Comprehensive Guide to Law and Practice in Physical Therapy

Law

Body of rules created by legislatures, courts, or government agencies that have binding legal force.

3 Major Areas of Law

Criminal law, Civil law, Contract law.

Criminal Law

Deals with crimes against society; prosecuted by the state; consequences include fines, probation, imprisonment.

Civil Law

Deals with private wrongs between individuals; usually results in monetary damages.

Contract Law

Agreements between two or more people that create legal obligations.

Negligence

Failure to act as a reasonably prudent person would, resulting in harm.

Example of Negligence

Failing to clean up spilled water, causing someone to slip and fall.

Malpractice

Professional negligence; failure to act as a reasonably prudent healthcare professional.

Example of Malpractice

Excessively mobilizing a joint and injuring the patient.

Difference Between Negligence and Malpractice

Negligence is failure of any reasonable person; malpractice is negligence by a healthcare professional.

Vicarious Liability

Employer or supervising PT may be held liable for actions of employees.

PT's Responsibility Under Vicarious Liability

PT has ultimate responsibility for patient care and proper delegation.

Who Can Be Held Liable?

PTs, PTAs, students, aides, and employers.

Risk Management

Process of identifying, assessing, and minimizing risks to patients, staff, visitors, and the organization.

Professional Liability Insurance

Protects against malpractice claims but not criminal acts or professional misconduct.

Purpose of Laws in PT

Protect the public, define scope of practice, ensure competent providers, and regulate reimbursement.

Scope of Practice

Defines what PTs and PTAs are legally allowed to do.

Statute

A law passed by a legislative body.

Federal Statutes

Apply nationwide and override conflicting state laws.

Examples of Federal Statutes

ADA, IDEA, HIPAA, Social Security Act, Medicare.

HIPAA

Protects patient privacy and confidentiality.

State Statutes

Govern PT practice when no federal law overrides them.

Practice Act

State law defining PT practice, delegation, supervision, and licensure.

Practice Act Importance

Final authority on legal PT practice in each state.

Model Practice Act

Developed by FSBPT as a guide for states; not legally enforceable.

FSBPT

Federation of State Boards of Physical Therapy; develops Model Practice Act and National Exam.

Differences in State Practice Acts

Direct access, joint mobilization, supervision, licensure, CE requirements, delegation.

Licensure

Authorizes practice, protects the title, defines scope of practice.

Certification

Protects title but may not define scope of practice or require licensure exam.

Registration

Least rigorous regulation; requires updated information with the state.

Regulations (Rules)

Rules developed by government agencies rather than legislatures.

Federal Agency Affecting PT

Centers for Medicare & Medicaid Services (CMS).

CMS Role

Determines provider participation and reimbursement for Medicare/Medicaid.

Medicare Regulations

Require accurate billing and documentation; prohibit fraud.

Consequence of Medicare Fraud

Fines, denial of reimbursement, criminal prosecution, loss of license.

State Board of Physical Therapy

Oversees licensing, clarifies scope of practice, and investigates misconduct.

Professional Misconduct

Actions showing inability to practice competently or ethically.

Examples of Professional Misconduct

Patient abuse, abandonment, fraud, incompetence, improper delegation, unnecessary treatment, practicing while intoxicated.

How Laws Are Made

Bill introduced → committee review → debate → vote in both houses → signed by governor/president.

Why PTs Should Monitor New Laws

Allows time to educate lawmakers and influence legislation.

How Regulations Are Made

Agency proposes rule, public comments, final regulation issued.

Federal Register

Daily publication of proposed federal regulations.

Common Law

Law created through court decisions and legal precedents.

Negligence Governed By

Common law.

Policy

A decision that guides actions on similar matters.

Procedure

Specific actions used to implement a policy.

Can Policies Be Legally Enforced?

Only if included in a contract.

APTA

American Physical Therapy Association; primary professional organization for PT.

Who Establishes APTA Policies?

Board of Directors and House of Delegates.

Who Must Follow APTA Policies?

APTA members.

Violation of APTA Policies

Reported to state chapter ethics committee for investigation.

Possible APTA Sanctions

Reprimand, suspension, or expulsion from membership.

Payer Reimbursement Policies

Determine covered services, providers, payment, documentation, and appeals.

Why Must PTs Know Payer Policies

To receive reimbursement for services.

Recent Reimbursement Challenges

Balancing patient care with reimbursement limitations.

How PTs Advocate for Patients

Use evidence-based practice and educate payers.

Employer Policies

Facility rules covering documentation, safety, job duties, and treatment protocols.

Can Employer Policies Result in Discipline?

Yes; violations may lead to disciplinary action or termination.

Should PTs Follow Employer Policies Blindly?

No; ensure policies are ethical, legal, and provide quality patient care.

Purpose of Risk Management

Reduce harm and decrease likelihood of lawsuits.

Direct Access

Patient's ability to receive PT services without physician referral (varies by state).