Read Scenario and write about what you would do if you were in that situation

Please read the following case scenarios and summarize the events. After working through the ethical decision-making process, what course of action would you suggest? Scenario 1: Student or PT Bob considers himself very fortunate; his first clinical placement following the conclusion of his first year in PTA school has been an incredible experience. His CI Stephanie, the practice manager, has been welcoming and willing to share not just her pt knowledge but insights into the business of physical therapy. In addition to her position as practice manager, Stephanie was one of the PTs for a dance troupe based in the city, but she accompanied them for 2 weeks at a time twice a year when they went on tour. Stephanie explained to Bob that she would be leaving on tour, but fortunately it was during the final 2 weeks of his clinical placement Bob wasn't quite sure why that was fortunate, but he trusted that Stephanie had the whole situation under control. He was determined to get as much as he could out of the next few weeks before Stephanie left; he kidded her that now that he knew she was leaving "he planned to drain her brain." The Friday before she left she sat down with Bob to review his performance. She was very complimentary of his performance at this point and told him that she was confident that the next 2 weeks would be most beneficial as he gained confidence in his skills. The PTA Gail could help him out if he needed it; they would not be admitting any new patients, and Tim, the agency float PT, would be in for 2-3 days per week depending on the caseload at the other offices. Stephanie had demonstrated through all of her interactions that she was a very knowledgeable practitioner, and Bob was confident that what he would be doing must be OK. Even though he was pretty sure he was supposed to be supervised, he was never completely clear about what exactly supervision is meant-after all since week four, Stephanie was always available but not always right by his side. Bob was actually quite excited that his CI was confident in his ability to carry on in her absence, allowing him to rely on his skills, and he still had staff to rely on. Gail had been a PTA for a long time and Tim the float PT was used to fitting in to operations that were up and running. Stephanie was careful to make sure that Bob knew all of the patients, and he was clear on the plan of care. She left him Tim's phone number "just in case." The first 2 days Bob was quite comfortable-he continued the plan of care that he helped Stephanie create before she left, and he felt pretty confident. He accepted that his documentation would await the arrival of Tim who would countersign his notes. He prepared the billing forms the way Stephanie showed him, giving little thought to whose license number that billing form was utilizing, or the fact that he was billing Medicare Part B, something that he vaguely recollected was "not permitted." On the third day, Bob had a wake-up call. Dan, a patient he had been treating arrived in considerable pain. Bob immediately went to Gail who suggested that he give Tim a call. Tim responded right away, but not knowing the patient he suggested that Bob tell the patient that he cannot treat him and he should call his doctor. The patient was visibly annoyed, stating he has had this type of a flare-up before, and it always calmed down with some stretching with the machine that makes your skin tingly. Bob knew he could do what the patient was telling him "works," but he was not sure why there was pain and he recognized that "just because he could, didn't mean he should." Bob was conflicted; he wanted to do what was best for the patient, but he just wasn't sure what was the best thing to do. The incident was a "wake-up call" for Bob. Confronted with a patient in pain, his first instinct was to provide the care that the patient requested; however, he recognized that his limited experience should make him apprehensive. He suddenly saw that perhaps his ego had gotten dangerously in the way of his judgment. Scenario 2: Inappropriate Supervision When we receive our license to practice, we are granted certain rights under the law, but we also have taken on certain responsibilities. It is imperative that we be familiar with and adhere to all dictates of the practice acts of states within which we work. To do otherwise is both illegal and unethical. Sandra has been a physical therapist assistant (PTA) for 2 years. Her first job was at an outpatient clinic where a friend of hers also was employed, but she'd always wanted to work at a skilled nursing facility (SNF). When the opportunity arises to join a large company that owns SNFs in several states, she seeks out and secures a position. It strikes her as a perfect fit, in that she wants to serve older adults, the salary and benefits are better than they were in her old