CODE OF CONDUCT - Scales Nutrition and Wellness Center

 

Effective 6/13/11

Revised 3/16/12

Revised 6/30/12

 

The Scales Nutrition and Wellness Center and its employees must, at all times, comply with all applicable laws and regulations. The SNWC will not condone the activities of employees whom

achieve results through violation of the law or unethical business dealings. This includes

any payments for illegal acts, indirect contributions, rebates, and bribery. The

SNWC does not permit any activity that fails to stand the closest possible public

scrutiny.

All business conduct should be well above the minimum standards required by law.

Accordingly, employees must ensure that their actions cannot be interpreted as being, in

any way, in contravention of the laws and regulations governing the SNWC’s

operations.

Employees uncertain about the application or interpretation of any legal requirements

should refer the matter to their supervisor, who, if necessary, should seek appropriate

legal advice.

 

General Employee Conduct:

The SNWC expects its employees to conduct themselves in a businesslike manner.

Drinking, gambling, fighting, swearing, and similar unprofessional activities are strictly

prohibited while on the job.

Employees must not engage in sexual harassment, or conduct themselves in a way that

could be construed as such, for example, by using inappropriate language, keeping or

posting inappropriate materials in their work area, or accessing inappropriate materials

on their computer.

 

Conflicts of Interest:

The SNWC expects that employees will perform their duties conscientiously,

honestly, and in accordance with the best interests of the Organization. Employees must

not use their positions or the knowledge gained as a result of their positions for private or

personal advantage. Regardless of the circumstances, if employees sense that a course

of action they have pursued, or are presently pursuing, or are contemplating pursuing

may involve them in a conflict of interest with their employer, they should immediately

communicate all the facts to their supervisor.

 

Outside Activities, Employment, and Directorships:

All employees share a serious responsibility for the SNWC’s good public relations,

especially at the community level. Their readiness to help with religious, charitable,

educational, and civic activities brings credit to the SNWC and is encouraged.

Employees must, however, avoid acquiring any business interest or participating in any

other activity outside the SNWC that would, or would appear to:

􀂾 Create an excessive demand upon their time and attention, thus depriving the

SNWC of their best efforts on the job.

􀂾 Create a conflict of interest - an obligation, interest, or distraction - that may interfere with

the independent exercise of judgment in the SNWC’s best interest.

 

Relationships with Clients and Suppliers:

Employees should avoid investing in or acquiring a financial interest for their own

accounts in any business organization that has a contractual relationship with the

SNWC, or that provides goods or services, or both, to the SNWC if such

investment or interest could influence or create the impression of influencing their

decisions in the performance of their duties on behalf of the SNWC.

  

Gifts, Entertainment, and Favors:

Employees must not accept entertainment, gifts, or personal favors that could, in any

way, influence, or appear to influence, business decisions in favor of any person or

organization with whom or with which the SNWC has, or is likely to have, business

dealings. Similarly, employees must not accept any other preferential treatment under

these circumstances because their positions with the SNWC might be inclined to,

or be perceived to, place them under obligation to return the preferential treatment.

 

Kickbacks and Secret Commissions:

Regarding the SNWC’s business activities, employees may not receive payment or

compensation of any kind, except as authorized under the SNWC’s business and

payroll policies. In particular, the SNWC strictly prohibits the acceptance of

kickbacks and secret commissions from suppliers or others. Any breach of this rule will

result in termination and possible prosecution.

 

Funds and Other Assets:

Employees who have access to SNWC funds in any form must follow the

prescribed procedures for recording, handling, and protecting money. Any money/payment received by a provider of the SNWC must be given to the receptionist or office manager. Funds received posted on doctor’s access software program via the billing service and are deposited to the bank on a daily basis with records kept with deposit slip. Bank deposits and payments received in the form of insurance payments, credit card payments, and cash payments are reconciled with the payments posted on doctor’s access software. Any discrepancy must be accounted for and office manager and owner must be aware of any discrepancies. The

SNWC imposes strict standards to prevent fraud and dishonesty. If employees

become aware of any evidence of fraud and dishonesty, they should immediately advise

their supervisor or seek appropriate legal guidance so that the SNWC can promptly

investigate further.

When an employee’s position requires spending SNWC funds or incurring any

reimbursable personal expenses, that individual must use good judgment on the

SNWC behalf to ensure that good value is received for every expenditure.

SNWC funds and all other assets of the SNWC are purposed for the

SNWC only and not for personal benefit. This includes the personal use of

SNWC assets, such as computers.

 

Reporting of Fraud or Abuse

If another employee has knowledge that fraud, waste, abuse, or other wrongdoing is occurring, immediately report any alleged misappropriations to the office manager or the owner within 2 days. There is a no-reprisal system in place for reporting of abuse and the one reporting is kept confidential and will have no monetary or positional repercussions incurred as a result of such reporting. Once a report is made, an investigation will be initiated and a determination regarding actual misappropriations will then be made. Job termination or legal prosecution can result if a determination of misappropriations is made.

 

SNWC Records and Communications:

Accurate and reliable records of many kinds are necessary to meet the SNWC’s

legal and financial obligations and to manage the affairs of the SNWC. The

SNWC’s books and records must reflect in an accurate and timely manner all

business transactions. The employees responsible for accounting and recordkeeping

must fully disclose and record all assets, liabilities, or both, and must exercise diligence in

enforcing these requirements.

Employees must not make or engage in any false record or communication of any kind,

whether internal or external, including but not limited to:

􀂾 False expense, attendance, production, financial, or similar reports and statements

􀂾 False advertising, deceptive marketing practices, or other misleading representations

 

Dealing With Outside People and Organizations:

Employees must take care to separate their personal roles from their SNWC

positions when communicating on matters not involving SNWC business.

Employees must not use SNWC identification, stationery, supplies, and equipment

for personal or political matters. Employees must not presume to speak for the SNWC on any topic, unless they are certain that the views they express are those of the SNWC, and it is the SNWC’s desire that such views be publicly disseminated.

When dealing with anyone outside the SNWC, including public officials, employees

must take care not to compromise the integrity or damage the reputation of either the

SNWC, or any outside individual, business, or government body.

 

Prompt Communications:

In all matters relevant to customers, suppliers, government authorities, the public and

others in the SNWC, all employees must make every effort to achieve complete,

accurate, and timely communications - responding promptly and courteously to all proper

requests for information and to all complaints.

 

Privacy and Confidentiality:

When handling financial and personal information about customers or others with whom

the SNWC has dealings, observe the following principles:

• Collect, use, and retain only the personal information necessary for the SNWC’s

business. Whenever possible, obtain any relevant information directly from the person

concerned. Use only reputable and reliable sources to supplement this information.

• Retain information only for as long as necessary or as required by law. Protect the physical

security of this information.

• Limit internal access to personal information to those with a legitimate business reason for

seeking that information. Use only personal information for the purposes for which it was

originally obtained. Obtain the consent of the person concerned before externally disclosing

any personal information, unless legal process or contractual obligation provides otherwise.

 

Marketing:

When marketing, money will not be exchanged to a referral source after a referral has been made to the SNWC. Marketing to referral sources in the form of providing meals/ beverages, pens, small amounts of money or gifts not in excess of $50 dollars are acceptable.

 

Personal fund raising:

Personnel soliciting funds to other employees on behalf of a personal cause such as selling cookies for a daughter in girls scouts or selling candy or wrapping paper for a child’s school is permissible because the other personnel are under no obligation to purchase the goods and will not have any monetary or other repursions of not purchasing the item. Soliciting funds by personnel to persons served by the SNWC is strictly forbidden under any circumstance. Also having persons served selling items on behalf of the SNWC is also strictly forbidden. Allowing persons served to raise funds by appeals to personnel or other persons served is strictly forbidden.

 

Personal property:

Personal property of persons served is safeguarded in one particular room while they are engaged in treatment. Personal property of the SNWC should also be respected and damage done intentionally by persons served can result in the person served being responsible for the monetary costs of replacing the property damaged.

