ETHICS
GOALS
Course
Description
“Ethics and Jurisprudence – Tennessee Physical Therapy” is a home study
continuing education program for TN licensed physical therapists and physical
therapist assistants. The course focuses
on defining moral, ethical, and legal behavior of physical therapy
professionals. The information presented
includes the Tennessee Physical Therapy Practice Act (TN Code, Title 63,
Chapter 13, Parts 1 & 3), the TN Rules Governing the Practice of Physical
Therapy (Chapter 1150-1), TN Board of Physical Therapy Policy Statements,
licensure process, scope of practice, licensure renewal, disclosures to
patients, offenses that may lead to disciplinary actions, supervision requirements,
the APTA’s Code of Ethics and Guide for Professional Conduct for Physical
Therapists and assistants, model for ethical decision making, and hypothetical
case analysis.
Course Rationale
This course is designed to educate, promote and facilitate ethical and
legal behavior by
Course Goals & 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.
understand and
apply the APTA’s standards of professional ethical conduct
3.
understand the
ethical decision making model
4.
apply the ethical
decision making model to clinical situations to determine appropriate
professional behavior
5.
understand all of the
rights and responsibilities of physical therapy licensure as defined by the
Tennessee Physical Therapy Practice Act and the Tennessee Rules Governing the
Practice of Physical Therapy
6.
identify,
understand, and apply pertinent laws and rules relating to licensure process
7.
identify,
understand, and apply pertinent laws and rules relating to scope of practice
8.
identify,
understand, and apply pertinent laws and rules relating to patient disclosure
9.
identify,
understand, and apply pertinent laws and rules relating to disciplinary action
10.
identify,
understand, and apply pertinent laws and rules relating to supervision
requirements.
Course
Instructor - Michael Niss, DPT
Target Audience -
Course Educational Level - This course is applicable for
introductory learners.
Course Prerequisites – None
Criteria for issuance of Continuing Education Credits - A documented score of 70% or greater on the written post-test.
Continuing Education
Credits - Four (4) hours of continuing education
credit
Method of
Instruction/Availability – Text-based home
study course available continuously via the internet
Criteria for
Issuance of Continuing Education Credits -
A documented score of 70% or greater on the written post-test.
Determination of Continuing Education
Contact Hours
“Ethics and Jurisprudence – Tennessee Physical Therapy” 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 48 pages (excluding References and
Post Test)
OUTLINE
page
Goals and Objectives 1 start
hour 1
Outline 2
Ethics 3-27
Ethics Overview 3
Ethics Theories 4-6
Model for Ethical
Decision Making 6-7
APTA Code of Ethics 8-12
Standards of ethical
Conduct for the
The APTA Guide for Professional
Conduct 15 end hour 1
The APTA Guide for the
Conduct of the
Ethics Case Analysis 16-22
Case Study #1 – Confidentiality 16-17
Case study #2 – Qualifications of Practice 17-18
Case Study #3 – Informed Consent 18-19
Case Study #4 – Medical Necessity 19
Case Study #5 – Billing Coding 20
Case Study #6 – Conflict of Interest 20-22
Case Study #7 – Relationships with Referral Sources 22 end hour 2
Jurisprudence 23-49 start
hour 3
Statutes (T.A.C., Title
63, Chapter 13) 23
Part 1 23
Part 3 23
Rules (Chapter 1150-1) 24
Physical Therapy
Licensure Process 24-27
Licensure by
Examination 24-25
Licensure by
Reciprocity 25-26
Licensure
for Internationally Educated 26-27
Licensure to
Practice Electrophysiological Studies 27
Licensure Renewal 27
Change of Licensure
Status 28-29
Offenses That May Lead
to Disciplinary Actions 29-31
Disciplinary Actions
& Civil Penalties 31-33 end
hour 3
Continuing Competence 33-36 start
hour 4
Scope of Practice 36-39
Supervision Requirements 39-41
Disclosure &
Confidentiality 41-42
Consumer Right to Know Requirements 42
The Lawful Use of PT
&
Release of Client
Records 43
Policy Statements of the
TN Board of PT 43-49
Consent Form
without Referral 43
Physical
Therapy Discharge Plans 43
Direct Access
to Physical Therapy 44
Monitoring of
Home Health Aides 44
Continuing Competence 45
Renewal of
Licensees Called to Active Duty 45-46
Patient
Referrals for Physical Therapy 46-47
Lapsed
Licenses 47-48
Multidisciplinary
Health Screenings 48
References 49
Post-Test 50-51 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.
Ethics
are important on several levels.
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”.
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.
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).
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.
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.
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.
The foundation for making proper ethical decisions is
rooted in an individual’s ability to answer several fundamental questions
concerning their actions.
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.
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.
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.
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.
APTA Code of Ethics
Preamble
The Code of Ethics for the
Physical Therapist (Code of Ethics) delineates the ethical obligations of all
physical therapists as determined by the House of Delegates of the American
Physical Therapy Association (APTA). The purposes of this Code of Ethics are
to:
1. Define the ethical
principles that form the foundation of physical therapist practice in
patient/client management, consultation, education, research, and
administration.
2. Provide standards of
behavior and performance that form the basis of professional accountability to
the public.
3. Provide guidance for
physical therapists facing ethical challenges, regardless of their professional
roles and responsibilities.
4. Educate physical
therapists, students, other health care professionals, regulators, and the
public regarding the core values, ethical principles, and standards that guide
the professional conduct of the physical therapist.
5. Establish the standards by
which the American Physical Therapy Association can determine if a physical
therapist has engaged in unethical conduct.
No code of ethics is exhaustive nor can it address
every situation. Physical therapists are encouraged to seek additional advice
or consultation in instances where the guidance of the Code of Ethics may not
be definitive.
This Code of Ethics is built upon the five roles of
the physical therapist (management of patients/clients, consultation,
education, research, and administration), the core values of the profession,
and the multiple realms of ethical action (individual, organizational, and
societal). Physical therapist practice is guided by a set of seven core values:
accountability, altruism, compassion/caring, excellence, integrity,
professional duty, and social responsibility. Throughout the document the
primary core values that support specific principles are indicated in
parentheses. Unless a specific role is indicated in the principle, the duties
and obligations being delineated pertain to the five roles of the physical
therapist. Fundamental to the Code of Ethics is the special obligation of physical
therapists to empower, educate, and enable those with impairments, activity
limitations, participation restrictions, and disabilities to facilitate greater
independence, health, wellness, and enhanced quality of life.
Principle
#1: Physical therapists shall respect the inherent dignity and rights of all
individuals. (Core Values: Compassion, Integrity)
1A. Physical therapists shall act in a respectful manner toward
each person regardless of age, gender, race, nationality, religion, ethnicity,
social or economic status, sexual orientation, health condition, or disability.
1B.
Physical therapists shall recognize their personal biases and shall not
discriminate against others in physical therapist practice, consultation,
education, research, and administration.
Principle #2: Physical therapists shall be
trustworthy and compassionate in addressing the rights and needs of
patients/clients. (Core Values: Altruism, Compassion, Professional Duty)
2A.
Physical therapists shall adhere to the core values of the profession and shall
act in the best interests of patients/clients over the interests of the
physical therapist.
2B.
Physical therapists shall provide physical therapy services with compassionate
and caring behaviors that incorporate the individual and cultural differences
of patients/clients.
2C.
Physical therapists shall provide the information necessary to allow patients
or their surrogates to make informed decisions about physical therapy care or
participation in clinical research.
2D. Physical
therapists shall collaborate with patients/clients to empower them in decisions
about their health care.
2E.
Physical therapists shall protect confidential patient/client information and
may disclose confidential information to appropriate authorities only when
allowed or as required by law.
Principle #3: Physical therapists shall be
accountable for making sound professional judgments. (Core Values: Excellence, Integrity)
3A.
Physical therapists shall demonstrate independent and objective professional
judgment in the patient’s/client’s best interest in all practice settings.
3B.
Physical therapists shall demonstrate professional judgment informed by
professional standards, evidence (including current literature and established
best practice), practitioner experience, and patient/client values.
3C.
Physical therapists shall make judgments within their scope of practice and
level of expertise and shall communicate with, collaborate with, or refer to
peers or other health care professionals when necessary.
3D.
Physical therapists shall not engage in conflicts of interest that interfere
with professional judgment.
3E.
Physical therapists shall provide appropriate direction of and communication
with physical therapist assistants and support personnel.
Principle #4: Physical therapists shall demonstrate integrity in their
relationships with patients/clients, families, colleagues, students, research
participants, other healthcare providers, employers, payers, and the public. (Core
Value: Integrity)
4A.
Physical therapists shall provide truthful, accurate, and relevant information
and shall not make misleading representations.
4B.
Physical therapists shall not exploit persons over whom they have supervisory,
evaluative or other authority (eg, patients/clients, students, supervisees,
research participants, or employees).
4C.
Physical therapists shall discourage misconduct by healthcare professionals and
report illegal or unethical acts to the relevant authority, when appropriate.
4D.
Physical therapists shall report suspected cases of abuse involving children or
vulnerable adults to the appropriate authority, subject to law.
4E.
Physical therapists shall not engage in any sexual relationship with any of
their patients/clients, supervisees, or students.
