Tenn. Comp. R. & Regs. 0260-02-.13 - PROFESSIONAL ETHICS
Immoral, unprofessional, unethical, or dishonorable conduct shall include, but not be limited to, the following:
(1) Conduct designed to, or likely to,
deceive, or harm the public.
(2)
Being a party to or aiding and abetting the violation of these regulations or
the laws of the State of Tennessee regulating the practice of
chiropractic.
(3) The intentional
or negligent use of any false, fraudulent or forged statement, writing or
document, or the use of any fraudulent, deceitful, dishonest, or immoral
practice in connection with any of the licensing requirements of T.C.A.
§§
63-4-101, et seq.
(4)
Advertising or promoting, waiving, abrogating, or rebating the deductible
and/or co-payment amounts of any insurance policy by forgiving any or all of
any patient's obligations for payment, unless the insurer is notified in
writing of the fact of such waiver. Advertising or promoting the same must
include the notice to the insurer and the record must include proof of the
actual notice. If the patient is unable, due to circumstances, to pay for their
services and no advertising or promotion is given to the patient, the provider
may excuse any portion of fees to ensure that the patient may receive the
necessary procedure.
(5) Social
Media Standards
(a) The term social media
refers to all internet and mobile technologies and practices that are used to
share content, opinions, experiences and perspectives online. Examples of
social media platforms include, but are not limited to: Webpages, Instagram,
Facebook, Twitter (X), YouTube, LinkedIn, and blogging sites.
(b) Social media may present opportunities to
enhance patient care, education about chiropractic, intra- and
inter-professional communication and collaboration, and opportunities for
continuing education and professional development.
(c) A licensee is expected to comply with all
existing legal, regulatory and professional obligations when engaging in the
use of social media, including all relevant legislation, regulation, standards
of practice, policies and guidelines. The following guidelines identify some of
those obligations as they relate to the use of social media. A licensee must:
1. Uphold and comply with all legal and
professional obligations to maintain privacy and confidentiality of patients in
accordance with the Health Insurance Portability and Accountability Act
(HIPAA). A licensee may not divulge information through social media that
identifies a patient by name or through a combination of other identifying
information.
2. Any communication
between a licensee and patient, such as providing information, must be done
through secure private messaging only. A licensee must have a clear
understanding of the privacy settings available in any use of social media, and
apply their use accordingly. While patients or licensees of the public may make
themselves publicly known through posting, a licensee must not breach the
privacy or confidentiality of a patient in any context.
3. Not provide any clinical advice,
communicate a diagnosis and/or guarantee results to a patient or the public
through social media. However, a licensee may provide general health
information related to the chiropractic scope of practice for educational or
informational purposes.
4.
Regularly review Tennessee chiropractic scope of practice both in statute and
rule. A licensee must be aware of the risks of using social media for
professional reasons, such as the public incorrectly applying information found
online to their personal health situation. Whenever a licensee uses his
professional designation or provides health related information, that licensee
is viewed as acting in a professional capacity. A licensee must exercise
caution when posting health related information, so that it is clearly used for
education or informational purposes, and must not be used as clinical
advice.
5. Exercise caution when
posting health related information and links to journal articles or academic
information to ensure he is not infringing on any copyrighted
material.
6. Maintain appropriate
professional boundaries, and avoid posting information, comments or images that
may be perceived as disgraceful, dishonorable or unprofessional. A licensee is
not to post any information to social media that may be perceived as
harassment, bullying, or inflammatory in nature. A licensee is further
encouraged to have separate personal and professional social media
pages.
7. Comply with relevant
scope of practice, professional ethics and advertising provisions under Tenn.
Comp. R. & Regs. sections 0260-02-.02, 0260-02-.13, 0260-02-.20
respectively.
8. A licensee must
consider his legal, professional and regulatory obligations and exercise good
judgment and caution before posting material to social media.
(6) Grossly excessive
use of examinations of a patient or a pattern of clearly excessive use of
examinations of patients when patients are charged for this service or
reimbursement of the examination(s) is requested from a third party. The
conduct mentioned herein is presumed to have occurred when there is no
documented, substantiated, finding(s) or condition(s) of the patient(s) which
warrant(s) the use of examination(s) for a chiropractic diagnosis.
(7) Grossly excessive use of care and
treatment of a patient or a pattern of clearly excessive use of care and
treatment of patients when patients are charged for this service or
reimbursement of payment for the care and treatment is requested from a third
party. The conduct mentioned herein is presumed to have occurred when there is
no documented, substantiated finding(s) or condition(s) of the patient(s) based
on a chiropractic diagnosis which warrant(s) the treatment(s) and care
performed.
(8) A chiropractic
physician shall not overutilize or otherwise improperly use ionizing radiation.
In order to avoid overutilization of ionizing radiation, a chiropractic
physician shall observe the following guidelines:
(a) Routine radiography of any patient shall
not be performed without due regard for clinical need;
(b) Subsequent radiographic evaluation of the
patient shall not be undertaken without significant observable clinical
indication, as determined by the treating chiropractic physician.
(9) Sexual Misconduct
(a) Licensees shall not engage in sexual
harassment. Sexual harassment is sexual solicitation, physical advances or
verbal or nonverbal conduct that is sexual in nature, that occurs in connection
with the licensee's activities or roles as a licensee and that either is
unwelcome, offensive, or creates a hostile workplace environment and the
licensee knows or is told this, or is sufficiently severe or intense to be
abusive to a reasonable person in the context. Sexual harassment can consist of
a single intense or severe act or of multiple persistent or pervasive
acts.
