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American Chiropractic Association

Code Of Ethics

Preamble

This Code of Ethics is based upon the fundamental principle that the ultimate end and object of the chiropractor's professional services and effort should be: 
"The greatest good for the patient." 
This Code of Ethics is for the guidance of the profession with respect to responsibilities to patients, the public and to fellow practitioners and for such consideration as may be given to them by state legislatures, state administrative agencies and also by state chiropractic associations to the extent that they are authorized under state law to exercise enforcement or disciplinary functions.

A. Responsibility to the Patient

A (1) Doctors of chiropractic should hold themselves ready at all times to respond to the call of those needing their professional services, although they are free to accept or reject a particular patient except in an emergency.

A (3) Having once undertaken to serve a patient, doctors of chiropractic should not neglect the patient. Doctors of chiropractic should take reasonable steps to protect their patients prior to withdrawing their professional services; such steps shall include: due notice to them allowing a reasonable time for obtaining professional services of others and delivering to their patients all papers and documents in compliance with A (5) of this Code of Ethics.

A (5) Doctors of chiropractic should comply with a patient's authorization to provide records, or copies of such records, to those whom the patient designates as authorized to inspect or receive all or part of such records. A reasonable charge may be made for the cost of duplicating records.

A (7) Doctors of chiropractic owe loyalty, compassion and respect to their patients. Their clinical judgment and practice should be objective and exercised solely for the patient's benefit.

A (9) Doctors of chiropractic are entitled to receive proper and reasonable compensation for their professional services commensurate with the value of the services they have rendered taking into consideration their experience, time required, reputation and the nature of the condition involved. Doctors of chiropractic should terminate a professional relationship when it becomes reasonably clear that the patient is not benefiting from it. Doctors of chiropractic should support and participate in proper activities designed to enable access to necessary chiropractic care on the part of persons unable to pay such reasonable fees.

A (11) Doctors of chiropractic should be ready to consult and seek the talents of other health care professionals when such consultation would benefit their patients or when their patients express a desire for such consultation.

A (12) Doctors of chiropractic should employ their best good faith efforts that the patient possesses enough information to enable an intelligent choice in regard to proposed chiropractic treatment. The patient should make his or her own determination on such treatment.

B. Responsibility to the Public

B (2) Doctors of chiropractic should observe and comply with all laws, decisions and regulations of state governmental agencies and cooperate with the pertinent activities and policies of associations legally authorized to regulate or assist in the regulation of the chiropractic profession.

B (4) Doctors of chiropractic may advertise but should exercise utmost care that such advertising is relevant to health awareness, is accurate, truthful, not misleading or false or deceptive, and scrupulously accurate in representing the chiropractor's professional status and area of special competence. Communications to the public should not appeal primarily to an individual's anxiety or create unjustified expectations of results. Doctors of chiropractic should conform to all applicable state laws, regulations and judicial decisions in connection with professional advertising.

B (6) Doctors of chiropractic may testify either as experts or when their patients are involved in court cases, worker's compensation proceedings or in other similar administrative proceedings in personal injury or related cases.

B (8) Doctors of chiropractic who are public officers should not engage in activities which are, or may be reasonably perceived to be in conflict with their official duties.

C. Responsibility to the Profession

C (2) Doctors of chiropractic should by their behavior, avoid even the appearance of professional impropriety and should recognize that their public behavior may have an impact on the ability of the profession to serve the public. Doctors of chiropractic should promote public confidence in the chiropractic profession.

C (4) Doctors of chiropractic should attempt to promote and maintain cordial relationships with other members of the chiropractic profession and other professions in an effort to promote information advantageous to the public's health and well-being.

D (1) Ethics Committee. The president of ACA appoints seven doctors of chiropractic representing each of the seven ACA districts, who are general or life members of the ACA to serve a three year, staggered term as members of the Ethics Committee. All appointments to the Ethics Committee are subject to the approval of the House of Delegates. The president will make the appointments to the committee from among respected doctors of chiropractic who will, to the extent practicable, assure that the committee's composition is balanced as to relative age and experience and as to emphasis of the appointees upon practice, education, research or other endeavors within chiropractic. The executive governor from each district may recommend for the president's consideration doctors of chiropractic to represent their respective district on the Ethics Committee. Members of the Ethics Committee may serve no more than three three-year terms. Members may resign from the committee at any time. Membership on the Ethics Committee may be terminated by the executive board of governors of the ACA at any time and for any reason. Vacancies on the committee are filled by the ACA president. The Ethics Committee is responsible for (i) developing and implementing an educational program regarding the Code of Ethics among doctors of chiropractic and students of chiropractic colleges, (ii) investigating, with the advice and assistance of ACA staff and/or legal counsel, each inquiry regarding ethics and recommending after investigation whether the executive board of governors with assistance of legal counsel, should issue an advisory opinion interpreting the Code of Ethics, (iii) investigation, with the advice and assistance of ACA staff and/or legal counsel each challenge regarding ethics and recommending after investigation whether the executive board of governors should make a determination that a member of the ACA has failed to observe a provision of the Code of Ethics and recommend an appropriate authorized sanction, and (iv) assessing the Code of Ethics periodically and recommending any amendments to the ACA House of Delegates.