4F.
Physical therapists shall not harass anyone verbally, physically, emotionally,
or sexually.
Principle #5: Physical therapists shall fulfill their legal and
professional obligations. (Core
Values: Professional Duty, Accountability)
5A.
Physical therapists shall comply with applicable local, state, and federal laws
and regulations.
5B.
Physical therapists shall have primary responsibility for supervision of
physical therapist assistants and support personnel.
5C.
Physical therapists involved in research shall abide by accepted standards
governing protection of research participants.
5D.
Physical therapists shall encourage colleagues with physical, psychological, or
substance related impairments that may adversely impact their professional
responsibilities to seek assistance or counsel.
5E.
Physical therapists who have knowledge that a colleague is unable to perform
their professional responsibilities with reasonable skill and safety shall
report this information to the appropriate authority.
5F.
Physical therapists shall provide notice and information about alternatives for
obtaining care in the event the physical therapist terminates the provider
relationship while the patient/client continues to need physical therapy
services.
Principle #6: Physical therapists shall enhance their expertise through
the lifelong acquisition and refinement of knowledge, skills, abilities, and
professional behaviors. (Core Value: Excellence)
6A.
Physical therapists shall achieve and maintain professional competence.
6B.
Physical therapists shall take responsibility for their professional
development based on critical self-assessment and reflection on changes in
physical therapist practice, education, healthcare delivery, and technology.
6C.
Physical therapists shall evaluate the strength of evidence and applicability
of content presented during professional development activities before
integrating the content or techniques into practice.
6D.
Physical therapists shall cultivate practice environments that support
professional development, life-long learning, and excellence.
Principle #7: Physical therapists shall promote organizational behaviors
and business practices that benefit patients/clients and society. (Core
Values: Integrity, Accountability)
7A.
Physical therapists shall promote practice environments that support autonomous
and accountable professional judgments.
7B.
Physical therapists shall seek remuneration as is deserved and reasonable for
physical therapist services.
7C.
Physical therapists shall not accept gifts or other considerations that
influence or give an appearance of influencing their professional judgment.
7D.
Physical therapists shall fully disclose any financial interest they have in
products or services that they recommend to patients/clients.
7E.
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.
7F.
Physical therapists shall refrain from employment arrangements, or other
arrangements, that prevent physical therapists from fulfilling professional
obligations to patients/clients.
Principle #8: Physical therapists shall participate in efforts to meet
the health needs of people locally, nationally, or globally. (Core Values: Social Responsibility)
8A.
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.
8B.
Physical therapists shall advocate to reduce health disparities and health care
inequities, improve access to health care services, and address the health,
wellness, and preventive health care needs of people.
8C.
Physical therapists shall be responsible stewards of health care resources and
shall avoid over-utilization or under-utilization of physical therapy services.
8D.
Physical therapists shall educate members of the public about the benefits of
physical therapy and the unique role of the physical therapist.
Proviso: The Code of Ethics as substituted will take effect
The Standards
of Ethical Conduct for the Physical Therapist Assistant
Preamble
The Standards of Ethical Conduct for the
Physical Therapist Assistant (Standards of Ethical Conduct) delineate the
ethical obligations of all physical therapist assistants as determined by the
House of Delegates of the American Physical Therapy Association (APTA). The
Standards of Ethical Conduct provide a foundation for conduct to which all
physical therapist assistants shall adhere. Fundamental to the Standards of
Ethical Conduct is the special obligation of physical therapist assistants to
enable patients/clients to achieve greater independence, health and wellness,
and enhanced quality of life.
No document that
delineates ethical standards can address every situation. Physical therapist
assistants are encouraged to seek additional advice or consultation in
Standard #1: Physical therapist assistants shall respect the inherent
dignity, and rights, of all individuals.
1B.
Physical therapist assistants shall recognize their personal biases and shall
not discriminate against others in the provision of physical therapy services.
Standard #2: Physical therapist assistants shall be trustworthy and
compassionate in addressing the rights and needs of patients/clients.
2A.
Physical therapist assistants shall act in the best interests of
patients/clients over the interests of the physical therapist assistant.
2B.
Physical therapist assistants shall provide physical therapy interventions with
compassionate and caring behaviors that incorporate the individual and cultural
differences of patients/clients.
2C.
Physical therapist assistants shall provide patients/clients with information
regarding the interventions they provide.
2D.
Physical therapist assistants shall protect confidential patient/client
information and, in collaboration with the physical therapist, may disclose
confidential information to appropriate authorities only when allowed or as
required by law.
Standard #3: Physical therapist assistants shall make sound decisions in
collaboration with the physical therapist and within the boundaries established
by laws and regulations.
3A.
Physical therapist assistants shall make objective decisions in the
patient’s/client’s best interest in all practice settings.
3B.
Physical therapist assistants shall be guided by information about best
practice regarding physical therapy interventions.
3C.
Physical therapist assistants shall make decisions based upon their level of
competence and consistent with patient/client values.
3D.
Physical therapist assistants shall not engage in conflicts of interest that
interfere with making sound decisions.
3E.
Physical therapist assistants shall provide physical therapy services under the
direction and supervision of a physical therapist and shall communicate with
the physical therapist when patient/client status requires modifications to the
established plan of care.
Standard #4: Physical therapist assistants shall demonstrate integrity
in their relationships with patients/clients, families, colleagues, students,
other healthcare providers, employers, payers, and the public.
4A.
Physical therapist assistants shall provide truthful, accurate, and relevant
information and shall not make misleading representations.
4B.
Physical therapist assistants shall not exploit persons over whom they have
supervisory, evaluative or other authority (eg, patients/clients, students,
supervisees, research participants, or employees).
4C.
Physical therapist assistants shall discourage misconduct by healthcare
professionals and report illegal or unethical acts to the relevant authority,
when appropriate.
4D.
Physical therapist assistants shall report suspected cases of abuse involving
children or vulnerable adults to the supervising physical therapist and the
appropriate authority, subject to law.
4E.
Physical therapist assistants shall not engage in any sexual relationship with
any of their patients/clients, supervisees, or students.
4F.
Physical therapist assistants shall not harass anyone verbally, physically,
emotionally, or sexually.
Standard #5: Physical therapist assistants shall fulfill their legal and
ethical obligations.
5A.
Physical therapist assistants shall comply with applicable local, state, and
federal laws and regulations.
5B.
Physical therapist assistants shall support the supervisory role of the
physical therapist to ensure quality care and promote patient/client safety.
5C. Physical
therapist assistants involved in research shall abide by accepted standards
governing protection of research participants.
5D.
Physical therapist assistants shall encourage colleagues with physical,
psychological, or substance related impairments that may adversely impact their
professional responsibilities to seek assistance or counsel.
5E.
Physical therapist assistants who have knowledge that a colleague is unable to
perform their professional responsibilities with reasonable skill and safety
shall report this information to the appropriate authority.
Standard #6: Physical therapist assistants shall enhance their
competence through the lifelong acquisition and refinement of knowledge,
skills, and abilities.
6A.
Physical therapist assistants shall achieve and maintain clinical competence.
6B.
Physical therapist assistants shall engage in life-long learning consistent
with changes in their roles and responsibilities and advances in the practice
of physical therapy.
6C.
Physical therapist assistants shall support practice environments that support
career development and life-long learning.
Standard #7: Physical therapist assistants shall support organizational
behaviors and business practices that benefit patients/clients and society.
7A.
Physical therapist assistants shall promote work environments that support
ethical and accountable decision-making.
7B.
Physical therapist assistants shall not accept gifts or other considerations
that influence or give an appearance of influencing their decisions.
7C.
Physical therapist assistants shall fully disclose any financial interest they
have in products or services that they recommend to patients/clients.
7D.
Physical therapist assistants shall ensure that documentation for their
interventions accurately reflects the nature and extent of the services
provided.
7E.
Physical therapist assistants shall refrain from employment arrangements, or
other arrangements, that prevent physical therapist assistants from fulfilling
ethical obligations to patients/clients.
Standard #8: Physical therapist assistants shall participate in efforts
to meet the health needs of people locally, nationally, or globally.
8A.
Physical therapist assistants shall support organizations that meet the health
needs of people who are economically disadvantaged, uninsured, and
underinsured.
8B.
Physical therapist assistants shall advocate for people with impairments,
activity limitations, participation restrictions, and disabilities in order to
promote their participation in community and society.
8C.
Physical therapist assistants shall be responsible stewards of healthcare
resources by collaborating with physical therapists in order to avoid
over-utilization or under-utilization of physical therapy services.
8D.
Physical therapist assistants shall educate members of the public about the
benefits of physical therapy.
APTA 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 change 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. This Guide is subject to monitoring and
timely revision by the Ethics and Judicial Committee of the Association.
The interpretations expressed
in this Guide reflect the opinions, decisions, and advice of the Ethics and
Judicial Committee. These interpretations are intended to assist a physical
therapist in applying general ethical principles to specific situations. They
should not be considered inclusive of all situations that could evolve.
Reference to Code of Ethics
In light of the recent
amendments to the Code of Ethics, and in lieu of setting forth in the
Guide interpretations of the Code of Ethics, the Ethics and Judicial
Committee does hereby refer Physical Therapists to the Code of Ethics.