 

Dating Relationships:

Personnel dating other personnel of the SNWC or persons served by the SNWC  is strictly forbidden. Boundaries must be observed in the workplace.

 

Code of Conduct:

As an employee of the SNWC, you will adhere to the professional code of conduct as specified by your professional specialty organization (such as the code of conduct guidelines of American Dietetics Association, American Psychological Association, or American Psychiatric Association).

 

 

 

 

 

Signing of documents:

Personnel of the SNWC may be asked to witness documents of the persons served. Such examples of documents that personnel may be asked to witness can include powers of attorney, legal guardianship, and advance directives. The personnel of the SNWC will safeguard the personal property requests for the witnessing of these documents.

 

Professional Code of Conduct for dietetic practitioner:

 

1. The dietetics practitioner conducts himself/herself with honesty, integrity, and fairness.

2. The dietetics practitioner supports and promotes high standards of professional practice.

The dietetics practitioner accepts the obligation to protect clients, the public, and the profession

by upholding the Code of Ethics for the Profession of Dietetics and by reporting perceived

violations of the Code through the processes established by ADA and its credentialing agency, CDR.

3. The dietetics practitioner considers the health, safety, and welfare of the public at all times.

The dietetics practitioner will report inappropriate behavior or treatment of a client by another dietetics practitioner or other professionals.

4. The dietetics practitioner complies with all laws and regulations applicable or related to the profession or to the practitioner’s ethical obligations as described in this Code.

a. The dietetics practitioner must not be convicted of a crime under the laws of the United States, whether a felony or a misdemeanor, an essential element of which is dishonesty.

b. The dietetics practitioner must not be disciplined by a state for conduct that would violate one or more of these principles.

c. The dietetics practitioner must not commit an act of misfeasance or malfeasance that is directly related to the practice of the profession as determined by a court of competent jurisdiction, a licensing board, or an

agency of a governmental body.

5. The dietetics practitioner provides professional services with objectivity and with respect for the unique needs and values of individuals.

a. The dietetics practitioner does not, in professional practice, discriminate against others on the basis of race, ethnicity, creed, religion, disability, gender, age, gender identity, sexual orientation, national origin, economic status, or any other legally protected category.

b. The dietetics practitioner provides services in a manner that is sensitive to cultural differences.

c. The dietetics practitioner does not engage in sexual harassment in connection with professional practice.

6. The dietetics practitioner does not engage in false or misleading practices or communications.

a. The dietetics practitioner does not engage in false or deceptive advertising of his or her services.

b. The dietetics practitioner promotes or endorses specific goods or products only in a manner that is not false and misleading.

c. The dietetics practitioner provides accurate and truthful information in communicating

with the public.

7. The dietetics practitioner withdraws from professional practice when unable to fulfill his or her professional duties and responsibilities to clients and others.

a. The dietetics practitioner withdraws from practice when he/ she has engaged in abuse of a substance such that it could affect his or her practice.

b. The dietetics practitioner ceases practice when he or she has been adjudged by a court to be mentally

incompetent.

c. The dietetics practitioner will not engage in practice when he or she has a condition that substantially impairs his or

her ability to provide effective service to others.

8. The dietetics practitioner recognizes and exercises professional judgment within the limits of his or her qualifications and collaborates with others, seeks counsel, or makes referrals as appropriate.

9. The dietetics practitioner treats clients and patients with respect and consideration.

a. The dietetics practitioner provides sufficient information to enable clients and others to make their own informed decisions.

b. The dietetics practitioner respects the client’s right to make decisions regarding the recommended plan of care, including consent, modification, or refusal.

10. The dietetics practitioner protects confidential information and makes full disclosure about any limitations on his or her ability to guarantee full confidentiality.

11. The dietetics practitioner, in dealing with and providing services to clients and others, complies with the same principles set forth above in “Responsibilities to the Public”

12. The dietetics practitioner practices dietetics based on evidence- based principles and current

information.

13. The dietetics practitioner presents reliable and substantiated information and interprets controversial information without personal bias, recognizing that legitimate differences of opinion exist.

14. The dietetics practitioner assumes a life-long responsibility and accountability for personal competence in practice, consistent with accepted professional standards, continually striving to increase professional knowledge and skills and to apply them in practice.

15. The dietetics practitioner is alert to the occurrence of a real or potential conflict of interest and takes appropriate action whenever a conflict arises.

a. The dietetics practitioner makes full disclosure of any real or perceived conflict of interest.

b. When a conflict of interest cannot be resolved by disclosure, the dietetics practitioner takes such other action as may be necessary to eliminate the conflict, including recusal from an office,\position, or practice situation.

16. The dietetics practitioner permits the use of his or her name or the purpose of certifying that dietetics services have been rendered only if he or she has provided or supervised the provision of those services.

17. The dietetics practitioner accurately presents professional qualifications and credentials.

a. The dietetics practitioner, in seeking, maintaining, and using credentials provided by CDR, provides accurate information and complies with all requirements imposed by CDR. The dietetics practitioner uses CDR-awarded credentials (“RD” or “Registered Dietitian”; “DTR” or “Dietetic Technician, Registered”; “CS” or “Certified Specialist”; and “FADA” or “Fellow of the American Dietetic Association”) only when the credential is current and authorized by CDR.

b. The dietetics practitioner does not aid any other person in violating any CDR requirements, or in representing himself or herself as CDR-credentialed when he or she is not.

18. The dietetics practitioner does not invite, accept, or offer gifts, monetary incentives, or other

considerations that affect or reasonably give an appearance of affecting his/her professional

judgment.

Clarification of Principle:

a. Whether a gift, incentive, or other item of consideration shall be viewed to affect, or give the appearance of affecting, a dietetics practitioner’s professional judgment is dependent on all factors relating to the transaction, including the amount or value of the consideration, the likelihood that the practitioner’s judgment will or is intended to be affected, the position held by the practitioner, and whether the consideration is offered or generally available to persons other than the practitioner.

b. It shall not be a violation of this principle for a dietetics practitioner to accept compensation as a consultant or employee or as part of a research grant or corporate sponsorship program, provided the relationship is openly disclosed and the practitioner acts with integrity in performing the services or responsibilities.

c. This principle shall not preclude a dietetics practitioner from accepting gifts of nominal value, attendance at educational programs, meals in connection with educational exchanges of information, free samples of products, or similar items, as long as such items are not offered in exchange for or with the expectationof, and do not result in,

conduct or services that are contrary to the practitioner’s professional judgment.

d. The test for appearance of impropriety is whether the conductwould create in reasonable minds a perception that

the dietetics practitioner’s ability to carry out professional responsibilities with integrity, impartiality, and competence

is impaired.

19. The dietetics practitioner demonstrates respect for the values, rights, knowledge, and skills of colleagues and other professionals.

a. The dietetics practitioner does not engage in dishonest, misleading, or inappropriate business practices that demonstrate a disregard for the rights or interests of others.

b. The dietetics practitioner provides objective evaluations of performance for employees and coworkers, candidates for employment, students, professional association memberships, awards, or scholarships, making all reasonable efforts to

avoid bias in the professional evaluation of others.

PROCESS FOR CONSIDERATION OF ETHICS ISSUES

In accordance with ADA’s Code of Ethics, a process has been established for consideration of ethics issues. This process defines the procedure for review of and response to ethics complaints,

 ncluding hearings, disciplinary action, and appeals. The process was approved on June 2, 2009, by the

ADA Board of Directors, the House of Delegates, and the Commission on Dietetic Registration.

Committee

A three (3)-person committee, comprised of members of ADA and/or CDRcredentialed practitioners, will be appointed to handle all ethics matters. One person will be appointed each year by the president-elect of ADA, the chairperson of CDR, or the speakerelect of the House of Delegates (based on the expired term). Terms of office will be for three (3) years. Terms will be staggered to allow for continuity. The chairship will rotate among the three

(3) committee members. The chairship will be awarded to the person moving into the third year of the three (3)-year term of office. The Committee will have authority to consult with subject experts as necessary to conduct its business. The Committee may perform such other educational activities as might be necessary to assist members and credentialed practitioners to understand the Code of Ethics.

