Background
The PT involved in this matter was hired as a full-time employee of the physical therapy private practice. The PT had worked for the practice for the past three years and had reported having a good relationship with the owner of the practice, as well as the clients. At the time the PT was hired, and from time to time, he expressed aspirations of opening his own practice. During the course of the PT’s employment, he would frequently ask questions of the owner about managing a practice. Most recently, a client reported to the owner that, upon learning that the client had previously owned his own business, the PT utilized the session to ask questions about the now-retired client’s experience, rather than focusing on the client’s treatment and care. The private practice owner spoke to the PT about this matter and was assured it wouldn’t happen again.
Approximately three weeks later, the PT asked the practice owner if he could decrease his hours to part-time status. The owner explained that the PT had been hired as a full-time employee, which was what the practice needed. Two days later, the PT sent a text to the owner saying he was feeling ill and could not report to work. The next week, the PT sent a text to the owner saying he was feeling dizzy and did not feel comfortable driving to work, again missing a full day of work. Later that day, the PT sent another text stating that he had consulted with his primary care physician who told him to “take the rest of the week off from work due to health concerns.” Finally, on the day the PT was to report back to work, the PT sent a text to the owner stating that he decided not to continue with his position at the practice. The owner reminded the PT of the terms of their employment contract, which required a 30-day notice to terminate. The PT apologized for breaking those terms but stated: “My health is a priority at this time.”
The owner of the practice filed a complaint with the State Board of Physical Therapy (“the Board”) alleging:
- Patient abandonment
- Failure to supervise
- Failure to treat
- Failure to give sufficient notice terminating employment
Board Investigation
The Board considered the allegations against the PT and found that there was probable cause to institute formal proceedings. As part of their investigation, interviews and testimony were given by all parties, including the PT, PT practice owner, and other employees in the practice.
During his interview, the PT practice owner stated that, in his opinion, on the days that the PT called to state he was ill, it was done so to further his career, rather than due to illness. The owner described how the lost days of business were detrimental to the practice as it left the physical therapist assistants without a full-time supervisor. As a result, the practice was required to reschedule several current patient appointments and new patient evaluations to accommodate for the days and times that the PT was not available. Further, the PT practice owner stated that the complaint made by the client who reported being asked questions about owning a business during treatment sessions, negatively affected current and future business. The owner reported that the client posted a complaint online saying they were dissatisfied with their care, felt the clinician was not professional, and did not care to be charged for sessions that were not “100 percent focused on their health and progress toward their goals.”
Another assistant staff member testified that the PT approached her during work hours asking if she would be willing to come to work for his new company. The PT stated that he was “almost ready” to open and showed the assistant a piece of paper and what appeared to be his new company logo.
Under oath, the PT stated that he was opening a new company and thought his employer was threatened by the business competition. The PT said the allegations by the owner were not about patient care but, rather, an employment dispute to stop him from opening his practice. He stated that he had requested to transition to part-time status to accommodate for the time he needed to get everything in order. When the PT practice owner declined the change in status, he had no choice but to try to pursue both endeavors. The PT believed that calling in sick was justified because he was suffering from high blood pressure and “trying to get a new company off the ground was consuming his time and emotionally demanding.” Ultimately, the PT was forced to admit that he did not give sufficient notice to the owner to make reasonable arrangements to manage patients on the days he called to report his sickness, potentially placing patients at risk. The PT admitted that he should have worked on his new business venture on his own time and should have given proper notice to terminate his employment. In addition, the PT recognized that sending text messages about these matters was not a professionally appropriate communication method with his employer. The PT also admitted to trying to recruit therapists for his new company during work hours.
Resolution
The Board concluded that the PT practiced in a manner detrimental to the public health and welfare by abandoning or neglecting patients under current care without making reasonable arrangements for the continuation of such care. The Board ordered a 15-day license suspension, 30 hours of community service, and a monetary penalty.
This matter was resolved with a total incurred amount of more than
$12,000 in legal defense expenses.
Risk Management Recommendations
- Know and understand the scope of practice for your profession and/or licensure in your state and understand the standard of care to which you will be held.
- Ensure that clinical practices comply with professional standards endorsed by professional organizations, state practice acts and facility protocols through consultation with legal counsel, as needed.
- Avoid abandoning patients by making reasonable accommodations with your patients or your employer in order to avoid placing patients at risk. Clinicians are obligated to provide sufficient notice for the patient to seek the care of another practitioner so that they are not harmed by the clinician's departure.
- Acknowledge that physical therapy supervisors provide guidance to and monitor the performance of physical therapy staff. This ensures physical therapy staff follow regulatory compliance requirements and meet the standard of care.
- Review and understand employment contracts. Employment contracts provide terms and conditions intended to outline the expectations of a position and serve as legal protection for both employee and employer.
- Communicate with your employer in a professional manner. Text messages may be interpreted as casual or informal, which can give employers the impression that you don't take the job seriously. Depending upon the situation, you may be better served with an email or an in-person discussion.
Disclaimer
These are illustrations of actual claims that were managed by the CNA insurance companies. However, every claim arises out of its own unique set of facts which must be considered within the context of applicable state and federal laws and regulations, as well as the specific terms, conditions and exclusions of each insurance policy, their forms, and optional coverages. The information contained herein is not intended to establish any standard of care, serve as professional advice or address the circumstances of any specific entity. These statements do not constitute a risk management directive from CNA. No organization or individual should act upon this information without appropriate professional advice, including advice of legal counsel, given after a thorough examination of the individual situation, encompassing a review of relevant facts, laws and regulations. CNA assumes no responsibility for the consequences of the use or nonuse of this information.