Ethics in Physical Therapy Expert Witness
How to LOSE A Physical Therapy Negligence Case
When practicing clinically and when reviewing legal matters as an expert, the reviewer/physical therapist needs to always keep the Code of Ethics in mind. There is a Code of Ethics for occupational therapists as well. This blog will focus on one aspect of the Code of Ethics for Physical Therapy.
The Code of Ethics for Physical Therapy “delineates the ethical obligations of all physical therapists as determined by the House of Delegates of the American Physical Therapy Association”(APTA) (https://www.apta.org/siteassets/pdfs/policies/codeofethicshods(917) 301-1672.pdf.) Principle #3 states that Physical Therapists shall be accountable for making sound judgments. Under this principle, there is subsection 3C which states: Physical Therapists shall make judgments within their scope of practice and level of expertise and shall communicate with, collaborate with, or refer to peers or other health care professionals when needed.
This is an example of a case that I reviewed where the physical therapist did not abide by the code of ethics.
A 65-year-old woman had come into a physical therapy outpatient clinic with a diagnosis of left thigh and lower back pain from her primary care doctor. The physical therapist evaluated the patient and concluded that she was experiencing radicular pain from an injured disc or nerve at the level of L5-S1. The physical therapist proceeded to treat this patient for 14 visits. On the 14th visit there with no change in her pain level or any sign that the pain was lessening. There was no indication that the pain was improving. The patient then began complaining of sleepless nights due to the pain, diaphoresis in the middle of the night and stated that the pain was constant and not exacerbated by certain movements. These complaints that the patient made with no decrease in her pain level, constant pain not based on mechanical movements, disturbed sleep and acute diaphoresis during sleep are red flags that warrant the patient to be referred out to an MD who can do further testing. This physical therapist did not refer the patient out. Instead, he continued to treat her and changed the treatment plan around to include other modalities. After 10 additional visits, the patient called the physical therapist. She explained to him that she had intense searing pain in her buttock and she could not walk and that her husband was taking her to the emergency room. During her emergency room visit, it was found via imaging that the patient had a large malignant tumor on her pelvis which caused a pathological fracture to her left acetabulum.
The physical therapist had an ethical duty to refer this patient out to a medical doctor so she could have been properly diagnosed when these red flags appeared during therapy. The physical therapist deviated from the standard of care and did not appropriately refer this patient out to get diagnosed in a timely manner.
