Issues in Ethics: Client Abandonment

About This Document
Issues in Ethics Statements: Definition
Introduction
Guidance
Discussion

About This Document

Published 2020. This Issues in Ethics statement is a revision of Client Abandonment (originally published in 2007, and revised in 2010, 2017, and 2019). The Board of Ethics reviews Issues in Ethics statements periodically to ensure that they meet the needs of the professions and are consistent with ASHA policies.

Issues in Ethics Statements: Definition

From time to time, the Board of Ethics (hereinafter, the "Board") determines that members and certificate holders can benefit from additional analysis and instruction concerning a specific issue of ethical conduct. Issues in Ethics statements are intended to heighten sensitivity and increase awareness. They are illustrative of the Code of Ethics (2016) (hereinafter, the "Code") and are intended to promote thoughtful consideration of ethical issues. They may assist members and certificate holders in engaging in self-guided ethical decision making. These statements do not absolutely prohibit or require specified activity. The facts and circumstances surrounding a matter of concern will determine whether the activity is ethical.

Introduction

For a variety of reasons, such as leaving a practice to pursue other career opportunities or relocating for family reasons, clinicians may decide to end their relationships with clients. There is nothing unethical about such departures. (Although, given the shortage of professionals in this field, it may be necessary to caution managers of care-giving facilities that it is unethical to try to exert moral pressure on clinicians to continue once they have indicated their plans to leave.) However, professionals must be mindful of the fact that such departures may result in former clients being left without appropriate care. It is therefore imperative that audiologists and speech-language pathologists in such transitional situations maintain their focus on the welfare of the client. They should be careful to uphold the Code so that clients are not harmed by the clinician’s departure.

When clinicians leave a caseload without coverage by an appropriately qualified professional, it is called client abandonment. A professional who abandons their clients without making effective efforts to provide for the clients’ continuing care violates Principle I of the Code, which states that the professional must "honor their responsibility to hold paramount the welfare of persons they serve professionally."

Guidance

Examples of misconduct may include the following:

Failing to give sufficient notice to employers when leaving a position may represent misconduct. Sufficient notice will vary depending on factors such as contract of employment terms, location of practice, workplace traditions, employment status, and duration. These factors influence the timing of notification from as short as 2 weeks to several months. This failure violates Principle I, Rule T: "Individuals shall provide reasonable notice and information about alternatives for obtaining care in the event that they can no longer provide professional services."
Abandoning clients of one employer to see clients of another employer for personal gain or convenience is a detriment to those you serve. For example, a practitioner who is motivated to leave one job for another job that is perceived as more prestigious, better paying, or closer to home must provide sufficient notice prior to making that change. To do otherwise would violate Principle III, Rule B: "Individuals shall avoid engaging in conflicts of interest whereby personal, financial, or other considerations have the potential to influence or compromise professional judgment and objectivity."
In all settings, the transition of care must be done properly and in a timely manner so as not to negatively impact those we serve. For example, misconduct in private practice may involve failing to inform clients in a timely manner of plans to terminate treatment. In other employment settings, misconduct may involve failing to develop clear plans with the employer concerning the notification of clients. This violates Principle I, Rule T: "Individuals shall provide reasonable notice and information about alternatives for obtaining care in the event that they can no longer provide professional services."
When changes in employment occur, failing to provide an interim plan for each client or to provide alternative care options may violate Principle I, Rule B: "Individuals shall use every resource, including referral and/or interprofessional collaboration when appropriate, to ensure that quality service is provided." It may also violate Principle I, Rule T: "Individuals shall provide reasonable notice and information about alternatives for obtaining care in the event that they can no longer provide professional services."
Any attempt to provide continuing services by correspondence alone is not sufficient to meet the standard of care. For example, a practitioner relocates and is motivated to continue to provide services solely by mail and electronic mail. Such an attempt violates Principle I, Rule N: "Individuals who hold the Certificate of Clinical Competence shall not provide clinical services solely by correspondence, but may provide services via telepractice consistent with professional standards and state and federal regulations."
When managing one's caseload during changes in employment, such as closing a practice or moving to a new employment setting, practitioners are obligated to refer clients to other qualified professionals when appropriate. To not do so violates Principle I, Rule B: "Individuals shall use every resource, including referral and/or interprofessional collaboration when appropriate, to ensure that quality service is provided."
When leaving an employment setting, failing to complete all remaining reports, billing, and other required documentation is a violation of Principle I, Rule Q: "Individuals shall maintain timely records and accurately record and bill for services provided and products dispensed and shall not misrepresent services provided, products dispensed, or research and scholarly activities conducted." This issue highlights the mandatory obligation to complete all clinical/administrative responsibilities when leaving a position.
Upon transitioning from employment, withholding paperwork so that the clinician’s successor does not have access to the client's entire record is manifestly harmful to clients. Such misconduct is a violation of Principle I, Rule Q: "Individuals shall maintain timely records and accurately record and bill for services provided and products dispensed and shall not misrepresent services provided, products dispensed, or research and scholarly activities conducted." It is also a violation of Principle IV, Rule A: "Individuals shall work collaboratively, when appropriate, with members of one’s own profession and/or members of other professions to deliver the highest quality of care."
Removing materials, records, protocols, and other administrative materials without the consent of the administrator of the facility or organization, even if intended by the clinician to ensure the care of a client, negatively impacts those we serve. This is a violation of Principle I, Rule O: "Individuals shall protect the confidentiality and security of records of professional services provided, research and scholarly activities conducted, and products dispensed. Access to these records shall be allowed only when doing so is necessary to protect the welfare of the person or of the community, is legally authorized, or is otherwise required by law."
When changes in employment occur, maligning the facility that the professional is leaving and/or its employees while in the presence of clients represents misconduct. Specifically, it violates Principle IV, Rule A: "Individuals shall work collaboratively, when appropriate, with members of one’s own profession and/or members of other professions to deliver the highest quality of care." This behavior is also a violation of Principle IV, Rule D: "Individuals shall not engage in any form of conduct that adversely reflects on the professions or on the individual’s fitness to serve persons professionally."
When transitioning to a new job, the potential benefit of recruiting clients from the previous employment setting to the new setting could be considered misconduct. This behavior may violate Principle III, Rule B: "Individuals shall avoid engaging in conflicts of interest whereby personal, financial, or other considerations have the potential to influence or compromise professional judgment and objectivity."