D (3) Meeting of the Committee. Meetings of the Ethics Committee are called upon at least seven days written notice of committee members, which notice includes a copy of the agenda for the meeting. A quorum consists of a majority of all of the appointed committee members. Voting is by majority of those present at a meeting (or by a majority of those submitting votes in a mail vote). Mail voting without a meeting is permitted where all committee members submit mail votes or abstentions. Voting by proxy is not permitted. A member of the committee must decline to participate in the consideration of, or the decision in, any matter before the committee in which the member has a personal interest.

D (5) Indemnification and Insurance. All Ethics Committee members, staff, ACA legal counsel, and other individuals engaged in investigations at the written request of the chairman, are indemnified and defended by the Association against liability arising from committee-related activities to the extent provided by the Bylaws of the ACA for governors, officers, employees and agents. The ACA maintains indemnification insurance against such liability.

D (7) Inquiries and challenges -- Prelindnary Dispositions. Upon preliminary review of a submission involving the Code of Ethics, the chairman may conclude, with the advice and assistance of ACA staff and/or legal counsel, that the submission (i) contains insufficient information on which to base an investigation or (ii) is patently frivolous or inconsequential, i.e., it does not present an issue of interpretation of this Code of Ethics adequate to constitute a valid and actionable inquiry and to justify bringing the submission before the committee for investigation and recommendation to the executive board of governors on issuance of an advisory opinion or it does not present an issue of observe a provision of this Code of Ethics adequate to constitute an actionable challenge and to justify bringing the submission before the committee for investigation and recommendation to the executive board of governors on a determination of failure to observe a provision of this Code of Ethics. If so, the submission is disposed of by notice from the chairman to its submitter, if the submitter is identified. Each such preliminary disposition by the chairman of a submission involving this Code of Ethics is reported to the Ethics Committee. Within 30 days of receipt of notice of the chairman's determination that the submission does not justify committee investigation, the submitter may request that a written copy of the submission and a written copy of the chairman's rationale for denying the submission be forwarded to the entire Ethics Committee for consideration. The Ethics Committee either affirms or overrules the determination of the chairman with notice to the submitter.

D (9) Proceedings on Inquiries -- Hearings on an Inquiry. In the course of an investigation involving an inquiry, the committee, with the advice and assistance of ACA staff and/or legal counsel, may conduct a public administrative hearing to receive the views of those who are interested in, or may be affected by, issuance by the executive board of governors of an advisory opinion interpreting a provision of this Code of Ethics. Notice of the hearing is given to the members of the ACA and to others who, in the opinion of the committee, may be interested in, or affected by, issuance of an advisory opinion. The notice may include a tentative proposed advisory opinion. The hearing is conducted by the committee with any three or more committee members participating. The chairman of the committee presides at the hearing and assures that these administrative procedures are followed. The chairman may issue any appropriate procedural or evidentiary ruling in the course of the hearing and may be assisted by legal counsel. The chairman presents at the hearing the issues raised by the inquiry, the results of the investigation up to the time of the hearing, and any tentative proposed committee recommendation to the board of governors for an advisory opinion. Information is offered through witnesses, who may be assisted by legal counsel and are subject to questioning by the committee. Any information may be considered which is relevant or potentially relevant. A transcript or recording of the hearing is made. The official record of the hearing becomes a part of the investigation of the inquiry.

D (11) Proceeding on Inquiries -- Advisory Opinion. The executive board of governors, with the advice and assistance of ACA staff and/or legal counsel, issues an advisory opinion interpreting a provision of this Code of Ethics (i) upon the recommendation of the Ethics Committee arising from an inquiry and following an investigation (ii) upon the recommendation of the committee arising from its own initiative. A representative of the committee presents to the board of governors for its review the recommendation of the committee and the record of the investigation. The executive board of governors may accept, reject or modify any committee recommendation. Once issued by the executive board of governors, the advisory opinion is promulgated by publication to the members of the ACA. Advisory opinions are compiled by the Ethics Committee, and the compilation is periodically made available to the members of the Association and the public.

