Alan’s Dilemma

Alan is a physical therapist in a hospital based outpatient

orthopaedic clinic. The hospital employs physical
therapists, physical therapist assistants and athletic
trainers. Alan knows that the athletic trainer on his team
has a four year degree and is better educated that the
physical therapist assistant on his team, despite her 20
years of experience. The PTA doesn’t appreciate the fact
that Alan will have the athletic trainer take a look at his
more complex patients as a “second pair” of eyes. After
all, it is the current policy of the APTA that physical
therapy can only be provided by the physical therapist
and/or physical therapist assistant. And, some of these
patients that Alan asks the AT to look at are Medicare
beneficiaries. In addition, Alan also knows that the
athletic trainer can handle a higher load (volume) than the
PTA and the clinic has been very busy lately. What
ethical dilemma is presented to Alan and/or the PTA.
Questions to Ponder/Proposed answer:

1. What is the language of the state Practice Act?

2. Are there Medicare beneficiaries involved?
3. What is the policy of the organization (hospital)?
4. Does Medicare policy even apply? This is the red
herring in this case study. Although athletic trainers
are not qualified providers under Medicare, they are
generally state licensed. There is nothing in the fact
pattern to suggest that the athletic trainer has
established the plan of care or is billing for their
services. No Medicare policy disallows the provider
from seeking the opinion of another.
5. Is this just an issue of inter team rivalry/jealousy?
6. Is there really an ethical dilemma here?
In my opinion, this is this an example of a
compliance/regulatory issue with HR overtones? This is
not a true ethical dilemma.