 

Professional Codes of Conduct for psychiatric and psychological practitioners per American Psychiatric Association position paper:

 

THE PRINCIPLES OF MEDICAL ETHICS With Annotations Especially Applicable to Psychiatry 2009 Edition Revised

In 1973, the American Psychiatric Association (APA) published the first edition of The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry. Subsequently, revisions were published as the APA Board of Trustees and the APA Assembly approved additional annotations. In July of 1980, the American Medical Association (AMA) approved a new version of the Principles of Medical Ethics (the first revision since 1957), and the APA Ethics Committee1 incorporated many of its annotations into the new Principles, which resulted in the 1981 edition and subsequent revisions. This version includes changes to the Principles approved by the AMA in 2001. Foreword

1The committee included Herbert Klemmer, M.D., Chairperson, Miltiades Zaphiropoulos, M.D., Ewald Busse, M.D., John R. Saunders, M.D., and Robert McDevitt, M.D. J. Brand Brickman, M.D., William P. Camp, M.D., and Robert A. Moore, M.D., served as consultants to the APA Ethics Committee. 2Current Opinions with Annotations of the Council on Ethical and Judicial Affairs, Chicago, American Medical Association, 2002–2003. 3Chapter 7, Section 1 of the Bylaws of the American Psychiatric Association (May 2003 edition) states, ―All members of the Association shall be bound by the ethical code of the medical profession, specifically defined in the Principles of Medical Ethics of the American Medical Association and in the Association’s Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry.‖ In interpreting the Bylaws, it is the opinion of the APA Board of Trustees that inactive status in no way removes a physician member from responsibility to abide by the Principles of Medical Ethics.

ALL PHYSICIANS should practice in accordance with the medical code of ethics set forth in the Principles of Medical Ethics of the American Medical Association. An up-to-date expression and elaboration of these statements is found in the Opinions and Reports of the Council on Ethical and Judicial Affairs of the American Medical Association.2 Psychiatrists are strongly advised to be familiar with these documents.3

However, these general guidelines have sometimes been difficult to interpret for psychiatry, so further annotations to the basic principles are offered in this document. While psychiatrists have the same goals as all physicians, there are special ethical problems in psychiatric practice that differ in coloring and degree from ethical problems in other branches of medical practice, even 2

though the basic principles are the same. The annotations are not designed as absolutes and will be revised from time to time so as to be applicable to current practices and problems. Following are the AMA Principles of Medical Ethics, printed in their entirety, and then each principle printed separately along with an annotation especially applicable to psychiatry. Principles of Medical Ethics American Medical Association Preamble The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. The following Principles adopted by the American Medical Association are not laws, but standards of conduct which define the essentials of honorable behavior for the physician. Section 1 A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights. Section 2 A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities. Section 3 A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient. Section 4 A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law. Section 5 A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated. 3

Section 6 A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care. Section 7 A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health. Section 8 A physician shall, while caring for a patient, regard responsibility to the patient as paramount. Section 9 A physician shall support access to medical care for all people. Principles With Annotations Following are each of the AMA Principles of Medical Ethics printed separately along with annotations especially applicable to psychiatry. Preamble

The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. The following Principles adopted by the American Medical Association are not laws, but standards of conduct which define the essentials of honorable behavior for the physician.4 Section 1 A physician shall be dedicated to providing competent medical care with compassion and respect for human dignity and rights. 1. A psychiatrist shall not gratify his or her own needs by exploiting the patient. The psychiatrist shall be ever vigilant about the impact that his or her conduct has upon the boundaries of the doctor–patient relationship, and thus upon the well-being of the patient. These requirements become particularly important because of the essentially private, highly personal, and sometimes intensely emotional nature of the relationship established with the psychiatrist. 2. A psychiatrist should not be a party to any type of policy that excludes, segregates, or demeans the dignity of any patient because of ethnic origin, race, sex, creed, age, socioeconomic status, or sexual orientation.

4Statements in italics are taken directly from the American Medical Association's Principles of Medical Ethics. 4

3. In accord with the requirements of law and accepted medical practice, it is ethical for a physician to submit his or her work to peer review and to the ultimate authority of the medical staff executive body and the hospital administration and its governing body. In case of dispute, the ethical psychiatrist has the following steps available: a. Seek appeal from the medical staff decision to a joint conference committee, including members of the medical staff executive committee and the executive committee of the governing board. At this appeal, the ethical psychiatrist could request that outside opinions be considered. b. Appeal to the governing body itself. c. Appeal to state agencies regulating licensure of hospitals if, in the particular state, they concern themselves with matters of professional competency and quality of care. d. Attempt to educate colleagues through development of research projects and data and presentations at professional meetings and in professional journals. e. Seek redress in local courts, perhaps through an enjoining injunction against the governing body. f. Public education as carried out by an ethical psychiatrist would not utilize appeals based solely upon emotion, but would be presented in a professional way and without any potential exploitation of patients through testimonials. 4. A psychiatrist should not be a participant in a legally authorized execution. Section 2 A physician shall uphold the standards of professionalism, be honest in all professional interactions and strive to report physicians deficient in character or competence, or engaging in fraud or deception to appropriate entities. 1. The requirement that the physician conduct himself/herself with propriety in his or her profession and in all the actions of his or her life is especially important in the case of the psychiatrist because the patient tends to model his or her behavior after that of his or her psychiatrist by identification. Further, the necessary intensity of the treatment relationship may tend to activate sexual and other needs and fantasies on the part of both patient and psychiatrist, while weakening the objectivity necessary for control. Additionally, the inherent inequality in the doctor-patient relationship may lead to exploitation of the patient. Sexual activity with a current or former patient is unethical. 5

2. The psychiatrist should diligently guard against exploiting information furnished by the patient and should not use the unique position of power afforded him/her by the psychotherapeutic situation to influence the patient in any way not directly relevant to the treatment goals. 3. A psychiatrist who regularly practices outside his or her area of professional competence should be considered unethical. Determination of professional competence should be made by peer review boards or other appropriate bodies. 4. Special consideration should be given to those psychiatrists who, because of mental illness, jeopardize the welfare of their patients and their own reputations and practices. It is ethical, even encouraged, for another psychiatrist to intercede in such situations. 5. Psychiatric services, like all medical services, are dispensed in the context of a contractual arrangement between the patient and the physician. The provisions of the contractual arrangement, which are binding on the physician as well as on the patient, should be explicitly established. 6. It is ethical for the psychiatrist to make a charge for a missed appointment when this falls within the terms of the specific contractual agreement with the patient. Charging for a missed appointment or for one not canceled 24 hours in advance need not, in itself, be considered unethical if a patient is fully advised that the physician will make such a charge. The practice, however, should be resorted to infrequently and always with the utmost consideration for the patient and his or her circumstances. 7. An arrangement in which a psychiatrist provides supervision or administration to other physicians or nonmedical persons for a percentage of their fees or gross income is not acceptable; this would constitute fee splitting. In a team of practitioners, or a multidisciplinary team, it is ethical for the psychiatrist to receive income for administration, research, education, or consultation. This should be based on a mutually agreed-upon and set fee or salary, open to renegotiation when a change in the time demand occurs. (See also Section 5, Annotations 2, 3, and 4.) Section 3 A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.