job, and she knows that she could at some point relocate within the same company if she so chooses. In fact, one of the conditions of employment is that Sandra get licensed and be willing to substitute as needed at an SNF across the river, in a neighboring state from the facility at which she regularly works. She has no hesitation agreeing to this stipulation, as the other facility is only a 15-minute drive from her home. Sandra is assigned to a small subacute facility in her home state for orientation and her first few months of employment. She quickly establishes a strong working relationship with Lori, her supervising physical therapist (PT). Lori is a wonderful and supportive teacher, and Sara thrives under her tutelage. About 4 months into their time together, Lori tells Sandra she'll be needed the following week at the SNF in the neighboring state, as someone there is going on vacation for a week. The news makes Sandra a little nervous, but Lori reminds her that she's been carrying her own caseload with supervision for months now and has done a good job. "You'll be fine!" Lori says, adding, "And you already know Tina." Sandra doesn't really "know" Tina, the PT who'll be supervising her at the other facility, but she has met her a couple of times at meetings for area staff and has found her to be friendly and highly knowledgeable. So, the following Monday Sandra crosses over the bridge and confidently meets up with her new-if temporary-colleagues. Tina is very welcoming, as are Mike and Mabel, the aides to whom Sandra is introduced. Her first day goes smoothly, but Sandra is stunned when, in late afternoon, Tina says, "See, you fit right in here! I know I won't have to worry about you while I'm gone." "Gone?" Sandra asks, suddenly worried and confused. "My husband and I are off to Paris in the morning!" Tina says excitedly. "But, who will be supervising me in your absence?" Sandra nervously asks. "Direct supervision isn't required in this state," Tina says. "You'll be fine. And it's just for a few days." Sandra realizes with a sinking feeling that she is subbing for a vacationing PT-not a vacationing PTA, as she had assumed. Sandra gets a chance before leaving that day to place a quick call to George, the company's regional administrator. He is not a PT, but he encourages staff to come to him with questions about company policies. George, who is based in Sandra's home state, confirms that supervision requirements are different "across the river." All Sandra needs to do, he says, is be able to communicate with a PT when and if it proves necessary. "But my supervising PT is going to be in France!" Sandra blurts out. George tells her not to worry about it-just to take care of patients and leave the administrative details to others. Sandra is hardly reassured by George's words, as there won't be any other PT on staff at the facility while Tina is gone. Still, she figures she can ask Lori to countersign her patient notes and drive over to evaluate any new patients, since the distance is not prohibitive. The next 2 days go well. There are no new patients, and Sandra enjoys working with the older adults she sees. Mike and Mable are able, helpful, and friendly. Sandra is a bit concerned that Lori hasn't yet come to countersign her patient notes, but she knows that Lori is busier than usual without Sandra there to assist her. The following morning, however, Sandra learns that a new patient has arrived at the SNF overnight and needs to be evaluated. Mabel looks confused when Sandra says, "We can't do anything until I can get Lori over here for the evaluation." "You mean you can't just do it yourself?" Mabel asks. "I'm not totally familiar with this state's practice act, but no, I don't think so," Sandra responds. She's finally able to reach Lori on the phone. Lori is surprised by and sympathetic to Sandra's dilemma, "I was under the impression you'd be subbing for a PTA," she says-but she adds that she's in no position either to countersign Sandra's notes or to conduct a patient evaluation at the neighboring facility. "I'm not licensed to practice in that state," Lori says. "In fact, that's purposeful on my part. I don't need the headaches of the back-and-forth travel." "What should I do?" Sandra asks. "You need to get back in touch with George before you do anything else," Lori says. "Good luck. Let me know what happens. 1 They hang up, and Sandra begins to dial George's number. She is trying not to panic, but she finds it difficult to be calm as she reviews the facts. Lori can't help her. Tina is in Europe. Sandra can't find Tina's cell number on the company website, but will that phone even work overseas? And why had Mabel thought Sandra could perform the patient evaluation herself? Could that possibly be the case? Should she consult the state practice act before she even calls George? And why had George seemed so cavalier about the situation in their previous conversation