D (13) Proceedings on Challenges - Recommendations on a Challenge. Upon completion of an investigation involving a challenge, the Ethics Committee recommends whether the executive board of governors should make a determination that the member of the ACA who is the subject of the challenge has failed to observe a provision of this Code of Ethics. When the committee recommends a determination by the executive board of governors of non-observance. and Committee also recommends imposition by the executive board of governors of an appropriate sanction. If the committee so recommends, a proposed determination with a proposed sanction is prepared under the supervision of the chairman and is presented by a representative of the committee to the board of governors along with the record of the committee's investigation. If the committee recommends against a determination of nonobservance, the challenge is dismissed. with notice to the member of the ACA who is the subject of the challenge and to the submitter of the challenge, and a summary report is made to the executive board of governors

D (15) Proceedings on Challenges - Sanctions. Any of the following sanctions may be imposed by the executive board of governors upon a member of the ACA, who the board has determined, has failed to observe a provision of this Code of Ethics, although the sanction applied must reasonably relate to the nature and severity of the Non- observance, focusing upon reformation of the conduct of the member and deterrence of similar conduct by others:

b. Suspension of the member from the ACA for a designated period with publication of the determination with or without publication (at the discretion of the board of governors) of the member's name; or

c. Termination of the member from the ACA with publication of the determination and of the member's name. Members of the ACA who are suspended are deprived of all benefits and incidents of membership during the period of suspension, except continued participation in ACA insurance programs. In addition, if the member is suspended with publication of the name or terminated, the executive board of governors, with the advice and assistance of ACA staff and/or legal counsel, may direct the Ethics Committee to communicate the determination and transfer a summary or the entire record of the proceeding on the challenge, to an entity engaged in the administration of law or the regulation of the conduct of chiropractors in a proceeding that relates to the subject matter of the challenge, provided, however, that the entity is a law enforcement agency, chiropractic licensing authority, quality review board, professional peer review committee, or similar entity; and provided that such summary or record is relevant to the entity's jurisdiction. The chairman or such other member as the chairman may designate of the Ethics Committee may appear if requested as a witness to that determination and record. Except in the instance of communication of the determination and transferal of the record, or in the instance of request of the record by the member of the ACA who was the subject of the challenge, the entire record, including the record of any appeal, is sealed by the Ethics Committee and the executive board of governors and no part of it is communicated by the members of the Ethics Committee, the staff or any other who assisted in the proceeding on the challenge, to any third parties except as otherwise required by law. Members of the ACA who are terminated may not reapply for membership in any classification for a period of five years from the date of termination.

ADDENDUM SEXUAL INTIMACIES WITH A PATIENT

The physician/patient relationship requires the doctor of chiropractic to exercise utmost care that he or she will do nothing to "exploit the trust and dependency of the patient." Doctors of chiropractic should make every effort to avoid dual relationships that could impair their professional judgment or risk the possibility of exploiting the confidence placed in them by the patient.

Addendum ACA ETHICS COMMITTEE ADVISORY OPINIONS Rental Arrangements and Clinic or Laboratory Referrals

It is unethical for a doctor of chiropractic to receive a fee, rebate, rental payment or any other form of remuneration for the referral of a patient to a clinic, laboratory or other health service entity. The ACA Code of Ethics mandates, as primary obligation of the doctor of chiropractic, the exercise of clinical judgment and practice "solely for the patient's benefit." In the view of this association, the receipt of any form of remuneration for a patient referral runs directly counter to this primary obligation and tends to adversely impact upon the relationship between chiropractor and patient.

The ACA recognizes that there are some forms of rental agreements for space or equipment which are legitimate arm-length business transactions not conditioned on patient referrals. However, some forms of rental agreements may be designed to conceal the real nature of the payment, that is, to induce referrals. The ACA also recognizes that the federal government has developed guidelines which outline those circumstances in which space or equipment rentals would not constitute an illegal or improper form of remuneration in return for Medicare or Medicaid referrals.

A lease agreement for space or equipment in which a doctor of chiropractic refers a patient to an entity which either leases to or from the doctor space or equipment, will not constitute an unethical practice where:

2. The lease specifies the space or equipment covered by the lease.

4. The term of the lease is for not less than one year.

Doctors of chiropractic are advised to consult with their local examining board or other regulatory agencies for specific
requirements which may relate to clinic or laboratory referrals.

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