Speech-Language-Hearing Association (ASHA) Ad Hoc Committee on Professional Liability and R
The following report was developed by the American Speech-Language-Hearing Association (ASHA) Ad Hoc Committee on Professional Liability and Risk Management and approved by the Executive Board (EB 181-93) in De-cember 1993. Members of the committee include Elca Swigart, current chair; Marc Kramer, past chair; Charlene Zand; John Ferraro; and Evelyn Cherow, ex officio. The report was completed under the guidance of Jean Lovrinic,vice president for governmental and social policies.The ASHA Ad Hoc Committee on Professional Liability and Risk Management was charged with developing a report on (a) the professional claims his-tory of the professions and (b) risk management pro-cedures to minimize liability exposure for speech-lan-guage pathologists and audiologists and maximize service to clients/patients, hereafter referred to as cli-ents throughout this report.
This report is designed to increase the awareness of speech-language pathologists and audiologists con-cerning issues in risk management. It is not intended to serve as a standard or as a substitute for legal ad-vice.
I. Background
An individual who causes injury to another either intentionally or unintentionally can be held liable for the action. By virtue of advanced knowledge, training,
and skill, a professional has a responsibility to con-form to certain standards of conduct to protect the public from unreasonable risks. A professional stan-dard of care is traditionally established by codes of ethics, scopes of practice, preferred practice patterns of professional associations, and state licensure laws.The responsibility of licensed and/or certified profes-sionals to conform to those standards may be referred to collectively as professional liability.
As professionals, practicing speech-language pa-thologists and audiologists are vulnerable to liability claims. Risk exposure may be increased if services are provided for invasive procedures, specific disorders,in certain physical settings, or for special https://www.wendangku.net/doc/3b4176235.html,plaints of unethical practice and unprofessional conduct for the professions in various work settings have been reported (Miller, 1983). Therefore, it is pru-dent for all members of the profession to develop an awareness and knowledge base about professional liability and to maintain responsible professional stan-dards for risk management within their own scope of practice and practice setting.
Although legal claims against speech-language pathologists and audiologists and reports of unpro-fessional or unethical practice have been relatively few (Miller & Lubinski, 1986), their incidence may increase in the future as a result of a variety of factors:
?increase in the number of practitioners in the speech-language pathology and audiology professions;
?increase in the number of individuals who re-ceive services;
?expanding scope of practice and responsibili-ties of speech-language pathologists and audi-ologists;
?enhanced professional autonomy within insti-tutions or organizations and through private practice, which encompasses approximately
Ad Hoc Committee on Professional Liability and Risk Management
Professional Liability and
Risk Management for the
Audiology and Speech-Language Pathology Professions
Reference this material as: American Speech-Language-Hearing Association (1994). Professional liability and risk management for the audiology and speech-language pathology professions. Asha, 36, (March, Suppl. 12), pp.25–38.
Index terms: documentation activities, ethics (professional practice issues), law and litigation, liability insurance, risk management
Document type: technical report
one-third of the speech-language pathology
and audiology professions;
?staff shortages and institutional policies requir-ing cross-training and use of support person-
nel and temporary employees;
?development of new technologies and diagnos-tic and treatment modalities, including inva-
sive procedures;
?lack of standards of care for nontraditional sites
(e.g., home care);
?media reports of “innovative treatments” that may lead to unrealistic expectations of out-
come;
?high cost of medical care that may affect tradi-tionally accepted standards of care;
?heightened public awareness of clients’ rights and the potential to recover costs and damages
when the injury is deemed serious; and ?increase in prosecutions of personal injury cases due to specialization of attorneys.
The two most important factors influencing a practitioner’s ability to reduce exposure to liability are awareness and education. Therefore, this report gives a broad overview of the legal process as related to pro-fessional liability, summarizes data related to liabil-ity claims and sanctions for unethical conduct in the speech-language pathology and audiology profes-sions, discusses standards of care, and suggests risk management strategies to reduce situations that may result in liability exposure. The report is designed to increase the awareness of speech-language patholo-gists and audiologists concerning issues in risk man-agement. As stated earlier, this is not intended to serve as a standard or to substitute for legal advice.
