As I cruise through online Facebook Pelvic Health Mentorship Groups - a weird bedtime passtime that brings me more satisfaction than doom scrolling on TikTok - I hear many providers worried about getting in trouble for patient abandonment. As rehab providers, we have worked hard to get our education, licensure, jobs, and clients that trust us, so it makes sense there would be a fear of losing any of all of those things.

When this concern comes up, I just want to reassure providers and also let them know that there are three continuing education classes in the Herman & Wallace curriculum tailor-made to address other ethical questions and concerns pelvic rehabilitation providers may have:

• Ethical Considerations from a Legal Lens - Scheduled for April 12th
• Ethical Considerations for Pediatric Pelvic Health - Scheduled for July 27th
• Ethical Concerns for Pelvic Health Professionals - Next date TBD

What is patient abandonment? Patient abandonment is a failure of the provider to fulfill their duty of care, leaving a patient without necessary medical support at a critical time. Unlike a patient voluntarily discontinuing care or being referred to another provider, abandonment involves a lack of appropriate communication or planning.

What are some myths surrounding patient abandonment? Some providers believe that any discontinuation of care constitutes abandonment. This is actually untrue if proper steps are followed to end the plan of care. It is also false to assume that providers are legally obligated to see a patient indefinitely. Patient abandonment does not only apply to doctors, it applies to all healthcare providers, including therapists and nurses.

How do I know something would be considered abandonment? For an act to qualify as patient abandonment, several factors must be present including a lack of adequate notice to the patient, no opportunity for the patient to secure alternative care, and abandonment occurring during an ongoing or critical phase of treatment. A provider’s failure to meet their duty of care without justified cause is central to this issue. There is a difference between ethical termination of care and actual abandonment.

How can a provider avoid being accused of abandonment? The provider can give the patient written notice, typically 30 days in advance, and includes referrals to other providers. If a patient consistently refuses to follow treatment recommendations or fails to attend appointments, the provider may have grounds to terminate care. The important take-home here is proper communication, documentation of this communication, and adherence to professional guidelines of your profession and state.

“I had this person call my clinic and I didn’t want to take their case, did I abandon them?” In order for it to even enter the possibility of abandonment, care has to be initiated. This means if someone calls your office, and you decline to treat them, as long as you give them a referral to someone else who might be able to help them, you should be safe.

“I started seeing someone and I want to stop. What do I do?” If you have seen them for a visit and started their care and choose to stop it, for any reason, you must follow some steps to cover yourself legally and ethically. First, consider why you are ending the plan of care. Are they not listening to you? Are their needs outside of your skill set? Are they being inappropriate? Are they not complying with their clinical contract - for example not paying outstanding balances, etc? Second, you must provide reasonable notice to give a patient adequate time to find another provider. Make sure to provide this in writing and verbally, and give a specific end date. Document the reason for termination - for example, non-compliance, missed appointments, not following appropriate clinical behavioral guidelines, etc. Explain the reason to the patient as appropriate while offering referrals, resources, and emergency assistance if it may be needed. When in doubt, a short consultation with a lawyer about the guidelines of your profession and state can save you money and worry in the long run.

“What if I don’t feel safe?” If a patient threatens you or your staff, stopping care is justified for safety reasons, but it must still be handled properly to avoid claims of abandonment. First, get to a safe space physically and emotionally. Document the incident and contact law enforcement and legal help as appropriate. Draft and deliver a formal termination notice where delivery can be confirmed and referrals for other providers should be included within this.

“I don’t want to pass off a dangerous person to someone else.” We must refer out as part of the termination process BUT it does not have to be a fellow therapist. We can send them back to their referring provider as one option. If you feel someone is predatory or engaging in criminal behavior, referral to mental health with the inclusion of law enforcement may be the next step. Having a lawyer to consult with can help you uphold your license, state, and HIPAA responsibilities.

As it goes with many ethical things, there may not be a perfect answer and there is room for nuance as well as “it depends.” But if you follow the principles of giving notice, providing referrals, and documentation of the scenario and actions, this should help you with taking care of your personal and professional safety.

AUTHOR BIO
Mora Pluchino, PT, DPT, PRPC

Mora Pluchino, PT, DPT, PRPC (she/her) is a graduate of Stockton University with a BS in Biology (2007) and a Doctorate of Physical Therapy (2009). She has experience in a variety of areas and settings, working with children and adults, including orthopedics, bracing, neuromuscular issues, vestibular issues, and robotics training. She began treating Pelvic Health patients in 2016 and now has experience treating pelvises and ages with a variety of Pelvic Health dysfunctions. There is not much she has not treated since beginning this journey and she is always happy to further her education to better help her patients meet their goals.

