Published 5/1/2007
Kathleen I. Delaney

Professional compliance program continues to evolve

Holds fellows, members accountable for actions
In just two short years, the AAOS Professional Compliance Program has grown from a simple idea to a flourishing program. When it was established by a vote of the fellowship in April 2005, some suspected that the program would be inundated with petty complaints, while others viewed it largely as a symbolic gesture. Neither viewpoint has been realized.

In fact, the program has functioned much as it was intended to function—as a way to hold orthopaedic surgeons accountable for meeting minimum standards of acceptable conduct. During the past two years, 22 automatic professional compliance actions have been taken, 19 grievances have been filed with the AAOS Office of General Counsel (OGC), five hearings have been conducted by the Committee on Professionalism (COP), one grievance has been appealed to the Judiciary Committee, and two grievances have been considered by the AAOS Board of Directors, resulting in a one-year suspension for one fellow and a censure for another fellow.

Under the Association Bylaws establishing the Professional Compliance Program, the Board of Directors may take appropriate professional compliance action based on the recommendations of the COP and the Judiciary Committee. Professional compliance action may be recommended as the result of alleged violations of the Standards of Professionalism (SOPs). In addition, automatic professional compliance action may be recommended following licensing board limitations on a fellow’s or member’s right to practice medicine.

The following is a summary of the program’s activities and procedures; a complete description of the Professional Compliance Program—including the text of approved and proposed SOPs, grievance procedures, and links to additional information—is available on the AAOS Web site (www.aaos.org/profcomp)

COP provides oversight, review
The COP, chaired by Peter J. Mandell, MD, oversees the Professional Compliance Program and any grievances. Members of the COP—Richard A. Brown, MD; Dale R. Butler, MD; Murray J. Goodman, MD; Michael H. Gordon, MD; William J. Hopkinson, MD; Vincent J. Silvaggio, MD; and Richard E. Strain, MD (or a panel of COP members)—conduct objective, substantive review of formal grievances filed by fellows or members who have charged other fellows or members with alleged violations of the SOPs.

The COP, however, only sees grievances that have passed an initial administrative review conducted by the AAOS OGC. Of the 19 grievances submitted to the Professional Compliance Program, four have not passed the administrative review and have not been sent to the COP for review. Grievances often fail the administrative review because an underlying matter remains unresolved in the court system. Until notice of final legal action is received, the OGC holds these grievances in abeyance.

In some instances, the COP’s initial review indicates that the evidence submitted does not support the charge of violating an SOP. In these cases, the COP notifies the grievant (the fellow/member who made the charge) that it has declined to hear the case. To date, the COP has determined that three grievances have not merited formal hearings.

If the grievant demands a hearing, despite the COP’s initial decision not to hold one, he or she may bear certain financial obligations that are detailed in the Professional Compliance Program Grievance Procedures. To date, one grievant has demanded a hearing before the COP.

After the grievance hearing, the COP issues a report of its findings and recommendations to both the grievant and the respondent (the fellow/member charged with the violation). At this point, either party may file an appeal to the Judiciary Committee. To date, one COP recommendation has been appealed to the Judiciary Committee.

Judiciary Committee hears the appeal
The Judiciary Committee—Richard D. Schmidt, MD, chair; Edward V. Craig, MD; Joseph C. DeFiore Jr., MD; Richard A. Geline, MD; and Thomas M. Green, MD—serves as the appellate body for the AAOS Professional Compliance Program. If a fellow appeals the COP’s recommendations, the Judiciary Committee will hear the appeal and makes its recommendations to the Board.

The Judiciary Committee plays a pivotal role in the grievance process, because parties to a grievance may only appeal to the Board of Directors by first appealing to the Judiciary Committee. Without an appeal to the Judiciary Committee, parties to a grievance may not appear before the Board. To date, the Judiciary Committee has conducted one appeals hearing.

In June 2006, the Board increased the scope of the Judiciary Committee’s charges to include review of state licensing board actions against a fellow/member involving the loss, restriction on, or limitation of any right associated with the practice of medicine. Association Bylaws require that the Board be notified when AAOS learns of any state licensure action. Based on its review of the state’s action, the Judiciary Committee will recommend appropriate professional compliance action to the Board. To date, the Judiciary Committee has made recommendations on 12 state licensure matters.

Board decisions are final
A two-thirds vote of members present and voting is required for the Board to take professional compliance action. Board members have recused themselves from voting due to conflicts of interest. Board actions range from no action to expulsion. In addition, the Board may vote to issue a Letter of Concern, which is not an official professional compliance action.

In order of seriousness, the Board may take the following official professional compliance actions:

  • Censure: A written reprimand to the fellow/member from the Association, with no loss of fellowship/membership benefits. The censure is included in the fellow’s or member’s membership file.
  • Suspension: A loss of fellowship/membership benefits for a specified period. The Board may set the length of the suspension as necessary to ensure modification of behavior. The individual may request and be fully reinstated after the suspension period, provided he or she pays all past dues, fees, or special assessments owing upon reinstatement.
  • Expulsion: Removal from the rolls of the Association. An expelled fellow/member is not entitled to any of the benefits of fellowship/membership. The Association shall not accept a reapplication for fellowship/membership from an expelled fellow/member until a prescribed period, as the Board shall determine, has elapsed from the date the individual was notified of the Board’s action.

When the AAOS Board takes a professional compliance action based on violations of the SOPs or for state licensure matters, the action is reported to the American Board of Orthopaedic Surgery, as well as to the individual’s state medical society, state orthopaedic society, and state licensing board. Notification of suspensions or expulsions relating to patient health or welfare is also forwarded to the National Practitioner Data Bank. In addition, AAOS notifies fellows/members of all professional compliance actions taken, identifying the respondent by name. Notices are regularly published in AAOS Now.

For more information about the Professional Compliance Program, visit the program’s Web site at www.aaos.org/ProfComp

Kathleen I. Delaney is the Professional Compliance Program Administrator. She can be reached at professionalcompliance@aaos.org or (847) 384-4047.