Little Health Law Blog
Our healthcare and business law firm works with many providers as they undergo investigations, discipline, and/or hearings before the provider’s licensing board. Over the years, our firm has been able to determine which situations licensing boards find particularly worrisome. Boundary violations are often one of those situations that boards are particularly concerned with. This blog post outlines three steps for avoiding boundary violations. If you need assistance with a licensing board matter or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.
Boundary violations discussed in this blog post include inappropriate relationships between provider and patient, which could involve romantic relationships or providing care to and writing prescriptions for immediate family members. Here three steps to avoid boundary violations.
First, know your licensing board’s rules!
These rules will explain boundaries that you, as a provider, must always maintain. For instance, Georgia Rule 360-3-.02 defines “unprofessional conduct” to include “writing prescriptions for controlled substances for personal use or, except for documented emergencies, for immediate family members.” The rule defines “immediate family members” to include “spouses, children, siblings, and parents.” The rule also explains that it is unprofessional conduct to “commit[] any act of sexual intimacy . . . related to the physician’s practice of medicine regardless of consent.” The rule explains that this applies to a physician’s former patient “where the licensee did not terminate in writing the physician patient relationship before engaging in a romantic relationship with the patient.” The rule also states, “The Board will consider the physician patient relationship terminated if the physician has not evaluated or treated the patient for a period of at least two (2) years.” In Georgia, the Board has previously interpreted this rule to mean that a physician must always wait two years before engaging in a romantic relationship. Be sure you understand the boundary requirements imposed by your licensing board!
Second, consult relevant ethical rules.
Not all boundaries are clear cut. There can be difficult grey areas that may not clearly violate your licensing board’s rules but still may raise boundary concerns. Consult ethical rules and opinions on those rules. For instance, the American Medical Association publishes its Code of Ethics and devotes an entire journal to the subject. The AMA Code of Medical Ethics is available here and the Journal of Ethics can be accessed here. As an example, the AMA Code of Medical Ethics Opinion 9.1.1 provides:
Romantic or sexual interactions between physicians and patients that occur concurrently with the patient physician relationship are unethical. Such interactions detract from the goals of the patient-physician relationship and may exploit the vulnerability of the patient, compromise the physician’s ability to make objective judgments about the patient’s health care, and ultimately be detrimental to the patient’s well-being.
A physician must terminate the patient-physician relationship before initiating a dating, romantic, or sexual relationship with a patient.
Likewise, sexual or romantic relationships between a physician and a former patient may be unduly influenced by the previous physician-patient relationship. Sexual or romantic relationships with former patients are unethical if the physician uses or exploits trust, knowledge, emotions, or influence derived from the previous professional relationship, or if a romantic relationship would otherwise foreseeably harm the individual.
In keeping with a physician’s ethical obligations to avoid inappropriate behavior, a physician who has reason to believe that nonsexual, nonclinical contact with a patient may be perceived as or may lead to romantic or sexual contact should avoid such contact.
Third, seek additional education if needed.
There are many options for providers who need assistance creating and maintaining boundaries. On the same webpage as many AMA Code of Ethics opinions is a button to find relevant AMA CME courses. For instance, there is one for Sexual and Romantic Boundary Violations. There are also reputable intensive boundaries programs offered virtually and in person. One such program is Vanderbilt University Medical Center’s Maintaining Professional Boundaries program, designed to “improve professional boundaries in your practice of medicine.” These courses can also be used to rehabilitate those who previously engaged in a professional boundary violation.
We hope you found this blog post helpful. If you need assistance with a licensing board matter or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.