1. It would seem self-evident that a psychiatrist who is a law-breaker might be ethically unsuited to practice his or her profession. When such illegal activities bear directly upon his or her practice, this would obviously be the case. However, in other instances, illegal activities such as those concerning the right to protest social injustices might not bear on either the image of the psychiatrist or the ability of the specific psychiatrist to treat his or her patient ethically and well. While no committee or board could offer prior assurance that any illegal activity would not be considered unethical, it is conceivable that an individual could violate a law without being guilty 6

of professionally unethical behavior. Physicians lose no right of citizenship on entry into the profession of medicine. 2. Where not specifically prohibited by local laws governing medical practice, the practice of acupuncture by a psychiatrist is not unethical per se. The psychiatrist should have professional competence in the use of acupuncture. Or, if he or she is supervising the use of acupuncture by nonmedical individuals, he or she should provide proper medical supervision. (See also Section 5, Annotations 3 and 4.) Section 4 A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law. 1. Psychiatric records, including even the identification of a person as a patient, must be protected with extreme care. Confidentiality is essential to psychiatric treatment. This is based in part on the special nature of psychiatric therapy as well as on the traditional ethical relationship between physician and patient. Growing concern regarding the civil rights of patients and the possible adverse effects of computerization, duplication equipment, and data banks makes the dissemination of confidential information an increasing hazard. Because of the sensitive and private nature of the information with which the psychiatrist deals, he or she must be circumspect in the information that he or she chooses to disclose to others about a patient. The welfare of the patient must be a continuing consideration. 2. A psychiatrist may release confidential information only with the authorization of the patient or under proper legal compulsion. The continuing duty of the psychiatrist to protect the patient includes fully apprising him/her of the connotations of waiving the privilege of privacy. This may become an issue when the patient is being investigated by a government agency, is applying for a position, or is involved in legal action. The same principles apply to the release of information concerning treatment to medical departments of government agencies, business or-ganizations, labor unions, and insurance companies. Information gained in confidence about patients seen in student health services should not be released without the students’ explicit permission. 3. Clinical and other materials used in teaching and writing must be adequately disguised in order to preserve the anonymity of the individuals involved. 4. The ethical responsibility of maintaining confidentiality holds equally for the consultations in which the patient may not have been present and in which the consultee was not a physician. In such instances, the physician consultant should alert the consultee to his or her duty of confidentiality. 5. Ethically, the psychiatrist may disclose only that information which is relevant to a given situation. He or she should avoid offering speculation as fact. Sensitive information such as an individual’s sexual orientation or fantasy material is usually unnecessary. 7

6. Psychiatrists are often asked to examine individuals for security purposes, to determine suitability for various jobs, and to determine legal competence. The psychiatrist must fully describe the nature and purpose and lack of confidentiality of the examination to the examinee at the beginning of the examination. 7. Careful judgment must be exercised by the psychiatrist in order to include, when appropriate, the parents or guardian in the treatment of a minor. At the same time, the psychiatrist must assure the minor proper confidentiality. 8. When, in the clinical judgment of the treating psychiatrist, the risk of danger is deemed to be significant, the psychiatrist may reveal confidential information disclosed by the patient.‖ 9. When the psychiatrist is ordered by the court to reveal the confidences entrusted to him/her by patients, he or she may comply or he/ she may ethically hold the right to dissent within the framework of the law. When the psychiatrist is in doubt, the right of the patient to confidentiality and, by extension, to unimpaired treatment should be given priority. The psychiatrist should reserve the right to raise the question of adequate need for disclosure. In the event that the necessity for legal disclosure is demonstrated by the court, the psychiatrist may request the right to disclosure of only that information which is relevant to the legal question at hand. 10. With regard for the person’s dignity and privacy and with truly informed consent, it is ethical to present a patient to a scientific gathering if the confidentiality of the presentation is understood and accepted by the audience. 11. It is ethical to present a patient or former patient to a public gathering or to the news media only if the patient is fully informed of enduring loss of confidentiality, is competent, and consents in writing without coercion. 12. When involved in funded research, the ethical psychiatrist will advise human subjects of the funding source, retain his or her freedom to reveal data and results, and follow all appropriate and current guidelines relative to human subject protection. 13. Ethical considerations in medical practice preclude the psychiatric evaluation of any person charged with criminal acts prior to access to, or availability of, legal counsel. The only exception is the rendering of care to the person for the sole purpose of medical treatment. 14. Sexual involvement between a faculty member or supervisor and a trainee or student, in those situations in which an abuse of power can occur, often takes advantage of inequalities in the working relationship and may be unethical because: a. Any treatment of a patient being supervised may be deleteriously affected. b. It may damage the trust relationship between teacher and student. c. Teachers are important professional role models for their trainees and affect their trainees’ future professional behavior. 8

Section 5 A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated. 1. Psychiatrists are responsible for their own continuing education and should be mindful of the fact that theirs must be a lifetime of learning. 2. In the practice of his or her specialty, the psychiatrist consults, associates, collaborates, or integrates his or her work with that of many professionals, including psychologists, psychometricians, social workers, alcoholism counselors, marriage counselors, public health nurses, and the like. Furthermore, the nature of modern psychiatric practice extends his or her contacts to such people as teachers, juvenile and adult probation officers, attorneys, welfare workers, agency volunteers, and neighborhood aides. In referring patients for treatment, counseling, or rehabilitation to any of these practitioners, the psychiatrist should ensure that the allied professional or paraprofessional with whom he or she is dealing is a recognized member of his or her own discipline and is competent to carry out the therapeutic task required. The psychiatrist should have the same attitude toward members of the medical profession to whom he or she refers patients. Whenever he or she has reason to doubt the training, skill, or ethical qualifications of the allied professional, the psychiatrist should not refer cases to him/her. 3. When the psychiatrist assumes a collaborative or supervisory role with another mental health worker, he or she must expend sufficient time to assure that proper care is given. It is contrary to the interests of the patient and to patient care if the psychiatrist allows himself/herself to be used as a figurehead. 4. In relationships between psychiatrists and practicing licensed psychologists, the physician should not delegate to the psychologist or, in fact, to any nonmedical person any matter requiring the exercise of professional medical judgment. 5. The psychiatrist should agree to the request of a patient for consultation or to such a request from the family of an incompetent or minor patient. The psychiatrist may suggest possible consultants, but the patient or family should be given free choice of the consultant. If the psychiatrist disapproves of the professional qualifications of the consultant or if there is a difference of opinion that the primary therapist cannot resolve, he or she may, after suitable notice, withdraw from the case. If this disagreement occurs within an institution or agency framework, the differences should be resolved by the mediation or arbitration of higher professional authority within the institution or agency. Section 6 A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care. 9

1. Physicians generally agree that the doctor-patient relationship is such a vital factor in effective treatment of the patient that preservation of optimal conditions for development of a sound working relationship between a doctor and his or her patient should take precedence over all other considerations. Professional courtesy may lead to poor psychiatric care for physicians and their families because of embarrassment over the lack of a complete give-and-take contract. 2. An ethical psychiatrist may refuse to provide psychiatric treatment to a person who, in the psychiatrist’s opinion, cannot be diagnosed as having a mental illness amenable to psychiatric treatment. Section 7 A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health. 1. Psychiatrists should foster the cooperation of those legitimately concerned with the medical, psychological, social, and legal aspects of mental health and illness. Psychiatrists are encouraged to serve society by advising and consulting with the executive, legislative, and judiciary branches of the government. A psychiatrist should clarify whether he/ she speaks as an individual or as a representative of an organization. Furthermore, psychiatrists should avoid cloaking their public statements with the authority of the profession (e.g., ―Psychiatrists know that‖). 2. Psychiatrists may interpret and share with the public their expertise in the various psychosocial issues that may affect mental health and illness. Psychiatrists should always be mindful of their separate roles as dedicated citizens and as experts in psychological medicine. 3. On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement. 4. The psychiatrist may permit his or her certification to be used for the involuntary treatment of any person only following his or her personal examination of that person. To do so, he or she must find that the person, because of mental illness, cannot form a judgment as to what is in his/ her own best interests and that, without such treatment, substantial impairment is likely to occur to the person or others. 5. Psychiatrists shall not participate in torture. 10

Section 8 A physician shall, while caring for a patient, regard responsibility to the patient as paramount. New section recently adopted by the AMA. Section 9 A physician shall support access to medical care for all people. New section recently adopted by the AMA. 11

Procedures for Handling Complaints of Unethical Conduct The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility not only to patients but also to society, to other health professionals, and to self. The Principles, adopted by the American Medical Association, are not laws but standards of conduct that define the essentials of honorable behavior for the physician. Complaints charging members of the American Psychiatric Association (APA) with unethical behavior or practices shall be investigated, processed, and resolved in accordance with procedures approved by the APA Assembly and the APA Board of Trustees.

