Physical Therapist Student Experiences With Ethical and Legal Violations During Clinical Rotations: Reporting and Barriers to Reporting

Abstract

BACKGROUND AND PURPOSEAs the physical therapy profession moves toward increased professional autonomy, it is in the best interest of the public and the profession for physical therapists to continually develop the skills required to uphold legal and ethical standards in the workplace.1 With increased clinical autonomy, physical therapists (PTs) will need to navigate more complex ethical dilemmas. The foundation for developing clinical skills related to ethical decision making should occur in didactic coursework of physical therapist education programs. Physical therapist education must teach students to make ethical and legal clinical judgments in order to meet the challenges of clinical practice.2The specific aims of this research were to: (1) gain insight on students' ability to identify, address, and report legal issues, ethical issues, and dilemmas; (2) gather insight into barriers that prevent students from reporting these violations encountered in the clinic; and (3) collect student suggestions for the curriculum and clinical supervision that might assist students in identifying and reporting ethical and legal violations.Previous research has shown that many ethical conflicts arise from inappropriate use of resources,3'5 improper supervision,6 sexual harassment,7,8 lack of truth telling,4,5,9 respect,3'5,10 and blatant wrongdoing.6,9 In a fast-paced practice environment, it can be challenging to recognize ethical dilemmas and determine the appropriate course of action. Students in many health care professions are encountering an increased number of ethical dilemmas and conflicts when practicing in the clinical setting.10'12 The Code of Ethics for the Physical Therapist13 serves as a resource for physical therapists and physical therapist students to aid in recognition and resolution of ethical and legal dilemmas. Recent literature has provided some explanation and insight into the health care practitioner's ability to identify and resolve certain ethical and legal issues.4,6,12,14 For the purposes of this study, legal issues are defined as those explicit behaviors which violate the state practice act, state laws, or any of the federal laws governing the health care workforce, including but not limited to the Health Insurance Portability and Accountability Act (HIPAA) and Occupational Saftey and Health Administration (OSHA) or Medicare and Medicaid rules and regulations. Ethical issues are those areas such as respect for autonomy or beneficence that are essential to professional conduct but may not be required by law. Ethical dilemmas are defined as situations in which moral reasons come into conflict, and it is not immediately obvious what should be done.8(p3) In most cases we are concerned with both ethical issues and dilemmas. The following are domains of concern that appeared repeatedly in the literature relevant to clinical behaviors witnessed or performed by health care students in various health professions.Inappropriate Use of ResourcesThe Ethics and Judicial Committee of the American Physical Therapy Association (APTA) has identified the following as examples of improper use of resources: overutilization of services, billing fraud, improper use of personnel, false advertising, endorsement of products, and inappropriate fees.6 The literature supports that these issues are among the most common current ethical issues facing physical therapists.10,13,15,16Improper SupervisionState practice acts, as well as payers such as the Centers for Medicare and Medicaid Services, establish specific requirements for PTs regarding supervision of students, physical therapist assistants (PTAs), and physical therapy aides involved in patient care. Supervision also includes proper use of clinical time. In spite of these laws and regulations, improper supervision is a frequent theme experienced by students in many health professions, including medicine, nursing, occupational therapy, and physical therapy. …