II. Overview of the Legal Process and Ethical Practices
When through private practice audiologists and speech-language pathologists “establish themselves as legal entities in their own right and not mere agents, servants, or employees of another” (Muraski, 1982), they may find themselves named as defendants in le-gal action or as respondents to ethical complaints. They may also be drawn into lawsuits in conjunction with others, such as employees or manufacturers. Con-sequently, it is important that professionals be able to recognize types of situations out of which claims and lawsuits are likely to arise. For this reason, a brief dis-cussion of the various types of liability and unprofes-sional or unethical practice follows.A. Theories of Liability
1. Civil Professional Liability. When a lawsuit is filed, the theory of liability under which damages may be recovered must be set forth. When bringing an ac-tion against a health care provider, the two theories that are generally pursued are action in tort or action in contract.
a.Action in Tort. Professional liability (errone-
ously but commonly called “malpractice” by
the lay public) stems primarily from actions in
tort, which are private legal actions in which
one person (the plaintiff seeks a remedy (usu-
ally monetary) for damages to health, physical
integrity, property, peace of mind, or reputation
caused by another person (the defendant). Tort
derives from two bases:
?unintentional tort—actions that were uninten-tional and during which the practitioner
failed to exercise the degree of care that a pro-
fessional of ordinary prudence would exer-
cise under the same circumstances, such as
negligence, misdiagnosis, incorrect or inad-
equate treatment, injuries from equipment or
premises, or harmful effects from human
subject research.
?intentional tort—illegal actions that were in-tentional and from which a reasonable per-
son would believe that a particular result
was substantially certain to follow, such as
assault (an attempt to do violence to another
person), battery (unauthorized physical con-
tact), false imprisonment, or defamation of
character.
Unintentional tort of negligence is the most
likely civil litigation to be brought against a
speech-language pathologist or audiologist.
In order for a cause of action of negligence to
be pursued, four elements must be present:? A legal duty must exist between the practi-tioner and the plaintiff. That is, a provider/
client relationship was established.
? A breach of legal duty must exist (i.e., service was not adequately provided, an improper
diagnosis was reached, there was a failure
to diagnose, or a physical injury resulted
from the diagnosis or treatment).
? A proximate cause (i.e., cause and effect re-lationship) must exist between the breach of
duty and the injury.
?An actual loss or damage must result from the injury. Actual loss or damage includes
physical, psychological or developmental
damage, loss of wages or services, or addi-
tional incurred expense.
Professional liability presupposes the existence of an accepted standard of care when the practitioner possesses the degree of education, credentials, and skills ordinarily possessed by practitioners in that professional field. Although level of care need not be extraordinary, it must be reasonable and diligent and must reflect the practitioner’s maintenance of current knowledge in the professional area of practice.
Negligence is committed when there is an injury to the client resulting from failure to exercise the ac-cepted standard of care. Both statutory law (created by federal, state, or local legislative bodies acting accord-ing to constitutional power) and common law (the development of legal principles from previously de-cided cases) define negligence. Although common law standards for our professions are minimal, they could develop over time with increased adjudication and testimony of expert witnesses in our profession as to “acceptable standard of care” (Kooper & Sullivan, 1986). Potential areas for litigation, in addition to those cited previously under the theory of unintentional tort, include failure to refer, consult, or follow; failure to properly warn or instruct; failure to obtain informed consent; and failure to reveal alternatives.
Intentional torts that might be filed against audi-ology and speech-language pathology professionals include assault, battery, and violation of confidential-ity. For example, failure to obtain requisite consent to perform evaluation or therapeutic procedures may re-sult in an allegation of battery. Unauthorized release of client information may result in a claim for damages as a result of the loss of privacy and confidentiality. In the cases of intentional or unintentional tort suits, the courts require payments from defendants only when the plaintiff can prove fault.
b.Action in Contract. Another form of civil litiga-
tion includes that related to representation and
promises. Failure to fulfill promises and other
obligations may result in litigation under con-
tract law. Practitioners must never state or im-
ply a guarantee of results of treatment (1993
ASHA Code of Ethics, Principle of Ethics I,
Rules of Ethics F), even though they may become
involved with guarantees of dispensed prod-
ucts.
c.Product Liability. As audiologists and speech-
language pathologists continue to increase their
role in the acquisition, distribution, and utili-
zation of assistive and augmentative devices
and diagnostic and therapeutic tools, they also
increase their potential for litigation in the event
of product misuse or failure. Practitioners may
be party to a product liability suit if they can in
any way be connected with a defective device
(e.g., dispense, utilize, or prescribe).
