Ethical Scenario: Meredith is a Level 2 OT fieldwork student doing a specialty affiliation in an outpatient hand clinic. Her OT supervisor, who is the only other OT in the clinic, had a death in the family and had to leave suddenly. While her supervisor was gone, the PT manager directed Meredith to treat all of the OT supervisor’s patients, including providing the PAMs on the physician referral, an intervention for which she has no training. The PT manager oversees several clinics and also asked her to treat one of his PT groups while he was offsite. She then documented and billed Medicare for these treatments. While doing so, she noticed that the PT patient has been in therapy for over 6 months and now has exceeded the $1,900 reimbursement cap for PT/SLP.

Ethical Scenario: Meredith is a Level 2 OT fieldwork student doing a specialty affiliation in an outpatient hand clinic. Her OT supervisor, who is the only other OT in the clinic, had a death in the family and had to leave suddenly. While her supervisor was gone, the PT manager directed Meredith to treat all of the OT supervisor’s patients, including providing the PAMs on the physician referral, an intervention for which she has no training. The PT manager oversees several clinics and also asked her to treat one of his PT groups while he was offsite. She then documented and billed Medicare for these treatments. While doing so, she noticed that the PT patient has been in therapy for over 6 months and now has exceeded the $1,900 reimbursement cap for PT/SLP.

Potential ethical dilemma (use the code of ethics language)

Professional and liability issues to consider

Decision for putting this action step in place and why

Beneficence

Nonmaleficence

This principle states that OT practitioners should refrain from actions that cause harm (AOTA, 2015).

Part D of this code states that duties which are delegated to OT’s should be in line with their “credentials, qualifications, experience, competency, and scope of practice with respect to service delivery, supervision, fieldwork education, and research” (AOTA, 2015).

The OT who serves as the clinical instructor for Meredith is at risk of getting her liscence suspended

The physical therapy (PT) manager for the clinic also violated his professional code of ethics by asking a student to treat all of her clinical instructor's patients. Not only would this affect his managerial position in the clinic but his license as well.

Potential action step to resolve dilemma

Clinical instructor communicate to manager

Meredith (OT student) reach out to university fieldwork coordinator

Her school can provide guidance and be a helpful resource to how she should handle the situation

If clinical instructor had open lines of communication and spoke to the manager well in advance, prior to Meredith's arrival, this situation could have been handled ethically. Rather than rushing to find a solution and throwing the student in and unethical situation.

Clinical instructor communicate to Meredith (OT student)

Open lines of communication are essential for both the success of the student and preventing stressful situations for the clinical instructor which can ultimately threaten their license.

Meredith could approach the PT manager and share the OT code of ethics and how she would be in violation if these codes if she were to assist in that capacity. PT services are not in the scope of practice for an OT therefore, it would not even be appropriate for Meredith to treat the PT patients.

A student or therapist who administers any therapeutic modality or intervention without training and knowledge can potentially harm the patient.

Resources

American Occupational Therapy Association [AOTA]. (2015). Occupational therapy code of ethics (2015). American Journal of Occupational Therapy, 69, 1–8. https://doi.org/10.5014/ajot.2015.696S03

Without a licensed OT on site if a situation were to arise where the student needed help with a patient she would have no one to turn to and could potentially create an unsafe situation for the patient she is treating.

Meredith voice her concerns with the clinical manager