If a complaint of unethical conduct against a member is sustained, the member shall receive a sanction ranging from reprimand to expulsion. Any decision to expel a member must be approved by a two-thirds (2/3) affirmative vote of all members of the APA Board of Trustees present and voting.5 PART I: INITIAL PROCEDURES

5 Chapter 7, Sections 1, 2, and 3, Bylaws, American Psychiatric Association, May 2005 edition. 6 As used in these Procedures, the term investigation is meant to include both an information-gathering or investigatory phase of a case and a hearing phase. This term does not apply to the process by which a district branch initially determines whether or not a complaint warrants investigation. 7 The Procedures set out minimum requirements. Each district branch should comply with any additional or more stringent requirements of state law. 8 In the case of a minor patient, the ten (10) years will not begin until the patient reaches majority.

1. a. Unless the complaint may be decided solely on the basis of extrinsic evidence, all formal complaints charging a member of the APA with unethical behavior shall be made in writing, signed by the complainant, and addressed to the district branch of the charged member (―respondent‖) or, if addressed to the APA, shall be referred by the APA to the respondent’s district branch for investigation6 and decision in accordance with these Procedures.7 Cases that may be decided solely on the basis of extrinsic evidenced may be initiated by the forwarding of documentation supporting the complaint to the district branch or APA Ethics Chair without a formal, signed charging letter. b. If the respondent is a member-at-large of the APA, the complaint shall be referred to an ad hoc investigating committee, as provided for in Paragraph 2 below.

c. To be considered pursuant to these Procedures, a complaint alleging unethical conduct must be received within ten (10) years of the alleged conduct8. 12

d. Unless (i) the case will be decided solely on the basis of extrinsic evidence obtained entirely from sources other than the respondent, and/or (ii) the complaint is referred to a licensing board or similar authority for initial or final processing, without receiving information from the patient, 9 at the time it notifies respondent of a complaint received, the district branch ethics committee shall obtain and provide the respondent with valid written authorization(s) from the patient(s) involved to provide (i) relevant medical records and other information about the patient, and, if applicable, (ii) psychotherapy notes, to the district branch for the purposes of its investigation. 10

2. If, after receiving a written complaint, the district branch determines that there are compelling reasons why it would not be the appropriate body to consider the complaint, the district branch shall write to the Chair of the APA Ethics Committee, requesting that it be excused, providing a detailed explanation of the reasons for its request. If the Chair of the APA Ethics Committee determines that the district branch should not be excused, the district branch shall proceed with the complaint. If the Chair of the APA Ethics Committee agrees that the district branch should be excused from considering the complaint, the Chair shall then appoint three (3) Fellows of the APA to serve as an ad hoc investigating committee to conduct the investigation and to render a decision.11 When possible, these Fellows shall reside in the same Area as the respondent and in no event shall any such Fellow be a member of the APA Ethics Committee or the APA Board of Trustees. 3. If the district branch finds it cannot determine that the complaint warrants investigation under the ethical standards established by The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry, the district branch shall so notify the complainant, requesting additional information when appropriate. If the district branch determines that the charges do not warrant investigation, it shall notify the complainant, stating the basis for the conclusion and informing the complainant that he/she may request a review of this decision no later than sixty (60) days from the Chair of the APA Ethics Committee. If the Chair of the APA Ethics Committee determines that the complaint warrants investigation, he/she will appoint an ad hoc investigating committee as provided for in Paragraph 2 above. When an ad hoc investigating committee is appointed, the district branch shall be so notified by the Chair of the APA Ethics Committee.

9 Prior to forwarding a complaint to the licensing board, any other authority or individual, the district branch should obtain the patient’s consent to potentially involving the complainant in a procedure s/he did not wish to invoke. 10 If not provided by the patient/complainant, the district branch shall provide the patient/complainant with an authorization form or forms that comply with federal law (HIPAA) and applicable state law. If investigation reveals that medical information or records and/or psychotherapy notes of a patient who is not the complainant are relevant, the district branch must obtain the authorization of such patient before obtaining such records from a member. Whenever psychotherapy notes are relevant to the case, separate authorizations for medical records and psychotherapy notes will be provided. In extrinsic evidence cases, if the respondent wishes to provide medical information or records and/or psychotherapy notes in connection with the sanction phase of the case, appropriate authorizations shall be obtained. 11 Unless otherwise indicated, whenever these Procedures refer to activities of a district branch, the same requirements shall apply to the ad hoc investigating committee when it performs an investigation. 13

4. If the district branch determines that a complaint warrants investigation under the ethical standards established by The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry, the district branch shall advise the APA Secretary as well as the complainant and the respondent that it will be conducting the investigation. The district branch shall also send a copy of the complaint to the respondent, along with copies of The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry and these Procedures. If the district branch decides to consider the complaint in accordance with the procedures in Part II (Enforcement Option), the respondent shall further be informed that he/she has the right to be represented by counsel; that he/she has the right to a hearing; and that if there is a hearing, at the hearing, he/she will have the rights set out in Paragraph 9 below. The respondent will also be informed of his/her right to appeal an adverse decision to the APA Ethics Committee or, where appropriate, to the APA Ethics Appeals Board in accordance with the provisions of Paragraphs 19–23 below. 5. The district branch investigation shall be comprehensive and fair and conducted as provided herein. The district branch may decide: a. to conduct a formal enforcement proceeding, including where appropriate a hearing, pursuant to the Enforcement Option procedures set out in Part II, Paragraphs 6-25 below, or b. with the agreement of the respondent , to attempt to consider and resolve the complaint in accordance with the Educational Option procedures set out in Part III, Paragraphs 26-33 below. In deciding which approach to use, the district branch shall consider factors including the nature and seriousness of the alleged misconduct, prior findings or allegations of unethical conduct, and guidelines developed by the APA Ethics Committee. Any attempt to resolve the matter through the Educational Option shall be without prejudice to the right of the district branch to determine at a later time that resolution pursuant to this option is not possible and to proceed to consider and resolve the complaint pursuant to the Enforcement Option procedures of Part II. PART II: ENFORCEMENT OPTION 6. If the district branch pursues investigation and resolution of a complaint in accordance with the provisions in this Part, a hearing conducted in accordance with the provisions of Paragraph 9 below shall be held unless the respondent has voluntarily waived his/her right to a hearing, or the district branch, prior to the hearing, has determined that there has been no ethics violations. The respondent’s waiver of a hearing shall not prevent the district branch from meeting with, and hearing the evidence of, the complainant and other witnesses and reaching a decision in the case. 7. The respondent will be notified of the hearing by certified mail or overnight delivery (signature required) at least thirty (30) days in advance of the hearing. The notice will include the following: 14

a. The date, time, and place of the hearing; b. A list of witnesses expected to testify; c. Notification of the respondent’s right to representation by legal counsel or another individual of his/her choice;

d. Notification of the respondent’s right to appeal any adverse decision to the APA Ethics Committee; and

e. The names of the members of the ethics committee or panel which will conduct the hearing.

 

8. The initial, information-gathering stages of the investigation, which may include preliminary interviews of the complainant and the respondent, may be conducted by any single member of or a subcommittee of the ethics committee. In all cases in which there may be a decision adverse to the respondent, unless the respondent has waived his/her right to a hearing, there must be a hearing before the district branch ethics committee or a specially constituted panel of at least three (3) members, at least one (1) of whom must be a member of the district branch ethics committee. 9. The hearing shall provide fairness and respect for both the respondent and the complainant. The following procedures shall apply: a. The respondent may be represented by counsel or other person. The counsel or other person may answer questions addressed to him/her, advise his/her client, introduce evidence, examine and cross-examine witnesses, and make opening and closing statements. Counsel’s participation is subject to the continuing direction and control of the Chair. The Chair shall exercise its discretion so as to prevent the intimidation or harassment of the complainant and/or other witnesses and with regard to the peer review nature of the proceedings. Questions addressed by members of the committee or panel to the respondent shall be answered by the respondent.

b. Except when the district branch concludes that it is prepared to proceed solely on the basis of extrinsic evidence,12 the complainant must be present at the hearing unless excused by the committee or panel Chair. The complainant will be excused only when he/she has so requested and, in the judgment of the Chair, participation would be harmful to him/her.