As noted in the Purpose of the
Guide set forth above, this Guide is subject to change and the Ethics and
Judicial Committee will monitor and timely revise this Guide when necessary and
as needed.
Issued by
Ethics and Judicial Committee , American Physical Therapy Association ; October
1981
Last Amended
July 2009 (Effective
APTA
Guide for Conduct of the Physical Therapist Assistant
This Guide for Conduct of the Physical
Therapist Assistant (Guide) is intended to serve physical therapist
assistants in interpreting the Standards of Ethical Conduct for the Physical
Therapist Assistant (Standards) of the American Physical Therapy
Association (APTA). The Guide provides guidelines by which physical therapist
assistants may determine the propriety of their conduct. It is also intended to
guide the development of physical therapist assistant students. The Standards
and Guide apply to all physical therapist assistants. These guidelines are
subject to change 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. This Guide is subject to monitoring and timely
revision by the Ethics and Judicial Committee of the Association.
Interpreting Standards
The interpretations expressed in this
Guide reflect the opinions, decisions, and advice of the Ethics and Judicial
Committee. These interpretations are intended to guide a physical therapist
assistant in applying general ethical principles to specific situations. They
should not be considered inclusive of all situations that a physical therapist
assistant may encounter.
Reference to Standards of Ethical Conduct
for the Physical Therapist Assistant
In light of the recent amendments to the Standards
of Ethical Conduct for the Physical Therapist Assistant, and in lieu of
setting forth in the Guide interpretations of the Standards of Ethical
Conduct for the Physical Therapist Assistant, the Ethics and Judicial
Committee does hereby refer Physical Therapist Assistants to the Standards
of Ethical Conduct for the Physical Therapist Assistant.
As noted in the Purpose of the Guide set
forth above, this Guide is subject to change and the Ethics and Judicial
Committee will monitor and timely revise this Guide when necessary and as
needed.
Issued by Ethics and
Judicial Committee, American Physical Therapy Association ; October 1981
Last
Amended July 2009 (Effective
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
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.
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.
In
this situation, 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).
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.
Case Study #5 – Billing and Coding
A Chiropractic / 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.
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.
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.
Statutes
Statutes are proposed and made law by the Tennessee State General Assembly (Legislature). The statutes
pertaining to physical therapy are known as the Physical Therapy Practice Act,
and are written as part of the Tennessee Code Annotated (T. C. A. Title 63,
Chapter 13). To read the statutes in
their entirety, go to:
http://michie.lexisnexis.com/tennessee/lpext.dll?f=templates&fn=main-h.htm&cp=
The Occupational and
Physical Therapy Practice Act
(
Table of Contents
63-13-101
Short title.
63-13-102
Legislative intent.
63-13-103
Chapter definitions.
63-13-104
Repealed
63-13-105
Repealed
63-13-106
Repealed
63-13-107
Repealed
63-13-108
Repealed
63-13-109
Unauthorized practice of medicine — Scope of practice.
Table of Contents
63-13-301
License requirement.
63-13-302
Referrals — Ethical standards.
63-13-303
Exceptions to Referral Requirements
63-13-304
Board Powers
63-13-305
Claims and practices of other licensed professionals — Exemptions
from licensure.
63-13-306
Application — Examinations.
63-13-307
Qualifications of applicants — Reciprocity.
63-13-308
License renewal — Changes in name or address — Retirement — Inactive status —
Exemption from continuing education
requirements.
63-13-309
Reinstatement of license — Failure to renew license.
63-13-310
Unlawful use of titles or designations indicating licensure.
63-13-311
Supervision of students and assistive personnel.
63-13-312
Denial, suspension or revocation of licenses.
63-13-313
Disciplinary actions of the Board.
63-13-314
Administrative procedure of disciplinary actions — Jurisdiction of Board.
63-13-315
Penalties.
63-13-316
Peer assistance program — Fees.
63-13-317
Disclosures to patient — Confidentiality of information —
63-13-318 Board of Physical Therapy
Rules
The Board of Occupational and Physical Therapy Examiners adopts
rules. The rules specific to physical
therapy are found in Chapter 1150-1.
Both the statutes (T.C.A. Title 63, Chapter 13) and the rules (Chapter
1150-1) have the force of law and are used in the regulation of the profession.
Tennessee General Rules Governing the Practice of Physical Therapy
(Official Compilation, Rules & Regulations,
Chapter 1150-1)
Chapter 1150-1 Table of
Contents
1150-1-.01 Definitions
1150-1-.02 Scope of Practice and Supervision
1150-1-.03 Necessity of Licensure
1150-1-.05 Procedures for Licensure
1150-1-.06 Fees
1150-1-.07 Application Review, Approval and Denial
1150-1-.08 Examinations
1150-1-.09 Renewal of License
1150-1-.10 Provisional License
1150-1-.11 Retirement and Reactivation of License
1150-1-.12 Continuing Competence
1150-1-.13 Advertising
1150-1-.14 Code of Ethics
1150-1-.15 Disciplinary Actions, Civil Penalties,
Assessment of Costs, and Screening Panels
1150-1-.16 Duplicate (Replacement) License
1150-1-.17 Change of Address and/or Name
1150-1-.18 Mandatory Release of Client Records
1150-1-.19 Board Meetings, Officers, Consultants,
Records, and Declaratory Orders
1150-1-.20 Consumer Right-To-Know Requirements
1150-1-.21 Professional Peer Assistance
To read
the rules in their entirety, go to: http://www.state.tn.us/sos/rules/1150/1150-01.pdf
Physical Therapy
Licensure Process
Licensure by Examination (1150-1-.04(1))
To qualify for licensure by examination,
a Physical Therapist or a Physical Therapist Assistant must:
1. Be of good moral character; and
2. Be a graduate of a school of physical
therapy accredited by CAPTE or a school for physical therapy assistants
accredited by CAPTE; and
3. Pass to the satisfaction of the
committee an examination conducted by it to determine fitness for practice as a
physical therapist or physical therapy assistant.
Licensure
by Reciprocity (1150-1-.04(2))
To qualify for licensure by reciprocity a
physical therapist or physical therapist assistant must possess a current and
unrestricted license from another
(a) Credentials required for individuals
who attained certification, registration or licensure in another state or
country from July, 1995, to date:
1. Be of good
moral character;
2. Graduate
from a physical therapist or physical therapist assistant program accredited by
CAPTE and approved by the Committee of Physical Therapy;
3. Obtain
verification of licensure status from all states in which he holds or has held
a license; and
4. Candidates
qualifying for licensure by reciprocity must have passed the licensing
examination with a criterion referenced passing point.
(b) Credentials required for applicants
who attained certification, registration, or licensure in another state or
country from
1. Be of good
moral character;
2. Graduate
from a physical therapist or physical therapy assistant program accredited by
CAPTE and approved by the Committee of Physical Therapy;
3. Obtain
verification of licensure status from all states in which he holds or has held
a license; and
4. Candidates
qualifying for licensure by reciprocity must have passed the licensing
examination with a minimum converted score of seventy-five (75), based on one
point five (1.5) sigma below the national mean for the examination. This
applies to the score of each individual part as well as the total score.
(c) Credentials required for applicants
who attained certification, registration or licensure in another state or
country from
1. Be of good
moral character;
2. Graduate
from a physical therapist or physical therapist assistant program accredited by
CAPTE or a physical therapist or physical therapist assistant program approved
by the American Medical Association;
3. Pursuant to
Rule 1150-1-.07, obtain verification of licensure status from all states in
which he holds or has held a license; and
4. Candidates
qualifying for licensure by reciprocity must have passed the licensing
examination with a minimum converted score of seventy-five (75), based on one
point five (1.5) sigma below the national mean for the examination. This applies
to the score of each individual part as well as the total score.
Licensure
for Internationally Educated (1150-1-.04(3))
In addition to meeting the
requirements outlined either in Rule 1150-1-.04(1) except 1150-1-.04(1)(b), or
1150-1-.04(2) except 1150-1-.04(2)(b)2, international graduates must:
(a) Have submitted directly to
the Board’s administrative office a validly issued and error-free
“Comprehensive Credential Evaluation Certificate for the Physical Therapist”
(Type 1 Certificate) from the Foreign Credentialing Commission on Physical
Therapy (FCCPT) for the purpose of evaluating and verifying that the
applicant’s education is substantially equivalent to a curriculum approved by
CAPTE.
1. Submitting the “Visa Credential Verification
Certificate,” also issued by the FCCPT,
will not constitute meeting this requirement.
2. Applicants who cannot obtain a Type 1 Certificate from
the FCCPT based on their
ineligibility to sit for the Test of English as a Foreign Language internet Based Test (TOEFL iBT) must
submit all other components of the
Type 1 Certificate directly to the Board’s administrative office, for the purpose of
evaluating and verifying that the applicant’s education
is substantially equivalent to a curriculum approved by CAPTE; or
(b) Have submitted directly to
the Board’s administrative office a validly issued and error-free certification
from any agency verifying that the applicant’s education is substantially
equivalent to a curriculum approved by CAPTE.
1. The agency must evaluate the curriculum in a manner
similar to the FCCPT educational
credentials review.
