Interview with Nancy Huffman Audiologist. Chairperson of the Board of Ethics, American Speech Language Hearing Association
AO/Beck: Hi Nancy. It's nice to speak with you again.
Huffman: Hi Doug. Thank you for the invitation.
AO/Beck: You're welcome. I'd like to learn a little about the ASHA Board of Ethics, how it operates and related issues, but first, can you please tell me a little about your professional background?
Huffman: Sure, as you probably recall from our conversation last year, I am a dually certified audiologist and speech-language pathologist. The vast majority of my work has been as an audiologist. I worked for the Monroe # 1 Board of Cooperative Educational Studies in Fairport, New York. At this point I am basically retired from clinical practice after working for 32 years. Now I consult on administrative and regulatory issues in the fields of audiology and speech-language pathology in educational practice. I continue to volunteer time for ASHA and other professional and community organizations.
AO/Beck: Very good. Can you tell me a little about the ASHA Board of Ethics please? How many board members are there and who is on the Board with you?
Huffman: There are 12 people on the board; Mary Bolton-Koppenhaver, Alan Diefendorf, Melanie Frazek, Judson Garrett (Public Member), Harvey Gilbert, Kevin Kearns, Deborah King, Charissa Lansing, Jim McCartney, William Mustain, Polly Pooser, and I serve as Chair.
AO/Beck: How long is the chairmanship?
Huffman: The chair position is authorized in one year increments, but I am now serving in my third year on the Board and my second year as chairperson.
AO/Beck: Nancy, what are the responsibilities of the Board?
Huffman: We have three charges. The primary function is that we adjudicate cases of alleged violation of the ASHA Code of Ethics, and that's probably the function that most people associate with us. Another charge is that we review and evaluate the Code of Ethics and formulate and propose amendments to the Code. In November 2001 the Legislative Council approved several amendments. Currently we are in the process of developing amendments with more specificity to research activities. Another charge is to develop educational programs and materials on ethics.
AO/Beck: What types of cases do you actually rule on?
Huffman: The caseload and the issues vary tremendously. Probably about 1/4th to 1/3rd of the total cases deal with audiologists—audiologists complaining about audiologists, licensure boards alleging violations, complaints from consumers, and complaints from otolaryngologists. Some of the issues involve competence of the audiologist, misrepresentation of services, fraud, Medicaid fraud, falsification of records and related issues.
AO/Beck: Although I think I know what you mean when you say fraud, can you give me an example please?
Huffman: Yes. Examples of types of fraud include billing for services not rendered, billing for a more costly procedure than what was actually performed, providing and billing for unnecessary services/ tests. More specific examples would include doing a screening examination but billing for a comprehensive evaluation; billing old items as new- i.e. selling a used hearing aid; and falsifying records regarding service delivery.
AO/Beck: And how would the Board proceed in those situations?
Huffman: The first issue would be to determine whether or not we have jurisdiction over that person. That is; is the person is an ASHA certificate holder, an ASHA member, a clinical fellow, or an applicant for ASHA membership or certification? Assuming we do have jurisdiction, we would then determine whether or not the subject matter is something that is addressed in the Code itself. Then, after we determine that we have jurisdiction and that the subject matter is a topic covered by the Code, we can proceed and process the complaint. The complaint can come from a professional or the public, a licensing board, courts, and of course written evidence or physical evidence, or hard proof is important to substantiate a complaint. Certainly we make sure that the person who the complaint is lodged against is aware of the complaint. The respondent is given the opportunity to respond to the complaint.
AO/Beck: Is that called the Initial Consideration Hearing?
Huffman: Yes, exactly. So that is where the complaint, the evidence and the response are all examined by the Board. If we render a decision at that time, the decision can be appealed, but only a few are.
AO/Beck: I must assume that if a complaint gets all the way to the Initial Consideration Hearing, it is very likely a good idea for the respondent to have an attorney present?
Huffman: Yes, it is their decision, but I would recommend it. These are professional proceedings, and there will be record, and the decisions made can certainly impact the respondent's ability to earn a living as an audiologist or a speech-language-pathologist, and it can impact their state license and other issues too. Of course, we have had many respondents who very competently state their cases, and they defend themselves successfully, but I would recommend legal counsel. It is not unusual for these cases to become very complex very quickly.
AO/Beck: Do you have an attorney on the Board?
Huffman: Actually at this time we have two. The public member of the Board is an attorney, and then we have another Board member who is also an attorney.
AO/Beck: Nancy, as you probably recall, I actually teach the ethics course for the Arizona Au.D. program. Every now and then a professional will make the statement that there are two sets of ethics, specifically they separate business ethics and professional ethics. Frankly, I usually determine that there is only one set of ethics, but I'm curious to get your view on that?
Huffman: Well, we are intending to provide some written guidance on this topic because it is a topic that comes to our attention too. We are in the process of drafting a publication, which will probably be titled Business Ethics, and I hope it will be released later this year or perhaps more likely, in 2003. We're just in the early stages of this project and it has to go through multiple layers of editing and review before we're ready to release it. The document will probably cover all of the basics, but will also cover related topics like record keeping, advertising, warranty statements, contractual agreements between employer and employee and similar topics.
AO/Beck: Can you address specific situations at this time? Such as, presume that a dispensing audiologist works for ABC Hearing Associates, and at approximately the hiring date, the audiologist signed a non-compete form which says they will not open or join a competing office for 24 months within 5 miles after leaving the practice - is that enforceable?
Huffman: Basically your example is a legal issue, subject to the law of contract in the state where the non-compete agreement is entered into. The Board of Ethics would probably not address that specific issue. In essence, the Board addresses issues associated with allegations that assert a violation of one or more provisions of our Code of Ethics. It would depend on the specifics of the situation, and it would depend on the complaint being lodged. Probably the best thing in that situation, whether you are the one proposing the contract or the one signing the contract, is to speak with your attorney and get their opinion first. Business contracts and legal and ethical issues surrounding them, versus rules in a code of professional ethics and issues surrounding them may be distinct from one another. Certainly the professional should be aware of ramifications of their behavior in both contexts.
AO/Beck: Nancy, what about the Revised Code of Ethics? What's new in there, and what has changed from the previous version?
Huffman: There were several statements that were revised and there are new statements too. Some address misrepresentation of credentials by assistants, and there is a new statement that allows practice by telecommunication. There are new statements which address kickbacks and practice referral issues, and then there are statements about sexual harassment.
AO/Beck: How do the readers get copies of the Revised Code?
Huffman: The easiest way is through the website. Once you're in the professional website (https://www.asha.org/practice/) you'll see the Ethics Index there with the Code of Ethics, the Statements of Procedures, the Practices and Procedures and then there are also some 15 or so Issues in Ethics and then Roundtable is there also, so it's a fairly comprehensive guideline and it covers the major issues. Of course when you view the website, you need to understand that just like Audiology Online, it's a work in progress, and it changes as new information becomes available, so it's a good idea to review the website now and then to make sure you're current, and also, it's good to know what information is there in case you want it or need it later.
AO/Beck: Thanks Nancy. That's a good point. I would really like to examine the website in detail and go through that with you, but we've actually run out of time. So I think we'll have to just encourage people to check it out, and to write to you with questions as they come up.
Huffman: Thanks Doug, that'll be fine.
AO/Beck: Thank you too Nancy. I certainly appreciate your willingness to speak with me on these issues and perhaps we can get together again on these issues?
Huffman: Certainly. I'll look forward to it.
AO/Beck: Thanks Nancy.