Discussion

When there is employment transition or any other change in the relationship with our clients, audiologists and speech-language pathologists should hold paramount their obligations to those being served. Every effort should be made to ensure continuity of care and to accommodate the needs of clients. When good-faith efforts are not sufficient to guarantee that continuity, acceptable alternative plans should be pursued. Such plans might involve developing home programs that could be used during an interim period without professional services, referring clients to appropriately qualified professionals in the surrounding area, and providing clients and their families with troubleshooting techniques and maintenance activities.

A professional who is leaving a facility should, if requested, assist the organization with recruitment of a replacement and should offer to participate in the orientation of replacement personnel as necessary. Audiologists and speech-language pathologists who leave an organization or facility should attempt to sever ties with the employer amicably. Employers should cooperate in every way with departing clinicians in order to safeguard the well-being of clients. Such behavior is consistent with Principle IV: "Individuals shall uphold the dignity and autonomy of the professions, maintain collaborative and harmonious interprofessional and intraprofessional relationships, and accept the professions' self-imposed standards."

When the practitioner’s departure has been precipitated by difficulties in workplace relationships or perceived deficiencies in working conditions, there may be increased potential for conduct that violates the Code. Professionals in such situations should avoid engaging in behaviors that might be viewed as retaliatory or slanderous. Employers who are ASHA members are likewise expected to behave in ways that place the highest priority on the needs of the clients. Angry and spiteful words, obstructive actions, and uncooperative or aggressive behavior are potentially harmful to clients and adversely reflect on the professions. It is also a violation of the Code if such behaviors lead to filing a frivolous complaint, as stated in Principle IV, Rule O: "Individuals shall not file or encourage others to file complaints that disregard or ignore facts that would disprove the allegation; the Code of Ethics shall not be used for personal reprisal, as a means of addressing personal animosity, or as a vehicle for retaliation."

If a practitioner believes that a facility is not meeting professional standards, they should report the facility to the appropriate oversight organization. If an employer believes that a clinician is unqualified or has behaved unethically, that problem should be reported to the appropriate oversight body. This reporting is required by Principle IV, Rule N: "Individuals shall report members of other professions who they know have violated standards of care to the appropriate professional licensing authority or board, other professional regulatory body, or professional association when such violation compromises the welfare of persons served and/or research participants."

Some disruptions of clinician–client relationships are involuntary. If a clinician is dismissed for cause, the employee’s responsibility to clients terminates with the dismissal, and the facility assumes all responsibility for seeing that no clients suffer harm as a result of the departure. Clinical relationships may also be interrupted if an organization decides to close a program or when emergency situations occur (e.g., natural disasters or public health emergencies). It is expected that even in these types of situations, practitioners would hold paramount the welfare of the clients they serve; however, no clinician is ever ethically required to work without pay.

Likewise, clinicians are never ethically obligated to place themselves in danger to deliver client care. On rare occasions, clinicians may be threatened with physical danger and/or extreme emotional distress (e.g., sexual harassment, physical assault, specific threat of harm, or other serious misconduct). When clients and/or their families exhibit this behavior, it seriously interferes with their treatment and jeopardizes clinician safety. In these circumstances, the provider may immediately elect to (a) inform the client that treatment will be discontinued (this does not constitute client abandonment) and (b) notify their supervisor/director.

Potential disruptions in clinician–client relationships may also occur as the result of a school strike. If a district makes the decision to close schools because of a strike, this temporary lack of services would not be construed as client/student abandonment by the audiologist or speech-language pathologist (SLP). If schools remain open during a strike, the audiologist or SLP should ensure that parents are notified that their children may not receive services as scheduled. (Whether FAPE [free appropriate public education] has been denied as the result of a missed session is to be decided on a case by case basis. The school district is responsible for addressing parent concerns. For additional guidance, refer to Missed Speech-Language Sessions in Schools and ASHA Guidance on School Walkouts or Strikes on the ASHA website.)

It should be clear from this discussion that whenever it is necessary to terminate a clinical relationship, for whatever reason, there is an unavoidable impact on those we serve. As the welfare of our clients is paramount, practitioners need to effectively eliminate the possibility of client abandonment.