Matt Hill, OTS

Case 57, Page 105: You do some fill-in work in a clinic. The clinic is very busy. You finally get
a short break and you inquire about documentation requirements. They tell you not to worry:
We will do your notes for you.

Ethical Dilemma Worksheet

(1) What is the problem?

- The problem here is that someone else is offering to do documentation on clients that
they did not see. I am supposed to write my own documentation because I am liable for
that patient. I would not want anyone doing documentation under my OT license.

(2) What are the facts of the situation?

- The facts are that someone else from the facility offered to do my documentation
because I am unfamiliar with the documentation requirements of the facility.
- The clinic is very busy.
- Doing fill-in work at a clinic.

(3) Who are the interested parties?

Therapist, clinic employees, insurance company, the client or clients the documentation is
being completed on, clients family, other therapists within the facility, future employers, other
clients in the facility.

(4) What is the nature of their interest? Why is this a problem?

Therapist:
Professional: Violates the AOTA code of ethics.
Personal: Violate personal morals as well as values.
Clinic Employees:
Professional: Need to provide the client with best practice therapy.
Personal: May violate their personal morals or values.
Insurance Company:
Professional: Need good, clear, accurate documentation for
reimbursement.
Societal: The need to provide funds for the most accurate
documentation for clients.
Economical: Wants to spend the least amount of money.
Client:
Personal: Wants to achieve personal goals as quickly as possible
Economical: Client wants to save as much money as possible and poor
documentation can effect the cost of OT sessions.
Clients family:
Personal: Wants their family member to have a clear plan from the
therapist to direct their loved ones care and proper documentation is a
large part of this.
 Economical: Similar to the client, if the clients family is having to
cover the costs of therapy they would want to keep the costs down by
having accurate and effective documentation.
Future Employers:
Professional: Future employers want to hire OTs that are honest and
have integrity.
Economic: Future employers want to hire OTs that can document well
so insurance companies will accept their documentation for coverage.
Societal: Employers want to maintain a certain image within the
community.

(5) Is there an ethical issue? Does it violate a professional code of ethics? Which section(s)?
Does it violate moral, social, or religious values?
Yes, this situation does involve an ethical issue and violates the AOTA code of ethics.

Nonmaleficence - Principle 2. Occupational therapy personnel shall refrain from actions

that cause harm.
H. Avoid compromising rights or well-being of others based on arbitrary directives (e.g.,
unrealistic productivity expectations, falsification of documentation, inaccurate coding)
by exercising professional judgment and critical analysis.
- Allowing someone else to do my documentation is falsification of documentation
because only I could write up a client-centered note because I was the one doing the therapy
session. It is not only an ethical issue; this is a legal issue.

Beneficence - Principle 1. Occupational therapy personnel shall demonstrate a concern for

the well-being and safety of the recipients of their services.
C. Use, to the extent possible, evaluation, planning, intervention techniques, assessments,
and therapeutic equipment that are evidence based, current, and within the recognized scope of
occupational therapy practice.
- Allowing someone else to do documentation is not best practice for evaluation,
planning, assessments and therapeutic equipment because the person doing the documentation
would not be able to write a client-centered note.

Justice Principle 4. Occupational therapy personnel shall promote fairness and objectivity
in the provision of occupational therapy services.
M. Bill and collect fees legally and justly in a manner that is fair, reasonable, and
commensurate with services delivered. N. Ensure compliance with relevant laws and promote
transparency when participating in a business arrangement as owner, stockholder, partner, or
employee.
O. Ensure that documentation for reimbursement purposes is done in accordance with
applicable laws, guidelines, and regulations.
K. Report to appropriate authorities any acts in practice, education, and research that are
unethical or illegal.
- In order to bill and collect fees legally and justly the OT would have to write their own
documentation. In order for the documentation for reimbursement purposes to be fully accurate,
the OT completing the session should write up the note. I also feel that this situation should be
reported to the appropriate authorities so an investigation can take place. To me it seems if they
have done this one time, they may do it again.
This scenario would violate moral, social and religious values if the therapist allowed
someone else to do their documentation.

(6) Is there a legal issue?