2. The result or outcome of the evaluation is the
issuance of certification that the Board
considers to be equivalent to the “Comprehensive Credential Evaluation Certificate for the Physical Therapist”
(Type 1 Certificate) from the FCCPT.
(c) Submit proof of
(d) Have credentials that
comply with the applicable provisions of T.C.A. § 63-13-307 (d) if the
applicant was registered, certified, or licensed as a physical therapist or
physical therapist assistant in another state or country prior to
(e) After receiving written
approval from the Board regarding the credentials in subparagraph (a), have
participated in and successfully completed a Board-approved supervised clinical
practice period to provide a broad exposure to general physical therapy skills,
pursuant to guidelines approved and issued by the Board.
1. The supervised clinical practice period shall be four
hundred and eighty (480) hours
and shall be accomplished at a rate of no more than forty (40) hours or no less than ten (10) hours per
week.
2. The supervising licensed physical therapist shall
submit the evaluation form
contained in the guidelines supplied by the Board to the Board’s administrative office upon completion
of the supervisory period.
3. If the Board determines the supervised clinical period
has not been successfully
completed, the Board may require additional time in supervised clinical practice, additional coursework,
and/or and oral examination.
4.
Supervision provided by the applicant's parents, spouse, former spouse, siblings, children, cousins, in-laws
(present or former), aunts, uncles,
grandparents, grandchildren, stepchildren, employees, present or former physical therapist, present or
former romantic partner, or anyone sharing
the same household shall not be acceptable toward fulfillment of licensure requirements. For the
purposes of this rule, a supervisor shall not
be considered an employee of the applicant, if the only compensation received by the supervisor consists of
payments for the actual supervisory hours.
Licensure
to Practice Electrophysiologic Studies (1150-1-.04(4))
(a) Applicants for licensure
as a Physical Therapist who seek to conduct diagnostic electromyography (invasive
needle study of multiple muscles for diagnosis of muscle and nerve disease),
while practicing must submit to the Board’s administrative office documented
evidence of possessing current ECS certification from the American Board of
Physical Therapy Specialties.
(b) Applicants for licensure
as a Physical Therapist who seek to conduct surface electrophysiological
studies (motor and sensory conduction, and somatosensory evoked potentials),
and kinesiologic studies (invasive needle study of muscles to determine the
degree and character of a muscle during certain movements), while practicing
must submit to the Board’s administrative office documented evidence of
possessing the theoretical background and technical skills for safe and
competent performance of such studies.
(c) Supervision - The
supervision of applicants who seek to conduct diagnostic electromyography,
surface electrophysiological studies, and kinesiologic studies shall be
consistent with sound medical practice.
Licensure Renewal
Methods
of License Renewal (1150-1-.09(1)(b))
1. Internet Renewals - Individuals may
apply for renewal and pay the necessary fees via the Internet. The application
to renew can be accessed at: www.tennesseeanytime.org
2. Paper Renewals - For individuals who
have not renewed their license online via the Internet, a renewal application
form will be mailed to each individual licensed by the Committee to the last
address provided to the Committee. Failure to receive such notification does
not relieve the licensee from the responsibility of meeting all requirements
for renewal.
Eligibility
for License Renewal (1150-1-.09(1)(c))
To be eligible for renewal, an individual
must submit to the Division of Health Related Boards on or before the
expiration date all of the following:
1. A completed and signed board renewal
application form; and
2. The renewal and State regulatory fees;
and
3. A statement attesting to the
completion of continuing competence requirements.
Licensees who fail to comply with the
renewal rules or notification received by them concerning failure to timely
renew shall have their licenses revoked
Anyone submitting a signed renewal form
or letter which is found to be untrue may be subjecting himself to disciplinary
action.
Reinstatement of an expired license may
be accomplished upon payment of the reinstatement fee and the renewal fee, and
by submitting proof of completing continuing competence requirements.
Change
of Licensure Status
Retirement of License (1150-1-.11(1),
1150-1-.11(2))
A person who holds a current license and
does not intend to practice as a physical therapist or physical therapist
assistant in
An individual who holds a retired license
will not be required to pay the renewal fee.
A person who holds an active license may
apply for retired status in the following manner:
(a) Obtain
from the Committee’s administrative office an affidavit of retirement form; and
(b) Complete
and submit the affidavit affirming that, while in retired status, the licensee
will not practice or in any way indicate or imply that he holds an active
Tennessee license or use within Tennessee any words, letters, titles, or
figures which indicate or imply that he is a licensed physical therapist or
physical therapist assistant; or
(c) Submit a
letter, which has been signed and notarized, requesting his license to be
placed in retirement. Such letter must contain a statement indicating that the
licensee understands that he can not practice or in any way indicate or imply
that he holds an active Tennessee license or use within Tennessee any words,
letters, titles, or figures which indicate or imply that he is a licensed PT or
PTA.
Reinstatement/Reactivation
of an Expired or Retired License (1150-1-.11(3))
License
holders whose licenses have been retired may reactivate their licenses in the
following manner:
(a)
Submit a written request for licensure reactivation to the Board’s
administrative office including a statement describing all relevant experiences
education during the period of retirement or inactivity; and
(b)
Pay the current licensure renewal fees and State regulatory fee as provided in
Rule 1150-1-.06. If retirement reactivation is requested prior to the
expiration of one (1) year from the date of retirement, the Board will
additionally require payment of the reinstatement fee as prescribed in Rule
1150-1-.06.
(c) Complete the continuing competence requirements,
as provided in Rule 1150-1-.12.
Offenses That May Lead to Disciplinary
Action (63-13-312)
The Board of Physical
Therapy has the power to deny, suspend, or revoke the license of a licensee who
is guilty of the following acts:
1.
Practicing physical therapy in violation of the provisions of Tennessee Code
Title 63, Chapter 13 or any
rule;
2. Practicing or offering to
practice beyond the scope of physical therapy practice;
3. Making false or
misleading statements or representations, being guilty of fraud or deceit in
obtaining admission to practice, or being guilty of fraud or deceit in the
licensee's practice;
4. Engaging in the
performance of substandard care by a physical therapist due to ignorance,
incompetence, or a deliberate or negligent act or failure to act regardless of
whether actual injury to the patient is established;
5. Engaging in the
performance of substandard care by a physical therapist assistant, which
includes exceeding the authority to perform the task selected and delegated by
the supervising physical therapist regardless of whether actual injury to the
patient is established;
6. Inadequately supervising
or delegating duties which exceed the scope of practice for assistive personnel
in accordance with the chapter and rules adopted by the committee;
7. Conviction of a felony or
any offense involving moral turpitude in the courts of TN or any other state,
territory or country. "Conviction," includes a finding or verdict of
guilt, or a plea of nolo contendere;
8. Practicing as a physical
therapist or working as a physical therapist assistant when physical or mental
abilities are impaired by the use of controlled substances, other habit-forming
drugs, chemicals or alcohol;
9. Disciplinary action
against a person licensed to practice as a physical therapist or physical
therapist assistant by another state or territory of the
10. Engaging in sexual
misconduct. "Sexual
misconduct," includes:
(A)
Engaging in or soliciting sexual relationships, whether consensual or
non-consensual, while a physical therapist or physical therapist
assistant/patient relationship exists;
(B)
Making sexual advances, requesting sexual favors, and engaging in other verbal
conduct or physical conduct or physical contact of a sexual nature with
patients; and
(C)
Intentionally viewing a completely or partially disrobed patient in the course
of treatment, if the viewing is not related to patient diagnosis or treatment
under current practice standards;
11. Directly or indirectly
requesting, receiving, or participating in the dividing, transferring,
assigning, rebating or refunding of an unearned fee, or profiting 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.
12. Failing to adhere to standards of ethics of
the physical therapy profession;
13. Charging unreasonable or fraudulent fees for
services performed or not performed;
14. Making misleading, deceptive, untrue or
fraudulent representations in the practice of the profession
15. Being under a current judgment of mental
incompetency rendered by a court of competent jurisdiction;
16. Aiding or abetting a person not licensed in
this state who directly or indirectly performs activities requiring a
license;
17. Failing to report to the committee any act or
omission of a licensee, applicant, or any other person, which violates the
provisions of therapy licensure;
18. Interfering with, or refusing to cooperate
in, an investigation or disciplinary proceeding, including willful
misrepresentation of facts or by the use of threats or harassment against any
patient or witness to prevent the patient or witness from providing evidence in
a disciplinary proceeding or any legal action;
19. Failing to maintain patient confidentiality
without prior written consent or unless otherwise required by law;
20. Failing to maintain adequate patient records
that contain a minimum of an evaluation of objective finding, a physical
therapy treatment diagnosis, the plan of care including desired outcomes, the
treatment record, a discharge plan including results of intervention, and
sufficient information to identify the patient;
21. Promoting unnecessary devices, treatment
intervention or service for the financial gain of the practitioner or of a
third party;
22. Providing treatment intervention unwarranted
by the condition of the patient, nor shall the licensee continue treatment
beyond the point of reasonable benefit;
23. A violation or attempted violation, directly
or indirectly, or assisting in or abetting the violation of or conspiring to
violate, any provisions of this chapter or any lawful order of the committee
issued pursuant thereto, or any criminal statute of the state of
Tennessee;
24. Division of fees or agreeing to split fees or
divide fees received for professional services with any person for bringing or
referring a patient; or
25. Payment or acceptance of commissions, in any
form or manner, on fees for professional services, references, consultations,
pathological reports, prescriptions, or on other services or articles supplied
to patients.