One example of litigation in this area involved battery ingestion by a young child. Although the case centered around the failure of the hearing aid manu-facturer to provide a child-proof battery compartment, the dispensing audiologist was also brought into the litigation for alleged failure to instruct the parent con-cerning proper care of the device. All who dispense instruments or who use them in their practice are sub-ject to being named if there is a product failure or if the device is used incorrectly.
d.Third Party Liability. Additional defendants
may be named in litigation if they are believed
to have played a role in the matter in question.
For example, if a practitioner is engaged to pro-
vide program consultation and the employer is
subsequently named as a defendant, it is pos-
sible that the employer will seek to litigate the
consultant, since the condition or situation for
which the employer has been named occurred
as a result of the consultant’s recommendation.
e.Employer Liability. Employers are subject to vi-
carious responsibility (respondeat superior) for
the acts of their employees and, in addition, are
subject to corporate liability. The respondeat su-
perior concept is based on the rationale that the
employee is acting on behalf of the employer,
that the employer exercises supervision and
control over the conduct of the employee, and
that the employer is frequently in a better finan-
cial position to pay damages awarded. Legal in-
terpretations have included any licensed pro-
fessional who does not adequately supervise
unlicensed persons acting in the professional’s
behalf, and all members of an evaluation or
treatment team being held liable for the actions
of any team member.
2. Criminal Liability. Criminal liability includes commission of misdemeanors or felonies arising out of the conduct of professional activities (i.e., battery, fraud, or grand larceny). These behaviors can subject the practitioner to fines and incarceration. In many cases, professional activities that may result in these complaints reflect an ignorance of applied regulation, or direct violation with full knowledge of applied regu-lations (i.e., Medicare and Medicaid law, state insur-ance codes, and other governmental regulation). Igno-rance of the law does not release one from liability. Battery, previously described as being litigated under the legal theory of intentional tort, may also be pursued
under criminal codes. Other areas that may be pros-ecuted under either theory include product liability, employee liability, and third-party liability.
B. Ethical Practice Complaints
Most professional organizations hold their mem-bers to a code of ethical conduct, and violation of ethi-cal codes subjects the respondent to jurisdictions of administrative tribunals, such as ethical practice com-mittees of state and national associations and state licensing boards. Although these organizations do not bring suit against the respondent, the actions and sanc-tions are sometimes admitted into evidence in support of any litigation being pursued. Professionals should be knowledgeable about professional association poli-cies, such as codes of ethics, scope of practice state-ments, preferred practice documents, guidelines, or other “best practices” statements that form the basis of an expected standard of care.
III. History of Unprofessional Conduct, Unethical Practice, and Malpractice
Insurance Claims
The reported incidence of unprofessional conduct and/or unethical practice leading to malpractice claims appears comparatively small for the audiology and speech-language pathology professions, as stated earlier. For purposes of this report, data from three primary sources were used to track trends:
? a study of state licensing boards presented at the 1992 ASHA Convention, “Speech-Lan-
guage Pathologists and Audiologists: Profes-
sional Liability” (Graff, 1992);
?published actions by ASHA’s Ethical Practice Board; and
?claims records from ASHA’s liability insurance broker, Albert H. Wohlers and Co.
A. Study of State Licensing Boards
In this study, the state licensing boards of the 39 states that had licensure were contacted to provide detailed information regarding complaints of unpro-fessional conduct and unprofessional practice for au-diologists and speech-language pathologists. Al-though 24 of the 39 states responded (62%), 19 provided “vague” data and 5 had no records to report. The total number of complaints reported was 134, 72 of which were undefined. The remaining 62 were broadly defined under the following categories:?advertising complaints (29 complaints reported by 4 states),
?license fraud (20 complaints reported by 3 states),
?fraud (5 complaints reported by 2 states),
?unprofessional conduct (4 complaints reported by 1 state),
?standard of care (1 complaint reported by 1 state),
?unethical practice (1 complaint reported by 1 state),
?refusal of service (1 complaint reported by 1 state), and
?record keeping (1 complaint reported by 1 state).