Dr. Pluchino strives to help all of her patients return to a quality of life and activity that they are happy with for the best bladder, bowel, and sexual functioning they are capable of at present. In 2020, She opened her own practice called Practically Perfect Physical Therapy to help meet the needs of more clients. She has been a guest lecturer for Rutgers University Blackwood Campus and Stockton University for their Pediatric and Pelvic Floor modules since 2016. She has also been a TA with Herman & Wallace since 2020 and has over 150 hours of lab instruction experience. Mora has also authored and instructs several courses for the Institute.

As a healthcare professional, staying informed about ethical and legal responsibilities is not just a requirement, but a crucial aspect of providing the best care for your patients. I instruct a remote course that tackles these difficult issues - my course, Ethical Considerations from a Legal Lens is a comprehensive remote course taking place on November 17, 2024, that will delve into these important topics from the perspective of the pelvic health rehabilitation field.

Why does this topic matter?
Navigating the complex legal and ethical landscape can be challenging for healthcare providers, particularly in specialized areas like pelvic rehabilitation or even more niche subsets within pelvic health. This course is designed to help practitioners gain a deeper understanding of ethical decision-making while helping a provider feel more legal compliance to safeguard the patient’s well-being and the integrity of a provider’s practice.

During this course, you’ll interactively explore key concepts including:

• Patient confidentiality and informed consent in sensitive treatments like pelvic health
• Legal obligations that impact your practice and decision-making process
• Practical case studies to strengthen ethical problem-solving skills
• Strategies to reduce legal risks while delivering high-quality care

Whether you’re a physical therapist, occupational therapist, or another healthcare provider working in pelvic health, this course is an excellent opportunity to sharpen your ethical compass and protect your practice from potential legal pitfalls.

Who Should Attend?
This course is designed for all pelvic health professionals who want to:

• Refresh their understanding of ethical standards
• Stay updated on legal obligations
• Ensure compliance with state and federal regulations
• Strengthen their ethical decision-making skills

Whether you're new to the field or a seasoned professional, this course offers valuable insights that will enhance your ability to care for patients ethically and legally. This class offers a “think tank” of your peers to help problem-solve real-time ethical or legal issues you may be experiencing in your practice.

With evolving legal and ethical complexities, staying educated is key to practicing responsibly and avoiding potential issues. Join us on November 17 for this impactful course that will empower you with the tools to uphold ethical excellence in pelvic health.

Ready to take your practice to the next level?
Register today and ensure you’re prepared to navigate the ethical and legal challenges in your profession.

AUTHOR BIO:
Mora Pluchino, PT, DPT, PRPC

Mora Pluchino, PT, DPT, PRPC (she/her) is a graduate of Stockton University with a BS in Biology (2007) and a Doctorate of Physical Therapy (2009). She has experience in a variety of areas and settings, working with children and adults, including orthopedics, bracing, neuromuscular issues, vestibular issues, and robotics training. She began treating Pelvic Health patients in 2016 and now has experience treating women, men, and children with a variety of Pelvic Health dysfunction. There is not much she has not treated since beginning this journey and she is always happy to further her education to better help her patients meet their goals.

She strives to help all of her patients return to a quality of life and activity that they are happy with for the best bladder, bowel, and sexual functioning they are capable of at the present time. In 2020, She opened her own practice called Practically Perfect Physical Therapy Consulting to help meet the needs of more clients. She has been a guest lecturer for Rutgers University Blackwood Campus and Stockton University for their Pediatric and Pelvic Floor modules since 2016. She has also been a TA with Herman & Wallace since 2020 and has over 150 hours of lab instruction experience. Mora has also authored and instructs several courses for the Institute.

Mora Pluchino, PT, DPT, PRPC sat down this week with Holly Tanner in an interview to discuss her new courses, Ethical Concerns for Pelvic Health Professionals and Ethical Considerations from a Legal Lens. She is a pelvic therapist who works in an outpatient clinic, has her own side company (Practically Perfect PT), has written 2 books available on Amazon, and is a senior TA and faculty member with Herman & Wallace. Mora joins the Herman & Wallace faculty with her new course series in ethics: Ethical Concerns for Pelvic Health Professionals and Ethical Considerations from a Legal Lens. 