12 For these purposes, ―extrinsic evidence‖ shall mean documents whose validity and accuracy appear to be clear on their face and which do not rely on the assertions or opinions of the complainant and/or his/her witnesses. Examples of such evidence include admissions by the respondent, formal judicial or administrative reports, sworn deposition or trial testimony that was subject to cross-examination, photographs, medical or hospital records, hotel or credit card receipts, and so forth. When the district branch decides to rely solely on such extrinsic evidence, it should take appropriate steps to ensure that members of the hearing panel do not take into account any information from the complainant or other witnesses and base their decision solely on the available extrinsic evidence. Additional information on extrinsic evidence is available from the APA. 15

c. Except when the district branch concludes that it is prepared to proceed solely on the basis of extrinsic evidence or the complainant is excused pursuant to Paragraph 9(b) above, the complainant shall testify regarding his/her charges. d. The respondent or his/her attorney may challenge material presented by the complainant or the complainant’s witnesses: (i) by appropriate direct challenge through cross-examination; or (ii) if the complainant asked to be excused from such direct challenge and the Chair determined that such direct challenge will be harmful to the complainant, by written questions submitted by the respondent and posed to the complainant by the Chair, with answers to be provided orally or in writing as the Chair in his/her discretion determines is appropriate. e. The respondent may choose not to be present at the hearing and to present his/her defense through other witnesses and counsel. f. The respondent may testify on his/her own behalf, call and examine supporting witnesses, and introduce relevant evidence in support of his/her case. Evidence may not be excluded solely on the grounds that it would be inadmissible in a court of law. g. Members of the hearing panel may ask pertinent questions during the hearing. h. A stenographic or tape record shall be made of the proceedings, and a copy shall subsequently be made available to the respondent at a reasonable charge. i. The respondent may make an oral statement and/or submit a written statement at the close of the hearing. 10. All ethics committee or panel recommendations shall be in writing and shall include a statement of the basis for the recommendation. If the investigation has been conducted by a panel, the panel shall make a recommendation only as to whether there has been an ethics violation, and the district branch ethics committee shall review this recommendation and add its recommendation as to sanction, if any. 11. Upon completion of the investigation and any internal review procedures required by the district branch’s governing documents, the district branch shall render a decision— a. that the respondent did not act unethically; b. that the case should be concluded without a finding; or c. that the respondent acted unethically, and what sanction is appropriate.

If the investigation has been conducted by an ad hoc investigating committee, the ad hoc investigating committee shall make the decision. The district branch decision shall be in writing and shall include a statement of the basis of the decision. In all cases, the district branch shall seek to reach a decision as expeditiously as possible. This should usually be within nine (9) months from the time that the complaint was received. All district branch 16

decisions must be reviewed by the APA Ethics Committee in accordance with Paragraph 15 below. 12. The three (3) sanctions in order of severity are as follows: a. reprimand;

b. suspension (for a period not to exceed five [5] years);13 c. expulsion.

13 A suspended member will be required to pay dues and will be eligible for APA benefits, except that such a member will lose his/her rights to hold office, vote, nominate candidates, propose referenda or amendments to the Bylaws, and serve on any APA committee or component, including the APA Board of Trustees and the APA Assembly. If the suspended member is a Fellow or Life Fellow, the Fellowship will be suspended for the same period of time. Each district branch shall decide which, if any, district branch privileges and benefits shall be denied during the period of suspension. 14 Personal treatment may be recommended, but not required, and any such recommendation shall be carried out in accordance with the ethical requirements governing confidentiality as set forth in The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry. In appropriate cases, the district branch may in addition refer the psychiatrist in question to a component responsible for considering impaired or physically ill physicians.

13. If the district branch renders a decision that the case should be concluded without a finding, it may issue a letter of concern to the member, which can include suggestions for education. The letter of concern will be signed by the president of the district branch after a draft has been reviewed by the APA Ethics Committee. The APA Ethics Committee must agree that the complaint resulted in an investigation that was comprehensive and fair, and in accordance with the procedures in Paragraphs 6–9 above. In addition to the three (3) sanctions noted in Paragraph 12, the district branch may also, but is not required to, impose certain conditions, such as educational or supervisory requirements, on a suspended member.14 When such conditions are imposed, the following procedures shall apply: a. If the district branch imposes conditions, it shall monitor compliance. b. If the ad hoc investigating committee imposes conditions, the Chair of the APA Ethics Committee shall establish a means for monitoring compliance. c. If a member fails to satisfy the conditions, the district branch or the APA monitoring body established by the Chair of the APA Ethics Committee may decide to expel the member. d. If it is determined that a member should be expelled for noncompliance with conditions, the member may appeal pursuant to the provisions set forth in Paragraphs 19–23 below. e. If a member expelled for noncompliance with conditions does not appeal, the APA Board of Trustees shall review the expulsion in accordance with the provisions of Paragraph 18 below. 17

14. After the district branch completes its investigation and arrives at its decision, the decision and any pertinent information concerning the procedures followed or relating to the action taken shall be forwarded to the APA Ethics Committee for review in accordance with the provisions of Paragraphs 15-17 below. If the Chair of the APA Ethics Committee determines that these review functions are best carried out instead by a subcommittee, he/she shall designate such a subcommittee (or subcommittees) that shall include at least three (3) voting members of the APA Ethics Committee and that shall be authorized to undertake these review functions on behalf of the full APA Ethics Committee. 15. In all cases, including those where the district branch finds that an ethics violation has not occurred or that the case should be concluded without a finding, the APA Ethics Committee shall review the information submitted by the district branch to assure that the complaint received an investigation that was comprehensive and fair and in accordance with the procedures in Paragraphs 6–9 above. If the APA Ethics Committee concludes that these requirements were not satisfied, it shall so advise the district branch, and the district branch shall remedy the deficiencies and shall make further reports to the APA Ethics Committee until such time as the APA Ethics Committee is satisfied that these requirements have been met. If, in the view of the APA Ethics Committee, the district branch is either unwilling or unable to complete the investigation in a satisfactory manner, the Chair of the APA Ethics Committee may appoint an ad hoc investigating committee to conduct the investigation and render a decision. 16. In cases where the district branch has found that an ethics violation has occurred, the APA Ethics Committee or subcommittee, after ascertaining that the investigation was comprehensive and fair and in accordance with these procedures, shall consider the appropriateness of the sanction imposed. If the APA Ethics Committee or subcommittee concludes that the sanction is appropriate, it shall so notify the district branch. If the APA Ethics Committee or subcommittee concludes that the sanction should be reconsidered by the district branch, it shall provide a statement of reasons explaining the basis for its opinion, and the district branch shall reconsider the sanction. After reconsideration, the decision of the district branch shall stand, even if the district branch decides to adhere to the original sanction, except that the sanction may be modified as provided for in Paragraphs 18, 22 or 24 below. 17. After the APA Ethics Committee or subcommittee completes the review process, the district branch shall notify the respondent of the decision and sanction, if any, by certified mail or overnight mail (signature required). The respondent shall be provided copies of the district branch ethics committee and/or panel recommendation(s) and the district branch decision. If the decision is that no ethics violation has occurred, the case shall be terminated, and the district branch shall also notify the complainant of this decision. If the decision is that an ethics violation has occurred, the respondent shall be advised that he/she has thirty (30) days to file a written letter of appeal with the Chair of the APA Ethics Committee. In such circumstances, the complainant shall not be advised of any action until after the appeal has been completed or until the APA notifies the district branch that no appeal has been taken or that the procedures provided for in Paragraph 18 below have been completed.