These data must be interpreted with caution, since it cannot be determined whether the limited number of cases reflects the true incidence or results from poor record keeping, obscure mechanisms for reporting complaints within the state, or government agencies’reluctance to release information.
B. Reported Sanctions by ASHA’s Ethical Practice Board
The Ethical Practice Board of ASHA publishes in Asha magazine the names of individuals found in vio-lation of the Code of Ethics when the sanction is cen-sure or revocation of membership or certification, or when publication of other sanctions is mandated by the Board. Table 1 is a summary of the numbers and types of violations resulting in published sanctions by the Board from February, 1985 through August, 1993.
Table 2 illustrates the number of published sanctions
by year. As seen from these tables, the number of pub-lished sanctions is small and has remained relatively stable over the past 8 years.
C. Claims Summary From ASHA’s Liability Insur-ance Broker
Group malpractice insurance from the Chicago In-surance Company (brokered through Albert H. Wholes and Co.) has been available to the ASHA membership since January 1, 1982. Although the speech-language pathology and audiology professions are not consid-ered “catastrophic exposure” industries by the insurer, all claims require investigation, whether initially ap-pearing serious or frivolous. Data from this insurance broker reveal that 129 incidents were reported between January 1982 and June 1993. Listed below are general categories under which the claims fell, along with the number of incidents reported within each category. The categories are listed in order of most- to least-frequent number of claims. It should be noted that malpractice insurance through Albert H. Wohlers and Co. is main-tained by approximately one-third of the ASHA mem-bership, and the committee did not have access to claims information from other insurance providers. Any trends extracted from these data, therefore, must be interpreted with caution.
1.Improper ProcedureTreatment (25 claims). Per-
formance of improper procedures was the most
frequently reported cause of malpractice claims.
It was impossible from the data received to iden-
tify the specific nature of these incidents, al-
though the majority appeared to have involved
audiologists and occurred in an “office” set-
ting.
2.Hearing Aids (23 claims). Incidents relating to
the testing, fitting, dispensing, and use of hear-
ing aids were the second most frequent cause
of malpractice claims. Eleven claims were made
because of earmold impression material break-
ing off or being left in the ear canal; five inci-
dents reported dispensing the “wrong aid.” An
incident of a child swallowing a hearing aid
battery was included in this category.
3.Employment Conflict (15 claims). These claims
involved such issues as breach of confidence,
slander, employee vs. employer, workmen’s
compensation, and discrimination cases.
4.Physical Injury to the Ear/Hearing (13 claims).
Claims that hearing testing damaged the ear
canal or caused hearing loss and/or tinnitus
to worsen were included in this category.
5.Physical Injury to Other Parts of the Body (11
claims). Burns to the face from solvents/elec-
trodes were the most common incidents in this
category. Eye damage was also claimed. One
client filed a claim for suffering shortness of
breath during an examination.
6.Improper Diagnosis (10 claims). These claims
involved improper diagnosis and misdiagno-
sis of a speech or hearing problem.
7.Injuries Due to Falls (9 claims). Claims involv-
ing clients who fell from examining tables or
wheelchairs comprised this category. Some of
these falls occurred outside the testing area but
within the clinical facility.
8.Client Death (8 claims). Although hearing/
speech testing was not the cause of death,
claims in this category involved the death of a
client undergoing or being prepared for an ex-
amination (e.g., heart attack). One claim was
made because of a fatal accident allegedly as-
sociated with obtaining repair for a defective
hearing aid. The case of a distraught individual
who killed her father after having her speech,
hearing, and academic status evaluated was
also included in this category.
9.Sexual Harassment (3 claims). Claims involv-
ing harassment by employers and misconduct
toward clients comprised this category.
10. Property Damage (3 claims). These claims in-
volved property damage by fire or water.
11. Failure to Provide Sufficient Information (2
claims). One client claimed that warning of
medical risks was not provided. The other claim
involved an ex-employer who tested HIV posi-
tive.