Disciplinary
Actions and Civil Penalties (1150-1-.15)
Upon a finding by the Committee that a
physical therapist or physical therapist assistant has violated any provision
of the T.C.A. §§ 63-13-101 the Committee may impose any of the following
actions separately or in any combination deemed appropriate to the offense.
1. Advisory
Censure - This is a written action issued to the physical therapist or
physical therapist assistant for minor or near infractions. It is advisory in
nature and does not constitute a formal disciplinary action.
2. Formal Censure or Reprimand - This is a
written action issued to a physical therapist or physical therapist assistant
for one time and less severe violations. It is a formal disciplinary action.
3. Probation - This is a formal
disciplinary action which places a physical therapist or physical therapist
assistant on close scrutiny for a fixed period of time. This action may be
combined with conditions which must be met before probation will be lifted
and/or which restrict the individual’s activities during the probationary
period.
4. Licensure Suspension - This is a formal
disciplinary action which suspends an individual’s right to practice for a
fixed period of time. It contemplates the reentry of the individual into the
practice under the license previously issued.
5. Licensure Revocation - This is the most
severe form of disciplinary action which removes an individual from the
practice of the profession and terminates the licensure previously issued. If
revoked, it relegates the violator to the status he possessed prior to
application for licensure. However, the Committee may, in its discretion, allow
the reinstatement of a revoked license upon conditions and after a period of
time it deems appropriate. No petition for reinstatement and no new application
for licensure from a person whose license was revoked shall be considered prior
to the expiration of at least one (1) year unless otherwise stated in the
Committee’s revocation order.
Civil
Penalties
The minimum and maximum civil penalties
which may be assessed.
1. Type A Civil Penalty - may be imposed
whenever the Committee finds a person who is required to be licensed,
certified, permitted or authorized by the Committee, guilty of a willful and
knowing violation of the Practice Act, or regulations promulgated pursuant
thereto, to such an extent that there is, or is likely to be, an imminent,
substantial threat to the health, safety and welfare of an individual patient
or the public. For purposes of this section, willfully and knowingly practicing
as a physical therapist or physical therapist assistant without a permit,
license, certification, or other authorization from the Board is one of the
violations of the Physical Therapy Practice Act for which a Type A Civil
Penalty is assessable. Type A Civil Penalties shall be assessed in the amount
of not less than $500 nor more than $1,000.
2. Type B Civil Penalty - may
be imposed whenever the Committee finds the person required to be licensed,
certified, permitted, or authorized by the Committee guilty of a violation of
the Physical Therapy Practice Act or regulations promulgated pursuant thereto
in such a manner as to impact directly on the care of patients or the public.
Type B Civil Penalties may be assessed in the amount of not less than $100 and
not more than $500.
3. Type C Civil Penalty - may be imposed
whenever the Committee finds the person required to be licensed, certified,
permitted, or authorized by the Committee guilty of a violation of the Physical
Therapy Practice Act or regulations promulgated pursuant thereto, which are
neither directly detrimental to patients or the public, nor directly impact
their care, but have only an indirect relationship to patient care or the
public. Type C Civil Penalties may be assessed in the amount of not less than
$50 and not more than $100.
Continuing Competence
(1150-1-.12)
(1) The requirements for continuing competence
are defined as planned learning experiences which occur beyond the entry level
educational requirements for physical therapists and physical therapist
assistants. Content of the experience must relate to physical therapy whether
the subject is intervention, examination, research, documentation, education,
management, or some other content area.
(2) For applicants approved
for initial licensure by examination, successfully completing the requirements
of Rules 1150-1-.04, .05, and .08, shall be considered proof of sufficient
competence to constitute compliance with this rule for the initial period of
licensure except for the ethics and jurisprudence education requirements of
paragraph (4). Applicants approved for initial licensure by examination must
successfully complete four (4) hours of ethics and jurisprudence education
during their initial period of licensure
(3) Two (2) Year Requirement
(January 1-December 31) - Continuing competence credit is awarded for the clock
hours spent in an activity. All required
hours may be met through Class I activities.
(a) Physical Therapist - Thirty (30) hours are required
for the two (2) calendar years
(January 1-December 31) that precede the licensure renewal year.
1. At least twenty (20) hours of the thirty
(30) hour requirement must
be from Class I activities as provided in paragraph (5).
2. Up to ten (10) hours of the thirty (30)
hour requirement may be from
Class II activities as provided in paragraph (6).
(b) Physical Therapist Assistant - Twenty (20) hours are
required for the two (2) calendar
years (January 1-December 31) that precede the licensure
renewal year.
1. At least ten (10) hours of the twenty (20)
hour requirement must be
from Class I activities as provided in paragraph (5).
2. Up to ten (10) hours of the twenty (20)
hour requirement may be from
Class II activities as provided in paragraph (6).
(4) Four (4) of the hours
required consist of ethics and jurisprudence education courses. These four (4)
hours are required every other two (2) calendar year period.
(a) Jurisprudence – This course shall be a minimum of two
(2) hours, shall be Class I
continuing competence
(b) Ethics – This course shall be a minimum of two (2)
hours, shall be Class I continuing
competence
(c) Course approval – The Board does not pre-approve
Class I and Class II continuing
competence courses, programs, and activities required by paragraphs (3), (5) and (6). It is the
licensee's responsibility, using his/her professional
judgment, to determine if the courses being taken are applicable, appropriate, and meet the requirements of this rule.
However, an ethics and jurisprudence
course provider must seek the Board’s course approval.
(5) Class I acceptable continuing competence evidence shall be any of
the following:
(a) External peer review of practice with verification of
acceptable practice by a
recognized entity, e.g., American Physical Therapy Association. Continuing competence credit is twenty (20)
hours per review with a maximum of
one (1) review per biennium.
(b) Internal peer review of practice with verification of
acceptable practice. Continuing
competence credit is two (2) hours per review with a maximum of two (2) reviews during the two (2)
year period.
(c) Courses, seminars, workshops, and symposia attended
by the licensee which have been
approved for continuing education units (CEUs) by appropriate CEU granting agencies.
(d) Courses, seminars, workshops, and symposia attended
by the licensee and approved by
recognized health-related organizations (e.g., American
Physical Therapy Association, Tennessee Physical Therapy Association, Arthritis Foundation, etc.) or
accredited physical therapy educational
institutions (e.g., Chattanooga State Technical Community College, East Tennessee State University,
etc.).
(e) Home study courses or courses offered through
electronic media approved
by recognized health-related organizations (e.g., American Physical Therapy Association, Tennessee
Physical Therapy Association, Arthritis
Foundation, etc.) or accredited physical therapy educational institutions (e.g., U.T. Center for
the Health Sciences, Volunteer State Community
College), and that include objectives and verification of satisfactory completion.
(f) University credit courses - Continuing competence
credit is twelve (12) hours
per semester credit hour.
(g) Participation as a presenter in continuing education
courses, workshops, seminars or symposia
which have been approved by recognized
health-related organizations. Continuing competence credit is based on contact hours and may not
exceed twenty (20) hours per topic.
(h) Authorship of a presented scientific poster,
scientific platform presentation or
published article undergoing peer review. Continuing competence credit is ten (10) hours per event with a maximum of
two (2) events per biennium.
(i) Teaching a physical therapy or physical therapist
assistant credit course when
that teaching is an adjunct responsibility and not the primary employment. Continuing competence credit
is based on contact hours not to
exceed twenty (20) hours. If the same course is taught more than once, contact hours may only be counted once.
(j) Certification of clinical specialization by the
American Board of Physical Therapy
Specialties (ABPTS). Continuing competence credit is twenty-six (26) hours and is recognized only in the
biennium in which certification or recertification
is awarded.
(k) Certification of clinical specialization by
organizations other than the ABPTS
(e.g. the McKenzie Institute, the Neuro Developmental Treatment Association, the Ola Grimsby Institute,
etc.) may be recognized as continuing
competence credit for up to twenty-six (26) hours, in the biennium in which certification or
recertification is awarded. The number of continuing
competence credit hours awarded is determined by the Board.
(l) Awarding of an advanced degree from an accredited
University. Continuing competence credit
is twenty-six (26) hours and is recognized only
in the biennium in which certification or recertification is awarded.
(m) Participating in a clinical residency program.
Continuing competence credit is five (5)
hours credit for each week of residency with a maximum of twenty-six (26) hours per program.
(6) Class II acceptable continuing competence evidence shall be any of
the following
(a) Self-instruction from reading professional
literature. Continuing competence
credit is limited to a maximum of one (1) hour each biennium.
(b) Attendance at a scientific poster session, lecture,
panel or symposium that does not meet the
criteria for Class I. Continuing competence credit is one (1) hour per hour of activity with a maximum of two (2) hours
credit each biennium.
(c) Serving as a clinical instructor for an accredited
physical therapist or physical
therapist assistant educational program. Continuing competence credit is one (1) hour per sixteen (16)
contact hours with the student(s).
