct of research.

Independent judgment

I-K: Individuals who hold the Certificate of Clinical Competence shall evaluate the effectiveness of services provided, technology employed, and products dispensed, and they shall provide services or dispense products only when benefit can reasonably be expected.

III-D: Individuals shall not defraud through intent, ignorance, or negligence or engage in any scheme to defraud in connection with obtaining payment, reimbursement, or grants and contracts for services provided, research conducted, or products dispensed.

IV-B: Individuals shall exercise independent professional judgment in recommending and providing professional services when an administrative mandate, referral source, or prescription prevents keeping the welfare of persons served paramount.

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FROM THIS ISSUE
July 2016
Volume 21, Issue 7