12. Intraoperative Monitoring (1 claim). The larg-
est claim (more than $1,000,000) was paid be-
cause of the examiner’s “failure to advise the
surgeon.” This occurred during an intraopera-
tive procedure wherein an audiologist was
monitoring somatosensory function.
13. False Guarantee of Results (1 claim). This claim
was made because the clinician falsely claimed
that the client’s stuttering would be cured in 2
days.
14. Other (4 claims). One case involved mistaken
identity; another was due to announcing a
death of the wrong person; the third involved
an unspecified criminal/fraudulent act; the
fourth involved a fatality and the subpoena of
the insured to serve as an expert witness.
Table 3 illustrates the number of claims by category and year. These ranged from an all-time low of 4 in 1986 to a high of 26 in 1992. Since the number of claims per year fluctuates widely, it may be more meaningful
to note trends over 5-year periods. The average num-ber of cases from 1983 through 1987, and 1988 to 1992,were 11 and 12 per year, respectively. Thus, the aver-age number of claims per year has remained relatively stable over the past 10 years. Table 4 is a summary of the total dollars paid for claims from January 1982through June 1993 for each general category. These amounts ranged from $0 for sexual harassment/mis-conduct to $1,025,392 for intraoperative monitoring.It should be noted that this latter amount was paid for a single claim.
Information regarding the number of claims per discipline and the settings where incidents leading to claims took place was available for 89 of the above cases. These data are presented in Tables 5 and 6, re-spectively. As shown in Table 5, claims filed against audiologists were almost three times more prevalent than claims filed against speech-language patholo-gists. The most common setting where incidents lead-ing to claims occurred was an “office” (Table 6).
IV. Standard of Care
Risk occurs when a person who has advanced knowledge, training, or skill does not exercise the stan-dard of care that would be exercised by the reasonable professional of like training and experience in similar circumstances. A professional standard of care tradi-tionally is established by:
1.Publications of professional associations ?Scope of Practice ?Code of Ethics
?Preferred Practice Patterns ?
Guidelines
?Position Statements
? Reports
2.State licensure laws
Local practices (training and skills of other pro-fessionals in a similar locality) may be considered in some cases. However, with the development of mod-ern communication techniques, this now has less in-fluence on the determination of accepted standard of care than in earlier years.
A. Scope of Practice Statements
ASHA has adopted a scope of practice statement that (a) informs ASHA members and certificate hold-ers of the activities for which certification in the ap-propriate area is required in accordance with the ASHA Code of Ethics, and (b) educates health care and educational professionals, consumers, and members of the general public about the services offered by au-diologists and speech-language pathologists as quali-fied providers (ASHA, 1990b). From a risk-manage-ment perspective, it is critical for clinicians to be knowledgeable about the range of services outlined in the scope of practice and any additional policies that expand the scope, such as advanced areas recently recognized within the scope of the professions (ASHA, 1992a).
B. Code of Ethics
Members of the Association should also be famil-iar with the ASHA Code of Ethics, which was devel-oped by the members of the Association for the mem-bers. Specifically, with regard to the interrelationship of the scope of practice definition and the ASHA Code of Ethics, the practitioner must adhere to Principle of Ethics II, which states that “individuals shall engage in only those aspects of the professions that are within the scope of their competence, considering their level of education, training, and experience” (ASHA, 1993e).
C. Preferred Practice Patterns
In 1993, ASHA adopted the Preferred Practice Patterns for the Professions of Speech-Language Pa-thology and Audiology (ASHA, 1993j). The preferred practice patterns were developed as a guide for speech-language pathologists and audiologists and as an educational tool for other professionals, members of the general public, consumers, administrators, regu-lators, and third-party payors. These patterns define universally applicable characteristics of activities di-rected toward individual clients that address structural requisites of the practice, processes to be carried out, and expected outcomes. They provide a broad concep-tual framework within which specific guidelines of practice apply.D. Policy Guidelines, Position Statements, and Re-ports
Historically, ASHA has had a committee structure to develop policy guidelines, position statements, and reports that outline suggested “best practice” param-eters. These policies may include protocols that sum-marize and reflect the state of the art in a particular area of practice, competencies for performing specific procedures, and cautions in the conduct of particular procedures. In litigation, “best practice” guidelines are often interpreted to represent a standard of practice. Guidelines, dynamic documents that are everchanging and require periodic updating based on evolving tech-nologies and research findings, are useful to practitio-ners for comparing routine practice methods to those suggested by peers and experts in specific practice ar-eas.
