12 Chapter 03 – Lecture Unit 3: Laws, Rules and Regulations
Laws, Rules and Regulations
This chapter will focus on the legalities surrounding the provision of physical therapy services as well as those that are specific to the practice of the PTA. While this may seem like a dry and dreadful chapter, like any endeavor, you won’t be able to practice long if you do not know the rules-of-the-game.
Primary Learning Objectives
DISCUSS HOW LAWS, REGULATIONS AND POLICIES AFFECT THE PRACTICE OF PHYSICAL THERAPY
Section 1:
- Identify resources that physical therapists and physical therapist assistants may use to find out more about laws, regulations, and policies that affect physical therapy practice.
- Explain the significance of the State Physical Therapy Practice Act
There are several essential resources for you to become familiar with as you enter the world of physical therapy. These can be found at:
- The APTA: https://www.apta.org/
This site will provide you not only with all of the APTA documents that direct our practice, our education, our continuing education but offers forums, documents and guidance for safe, legal and ethic practice of PT. - The Federation of State Boards of Physical Therapy: https://www.fsbpt.org/This is a resource that provides invaluable information regarding the practice acts for each of the 50 US states via direct links and related materials as well as essential licensure information. This is the agency that creates and administers the National PTA Exam.
- The PA State Board of Physical Therapy: https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/PhysicalTherapy/Pages/default.aspxThe State Board of PT regulates how PT is practiced in the state of PA. If you were to have questions of concerns regarding how you see PT being implemented (legal, ethically, etc.), you would contact (email, phone call) the PA State Board.
- The PA State Physical Therapy Practice Act: https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/PhysicalTherapy/Documents/Applications%20and%20Forms/Non-Application%20Documents/PTM%20-%20Physical%20Therapy%20Practice%20Act.pdf
The Practice Act governs aspects of practice such has the supervision level of the PTA and PT, the types of interventions a PTA can and cannot use as well as regulations surrounding direct and indirect supervision of the PTA. Technically, it is the State’s statue (legal foundation) for the scope, protection and regulation of a the PT and PTA profession in PA. - The History and Development of the Practice of the PTA: https://www.apta.org/apta-history/pta-history
- The Utilization of the Physical Therapist Assistant: https://www.apta.org/siteassets/pdfs/policies/direction-supervision-pta.pdf
An essential document to the successful practice of PTA. One we will now review in greater detail. This documents addresses two of the key learning objectives for this chapter:- Explain the responsibilities of both the Physical Therapist and the Physical Therapist Assistant to the patient.
- Explain who is directly responsible for the type of treatments the Physical Therapist Assistant will perform.
Utilization of the Physical Therapist Assistant
The following excerpts are from the linked document you have been provided above. Please review it in total is it is a keystone document to your successful practice (legally, logistically and ethically) as a PTA. We will look at some of the most important aspects of the document here. Please pay special attention to the bold or underlined terms. I will add commentary in black to help explain or clarify.
Utilization of the Physical Therapist Assistant
The physical therapist assistant assists the physical therapist in the provision of physical therapy. The physical therapist assistant is a graduate of a physical therapist assistant program accredited by the Commission on Accreditation in Physical Therapy Education. (CAPTE)
The physical therapist assistant is required to work under the direction and supervision of the physical therapist. The physical therapist assistant may perform physical therapy procedures and related tasks that have been selected and delegated by the supervising physical therapist.
Where permitted by law, the physical therapist assistant may also carry out ROUTINE OPERATIONAL FUNCTIONS, including supervision of the physical therapy aide or equivalent, the documentation of treatment progress.
The ability of the physical therapist assistant to perform the selected and delegated tasks shall be assessed on an on-going basis by the supervision physical therapist. (“on-going” means continuous over the length of your career. As you acquire new skills and experiences, you will be permitted to preform interventions of greater complexity)
The physical therapist assistant may, with prior approval by the supervision physical therapist, adjust a specific treatment procedure in accordance with changes in patient status. The physical therapist assistant makes modifications to elements of the intervention either to progress the patient or client as directed by the physical therapist or to ensure patient or client safety and comfort. Patients are moving targets; never the same two visits in a row. You must constantly be monitoring and adjusting their treatments. As they progress, you will advance their treatment as well. This may mean adding more weight or repetitions to exercises or additional types of training strategies for the given interventions.
If they are not responding well (not progressing) or if they are experiencing an unfavorable response to a treatment, you must act accordingly. This may mean just contacting your PT to discuss treatment options or alternatives or taking emergency action based on the severity of their unfavorable response. In either situation, you must continuously be monitoring your patient and adjusting your treatment based on their needs.