18. If, after review by the APA Ethics Committee or upon a finding of noncompliance with conditions as provided for in Paragraph 13(c) above, the decision is to expel a respondent, and the respondent fails to appeal the decision, the APA Board of Trustees at its next meeting shall 18

review the expulsion on the basis of a presentation by the Chair of the APA Ethics Committee and the documentary record in the case. A decision to affirm an expulsion must be by a vote of two-thirds (2/3) of those Trustees present and voting. A decision to impose a lesser sanction shall be by a majority vote. If necessary, the APA Board of Trustees may request further information from the district branch before voting on the decision to expel.

19. a. All appeals in cases in which the complaint was received by the district branch after January 1, 2003 shall be considered and decided by a panel of three (3) members of the APA Ethics Committee who have not been involved in a review of the case pursuant to Paragraphs 14-17. The Chair of the APA Ethics Committee may appoint a replacement if there are not three members of the Committee who have not been involved in the case who are able to serve.

 

b. In cases in which the complaint was received by the district branch prior to January 1, 2003, the APA Ethics Committee shall decide whether it is appropriate under the circumstances for the appeal to be heard by a panel of the Ethics Committee or by the APA Ethics Appeal Board pursuant to procedures in effect prior to January 1, 2003. In making this decision, the APA Ethics Committee shall consider the availability of an Ethics Committee panel which has not reviewed the case, whether the respondent was notified of his/her right to appeal to the Ethics Appeals Board and whether a respondent informed of an appeal to the Appeals Board will agree to an appeal to a panel of the Ethics Committee. 20. All appeals shall be based on one (1) or more of the following grounds: a. that there have been significant procedural irregularities or deficiencies in the case; b. that The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry has been improperly applied; c. that the findings of or sanction imposed by the district branch are not supported by substantial evidence; d. that substantial new evidence has called into question the findings and conclusions of the district branch. 21. a. The respondent’s request for an appeal must be received within 30 days of the date the respondent is notified of the district branch decision. Upon receipt of the respondent’s request for an appeal, the APA Ethics Committee or Ethics Appeals Board shall request a copy of the district branch file, which shall be made available to the respondent upon request and compliance with any conditions set by the Committee or Appeals Board.

b. In appeals heard by an Ethics Committee appeals panel, the panel will review, and decide the appeal solely on the basis of, the district branch’s documentary record of its investigation and decision and any written appeal statements filed by the respondent and the district branch. The respondent’s statement will be provided to the district branch, which may file a written response. Any district branch response will be forwarded to the respondent, who will have the opportunity to respond in writing prior 19

to the Ethics Committee’s consideration of the appeal. Filing deadlines and other procedures governing the appeal shall be established by the APA Ethics Committee.

c. In appeals heard by the Ethics Appeals Board,15 the respondent shall be entitled to file a written statement with the Appeals Board and may appear before the Board alone or accompanied by counsel. The Appeals Board shall request a representative of the district branch, accompanied by counsel if the district branch so requests, to participate in the appeal by speaker phone. In addition, the Appeals Board may request any information from the district branch and may also request the complainant, accompanied by counsel if he/she so requests, to attend the appeal. The APA counsel and other necessary APA staff may also attend if the Appeals Board so requests. Time limits and other procedures governing the appeal shall be established by the Appeals Board. 22. After reviewing all documents and hearing any oral presentation, the APA Ethics Committee appeals panel or the APA Ethics Appeals Board may take any of the following actions: a. affirm the decision, including the sanction imposed by the district branch; b. affirm the decision, but alter the sanction imposed by the district branch; c. reverse the decision of the district branch and terminate the case;

15 The Ethics Appeals Board shall be chaired by the APA Secretary and shall include two past Presidents of the APA, a past Speaker of the APA Assembly, the Chair of the APA Ethics Committee and a current chair of a district branch ethics committee. The Secretary and Chair of the APA Ethics Committee shall serve during their respective terms of office. All other members of the Ethics Appeals Board shall be appointed by the President for a three-year term. All members of the Ethics Appeals Board, including the chair, shall be entitled to one vote on all matters. If any of the above cannot serve, the President is authorized to appoint a replacement. 16 Remands will be employed only in rare cases, such as when new information has been presented on appeal or when there is an indication that important information is available and has not been considered.

d. remand the case to the district branch with specific instructions as to what further information or action is necessary.16 After the district branch or panel has completed remand proceedings, the case shall be handled in accordance with procedures in Paragraphs 14 through 22. 23. After the APA Ethics Committee appeals panel or Ethics Appeals Board reaches a decision as set forth in Paragraph 22, if the decision is anything other than to expel a member, the Chair of the APA Ethics Committee shall notify the district branch and the respondent simultaneously of the decision and that it is final.

24. If the decision is to expel a member, the APA Board of Trustees at its next meeting shall review the action solely on the basis of the presentation of the APA Secretary (or his/her designee) or the APA Ethics Committee Chair (or designee) and the documentary record in the case. The APA Board of Trustees may affirm the sanction, impose a lesser sanction, or remand 20

to the APA Ethics Committee appeals panel or the Ethics Appeals Board for further action or consideration. A decision to affirm an expulsion must be by a vote of two-thirds (2/3) of those Trustees present and voting. All other actions shall be by majority vote. Members of the APA Board of Trustees who participated as members of the APA Ethics Committee appeals panel or the Ethics Appeals Board shall not vote when the APA Board of Trustees considers the case. Once the APA Board of Trustees has acted or, in a case of a remand, has approved the action taken on remand, the APA Secretary shall notify the district branch of the decision and that it is final. 25. Once a final decision is reached, the district branch shall notify the complainant and the respondent by certified mail or by overnight mail (signature required). PART III: EDUCATIONAL OPTION

26. If the district branch decides to attempt to resolve the complaint pursuant to the Educational Option procedures in this Part III (Paragraphs 26-33), it shall proceed only after (a) the respondent has been informed (i) that the district branch wishes to proceed in this manner but that he/she is entitled to proceed under Part II enforcement procedures, and (ii) that the district branch reserves the right to begin the investigation again and use formal enforcement procedures in Part II if in its sole discretion it determines that the respondent has not satisfactorily cooperated, (b) the respondent agrees to proceed under Part III rather than Part II, and (c) the complainant has been notified that the district branch has decided to proceed in this manner and has been provided a copy of the Procedures. 27. The district branch’s consideration of an ethics complaint under this Part shall provide both the complainant and the respondent the opportunity to address the district branch. The district branch shall determine the procedures to be used, including whether to meet separately or together with the complainant and the respondent, whether to permit the respondent to be accompanied by a person of his or her own choosing, the size and composition of the group(s) meeting with the parties, and other matters involving the form and details of the district branch’s consideration of the complaint. However, in determining the procedure it will use, the district branch shall seek to provide a format that will facilitate the respondent’s understanding of the ethical issues raised by the complaint, including the reasons for or sources of the complainant’s concern, and to permit the district branch to assess the respondent’s understanding of these matters.  28. In proceedings under this Part, the district branch shall make no determination as to whether the respondent has violated the Principles or otherwise committed an ethics violation. 29. After its consideration of the complaint pursuant to Paragraph 27, the district branch may identify a specific educational program including courses, reading and consultation for the respondent to complete within a specified period. The respondent and the APA Ethics Committee will be notified of the required steps, the time frame in which they must be completed, and that failure to complete them as required will be grounds for being dropped from membership in the APA and the district branch for failure to satisfy educational requirements 21 (see Bylaws, Section 2.5 or for further proceedings pursuant to Part II of these Procedures. The district branch will monitor the respondent’s compliance with any such educational requirements. 30. The district branch shall retain records of complaints considered pursuant to this Part and of any education thereafter required of a respondent. The district branch may consider such information in connection with a decision as to how to handle any later complaints involving the respondent. 31. If the district branch at any time determines that the respondent has not cooperated with the district branch’s consideration of the complaint, has not otherwise participated in a manner that permits an adequate educational experience or has not satisfied any educational requirements it has imposed, the district branch may so notify the respondent and inform him/her (a) that the complaint will be returned to the district branch ethics committee for its consideration and resolution pursuant to the procedures set out in Part II, above, or (b) that the respondent’s name will be presented to the Board of Trustees at its next meeting and the member dropped from membership unless the Board acts to exempt the respondent from the educational requirements. The decision as to whether to proceed under Part II or to recommend that the respondent be dropped from membership in the APA and the district branch will be in the district branch’s discretion. 32. If the district branch decides to return the complaint for consideration and resolution pursuant to Part II of the Procedures, any subsequent investigation and hearing under Part II shall be conducted by district branch members who did not conduct the proceedings pursuant to the Educational Option in Part III. 33. If the district branch decides and notifies the respondent that his/her name will be presented to the Board of Trustees for purposes of being dropped from membership, the district branch shall also notify the APA Ethics Committee, which will notify the Office of Membership and the Board of Trustees.