(d) Acting as a clinical instructor for physical
therapist participating in a residency
program or as a mentor for a learner for a formal, nonacademic mentorship. Continuing competence
credit is one (1) hour per sixteen (16) contact
hours.
(e) Participating in a physical therapy study group
consisting of two (2) or more physical
therapists or physical therapist assistants. Continuing competence credit is limited to a maximum of one (1) hour
credit per biennium.
(f) Attending and/or presenting in-service programs.
Continuing competence credit is one
(1) hour per eight (8) contact hours with a maximum
of four (4) hours credit per biennium.
(g) Serving the physical therapy profession as a delegate
to the APTA House of Delegates, on
a professional board, committee, or task force. Continuing competence credit is limited to a maximum of one (1) hour
credit per biennium.
(7) Unacceptable activities for continuing competence include, but are
not limited to:
(a) Attending courses regarding:
1. Regulations of the United States
Department of Labor’s Occupational Safety and Health
Administration (OSHA);
2. Regulations of the Tennessee Department of
Labor and Workforce
Development’s Division of Occupational Safety and Health (TOSHA);
3. Cardiopulmonary resuscitation (CPR); and
4. Safety;
(b) Meetings for purposes of policy decisions;
(c) Non-educational meetings at annual association,
chapter or organization
meetings;
(d) Entertainment or recreational meetings or activities;
and
(e) Visiting exhibits.
(8) Documentation of compliance
(a) Each licensee must retain
documentation of completion of all continuing competence requirements of this
rule for a period of five (5) years from when the requirements were completed. This
documentation must be produced for inspection and verification, if requested in
writing by the Board during its verification process.
Scope of Practice (63-13-109(b) & 63-13-303)
(b) (1) The scope of practice of physical therapy shall be under the
written or oral referral of a licensed doctor of medicine, chiropractic,
dentistry, podiatry or osteopathy, with exceptions as stated in § 63-13-303.
(2) The scope of
practice of physical therapy shall not include the performance of treatment
where the physical therapist or physical therapist assistant uses direct thrust
to move a joint of the patient’s spine beyond its normal range of motion
without exceeding the limits of anatomical integrity.
(a) The practice of
physical therapy shall be under the written or oral referral of a licensed
doctor of medicine, chiropractic, dentistry, podiatry or osteopathy, except for
the following:
(1) A licensed physical
therapist may conduct an initial evaluation of a patient without referral;
(2) A licensed physical therapist
may provide physical assessments or instructions, including a recommendation of
exercise to an asymptomatic person, without the referral of a referring
practitioner;
(3) In emergency
circumstances, including minor emergencies, a licensed physical therapist may
provide assistance to a person to the best of a therapist’s ability without the
referral of a referring practitioner. Except as outlined in subdivision (a)(4)
below, the physical therapist shall refer such person to the appropriate health
care practitioner, as indicated, immediately after providing assistance. For
the purposes of this subdivision (a)(3):
(A) “Emergency
circumstances” means instances where emergency medical care is required; and
(B) “Emergency medical
care” means bona fide emergency services provided after the sudden onset of a
medical condition manifesting itself by acute symptoms of sufficient severity,
including severe pain, such that the absence of immediate medical attention
could reasonably be expected to result in:
(i) Placing the patient’s health in serious jeopardy;
(ii) Serious impairment to bodily functions; or
(iii) Serious dysfunction of any bodily organ or part; and
(4) A licensed physical
therapist may treat a patient without a referral when all of the following
apply:
(A) When a patient
provides the name of a licensed doctor of medicine, chiropractic, dentistry,
podiatry or osteopathy and expressly wants the physical therapist to inform
such physician, the physical therapist shall inform the patient’s licensed
doctor of medicine, chiropractic, dentistry, podiatry or osteopathy not later
than five (5) business days after the evaluation. A consultation shall occur
between the physical therapist and the patient’s licensed doctor of medicine,
chiropractic, dentistry, podiatry or osteopathy within the first six (6) visits
or fifteen (15) business days, whichever comes first, of the findings of the
patient’s initial visit for physical therapy and any subsequent visits. Should
that consultation not take place, no further therapy beyond the six (6) visits
or fifteen (15) days, whichever comes first, will be delivered;
(B) Where a patient does
not provide the name of a licensed doctor of medicine, chiropractic, dentistry,
podiatry or osteopathy or expressly states to the therapist that the patient
does not want a licensed doctor of medicine, chiropractic, dentistry, podiatry
or osteopathy informed of the initiation of therapy services, the therapist
shall have the patient sign a consent form that confirms the patient either
does not have a licensed doctor of medicine, chiropractic, dentistry, podiatry
or osteopathy or does not want a licensed doctor of medicine, chiropractic,
dentistry, podiatry or osteopathy informed of the initiation of therapy
treatment. Such consent form shall be maintained in the patient’s record;
(C) If the patient
presents to the physical therapist for a problem for which the patient has been
seen by a licensed doctor of medicine, chiropractic, dentistry, podiatry or
osteopathy within the past twelve (12) months, the consent of the patient is
not necessary to inform that licensed doctor of medicine, chiropractic,
dentistry, podiatry or osteopathy of the presentation for the physical therapy
treatment. If the patient has no licensed doctor of medicine, chiropractic,
dentistry, podiatry or osteopathy, then the physical therapist shall make a
suggestion from the list of available providers and shall inform the patient of
the forty-five (45) day limitation in subdivision (a)(4)(E);
(D) If the physical
therapist determines, based on reasonable evidence, that no substantial
progress has been made with respect to that patient within fifteen (15)
calendar days or six (6) visits, whichever occurs first, immediately following
the date of the patient’s initial visit with the physical therapist, the
physical therapist shall not provide any additional physical therapy services
and shall refer the patient to a licensed physician, doctor of chiropractic,
dentist, podiatrist or osteopath. If the patient previously was diagnosed with
chronic, neuromuscular, or developmental conditions by a physician, doctor of
chiropractic, dentist, podiatrist or osteopath and the evaluation, treatment or
services are being provided for problems or symptoms associated with one (1) or
more of those previously diagnosed conditions, then the provisions of this
subdivision (a)(4)(D) do not apply. If a patient returns to the physical
therapist within ninety (90) days of treatment with the same complaint, then
the physical therapist shall make an immediate referral to the appropriate
health care provider;
(E) When a patient’s
licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy
has not been notified of the physical therapy services, under no circumstances
should therapy services continue beyond thirty (30) days immediately following
the date of the patient’s first visit;
(F) (i) It shall be
considered unprofessional conduct for the purposes of § 63-13-312 for a
physical therapist to knowingly initiate services for the same complaint for
which a patient:
(a) Has started therapy
services but another therapist did not inform a licensed doctor of medicine,
chiropractic, dentistry, podiatry or osteopathy within five (5) business days
of the initial evaluation in accordance with Section 2(a)(4)(A); or
(b) Has reached the
fifteen (15) day and six (6) visit limit imposed by subdivision (a)(4)(D) where
no substantial progress has been made from another physical therapist; or
(c) Has reached the
thirty (30) day limit imposed by subdivision (a)(4)(E).
(ii) The provisions of
this subdivision (a)(4)(F) do not apply if a referral from a licensed doctor of
medicine, chiropractic, dentistry, podiatry or osteopathy is made; and
(G) If, at any time, the
physical therapist has reason to believe that the patient has symptoms or
conditions that require treatment or services beyond the scope of practice of a
physical therapist, the physical therapist shall refer the patient to a
licensed health care practitioner acting within the practitioner’s scope of
practice.
(b) No person shall
practice physical therapy other than upon the referral of a patient by a person
who is licensed in this or another state to practice medicine, chiropractic,
dentistry, osteopathic medicine, or podiatric medicine, within the scope of
such practices, and whose license is in good standing and who holds a CPR
certificate, or its equivalent, unless one of the following conditions is met:
(1) The person holds a
master’s or doctorate degree from a professional physical therapy program that
is accredited by a national accreditation agency recognized by the United
States Department of Education and by the board of physical therapy and the
person has completed at least one (1) year of experience as a licensed physical
therapist;
(2) The person has
successfully completed a residency or clinical fellowship in physical therapy
at a program approved by the board; or
(3) (A) The person has completed at least three (3) years of experience as
a licensed physical therapist; and (B) The person has completed a course
approved by the board of physical therapy and offered by an accredited
university of at least fifteen (15) hours, designed to enable the physical
therapist to identify signs and symptoms of systemic disease, particularly
those that can mimic cardiological, neurological, oncological, or
musculoskeletal disorders, and to recognize conditions that require timely
referral to a physician, dentist, osteopath, podiatrist or chiropractor.
Supervision Requirements (1150-1-.02)
Supervision of Licensed Physical Therapist Assistants
Supervision, as applied to the
licensed physical therapist assistant, means that all services must be
performed under the supervision of a physical therapist licensed and practicing
in
1. The licensed physical
therapist shall perform the initial evaluation of the patient with the
development of a written treatment plan, including therapeutic goals, frequency
and time period of services.