When the physical therapist and the physical therapist assistant are not within the same physical setting, the performance of the delegated functions by the physical therapist assistant must be consistent with safe and legal physical therapy practice and shall be predicated on the following factors: (If you practice in PA, this will impact you only after you complete 2000 hours of supervised practice and apply for your in-direct supervision license)
Patient or client criticality, acuity, stability, and complexity
Proximity and accessibility to the physical therapist
Supervision available in the event of emergencies or critical events
The physical therapist assistant’s education, training, experience, and skill level
The predictability of the consequences
The setting in which the care is being delivered
Federal and state statutes
Liability and risk management concerns
The mission of physical therapist services for the setting
The needed frequency of reexamination
The physical therapist assistant shall not perform the following physical therapy activities:
Interpretation of referrals
Physical therapy initial evaluation and re-evaluation
Identification, determination, or modification of plans of care (including goals and treatment programs)
Final discharge assessment/evaluation or establishment of the discharge plan
Therapeutic techniques beyond the skill and knowledge of the PTA
This list of “nots” is one you need to memorize; the list below pertains to the skills only a PT can provide. Please be fluent with this list as well.
Regardless of the setting in which the physical therapist service is provided, the following responsibilities must be borne solely by the physical therapist:
- Interpretation of referrals when available
- Evaluation, diagnosis, and prognosis
- Development or modification of a plan of care, which is based on the initial examination or reexamination and includes the physical therapy goals and outcomes
- Determination of when the expertise and decision‐making capability of the physical therapist requires the physical therapist to personally render services and when it may be appropriate to utilize the physical therapist assistant
- Revision of the plan of care when indicated
- Conclusion of an episode of care
- Responsibility for any “hand off” communication
- Oversight of all documentation for services rendered to each patient or client
Section 2:
- Define laws, regulations, and policies and describe how they are made.
- Explain the terms malpractice and negligence related to physical therapy practice.
- Explain issues involved in the various ways that physical therapists and physical therapist assistants can be held legally liable for the care they provide.
Laws and regulations that govern society at large are enacted for our protection and for the well-being of society at large. Let’s just take a quick look at some of these laws and how they might impact the practice of PT.
- Common Laws: Common Laws are created by a court decision rather than by a legislative action. You think of a common law as one that is made by common folk rather than by Washington DC folks. Think of laws that are particular to a given state or governance as opposed to the entire country. For example, in Wyoming it is illegal to ski while intoxicated; in Virginia you are not permitted to hunt on Sundays – unless it is for racoons. You get the idea.
- Civil Law: Laws that involve the protection of individuals; private citizens: Your ‘self’ or your property.
- Statues: Statues are formal written enactments created by the legislative branch of our government. These are created for the good of all US citizens as opposed to citizens of just one state.
Some examples are:
ADA: Americans with Disabilities Act. Requires accessibility for those with disabilities
HIPAA: Health Insurance Portability and Accountability Act.
Two Parts: COBRA (The continuation of health care benefits after an individual leaves a job) and
Privacy (The protection of personal health information) - Criminal Law: This involves violations that involve society at large. Robbing a bank, embezzlement, arson, etc.
- Tort: A tort is when someone who is legally obligated to provide a certain amount of carefulness in behavior to another violates that obligation. You are probably familiar with torts and tort reform as it regards auto insurance. Tort protections allow an injured party to seek legal action in the courts (ie: damages to their car or hospital costs when another driver was at fault in an auto accident.)
- Malpractice: Failure to do (or avoid doing) something that a reasonably prudent MEMBER OF THE PROFESSION would do, or not do. This will apply to the PTA.
- Negligence: Failure to do something that a reasonably prudent person would do or not do
- Vicarious Liability: Principle by which one individual may be held indirectly liable legally for the acts of another. This applies to the PT of record being responsible for the PTA they are supervising. To be clear, the PTA is also responsible for their own actions as well.
- Policy: A plan or course of action that directs or defines operational or administrative activities – such as those you found in the PTA Student Handbook.
- Practice Act: A State’s statue that is the legal foundation for the scope, protection and regulation of a specific profession.
Section 3:
- List and explain the Standards of Ethical Conduct for the Physical Therapist Assistant as codified by the American Physical Therapy Association
- Define what is meant by professional ethics.
- Define the Core Values of Professionalism in Physical Therapy.
To address these areas, we will look at the principles set forth by APTA for maintaining and promoting high standards of professional conduct among PTA’s in their document: The Standards of Ethical Conduct for the PTA. As related to laws and regulations: Failure to meet a standard of care or failure to do (or avoid doing) something that a reasonably prudent member of the profession would do, or not do: That is Malpractice or “Professional Negligence.” To avoid even the remote chance of an ethical infraction, our profession has clearly outlined the standards of conduct we are to adhere to in all our actions.
