AAOS Bulletin - October, 2005

How to file a professional compliance grievance

By Kathleen Delaney

Filing a grievance with the AAOS Professional Compliance Program offers an avenue to review, hear and adjudicate disputes between fellows and members. Members of the Committee on Professionalism (COP) serve as the hearing panel at an initial hearing, and members of the Judiciary Committee serve as the appellate hearing body. Professional compliance actions—such as censure, suspension or expulsion—may only be taken by the AAOS Board of Directors.

To initiate a grievance, fellows and members may access the Grievance Report form online at the Professional Compliance Program section of the AAOS Web site. After completing, signing and dating the form, the grievant (the person filing the grievance) should submit it with any supporting material to the AAOS Office of General Counsel. To be valid, a Grievance Report must meet the following three tests.

Subject matter

Grievances may only be filed for alleged violations of the Standards of Professionalism (SOPs) adopted by the AAOS fellowship in 2005. Currently, there are three SOPs on the following subjects:

• Providing Musculoskeletal Services to Patients

• Professional Relationships

• Orthopaedic Expert Witness Testimony

The SOPs are based on the AAOS Code of Medical Ethics and Professionalism for Orthopaedic Surgeons, which is a guide to ethical behavior. The Code covers a number of other topics important to orthopaedic surgeons, but remains aspirational in nature. In contrast, the SOPs set mandatory levels of minimum acceptable conduct in these three specific areas.

Time restrictions

The AAOS Professional Compliance Program will consider only matters that occurred on or after April 18, 2005, which is the effective date of the Bylaws amendments that created the Program and the initial three SOPs. AAOS is precluded from reviewing matters that occurred prior to this date. If the grievance relates to orthopaedic expert witness testimony, the matter may be filed with the court prior to April 18, 2005, but the deposition or trial testimony on which the allegation is based must occur on or after April 18, 2005.

In addition, AAOS will consider only those matters that have been resolved within the civil or administrative process, including appeals. Consequently, if a matter is still being considered at any level, a member may not file a grievance until the issue has been resolved.

Supporting material

The grievant must provide enough specific information for the COP to determine whether to conduct a hearing. The grievant must specify the SOP and identify the minimum standard(s) that allegedly were violated.

The COP also relies on the grievant to focus the allegation on specific conduct. In some cases, more than one minimum standard may be cited as the basis for the grievance.

In addition, the grievant is required to provide complete copies of any documents relied on as evidence of an alleged violation of the SOPs. For matters related to orthopaedic expert witness testimony, the documents are typically depositions and trial testimony, but may also include written opinions. The grievant is responsible for identifying statements within these documents that support an alleged violation of the SOPs. Again, the COP looks to the grievant to focus on specific conduct.

Supporting material must adhere to the requirements of the Health Insurance Portability and Accountability Act (HIPAA). Guidelines for de-identifying patient information are included with the Grievance Report form. HIPAA de-identification provisions are not required for grievances related to orthopaedic expert witness testimony when the patient initiated the litigation.

Kathleen Delaney is the Professional Compliance Program Coordinator. She can be reached at professionalcompliance@aaos.org, aaosexpertwitness@aaos.org, or (847) 384-4047.

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