AAOS Bulletin - February, 2005

AAOS introduces Standards of Professionalism

Fellowship will vote on implementing Professional Compliance Program

By David A. Halsey, MD, and Richard N. Peterson, JD

For nearly a year, the AAOS has been hard at work developing a Professional Compliance Program in response to member requests. The first component of that program was the Expert Witness Program, introduced after the 2004 Annual Meeting. At the 2005 Annual Meeting, bylaw amendments establishing an AAOS professional compliance program and three Standards of Professionalism (SOPs), which establish minimum standards of conduct, will be considered. These will be voted on during March and April 2005.


In 2003, the AAOS Board of Directors (Board) initially charged the AAOS Expert Witness Project Team, chaired by David A. Halsey, MD, with developing a program to address expert witness testimony issues. In discussing this program, the Board realized that broadening the scope of the Professional Compliance Program to include additional ethical violations beyond just expert witness issues would create a Fellowship-wide program that would address serious public concerns and elevate AAOS to a level of professionalism that meets or exceeds other medical associations.

With this broadened scope, the Project Team conducted a number of discussions and explored possible topics. It then developed an SOP on Orthopaedic Expert Witness Testimony as well as two additional SOPs, establishing minimum standards of acceptable conduct for orthopaedic surgeons in the areas of Professional Relationships and Providing Musculoskeletal Services to Patients.

In December 2004, the Project Team presented the Board with its recommendations for these three Standards of Professionalism as key components of the AAOS Professional Compliance Program. The Board had already approved draft procedures for handling professional compliance grievances; the establishment of a Committee on Professionalism (COP) to review, hear and adjudicate grievances; and the establishment of a Judiciary Committee, to hear appeals and adjudicate grievances.

Alleged violations of the SOPs may serve as grounds for filing a grievance or complaint under the AAOS Professional Compliance Program. Complaints must be submitted in writing and follow the Professional Compliance Procedures approved by the Board. AAOS fellows must ratify the SOPs, as well as the Bylaws amendments authorizing the program, before any complaints will be accepted or reviewed.

Once adopted, the mandatory SOPs will apply to and can be enforced by all AAOS fellows and members, including orthopaedic, osteopathic, basic science and allied specialty associate members. The SOPs will not apply to international affiliate or honorary members.


The SOPs represent extensive work and consideration. Nearly 150 orthopaedic surgeons and AAOS staff contributed countless hours toward their development.

When the Board approved draft procedures for the Professional Compliance Program in June 2004, it instructed the Expert Witness Project Team to continue its work refining the procedures and developing a set of standards based on the AAOS Code of Medical Ethics and Professionalism for Orthopaedic Surgeons.

The Project Team examined codes of ethics and statements of ethical principles from other medical organizations, such as the American Association of Neurological Surgeons, the American College of Obstetricians and Gynecologists, the American College of Radiology, and Evanston/Northwestern Hospital. It also sought input from members of the AAOS Ethics and Professional Liability Committees. The Board of Councilors actively contributed to developing the SOPs.

In October/November 2004, the Board of Councilors as well as the AAOS Professional Liability, Patient Safety, and Ethics Committees, reviewed drafts of the SOPs and submitted their comments to the Project Team. The final documents were debated and approved by the AAOS Board of Directors at its December 2004 meeting.

SOPs and the Code of Medical Ethics

The AAOS Code of Medical Ethics and Professionalism for Orthopaedic Surgeons represents aspirational statements of honorable behavior for orthopaedic surgeons. The Project Team decided to incorporate statements from the Code in the SOPs. In this way, the documents reinforce the guidance from the Code with the mandatory minimum standards of conduct expected of orthopaedic surgeons in the SOPs.

The Project Team carefully considered each statement in the SOPs because alleged violations of the SOPs may serve as the basis for complaints by an AAOS fellow or member against another AAOS fellow or member.

After a complaint is filed and a due process hearing has been conducted, the COP (and, when requested, the Judiciary Committee) may recommend that no further action is necessary or that a Letter of Concern be sent to the individual whose behavior has been questioned. Only the AAOS Board of Directors may take formal professional compliance action against an AAOS fellow or member, including censure, suspension, or expulsion from AAOS.

Presentation to the fellowship

The complete text of the SOPs and the changes required in the AAOS Bylaws to implement them were included in the Notice of Annual Business Meetings mailed to each fellow in January. The Academy News, the daily paper published during the Annual Meeting, will also include information and the complete texts of the SOPs.

Fellows are encouraged to participate in discussions about the SOPs and the Professional Compliance Program during the 2005 Annual Meeting. Opportunities for discussion include the Bylaws Committee Open Hearing on Feb. 23, the Business Meetings on Feb. 25 and the Town Hall Meeting immediately following the Business Meetings. In addition, AAOS staff and interested orthopaedic volunteers will be available in the Professional Compliance/Expert Witness Program booth on Academy Row, opposite the Resource Center in Hall D, throughout the Annual Meeting.

Following the meeting, AAOS fellows will vote on the three SOPs as well as the Bylaws amendments that incorporate the AAOS Professional Compliance Program. If adopted by the fellowship, it is likely that the Professional Compliance Program will begin operations in Spring 2005. Only those matters that occur after the completion of the fellowship vote will be reviewed or considered as grievances.

Complete information about the SOPs and the Professional Compliance Program may be accessed from the AAOS Web site, http://www.aaos.org/

Questions and comments about the SOPs and the Professional Compliance Program may be e-mailed to professionalcompliance@aaos.org. In addition, telephone calls may be directed to Kathleen Delaney, Expert Witness Program Coordinator, at 847-384-4047.

David A. Halsey, MD, is chair of the Board Project Team on the AAOS Expert Witness Program. He is also chair of the AAOS Council on Health Policy and Practice.

Richard N. Peterson, JD, is general counsel for the AAOS. He can be reached at peterson@aaos.org

Professional Compliance Program update

Bylaws Amendments/Standards of Professionalism:

February 23, 2005—1 p.m.

    • Bylaws Committee/Standards of Professionalism Oversight Committee Open Hearing

Washington Convention Center Room 150A

February 25, 2005 —9:40 a.m.

    • AAOS Business Meeting

Washington Convention Center Room Ballroom A

    • Proposed Bylaws amendments and SOPs will be presented to Fellowship

February 25, 2005—10:30 a.m.

    • Town Hall Meeting

Washington Convention Center Ballroom A

    • Open discussion of matters of interest, possibly including the AAOS Professional Compliance Program

March 2005

    • Fellowship votes on proposed Bylaws amendments and SOPs

Committee on Professionalism and Judiciary Committee:

February 2005

    • Board of Directors appoints chairs of the Committee on Professionalism and the Judiciary Committee

June 2005

    • Board of Directors appoints initial members to the Committee on Professionalism and the Judiciary Committee

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