2012 Student Ethics Essay Award – 3rd Place
The Role of the Individual and National Association in the Prevention of Compromised Patient Care Due to Impaired Practitioners
By Emily Norman
University of Iowa, Iowa City, Iowa
Chapter Advisor: Jean K. Gordon
Because mental illness and substance abuse in health professionals pose a considerable risk to our patients and can place the reputation of our profession in jeopardy, the issue of impaired professionals must be addressed by the American Speech-Language-Hearing Association (ASHA) and considered by all in our field. Both professionals and the national association have a responsibility to intervene in cases of impaired practitioners. "As professionals, ASHA members and certificate holders bear special responsibility for assisting with the enforcement of the Code by monitoring their own actions as well as the actions of others" (Denton, 2009, p. 74).
At the most basic level, impaired practitioners violate the first principle in the ASHA Code of Ethics; Principle 1, Rule A states that, "individuals shall provide all services competently." As professionals, allowing impaired practitioners to work in our field threatens the integrity of our profession by placing the service provider above the wellbeing of the client. Mental illness or substance abuse can affect the professional judgment and overall competence of the practitioner, which is in direct violation of the Code of Ethics. For example, allowing an impaired practitioner to continue his or her duties in a school could negatively impact a child's communication skills, if the practitioner is not professionally competent. In a hospital setting, impaired practitioners could risk a patient's life, if the professional's illness or addiction leads to poor assessment of the patient's ability to swallow safely.
The ASHA Code of Ethics more directly addresses the issue of impaired practitioners in Principle 4, Rule E, which reads, "Individuals shall not engage in any other form of conduct that adversely reflects on the profession or on the individual's fitness to serve persons professionally." Alcohol or substance abuse and mental illness can easily have a negative impact on the professional's ability to provide competent services. An addiction or behavior that impairs the professional's ability to perform his or her duties in a competent fashion also does a great disservice to our national association and other professionals in our field; practitioners who are not competent or professional in their behavior may cast the good work of their peers into doubt.
Ideally, in the interest of serving our clients competently, impaired practitioners should adhere to ASHA's Code of Ethics' Principle 1, Rule Q, which mandates, "Individuals whose professional services are adversely affected by substance abuse or other health-related conditions shall seek professional assistance and, where appropriate, withdraw from the affected areas of practice." However, as noted by Kincheloe & Litzenburg (2010), substance abusers often do not believe they are impaired and a noticeable lapse in professional ability and judgment often do not occur until the problem is extremely severe. Therefore, healthcare professionals are often unwilling to seek professional services in the early stages of their illness or addiction, and the quality of client care may be compromised before intervention is sought or imposed by an employer or the national association.
ASHA has a professional and ethical responsibility to maintain the integrity of the field. For this reason, the Code of Ethics provides guidelines that specify that professionals in the field are to report cases of impaired practitioners. As stated in the ASHA code of Ethics, Principle 4 Rule M, "individuals who believe that the ASHA Code of Ethics has been violated shall inform the Board of Ethics." Because impaired practitioners may risk the wellbeing of their clients and mar the reputation of our field, it is necessary that individuals intervene in cases of a suspected impaired practitioner. If the practitioner is unable or unwilling to recuse him or herself from practicing in order to acquire the assistance he or she needs, it becomes the duty of other professionals to address the problem with the practitioner and to notify ASHA of his or her infirmity.
However, the way that the professional association should deal with impaired practitioners is less clear. The purpose of the enforcement of the ASHA Code of Ethics is two-fold: first, for punishing ASHA members found in violation and, second, for rehabilitating these individuals and helping them return to the field (Denton, 2009). In many cases, it may be possible to aid the professional in seeking professional help for his or her addiction or illness. However, if the Code of Ethics has been violated and the practitioner has not recused him or herself from professional practice, ASHA has a responsibility to take disciplinary action in order to protect our patients. In cases of impaired practitioners, I suggest that the Board of Ethics take a light-handed approach in punishing the professional and concentrate on rehabilitation, particularly for a first-time offender. Ideally, ASHA should offer resources to help the practitioner recover and should facilitate his or her return to the profession, provided that patient care is no longer in jeopardy.
In addition to discipline, the Board of Ethics' goal is to provide rehabilitation and education (Denton, 2009). Baldisseri (2007) suggests that this education take the form of classes regarding substance abuse and teaching healthy coping strategies for stress. She also suggests holding presentations by professionals who have dealt with mental health or substance abuse problems. Prevention should be a primary focus of ASHA, in hopes that we can maintain a high quality of professionalism and patient care by providing practitioners with resources to manage stress in a healthy manner. For professionals who are recovering from addiction or mental illness, ASHA should also offer support groups, to provide an encouraging environment for recovery.
Drawing upon the professional code, it appears that certain circumstances require that ASHA intervene with heavier disciplinary action. More severe punishments may be warranted in cases where patient care or confidentiality has been compromised. Several examples of these situations are outlined by Kincheloe & Litzenburg (2010), who state that disciplinary action is necessary for professionals who are, "already under discipline, those who have been terminated from a rehabilitation program, those diverting drugs from the workplace to give or sell to others, and those whose continued practice is a serious risk of harm to the public" (p. 2). Unfortunately, in these cases, it is the responsibility of our professional association to suspend or revoke the individual's license in the interest of protecting our patients and the reputation of the profession.
In the interest of providing quality care to our patients and upholding the reputation of our profession, we all have an obligation, as professionals, to report ourselves or peers who are suffering from addiction or illness that impairs the ability to provide quality care and exercise professional judgment. ASHA also has a responsibility to aid and, when necessary, discipline impaired practitioners, and to provide education for the prevention of these impairments. Professionals in our field must be vigilant in preventing malpractice from occurring, for the sake of our personal and collective professional integrity.
American Speech-Language-Hearing Association. (2010). Code of Ethics [Ethics]. Available from www.asha.org/policy.
Baldisseri, M.R. (2007), Impaired healthcare professional. Critical Care Medicine, 35(2): 106–116.
Denton, D. R. (2009). How ASHA Sanctions Violators of Code of Ethics. American
Speech-Language-Hearing Association. Retrieved March 25, 2012, from www.asha.org/practice/sanctions.
Kincheloe, D.M. Esq., & Litzenburg, T.A. Esq. (2010). Impaired health care practitioners: help the healer heal himself. [Legal letter]. Richmond, VA: Hancock, Daniel, Johnson & Nagle, P.C.