What are your core values as a pelvic health practitioner? Depending on your practitioner license these may include (1):

• Accountability - Active acceptance of the responsibility for the diverse roles, obligations, and actions of the physical therapist and physical therapist assistant including self‐regulation and other behaviors that positively influence patient and client outcomes, the profession, and the health needs of society.
• Altruism - The primary regard for or devotion to the interest of patients and clients, thus assuming the responsibility of placing the needs of patients and clients ahead of the physical therapist’s or physical therapist assistant’s self‐interest.
• Collaboration - Working together with patients and clients, families, communities, and professionals in health and other fields to achieve shared goals. Collaboration within the physical therapist‐physical therapist assistant team is working together, within each partner’s respective role, to achieve optimal physical therapist services and outcomes for patients and clients.
• Compassion and Caring - Compassion is the desire to identify with or sense something of another’s experience; a precursor of caring. Caring is the concern, empathy, and consideration for the needs and values of others.
• Duty - The commitment to meeting one’s obligations to provide effective physical therapy services to patients and clients, to serve the profession, and to positively influence the health of society.
• Excellence - The provision of physical therapist services occurs when the physical therapist and physical therapist assistant consistently use current knowledge and skills while understanding personal limits, integrating the patient or client's perspective, embracing advancement, and challenging mediocrity.
• Integrity - Steadfast adherence to high ethical principles or standards, being truthful, ensuring fairness, following through on commitments, and verbalizing to others the rationale for actions.
• Social Responsibility - The promotion of mutual trust between the profession and the larger public that necessitates responding to societal needs for health and wellness.

Annual CEU requirements for license renewals don’t just look at hands-on skills. Many states also require a number of ethics credits including California, Georgia, Illinois, New Jersey, and Utah (2).  In her interview, Mora Pluchino explains that one day she and her colleague were at lunch talking about course options for their ethics CEU requirement. They had taken the same course over and over at Stockton University and wanted to do something different this time. This led to Mora reaching out to Herman & Wallace and Holly Tanner who helped her start writing the course. Mora’s new courses focus on this ethics requirement, provide 6 contact hours, and registration is $175.00 for each: 

• Ethical Concerns for Pelvic Health Professionals – June 18^th
• Ethical Considerations from a Legal Lens – December 10^th

What should you expect from an ethics course? Mora breaks down the Ethical Concerns for Pelvic Health Professionals course and shares that there is about an hour of pre-course video lectures to watch, then the live course involves “a little bit of lecture in relation to pelvic health and ethics, and then there will be some case studies and group work. After this, an ethical expert will come in and do live question/answers with us.”

These courses are to really make practitioners comfortable with these ethical and moral issues. Mora explains, “I really want practitioners who take this course to understand and know where to find information about those issues that come up with their boss, their organization, their patients, or themselves. A lot of times, ethical situations just make us just know instinctively that something doesn’t feel right.” Holly follows up with “Sometimes these situations can make us feel embarrassed, and maybe we contributed or didn’t contribute in the right way to a scenario. We don’t always bring them up to other people out of this embarrassment, or we just don’t know which pathway to take.”

A lot of common questions have an ethical component such as “How do I bill for this,” “How do I tell my boss I can’t do this,” or even “Can I reuse a biofeedback sensor?” Mora shares, “Sometimes, as a practitioner you can feel pressured to do (or not do) something, and you don’t know how to say no. With these courses, you will be able to give clear reasons such as it’s in my guidelines, in my practice act, and core values as being a PT or OT.” She further expands on this, “We have all of these people working for us in the APTA and AOTA that are creating all of these ethical guidelines and all of this information to give us the support.”

The ethics topics are broken down into two courses, with the first course Ethical Concerns for Pelvic Health Professionals focused specifically on people who treat pelvises scheduled for June 18, 2022. The second course, Ethical Considerations from a Legal Lens, is scheduled for December 10, 2022, and deals with the legalities and rights of health care providers. Some questions that are touched on during lectures include abandonment of care and discrimination.  Mora also shares that a lot of the ethics courses she has taken are “from the perspective of therapists that are abusing their patients, but when you work in pelvic health world you realize it can go the other way too, or it can be a back and forth kind of thing.”

To learn more, and fulfill that ethics CEU requirement, join H&W and Mora Pluchino this summer in Ethical Concerns for Pelvic Health Professionals on June 18^th or this winter in Ethical Considerations from a Legal Lens scheduled for December 10^th.

Resources:

1. APTA. Core Values for the Physical Therapist and Physical Therapist. HOD P06‐19‐48‐55. 9/20/2019. https://www.apta.org/siteassets/pdfs/policies/core-values-endorsement.pdf. Accessed 5/30/2022.
2. Fraticelli, T. PT Progress. Physical Therapy Continuing Education: PT CEU Requirements by State. October 8, 2018. https://www.ptprogress.com/physical-therapy-continuing-education-requirements-by-state/. Accessed 5/30/2022.
   
   

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