1. Professional Ethics Infractions in the Healthcare Setting Recognition – Management - Remediation

2. 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 Agenda

3. First, a Cautionary Tale The Story of Dr. “Jane Doe”

4. Categories of Infractions Infraction TypeJan 1993-Aug 2015 Boundaries35% Misrepresentation24% Financial16% Miscellaneous25% N = 1,558

5. 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)

6. 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

7. 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

8. 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

9. Another Cautionary Tale… The Story of “John Anyguy,” N.P.

10. 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

11. 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

12. 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)

13. 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

14. 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

15. 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

16. 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.”

17. 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

18. 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.”

19. 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

20. 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

21. 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.’’

22. 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.”

23. 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.)

24. 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.’’

25. 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 Professional Ethics Resources