You can use this link to review the document in total.
Below are the topic headings for the 8 Standards of ethical conduct. We will discuss them in more detail. However, you will need to be fluent with all 8. As you read through this standards, you will notice they are each linked to “Core Values”. Those values are presented after the Standards. You will need to know them well.
Standard #1:
Physical therapist assistants shall respect the inherent dignity, and rights, of all individuals.
(Core Values: Compassion and Caring, Integrity)
Standard #2:
Physical therapist assistants shall be trustworthy and compassionate in addressing the rights and needs of patients and clients.
(Core Values: Altruism, Collaboration, Compassion and Caring, Duty).
Standard #3:
Physical therapist assistants shall make sound decisions in collaboration with the physical therapist and within the boundaries established by laws and regulations.
(Core Values: Collaboration, Duty, Excellence, Integrity)
Standard #4:
Physical therapist assistants shall demonstrate integrity in their relationships with patients and clients, families, colleagues, students, research participants other health care providers, employers, payers, and the public.
(Core Value: Integrity).
Standard #5:
Physical therapist assistants shall fulfill their legal and ethical obligations.
(Core Values: Accountability, Duty, Social Responsibility)
Standard #6:
Physical therapist assistants shall enhance their competence through the lifelong acquisition and refinement of knowledge, skills, and abilities.
(Core Value: Excellence)
Standard #7:
Physical therapist assistants shall support organizational behaviors and business practices that benefit patients and clients and society.
(Core Values: Integrity, Accountability)
Standard #8:
Physical therapist assistants shall participate in efforts to meet the health needs of people locally, nationally, or globally.
(Core Value: Social Responsibility)
Core Values for the PT and the PTA:
Accountability:
The active acceptance of the responsibility for the diverse roles, obligations, and actions of the physical therapist and physical therapist assistant including self‐regulation and other behaviors that positively influence patient and client outcomes, the profession, and the health needs of society.
Altruism:
The primary regard for or devotion to the interest of patients and clients, thus assuming the responsibility of placing the needs of patients and clients ahead of the physical therapist’s or physical therapist assistant’s self‐interest.
Collaboration:
Working together with patients and clients, families, communities, and professionals in health and other fields to achieve shared goals.
Compassion and Caring
Compassion is the desire to identify with or sense something of another’s experience; a precursor of caring.
Caring is the concern, empathy, and consideration for the needs and values of others.
Duty
The commitment to meeting one’s obligations to provide effective physical therapist services to patients and clients, to serve the profession, and to positively influence the health of society
Excellence
The provision of physical therapist services occurs when the physical therapist and physical therapist assistant consistently use current knowledge and skills while understanding personal limits, integrate the patient or client perspective, embrace advancement and challenge mediocrity.
Integrity
The steadfast adherence to high ethical principles or standards, being truthful, ensuring fairness, following through on commitments, and verbalizing to others the rationale for actions.
Social Responsibility
The promotion of a mutual trust between the profession and the larger public that necessitates responding to societal needs for health and wellness.
Section 4:
Identify ways in which individuals can participate in professional and community organizations and the available opportunities for volunteerism, advocacy, and leadership.
This may seem like an odd topic to include under laws and regulations; however, it is done so in that one of the ways you can volunteer for your profession is by joining our professional organization. In so doing, you can help influence the policies and practice that govern our profession.
Other examples of advocacy include participation in support groups for various diagnoses, providing community education at health fairs or through your place of employment, being a Clinical Instructor or a regular participant in any community health organization. As you begin to become so active, you will find many other opportunities will arise for you; opportunities for leadership in areas you may (now) not even be thinking about. As per the last of the Core Values, Social Responsibility, we do have an obligation beyond ourselves: To our community.
Related to that obligation and responsibility is the role we will play reporting cases of suspected abuse to the appropriate authorities.
Explain the role of a mandated reporter to report to the appropriate authorities suspected cases of abuse of vulnerable populations.
PTs and PTAs are mandated reports of suspected abuse. If we suspect vulnerable patient is being abused, perhaps a patient in the pediatric or geriatric populations, we are mandated (required by law) to report that suspicion to the appropriate authorities. You will complete child abuse training next year that will provide you further information in this area, but for now appreciate your role as a PTA is greater than you may have thought.
Finally, we do need to address the Patient Bill of Rights
The patient bill of rights is a list of guarantees for those receiving medical care. It may take the form of a law or a non-binding declaration. This bill of rights guarantees patients information, fair treatment, and autonomy over medical decisions, among other rights. It is the basis for shared decision making between the patient and the medical provider and is in place to protect the patient from any unscrupulous or nefarious practices by those in the medical community.