Krista Frasco
Stephanie Burnett
Maribel Cervantez
Anna Hall
Ethical Dilemma #5
Due: 08/19/2010
1. What is the problem?
The main problem is that Ms. Lipinsky (Occupational Therapist), signed off on Mr. Dubois
(assistant) work. In order for the insurance to pay for the treatment it must have the signature
of an Occupational Therapist. With Ms. Lipinsky’s work load she did not have the time to
check up on Mr. Dubois work with her client, but had trusted his actions. Client filed a
complaint against Ms. Lipinsky, and unfortunately Ms. Lipinsky’s signature was on all of his
treatment records.
2. What are the interested parties? What is the nature of their interest?
1. Rehabilitation Hospital
Business- wants to maintain competence among their employees, keep their
clients happy in order to preserve a good reputation in their community.
2. The administrator
Professional- wants to maintain competence among their hired staff to keep
clients happy.
Personal- own reputation is at stake when things go wrong.
Business- It is the job as administrator to make sure things run smoothly and
safely for their clients.
3. Assistant (Mr. Dubois)
Personal- wants to be successful at his job
Professional- wants to his keep job as assistant
Economic- needs to work to support herself
4. Therapist (Ms. Lipinsky)
Personal- wants to be successful at her job and keep up her personal reputation
Professional- needs to keep her license to practice OT
Economic- needs to work to support herself
5. Insurance Company
Economic- does not want to pay for malpractice of therapists
6. Other staff members
Economic- needs the clients for business and money to the hospital
Professional- wants to keep hospitals competence high
Personal- wants to be considered competent at their job for own reputation
purposes.
7. The Clients
Personal- wants fair, just, and client centered treatment. Client wants to be known
and taken care of by therapists.
Societal- wants other clients to be treated fairly and appropriately
8. The lawyer
Professional- wants to protect therapist from malpractice
Economic- needs the money
Business- wants to promote his services in the future.
3. Is Ms. Lipinsky responsible for defending the treatment procedures, even though she
did not carry them out?
YES. She is liable according to “vicarious liability,” that states countersigning documents
carry the same responsibility for treatment of question, even if the therapist is signing for the
actions done by another (Bailey & Schwartzberg , 2003). The fact that the client was
assigned to Ms. Lipinsky’s, the treatment he receives therefore is her responsibility.
4. Is Mr. Lipinsky accountable for the treatment, even though she did not provide it?
YES. Ms. Lipinsky is also accountable because it was her duty to check and make sure that
Mr. Dubois was adequately treating the client before her signature was placed on his
document.
5. Does this case involve any OT Code of Ethics? If so, which section(s)?
Beneficence-
C- states “reevaluate and reassess” to determine further plan of action or changes
based off goals (in timely manner). This was not done by the OT, otherwise she
would have caught perhaps the clients interests and where things had gone wrong.
G- “take responsible steps” (in areas such as supervision) to ensure client safety
and proper treatment.
M- “report to appropriate authorities any acts in practice, education, and research
that appear unethical or illegal.” Ms. Lipinsky should have gone to her supervisor
and talked to them about her workload and how it affects her documentation and
supervision.
Nonmaleficence-
A- “Avoid inflicting harm or injury” depending on clients complaints, injury
and harm can be considered emotional, physical, and or psychological.
E- “Recognize and take appropriate action to remedy personal problems and
limitations that might cause harm to recipients of service...” Ms. Lipinsky
should have taken care of her over load issues before it affected the client.
I- “Avoid compromising client rights or well-being based on arbitrary
administrative directives by exercising professional judgment and critical
analysis.” Just because an OT has to sign all legal documentation she
should not let that get in the way of providing the best care to the client.
Autonomy and Confidentiality-
A- “Establish a collaborative relationship with recipients.” Ms. Lipinsky was
spread too thin and trusted her assistant would take care of things.
J- “Make every effort to facilitate open and collaborative dialogue with
clients and or responsible parties to facilitate comprehension of services
and their potential risks/benefits.” Once again, Ms. Lipinsky did not have
time to get to know her client or take the time to properly supervise her
assistant.
Procedural Justice-
A- “Be familiar with and apply the code of ethics standards”
B- “Be familiar with and seek to understand and abide by institutional rules, and
when those rules conflict with ethical practice, take steps to resolve the
conflict.” The documentation rules are affected by her large work load and is
unable to ethically sign.
D- “Be familiar with established policies and procedures for handling concerns.”
This would have been helpful for her to take action before the problem got out of
her control.
G- “Ensure that all duties assumed by or assigned to other occupational therapy
personnel match credentials, qualifications, experience, and scope of practice.”
Perhaps Mr. Dubois was expected to do work outside his scope of practice or
experience?
*** very important H- “ Provide appropriate supervision to individuals for whom
they have supervisory responsibility in accordance with AOTA official
documents and local, state, and federal or national laws, rules, regulations,
policies, procedures, standards, and guidelines.
L. make sure employers are aware of Code of ethics- this would have been helpful
if Ms. Lipinsky’s supervisor knew her work load was creating ethical dilemmas.
Veracity
A. Represent appropriately Occupational Therapy- one that sticks up for the
rights of self and services for patients. She should not have signed documents
if she had not correctly supervised assistant in application of therapies.
H- “Be honest, fair, accurate, respectful, and timely.” She was not honest in
signing off treatments that she did not know where adequately done.
6. Does this case involve any legal issue? If so, what law(s)/regulation(s)?
This case involves possible violation of the following:
- Filing a false report- if what was reported by Mr. Dubois and signed by Ms. Lipinsky was
different from what the client had actually received.
- Practice Act/ licensure law- violation of the code of ethics
- Negligence – negligent supervision of assistant (if harm was caused)
- Malpractice- professional standards have not been followed.
- Breach of contract- if following documentation and signing protocol has not been
adhered to.
7. Is there any other information needed for analyzing the case?
What are the clients complaints?Are there any protecting factors for Ms. Lipinsky since her
case load was heavy? What are the policies and procedures of supervision by OT’s and job
description of assistants? Does the hospital administrator have a role in this ethical dilemma?
Do the OT assistants have a license in this state? Are assistants even allowed to do the same
work of an OT? Is Ms. Lipinsky allowed to decrease her caseload without causing the
hospital and client harm?
8. What actions may be taken and what are the possible consequences?
Actions that may be taken include:
- Accept responsibility- learn from mistake
- Talk with department supervisor about lessening work load
- Research procedures for supervision of assistants
- Live and learn from mistake
- Blame Mr. DuboisX
- Quit and flee from the sceneX
- Try to talk with client and supervisor about remediation
- Take a class on ethical dilemmas in OT
- Learn ways to problem solve if this situation were to occur again
- Research and rehearse the role and scope of practice in AOTA document “Occupational
Therapy Roles”
X = should be ruled out based off the rotary four-way test
Reference:
Bailey & Schwartzberg (2003), Chapter 5, p. 86.
Reed, k., Hemphill, B., Ashe, A. M., Brandt, L. C., Estes, J., Foster, L. J., Homenko, D. F.,
Jackson, C. R., & Slater, D. Y. (2010). Occupational Therapy Code of Ethics and
Ethics Standards. Adopted by the Representative Assembly 2010, April 17.