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
Code of Ethics Violated:
Beneficence: this code of ethic would be broken by allowing a student to treat a patient without the clinical instructor on location. Because beneficence is a code of ethic that requires the provider to provide the best services that benefit the patients. Though the student is trained and qualified the clinical instructor should still be on site supervising to ensure a lower risk of injury or mistake.
Nonmaleficence: This would include the responsibility of providing transitional care or replaced care if the current provider is not available. The facility did not have a back up plan to provide occupational therapy services if on licensed therapist was not able to provide services.
Justice: This code could be broken if the student is unaware how to fill out required documents for documentation purposes such as PAMs.
Justice #2: The licensed therapist on staff is also responsible for billing correctly. The student attempting to treat and bill a pt that has exceeded the therapy cap would demonstrate a lack of ability to provide a justice in the billing department.
Consider:
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3.) If the student where to make a mistake while treating the patient this could result in loss of licensure of the OT clinical instructor.
4.) Treating physical therapy patients according to physical therpay scripts ordered by the physician is not with in our scope of practice.
References:
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Occupational Therapy, 69, 1–8.
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Course of Action:
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3.) Help create a plan to contact all patients either to reschedule when therapist has returned or in another location affiliated with the outpatient clinic
4.) In addition to rescheduling patients purpose a plan to make up hours lost in the clinic such as completing a research paper on related diagnosis commonly seen in the clinic.
Decision:
In conclusion, my decision would be to not treat the occupational therapy patients without supervision of my clinical instructor. I would immediately notify the PT manager to ensure proper communication as well as inform him that the situation would be mentioned to my fieldwork coordinator, This action would be taken to ensure all cod of ethics are followed as will as prevent a revoked licensure of my clinical instructor if I were to make a mistake while treating a patient.