PART IV: CONFIDENTIALITY
34. Except as described in Paragraph 35 below, disclosure by APA members of the name of the respondent, the fact that a complaint has been lodged, the substance of the complaint, or the identity of any witnesses shall be limited to persons who need this information to assure the orderly and effective administration of these procedures and/or APA membership action.

35. To assure proper protection of the public, there are times when disclosure of the identity of a respondent and other information may be essential. Such disclosure is authorized in the following instances:17

17 State and/or federal law may impose additional reporting requirements with which district branches or the APA must comply.

a. The name of any member who is expelled from the APA for an ethics violation, along with an explanation of the nature of the violation, shall be reported in Psychiatric News 22

and in the district branch newsletter or other usual means of communication with its membership. The name of any member who is expelled from the APA for an ethics violation, along with an explanation of the nature of the violation, shall also be reported to the medical licensing authority in all states in which the member is licensed. In addition, the name of any member who is also a member of a foreign psychiatric society or association and who is expelled shall be reported to the international society or association to which the member belongs.18 This Paragraph does not apply to those members who are dropped from membership for failure to satisfy educational requirements, pursuant to Paragraph 33, above.

18 Reporting shall include a press release to the media in the area in which the expelled member lives. If requested by a state licensing board to which the expulsion is reported, the APA and/or district branch may release relevant information from their files. 19 If requested by a state licensing board to whom the suspension is reported, the APA and/or district branch may release relevant information from their files. 20 Chapter 7, Sections 1, 2, and 3, Bylaws, American Psychiatric Association, May 2005 edition.

b. The name of any member who is suspended from the APA for an ethics violation, along with an explanation of the nature of the violation, shall be reported in Psychiatric News and in the district branch newsletter or other usual means of communication with its membership. The name of any member who is suspended from the APA for an ethics violation, along with an explanation of the nature of the violation, shall also be reported to the medical licensing authority in all states in which the member is licensed.19 c. The name of any member who resigns from the APA after an ethics complaint against him/her is received and before it is resolved shall be reported in Psychiatric News and in the district branch newsletter or other usual means of communication with its membership.

d. The APA Board of Trustees or, after approval by the APA Ethics Committee, any district branch’s governing council may report an ethics charge or a decision finding that a member has engaged in unethical conduct to any medical licensing authority, medical society, hospital, clinic, or other institutions or persons where such disclosure is deemed appropriate to protect the public.20 Addendum 1 Guidelines for Ethical Practice in Organized Settings 23

At its meeting of September 13–14, 1997, the APA Ethics Committee voted to make the ―Guidelines for Ethical Practice in Organized Settings,‖ as approved by the Board and the Assembly, an addendum to The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry, to be preceded by introductory historical comments and cross-referenced to the appropriate annotations, as follows: This addendum to The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry was approved by the Board of Trustees in March 1997 and by the Assembly in May 1997. This addendum contains specific guidelines regarding ethical psychiatric practice in organized settings and is intended to clarify existing ethical standards contained in Sections 1–9. Addendum Psychiatrists have a long and valued tradition of being essential participants in organizations that deliver health care. Such organizations can enhance medical effectiveness and protect the standards and values of the psychiatric profession by fostering competent, compassionate med-ical care in a setting in which informed consent and confidentiality are rigorously preserved, conditions essential for the successful treatment of mental illness. However, some organizations may place the psychiatrist in a position where the clinical needs of the patient, the demands of the community and larger society, and even the professional role of the psychiatrist are in conflict with the interests of the organization. The psychiatrist must consider the consequences of such role conflicts with respect to patients in his/her care, and strive to resolve these conflicts in a manner that is likely to be of greatest benefit to the patient. Whether during treatment or a review process, a psychiatrist shall respect the autonomy, privacy, and dignity of the patient and his/her family. These guidelines are intended to clarify existing standards. They are intended to promote the interests of the patient and should not be construed to interfere with the ability of a psychiatrist to practice in an organized setting. The Principles and Annotations noted in this communication conform to the statement in the preamble to the Principles of Medical Ethics. These are not laws but standards of conduct, which define the essentials of honorable behavior for the physician. 1. Appropriateness of Treatment and Treatment Options a. A psychiatrist shall not withhold information that the patient needs or reasonably could use to make informed treatment decisions, including options for treatment not provided by the psychiatrist. [Section 1, Annotation 1 (APA); Section 2, Annotation 4 (APA)] 24

b. A psychiatrist’s treatment plan shall be based upon clinical, scientific, or generally accepted standards of treatment. This applies to the treating and the reviewing psychiatrist. [Section 1, Annotation 1 (APA); Section 2 (APA); Section 4 (APA)] c. A psychiatrist shall strive to provide beneficial treatment that shall not be limited to minimum criteria of medical necessity. [Section 1, Annotation 1 (APA)] 2. Financial Arrangements When a psychiatrist is aware of financial incentives or penalties that limit the provision of appropriate treatment for that patient, the psychiatrist shall inform the patient and/or designated guardian. [Section 1, Annotation 1 (APA); Section 2 (APA)] 3. Review Process A psychiatrist shall not conduct reviews or participate in reviews in a manner likely to demean the dignity of the patient by asking for highly personal material not necessary for the conduct of the review. A reviewing psychiatrist shall strive as hard for a patient he or she reviews as for one he or she treats to prevent the disclosure of sensitive patient material to anyone other than for clear, clinical necessity. [Section 1, Annotations 1 and 2 (APA); Section 4, Annotations 1, 2, 4, and 5 (APA)] 25

 

Professional Codes of Conduct for psychological practitioners per American Psychological Association position paper:

(Please read the attached position paper regarding code of conduct for psychological providers)

 

Procedures to deal with allegations of violations of ethical codes for professional treatment providers of the SNWC

 

1.     If a complaint is rendered or a violation observed, a committee consisting or 2 or more professional staff of the SNWC will form . Collaborating information from the informant, other staff members, or outside authorities will be considered. Within 3 days, the committee will meet with the professional staff who allegedly violated an ethical code to fully understand the possible violation. The committee will then make a decision regarding the validity of the violation within 3 days. If a serious violation is found, the professional staff member would be terminated from employment from the SNWC and reported to the state licensing board for his/her discipline and the certifying board (ie.american board of psychiatry and neurology, marriage and family counseling, professional counselor, etc).  If a law has been broken, the police authorities will be contacted. If a less serious violation is found, a reprimand will be made to the staff in question.

 

 

Procedures to deal with allegations of violations of ethical codes for non-professional staff:

 

  1. A staff observing another staff with violations of ethical codes may come to the office manager or owner to report the alleged violation. A non-reprisal system is in effect for the reporting staff member. If a complaint is rendered or a violation observed with a staff member of the SNWC, the staff in question will meet with their supervisor (the office manager or the owner). The office manager or owner may get collaborating information from other staff members or other parties involved and if an allegation has validity based on this investigation, the staff member will be terminated from employment from the SNWC. If a law has been broken, the police authorities will be contacted. If a less serious violation is found, a reprimand will be made to the staff in question.

 

Personnel Adherence to their professional ethical code of conduct:

 

1.     As an employee of the SNWC, you will adhere to their professional designation’s ethical code of conduct.