Professional Ethics Infractions
in the Healthcare Setting
Recognition – Management - Remediation
Agenda
• Cautionary Tale #1: The Story of Dr. “Jane Doe”
• Examples of Common Ethical Infractions in Healthcare
• Cautionary Tale #2: The Tale of Nurse “John Anyguy”
• Introduction to ProBE
• Other Available Resources
First, a Cautionary Tale
The Story of Dr. “Jane Doe”
Categories of Infractions
Infraction Type
Jan 1993-Aug 2015
Boundaries
35%
Misrepresentation
24%
Financial
16%
Miscellaneous
25%
N = 1,558
Sample Infractions: Boundaries
• Sexual Misconduct (10% of total)
• Dual Relationships
• Favored treatment; borrowing money
• Supervisory Responsibilities
• Allowing non-regulated individuals to render care
• Inadequate supervision
• Privacy and Respect Violations
• Harassment; accessing privileged information
• Drug Diversion (8% of total)
Sample Infractions: Misrepresentation
• Lying on/omitting information from applications; credentials
deception (14% of total)
• Falsifying documents
• Recollection and sharing of licensure or specialty certification
examination items
• Exceeding scope of practice/knowledge
• Practicing w/o a license
Sample Infractions: Financial Issues
• Health insurance fraud
• Inaccurate billing, excessive fees
• Kick-backs
• Billing for services not provided
• Unnecessary testing/treatment
• Self-referral, conflict-of-interest
Sample Referral: Miscellaneous
• Clinical issues/negligence
• Poor record-keeping involving communication, informed consent
• Violations of infection control protocols
• Abandonment of patients or clients
• Breach of confidentiality or privacy
• Impairment
• Professional accountability
Another Cautionary Tale…
The Story of “John Anyguy,” N.P.
What is the ProBE Program?
• Ethics remediation
• Targeted to the participant’s particular misconduct
• Seminar, small-group, interactive format
• Multi-disciplinary
• Two and a half days
• 18 sessions across the U.S. and Canada in 2016
• Also “ProBE Plus”: 12-month, longitudinal, one-on-one
mentoring following ProBE Program
The ProBE Philosophy
• Objective: to demonstrate a capacity to think ethically about
the misconduct; to probe
• Non-judgmental
• Interactive intervention
• Problem-based, specific
• Primacy of patient and public welfare
• Restore professional ideals
Participant Preparation
• Written Assignment #1: Description of ideal healthcare
professional
• Letter of recommendation for or advice to prospective student in
one’s profession
• Written Assignment #2: Reason for referral; penalty
• How the misconduct came to attention
• How the referring entity perceived the misconduct
• Assignment #3: Professional oath/code
• Read the Syllabus (~140 pages)
The ProBE Curriculum
• Seven Modules
•
•
•
•
•
•
•
The Ideal Healthcare Professional
Stories of Misconduct and Penalties
Clinician-Patient Relationship: Models
Clinician-Patient Relationship: Boundaries
Accountability within Professions
Contemporary (External) Mechanisms of Accountability
Conceptual Resources for Applying Professional Ethics
Final Essay
• Written Assignment #3
• Relate the substance of the ProBE Program to the individual’s misconduct
as an ethics case analysis
• Employ syllabus materials, discussions, videos, conceptual ethical
frameworks
• Due two weeks after the session
Final Essay Guidelines
• Specific complaints/allegations
• Role of the referring entity
• Why should the referring entity care?
• The case from participant’s point of view (responses to
complaints/allegations)
• Participant’s thoughts about experience and aftermath
Statement of Specific Complaints
• Should correspond with all the formal complaints or
allegations
• Participant does not have to agree 100%, but all
complaints must be addressed and analyzed ethically
(perspective-taking)
• “These allegations were unfounded… I am actually glad I came
because… all doctors must be reminded of their oath.”
The Evaluation & Assessment Report
• Three components tailored to the participant
1. Seminar participation
2. Final essay
3. An overall evaluation of the participant's capacity for thinking ethically
about his/her misconduct as demonstrated over the course of the ProBE
Program
• Completed four weeks after the session
Seminar Participation
• Observations and description of behavior, involvement in
discussions, level of preparation
• Characterization of the presentation of misconduct:
defensiveness, candor, accuracy, completeness, seriousness
• “He…candidly spoke of his arrogance as a contributing factor.”
• “…pointedly more attentive to his Blackberry…”
• “He had some difficulty articulating the Board’s perception.”
Final Essay Assessment
• Capture the essence of the participant’s essay and ethical analysis
for the referring entity’s benefit. (Essay is provided with E&A
Report.)
• Critical assessment of the participant’s ethical analysis and
reasoning.
• Use of ethical frameworks.
• Choice of references.
• Depth of analysis: Probing, introspection, insight
Overall Evaluation
• Unconditional pass (~81%)
• Demonstrated a capacity to think ethically
• Conditional pass (~13%)
• Partial comprehension or involvement
• Fail (~6%)
• Limited capacity or concern for ethical and social obligations of the
profession
Unconditional Pass
• Unqualified success: They ‘’got’’ it
• ‘’His discussion of the value of peer assessment… is further evidence
of his developing self-awareness.’’
• ‘’He takes full responsibility and expresses deep regret…[W]e are
confident that …he will have increased awareness of boundaries.’’
• ‘’He realizes that it is unethical to accept cases beyond his capacity.’’
Conditional Pass
• Made a good effort, but missed some important aspects of
professional lapse
• “When I was able to look at myself through their eyes I could then
begin to understand their concern. My question …became why?...Could
I go in for every phone call?...My decision therefore is to find a
position… that does not involve being on call.”
• “While he shows good understanding of many of the professionalism
topics…he frequently refrains from applying them to his situation.”
Conditional Pass cont’d.
• ProBE does not impose additional conditions, but the
referring entity may do so.
• Assessment includes suggestions for other interventions to
make the remediation more successful (e.g., communications
course, mentorship relationship, efforts to address burnout,
etc.)
Failure
• Limited capacity or concern for ethical and social obligations of
the profession
• ‘’The entire remainder of the essay is an abstraction.’’
• ‘’Her explanation…is largely a quotation of the [State] Medical Practice
Act….[S]he would have served her purposes better had she used her
own words and applied them directly to her own violations.’’
Professional Ethics Resources
• ProBE: Professional Ethics and Boundaries
• http://www.cpepdoc.org/programs-courses/probe
• 18 sessions annually in various cities (2 in Raleigh)
• Vanderbilt Center for Professional Health: Maintaining
Proper Boundaries
• http://www.mc.vanderbilt.edu/root/vumc.php?site=cph&doc=36617
• 4 sessions annually in Nashville, TN
• Professional Boundaries, Inc.
• https://professionalboundaries.com/ethics_courses.php