See the Appendix for a complete list of ASHA documents pertaining to standard of care. A compen-dium of ASHA policies is available that includes all current policies, reports, and tutorials relevant to the practice of audiology and speech-language pathology (ASHA, 1992b).
V. Risk Management Strategies
The objective of risk management is to protect the financial assets of the health care practitioner or insti-tution by eliminating or reducing losses resulting from claims and lawsuits. By eliminating or reducing those situations that give rise to claims or lawsuits, the prac-titioner also protects customers of service. In this way, risk management and quality improvement are inter-related. Quality improvement concentrates on main-taining optimal levels of client care; risk management focuses on meeting acceptable levels of care from a le-gal perspective.
The Joint Commission of Accreditation of Healthcare Organizations (JCAHO) requires, as a stan-dard of accreditation, that the risk management and quality improvement functions within the institution be closely integrated. JCAHO defines risk management as the “clinical and administrative activities that hos-pitals undertake to identify, evaluate, and reduce the risk of injury and loss to clients, personnel, visitors, and the institution itself. Standards are applied to evaluate a hospital’s performance in conducting risk management activities designed to identify, evaluate, and reduce the risks of client injury associated with care and services” (Joint Commission on Accreditation of Healthcare Organizations, 1993).
Five steps in a risk management program are:
?identification of pure risks;
?analysis of those risks in terms of probable loss, frequency, and severity;
?development of alternative risk control and risk financing techniques and choice of the proper
technique or combination thereof;
?improvement of chosen techniques; and
?monitoring the program’s effectiveness and modifying it as risks change over time.
The individual practitioner can obtain maximum protection by reviewing potential areas of litigation, taking those steps necessary to reduce risks, and es-tablishing a defensible record in the event that litiga-tion does ensue. The four basic approaches to dealing with risks include risk avoidance, risk retention, risk transfer, and risk reduction.
Risk avoidance—refers to withdrawal from an ac-tivity (e.g., refrain from cerumen management).
This approach should be followed when the
professional lacks proper training or access to
appropriate equipment.
Risk retention—refers to self-insurance, in which case an entity has the financial reserves to pay
for any claims against it. This is usually accom-
plished by larger companies or corporations.
Risk transfer—refers to the purchase of insurance through an insurance agent, broker, or directly
from an underwriting insurance company.
Since defending oneself in a professional liabil-
ity action can be costly, and since an unsatis-
factory outcome is a possibility, it is incumbent
on the prudent practitioner to obtain adequate
liability insurance coverage.
Some professional associations, like ASHA, offer liability insurance as a member benefit. Some members purchase professional liability insurance from the Association’s program; other members may obtain coverage from separate carriers or are covered by vari-ous forms of employer-provided insurance. Some members may remain uncovered.
Insurance policies fall into two basic categories:“occurrence” insurance or “claims made” insurance. Occurrence insurance covers incidents for injuries re-sulting from activities carried out during the policy period, regardless of when claims are filed. This is the type of insurance offered through ASHA to its mem-bers. Claims-made insurance provides coverage only for the claims made and reported during the policy period. Because the statute of limitations for filing per-sonal liability claims may extend for many years after the evaluation or treatment was performed, profession-als should determine carefully the type of coverage that is purchased privately, provided by employers, or purchased by employees.
Risk reduction—refers to the development of preven-tion programs and conformance with specific
preventive techniques. This preventive ap-
proach is the focal point of the general strate-
gies for audiologists and speech-language pa-
thologists listed below. For clarification, these
strategies are categorized into six areas:
1. Awareness and Education of Practitioner
?Identify potential risks.
?Eliminate or reduce risks by providing an ac-cepted standard of care.
?Practice within the scope of your professional competence, license, and certification.
?Use only licensed or registered titles.
?Stay current with developments in your profes-sion.
?Keep abreast of evolving standards of practice.
?Maintain professional competence through continuing education.
?Know state licensing laws.
?Know applicable codes of ethics.
?Know relevant scopes of practice.