2. The licensed physical
therapist shall perform and document re-evaluations, assessments, and
modifications in the treatment plan at least every thirty (30) days. For
patients seen longer than sixty (60) days, the licensed physical therapist
shall inspect the actual act of therapy services rendered at least every sixty
(60) days.
3. The licensed physical
therapist may not supervise a physical therapist assistant that is delivering
services at a site further than sixty (60) miles or one (1) hour from the
licensed physical therapist. The supervising licensed physical therapist must
be available to communicate by telephone or other means whenever the physical
therapist assistant is delivering services.
4. The discharge evaluation
must be performed and the resulting discharge summary must be written by the
licensed physical therapist.
5. The licensed physical
therapist and the physical therapist assistant shall be equally responsible and
accountable for carrying out the provisions of this subparagraph.
(c) A physical therapist may
concurrently supervise no more than the equivalent of three (3) full-time
physical therapist assistants.
Supervision of Physical Therapy Assistive Personnel / Others
1. A physical therapist may
use physical therapy aides for designated tasks that do not require clinical
decision making by the licensed physical therapist or clinical problem solving
by the licensed physical therapy assistant. Direct supervision must apply to
physical therapy aides and is interpreted to mean that services are provided
under the supervision of an on-site physical therapist or physical therapist
assistant licensed and practicing in
2. A physical therapist may
use other assistive personnel for selected physical therapy designated tasks
consistent with the training, education, or regulatory authority of such
personnel. Other assistive personnel (nationally certified exercise
physiologists or certified athletic trainer and massage therapists, etc) must
perform the delegated task under the on-site supervision of a physical
therapist. The physical therapist shall then co-sign all related documentation
in the patient records.
3. “On-site supervision” means
the supervising physical therapist or physical therapist assistant must:
(i) Be continuously on-site and present in the department
or facility where assistive
personnel are performing services; and
(ii) Be immediately available to assist the person being
supervised in the services being
performed; and
(iii) Maintain continued involvement in appropriate
aspects of each treatment
session in which a component of treatment is delegated to assistive personnel.
A physical therapist may
concurrently supervise no more than the equivalent of two (2) full-time
assistive personnel or physical therapy aides. A physical therapist assistant
may concurrently supervise no more than the equivalent of two (2) full-time
physical therapy aides.
(d) Physical therapists and
physical therapist assistants shall provide direct on-site supervision of
volunteers. Volunteers may not provide physical therapy to patients.
(e) A physical therapist shall
provide on-site supervision to physical therapy clinical students at all times
and will be in accordance with the APTA guidelines for clinical education which
suggest a minimum of one (1) year of licensed clinical experience prior to
functioning as a clinical instructor for physical therapist students.
(f) A physical therapist
assistant shall provide on-site supervision to physical therapist assistant
clinical students at all times and will be in accordance with the APTA
guidelines for clinical education which suggest a minimum of one (1) year of
licensed clinical experience prior to functioning as a clinical instructor for
physical therapist assistant students.
Disclosure and
Confidentiality (63-13-317)
(a) Physical
therapists must inform the patient of any financial arrangements connected to
the referral process.
(b) Physical
therapists must disclose in writing any financial interest in products they
endorse and recommend to their patients.
(c) Physical
Therapists have the responsibility to ensure that the patient has knowledge of
freedom of choice in services and products.
(d) 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 written
consent of the patient. The physical therapist-patient confidentiality does not
extend to cases in which the physical therapist has a duty to report
information as required by law.
(e) Any person
may submit a complaint regarding any licensee or any other person potentially
in violation of this chapter. Confidentiality shall be maintained subject to
law.
(f) The
department must keep all information relating to the receiving and investigation
of complaints filed against licensees confidential until the information
becomes public record as required by law.
(g) Each
licensee shall display a copy of the licensee's license or current renewal
verification in a location accessible to public view at the licensee's place of
employment.
Consumer
Right to Know Requirements (1150-1-.20)
Malpractice
reporting requirements
The threshold amount below which medical
malpractice judgments, awards or settlements in which payments are awarded to
complaining parties need not be reported pursuant to the “Health Care Consumer
Right-To-Know Act of 1998” shall be ten thousand dollars ($10,000).
Criminal
conviction reporting requirements
For purposes of the “Health Care Consumer
Right-To- Know Act of 1998”, the following criminal convictions must be
reported:
1. Conviction
of any felony.
2. Conviction
or adjudication of guilt of any misdemeanor, regardless of its classification,
in which any element of the misdemeanor involves any one or more of the
following:
A. Sex.
B. Alcohol
or drugs.
C. Physical
injury or threat of injury to any person.
D. Abuse
or neglect of any minor, spouse or the elderly.
E. Fraud
or theft.
If any misdemeanor conviction reported
under this rule is ordered expunged, a copy of the order of expungement signed
by the judge must be submitted to the Department before the conviction will be
expunged from any profile.
The Lawful Use of PT and
PTA Titles (63-13-310)
A physical
therapist must use the letters "PT" in connection with their name or
place of business to denote licensure.
It is illegal for any person, or for any business entity to use the
words, "physical therapy," "physical therapist,"
"physiotherapy," "physiotherapist," "registered
physical therapist," "licensed physical therapist," or the
letters "PT," "LPT," "
A physical
therapist assistant must use the letters "
Release
of Client Records (1150-1-.18)
Upon request from a client or the
client’s authorized representative, licensees must provide a complete copy of
the client’s records or summary of such records which were maintained by the
provider. It shall be the provider’s
option as to whether copies of the records or a summary will be given to the
client. The requests for records must be
honored by the provider in a timely manner;
and the individual requesting the records
shall be responsible for payment of reasonable costs to the provider for
copying and mailing of the records.
Policy Statements of the
Consent Forms Without Referral
1. The Physical Therapist providing “direct access
services” shall have a patient sign an informed consent form that states one of
the following:
(a) The patient does not have a licensed doctor of
medicine, chiropractor, dentist, podiatrist, or doctor of osteopathic medicine
for the treating injury, OR
(b) The patient chooses direct access to physical
therapy services and forgoes the right to have a licensed doctor of medicine,
chiropractor, dentist, podiatrist, or doctor of osteopathic medicine informed
of the initiation of physical therapy treatment.
Physical Therapy Discharge Evaluations/Plans/Summaries
Patients receiving physical therapy are often
discharged from a facility with little or no notice to the Physical Therapy
department. In those situations where a patient’s discharge is outside the
control of a physical therapist, a discharge evaluation cannot be performed and
a formal discharge summary presents multiple logistical problems.
The physical therapy portion of the medical record is
in compliance with TCA 63-13-312. (20) when it includes the following:
• patient identification
• physical therapy evaluation
• physical therapy treatment diagnosis
• plan of care including desired outcomes
• treatment record
• results of interventions
• discharge plan
A discharge
evaluation/plan/summary, or evaluation is required for every physical therapy
record.
Direct Access to Physical Therapy
In order to provide physical therapy without a prior
referral, a physical therapist must meet the requirements of Tenn. Code Ann. §
63-13-303(b), including being licensed in good standing and having current CPR
certification, or its equivalent.
The physical therapist must also either:
1. Hold a master’s or doctorate degree from a professional
physical therapy program that is accredited by a national accreditation agency
recognized by the U.S. Department of Education and by the Board of Physical
Therapy. The physical therapist must also have completed at least one (1) year
of experience as a licensed physical therapist. (
2. Have successfully completed a residency or
clinical fellowship in physical therapy at a program approved by the Board of
Physical Therapy. (Tenn. Code Ann. § 63-13- 303(b)(2) The Board of Physical
Therapy has approved fellowships and residencies approved by the American
Physical Therapy Association and the
3. Have completed at least three (3) years of
experience as a licensed physical therapist and successfully completed a
physical therapy screening course that is approved by the Board of Physical
Therapy and offered by an accredited university that consists of at least
fifteen (15) contact hours. (
a. Any physical therapy screening course offered by
an accredited university.
b. Any physical therapy
screening course that meets the following criteria:
i. The course consists of at least fifteen (15)
contact hours and is taught by health professionals who hold a regular or
clinical faculty appointment in a physical therapy educational program.
ii. The course identifies that signs and symptoms of
systemic disease that are not appropriate for physical therapy intervention
without prior examination by a primary health care practitioner, including the
signs and symptoms of cancer and diseases of the cardiopulmonary, neurological,
and musculoskeletal systems.
iii. The course teaches participants the
decision-making process for determining when patients/clients require further
examination or consultation by a physical therapist or referral to another
health care practitioner.
iv. The course integrates the process of making an
appropriate and timely referral to another health care provider into the
physical therapy examination and evaluation.
Monitoring
of Home Health Aides
The monitoring of home health aides by physical
therapy practitioners is not in itself a violation of the physical therapy
practice act (Tenn. Code Ann. § 63-13-301 et seq.) and rules (Tenn. Comp. R.
& Regs. 1150-1) if no other ethical or practice violations are present.
Continuing Competence
A Physical Therapist and Physical Therapist Assistant
in
For Physical Therapists, thirty (30) hours are
required for the two (2) calendar years that precede the licensure renewal
year. For Physical Therapist Assistants, twenty (20) hours are required for the
two (2) calendar years that precede the licensure renewal year. (Please refer
to the Board’s rule Tenn. Comp. R. & Regs. 1150-1-.12 for complete information
regarding the continuing education requirements.)