(b) Licensees shall not
engage in sexual relationships with current patients, employees, or co-workers
because such relationships are likely to impair judgment or be
exploitative.
(c) Licensees shall
not accept as patients persons with whom they have engaged in sexual
intimacies.
(d) Licensees shall not
engage in sexual intimacies with a former patient for at least six (6) months
after cessation or termination of professional services.
(e) Licensees must respect a patient's
dignity at all times and should provide appropriate gowns and private
facilities for dressing, undressing, and examination. A licensee should not be
present in the room when a patient is dressing or undressing.
(f) Licensees may have a chaperone present
during examination for the protection of both the patient and the licensee. A
licensee should refuse to examine sensitive parts of the patient's body without
a chaperone present.
(10)
Unlicensed Assistants - Licensees shall not allow staff personnel to perform
procedures or services in the clinic for which the personnel do not hold the
license or certification required for such performance. This includes those
services for which certification as a chiropractic therapy assistant or a
chiropractic x-ray technologist is required. Violators will be subject to a
civil penalty of up to one thousand dollars ($1000.00) per month for each
employee found to be practicing without a license. Failure to pay any assessed
civil penalty may result in additional disciplinary action.
Notes
Authority: T.C.A. §§ 63-4-106, 63-4-114, 63-4-119, 63-4-120, 63-4-121, 63-4-122, and 63-4-123.
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
Immoral, unprofessional, unethical, or dishonorable conduct shall include, but not be limited to, the following:
(1) Conduct designed to, or likely to, deceive, or harm the public.
(2) Being a party to or aiding and abetting the violation of these regulations or the laws of the State of Tennessee regulating the practice of chiropractic.
(3) The intentional or negligent use of any false, fraudulent or forged statement, writing or document, or the use of any fraudulent, deceitful, dishonest, or immoral practice in connection with any of the licensing requirements of T.C.A. §§ 63-4-101, et seq.
(4) Advertising or promoting, waiving, abrogating, or rebating the deductible and/or co-payment amounts of any insurance policy by forgiving any or all of any patient's obligations for payment, unless the insurer is notified in writing of the fact of such waiver. Advertising or promoting the same must include the notice to the insurer and the record must include proof of the actual notice. If the patient is unable, due to circumstances, to pay for their services and no advertising or promotion is given to the patient, the provider may excuse any portion of fees to insure that the patient may receive the necessary procedure.
(5) Grossly excessive use of examinations of a patient or a pattern of clearly excessive use of examinations of patients when patients are charged for this service or reimbursement of the examination(s) is requested from a third party. The conduct mentioned herein is presumed to have occurred when there is no documented, substantiated, finding(s) or condition(s) of the patient(s) which warrant(s) the use of examination(s) for a chiropractic diagnosis.
(6) Grossly excessive use of care and treatment of a patient or a pattern of clearly excessive use of care and treatment of patients when patients are charged for this service or reimbursement of payment for the care and treatment is requested from a third party. The conduct mentioned herein is presumed to have occurred when there is no documented, substantiated finding(s) or condition(s) of the patient(s) based on a chiropractic diagnosis which warrant(s) the treatment(s) and care performed.
(7) A chiropractic physician shall not overutilize or otherwise improperly use ionizing radiation. In order to avoid overutilization of ionizing radiation, a chiropractic physician shall observe the following guidelines:
(a) Routine radiography of any patient shall not be performed without due regard for clinical need;
(b) Subsequent radiographic evaluation of the patient shall not be undertaken without significant observable clinical indication, as determined by the treating chiropractic physician. The significant observable indication required by this subsection shall not apply to reevaluations of the spinal subluxation complex. The spinal subluxation complex is determined to be a significant observable indication.
(8) Sexual misconduct.
(a) Licensees shall not engage in sexual harassment. Sexual harassment is sexual solicitation, physical advances or verbal or nonverbal conduct that is sexual in nature, that occurs in connection with the licensee's activities or roles as a licensee and that either is unwelcome, offensive, or creates a hostile workplace environment and the licensee knows or is told this, or is sufficiently severe or intense to be abusive to a reasonable person in the context. Sexual harassment can consist of a single intense or severe act or of multiple persistent or pervasive acts.
(b) Licensees shall not engage in sexual relationships with current patients, employees, or co-workers because such relationships are likely to impair judgment or be exploitative.
(c) Licensees shall not accept as patients persons with whom they have engaged in sexual intimacies.
(d) Licensees shall not engage in sexual intimacies with a former patient for at least six (6) months after cessation or termination of professional services.
(e) Licensees must respect a patient's dignity at all times and should provide appropriate gowns and private facilities for dressing, undressing, and examination. A licensee should not be present in the room when a patient is dressing or undressing.
(f) Licensees may have a chaperone present during examination for the protection of both the patient and the licensee. A licensee should refuse to examine sensitive parts of the patient's body without a chaperone present.
(9) Unlicensed assistants - Licensees shall not allow staff personnel to perform procedures or services in the clinic for which the personnel do not hold the license or certification required for such performance. This includes those services for which certification as a chiropractic therapy assistant or a chiropractic x-ray technologist is required. Violators will be subject to a civil penalty of up to one thousand dollars ($1000.00) per month for each employee found to be practicing without a license. Failure to pay any assessed civil penalty may result in additional disciplinary action.
Notes
Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-4-101, 63-4-106, 63-4-114, 63-4-119, 63-4-123, and 63-4-401.