Yes,thereareseverallegalissueshere.

201KAR28:140.Codeofethicsandunprofessionalconduct

Section 1. The following code of ethics consists of general guidelines for occupational therapy
practice. The code of ethics shall be as established in this section.
(5) An OT/L or an OTA/L shall report any illegal, incompetent, or unethical practice to
the appropriate authority.

- Once told that someone else would do my documentation, I have the legal obligation to
report that. It is illegal for someone else to do my documentation due to section 2. Failure to
comply with any of the provisions in this section shall constitute unprofessional conduct in the
practice of occupational therapy.

Section 2. Failure to comply with any of the provisions in this section shall constitute
unprofessional conduct in the practice of occupational therapy.
(8) An OT/L shall competently provide the following minimum services:
(c) The identification and documentation of the clients problems and goals;
(d) The identification and documentation of an intervention plan;

- As the fill in therapist, I have the obligation to document the clients problems and goals
as well as identify and document an intervention plan. Anything outside of this is considered
unprofessional conduct and could possibly lead to the loss of my OT license.

(7) Do I need more information?

I feel that there is much more information that is needed. As soon as someone told me
that they would be willing to do my documentation it should be a red flag. As previously
mentioned it is illegal and unethical for someone else to complete my documentation for me. If
someone told me they could do my documentation for me, I wonder if they have done more
documentation for other therapists. I would also be curious as to what the documentation process
for this company is. A mentor is unnecessary for this situation because I feel it can be addressed
ethically with a win-win outcome for both involved parties.

(8) Brainstorm Possible Steps:

1. Confront coworker about completing documentation for other therapists. Do it in a
way that does not create conflict? Present the facts as well as rules and regulations in a kind
manner as the coworker may not be aware of the laws. This is a legal and ethical issue that goes
against the AOTA code of ethics and could cause someone to lose their practice license.
2. Speak with a supervisor about the documentation process.
3. Speak with a spouse about the issue
4. Speak with a trusted mentor or friend about the issues.
5. Once the documentation process is known, do the documentation yourself even if it
means staying past the time youre supposed to be there to get it complete.
6. Speak with a mentor about how to talk to other therapists about the situation.
7. Inquire to coworkers about unethical documentation and if unethical documentation
practices are found, report it to the supervisor.
8. Allow coworker to complete my documentation
9. Do the research on applicable regulations and laws.

(9) Analyze Action Steps:

- Definitely do not do number 8. This is what caused the ethical dilemma in the first
place. Although, speaking with a spouse and/or a trusted mentor would be a good idea there are
better steps to be taken. Out of the ones above I would first do number 1: Confront the coworker
then 2: Speak with a supervisor about the documentation process. Next I would do 5. Complete
the documentation then 7.Inquire to coworkers and report if necessary. This process would abide
by the applicable code of ethics and by the applicable practice act and regulations. They would
also line up with my moral, religious, and social beliefs.

(10) Choose a Course of Action:

(a) Is it the truth?
Looking at the course of action above I feel that it is the truth. Getting to the bottom of
this ethical dilemma is what needs to happen. If they have been completing other therapists
documentation it needs to stop as it is unethical and illegal.

(b) Is it fair to all concerned?

I feel that the course of actions I would be taking are fair to all concerned. If they are
doing something illegal they need to know about it and stop doing it. If this was only a one time
deal, then there should not be a problem.

(c) Will it build goodwill and better friendships?

I believe that these actions have the best possibility to build goodwill and better
friendships.

(d) Will it be beneficial to all concerned?

It will be beneficial to all concerned as it will teach the coworker the rules and
regulations of documentation if they are not already aware of them. If they are caught in the act
of doing something illegal, then it is only for the good of the patient. The good of the patient
should always be our main concern.

Is it Win-Win?
It is only win-win if the person offering to complete my documentation is unaware of the
rules and regulations. Educating a coworker would be beneficial to all in this situation.
How do I feel about my course of action?
I am happy with my course of action. Instead of running straight to the supervisor I
would try to solve the issue by myself first by providing education. If, and only if, I found fraud
or abuse of documentation, then I would go to the supervisor to report the problem.