Should the Tennessee
licensed Physical Therapist or Physical Therapist Assistant fail to comply with
the continuing competence requirement for the two (2) calendar year period
preceding the licensure renewal year, the following shall occur:
1. The licensee must pay a
civil penalty in the amount of one hundred dollars ($100.00). Payment must be
rendered within thirty (30) days of notification from the Board.
2. The licensee must make
up the amount of continuing competence credit hours that he/she is lacking. The
deficient hours must be submitted with documented proof within sixty (60) days
of notification from the Board.
Failure to comply with the continued competence
requirement may result in disciplinary action. Failure to respond to a Board
request for documentation or to make up deficient continuing competence credit
hours after notification by the Board may result in disciplinary action.
Licensees found to be in noncompliance with continuing competence requirements
will be subject to a subsequent audit and cannot use continuing credit hours submitted
for past deficient hours for current continuing competence compliance.
Renewal of Licensees Called to Active Military Duty
The Division shall allow special consideration for
renewal of the licenses of military personnel who were called to active duty,
and were unable to obtain required continuing education or to renew their
license timely.
A. Any licensee who held an active license with
Health Related Boards at the time he/she was called to active duty in the
military of the
1. The licensee shall submit a letter stating the
reason for non-renewal of the license was active duty in the U.S. Military.
2. Dates and proof of service shall be submitted to
the office by the licensee.
B. Upon receipt of notification and proof of active
service, the licensee shall be allowed to renew the license with no late
renewal or penalty fees added to the cost of renewal.
1. A copy of all documentation regarding notification
and proof of active service shall be included in the permanent licensure file
of the licensee.
C. A licensee whose license has been expired for one
year or less shall not be required to complete required continuing education
for renewal of the license at that time.
D. A licensee whose license has been expired for more
than one year shall be required to obtain one-half of the required continuing
education in order to have the license renewed.
Patient Referrals for Physical Therapy
Tennessee Code Annotated Section 63-6-204(a) defines
what is considered to be included in the practice of medicine and then provides
exceptions in subsection (b) to allow the health care professional to perform
medical services that would otherwise require a license to practice medicine,
as follows:
(b)
Nothing in this chapter shall be so construed as to prohibit service rendered
by a physician assistant, registered nurse or a licensed practical nurse if
such service is rendered under the supervision, control and responsibility of a
licensed physician. The relationship between supervising physicians and
physician assistants, orthopedic physician assistants, and certified nurse
practitioners who are registered nurses who have been certified by the board of
Nursing pursuant to Tennessee Code Annotated §§ 63-7-123 and 63-207 (14) and issued
a certificate of fitness by the Board of Nursing, is defined as follows:
The
range of services which may be provided by a physician assistant [orthopedic physician
assistant] shall be set forth in a written protocol, jointly developed by the
supervising physician and the physician assistant [orthopedic physician
assistant.
A
physician assistant [orthopedic physician assistant] may perform only those
tasks which are within the physician assistant’s range of skill and competence,
which are within the usual scope of practice of the supervising physician, and
which are consistent with the protection of the health and well-being of the
patients. A physician assistant shall
function only under the control and responsibility of a licensed physician. The
supervising physician has complete and absolute authority over any action of
the physician assistant.
Additionally, Rules 0880-2-.18 (3), (5) and (6)
provide as follows:
(3)
A supervising physician and/or substitute supervising physician shall have experience
and/or expertise in the same area of medicine as the physician assistant.
(5)
Protocols are required and:
(a)
shall be jointly developed and approved by the supervising physician and
physician assistant;
(b)
shall outline and cover the applicable standard of care;…
(6)
The supervising physician shall be responsible for ensuring compliance with the
applicable standard of care under (5). Additionally, the supervising physician
shall develop protocols in collaboration and referral.
Likewise,
rules 0880-6-.02 (3), (5) and (6) provide that:
(3)
A supervising physician and/or substitute supervising physician shall have
experience and/or expertise in the same area of medicine as the certified nurse
practitioner.
(5)
Protocols are required and:
(a)
shall be jointly developed and approved by the supervising physician and nurse
practitioner;
(b)
shall outline and cover the applicable standard of care;…
(6)
The supervising physician shall be responsible for ensuring compliance with the
applicable standard of care
under
(5). Additionally, the supervising physician shall develop clinical guidelines
in collaboration with the certified nurse practitioner to include a method for
documenting consultation and referral.
The Tennessee Board of Physical Therapy, regarding
patient referrals for physical therapy, states the following as its policy:
Jointly developed protocols may include referral of
patients for physical therapy if referrals to physical therapy are within the
physician assistant’s, orthopedic physician assistant’s, or certified nurse
practitioner’s range of skill and competence, and such referrals are within the
usual scope of practice of the supervising physician. Consequently, when
referral for physical therapy is included in protocols, those referrals, if
made by a physician assistant, orthopedic physician assistant, certified nurse
practitioner, are considered referrals by supervision physicians, for the
purposes contemplated by Tennessee Code Annotated, Sections 63-13-109 and 303
that require, in pertinent
part, that “The
practice of physical therapy shall be under the written or oral referral of a
licensed doctor of medicine….. or osteopathy.. ..”
Lapsed
License
The Board of Physical Therapy recognizes that an
individual may inadvertently allow his/her license to expire. However, statute
prohibits an individual from working as a Physical Therapist or Physical
Therapy Assistant unless he/she has an active and unrestricted license. While
the Board does not condone an individual working on an expired license,
recognition is given to the fact that the problem does exist. As such, the
Board has adopted the following procedures for reinstatement of an expired or
administratively revoked license.
• Immediately upon recognition that his/her license
has expired, the individual must stop practicing and contract the board’s
administrative office to request a reinstatement application.
• Upon receipt of the reinstatement application, the
individual is to complete the application in its entirety, providing a detailed
work history since the license expiration date. The application is to be
signed, notarized, and returned to the board’s administrative office along with
any additional information and all fees specified in the instructions.
• Upon receipt of a completed reinstatement application,
supporting documentation, including continuing education, and fees, the board
administrator may immediately reinstate a license, which has been in an expired
status for less than three months.
• If the reinstatement application received reflects
in the work history that the individual has worked in excess of three months on
an expired license, the board will present to the licensee, official notice
which requires payment of a penalty in the amount of $100 per month for every
month worked in excess of three months from the expiration date.
• Failure to comply with
this policy may result in disciplinary action.
Multidisciplinary
Health Screening
The Board of Physical Therapy hereby adopts the following
resolution relative to multidisciplinary health screenings:
The board resolves that health screenings in
disciplines other than in one’s scope of practice are unsafe to the public and
may subject the licensee to disciplinary action by this board or possible
malpractice litigation.
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www.state.tn.us/sos/rules/1150/1150-01.pdf
Ethics
& Jurisprudence –
Post-Test
A. the three roles of physical therapist
B. the five realms of ethical action
C. the seven core values of the profession
D. personal interpretation
A. “The TN Physical Therapy Practice Act”
is written by the
B. “The TN Physical Therapy Practice Act”
is written by the Tennessee Board of Physical
Therapy Examiners and is found in Chapter 1150-1 of the TN Rules and Regulations.
C. “The TN General Rules Governing the
Practice of Physical Therapy” is written by theTennessee legislature and are found in
the TN Code Annotated, Title 63, Chapter
13.
D. “The TN General Rules Governing the
Practice of Physical Therapy” is written by the
Tennessee Board of Physical Therapy Examiners and is found in the TN Code Annotated,
Title 63, Chapter 13.
A. When a patient provides the name of a
licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy
and expressly wants the physical therapist to inform such physician, the
physical therapist shall inform the patient’s licensed doctor of medicine,
chiropractic, dentistry, podiatry or osteopathy not later than five (5)
business days after the evaluation.
B. A consultation shall occur between the
physical therapist and the patient’s licensed doctor of medicine, chiropractic,
dentistry, podiatry or osteopathy within the first five (5) visits or ten (10)
business days, whichever comes first, of the findings of the patient’s initial
visit for physical therapy and any subsequent visits.
C. Where a patient does not want a licensed
doctor of medicine, chiropractic, dentistry, podiatry or osteopathy informed of
the initiation of therapy services, the therapist shall have the patient sign a
consent form that confirms the patient does not want a licensed doctor of
medicine, chiropractic, dentistry, podiatry or osteopathy informed of the
initiation of therapy treatment.
D. When a patient’s licensed doctor of medicine,
chiropractic, dentistry, podiatry or osteopathy has not been notified of the
physical therapy services, under no circumstances should therapy services
continue beyond thirty (30) days immediately following the date of the
patient’s first visit.
9. Which of the following
is TRUE regarding supervision of physical therapy services?
10. Which of the following statements is FALSE according to the
policy statements of the Tennessee Board of Physical Therapy?
A. A discharge evaluation/plan/summary, or evaluation is required
for every physical therapy record.
B. Physical Therapists with a master’s degree and current CPR
certification who have practiced for at least one year may provide physical
therapy services without a prior referral.
C. It is a violation of the Tennessee Physical Therapy Practice
Act (TCA 63-13-301) for a physical therapist to monitor home health aides
D.