?Know and use current preferred practice pat-terns, guidelines, and position statements.
?Know clients’ Bill of Rights.
?Use only equipment or test materials with which you are trained or knowledgeable.
?Refer when you do not possess the knowledge, expertise, and credentials to provide a needed
service.
?Be certain of licensure, certification, and other qualifications of all persons to whom referrals
are made, as well as those of employers or em-
ployees.
?Know and use the policies and procedures of the hospital or organizations with which you
are employed.
2. Effective Communication
?Establish a positive relationship with clients.
?Be a good listener.
?Explain test results, treatment goals, treatment plans, and procedures, as well as realistic out-
comes.
?Take time to explain answers in lay terms.
?Avoid making statements that mislead clients into unreasonable expectations.
?Address both benefits and limitations of prod-ucts or treatment.
?Encourage observation of procedures by caregivers.
?Make full disclosure of fees, billing schedules, and arrangements for missed sessions before
treatment begins or equipment is dispensed.
?Provide written warranties and disclaimers of guarantees.
?Provide written warnings.
?Secure signature of client, caregiver, or signifi-cant other to acknowledge information trans-
fer and indicate understanding of written warn-
ings, warranties, and disclaimer of guarantees.
?Avoid criticizing colleagues in the presence of your clients.
3. Documentation—Record Keeping and Reporting
?Be aware that the care with which documents are kept will reflect the quality of care clients re-
ceive, and that these documents may be subpoe-
naed.
?Make all entries accurate, thorough, and legible.
?When corrections are necessary:
— Never “white out” or obliterate;
— Draw a line through incorrect information;
— Initial and date the correction; and
— Note why correction was necessary.
?Document all personal and telephone contacts with client and family.
?Keep copies of all correspondence with or about the client.
?Document all contacts with other professionals regarding the client.
?Document failure to show, cancellation, or re-scheduling of appointments.
?Document noncompliant behavior by describ-ing behavior that leads to that opinion, rather
than making judgmental or opinionated state-
ments.
?Document limitations of treatment process.
?Document recommendations.
?If team recommendations differ from your own, document your own recommendations and
state rationale and conclusions.
?Keep records of all dispensed products.
?Keep records of equipment maintenance and calibration.
?Document warnings of dangers of products.
?Document informed consent for evaluation and treatment procedures.
?Document consent for dispensing or receiving client information.
?Document when and where all client informa-tion was sent.
4. Confidentiality
?Release to a specific entity only information that was requested in writing.
?Obtain a signed and witnessed release.
?Know who is authorized to view or receive records by awareness of:
— state regulations;
— policies and procedures of hospitals or or-ganizations with which you are affiliated;
— the client’s rights of access to records;
— provider’s right of reasonable restrictions on access:
?Document does not have to be provided at any time or any place requested by the client, but
must be provided at a mutually agreed-on time
and place;
?Provider may need to be available to explain or interpret information; and
?Provider can charge reasonable fees for copies.
?Use fax or other forms of electronic mail cau-tiously to prevent disclosure to unauthorized
individuals.
5. Informed Consent
?Obtain informed consent for evaluation and treatment procedures.
?Inform the client of the following elements to obtain a valid informed consent:
— nature of ailment, proposed treatment, risk, consequences of treatment;
— probability of success;
— treatment alternatives; and
— prognosis.
?Determine who has the authority to sign an informed consent by securing knowledge of:
— state laws for determining minor status;
— state and local laws for determining legal guardian for minors in the absence of a par-
ent; and
— policies and procedures of the hospital or organization with which you are affiliated.
?Treat minors only when accompanied by a par-ent or guardian or when written permission
has been obtained to treat in their absence. 6. Client Safety—Make sure physical environment is free of hazards.
?Structure activities to reduce client injury.
?Follow universal infection control procedures.
?Ensure the availability of emergency services based on evaluation and treatment risks. IV. Illustrations of Risk Management Strategies
Examples of related risk-management strategies are outlined here to provide sample approaches to handling practice risk. For purposes of this report, sig-nificant ASHA policies and related documents are listed below for several areas of practice. The develop-ment of risk management strategies may be procedure-, disorder-, population-, and/or setting-specific. These suggestions are not intended to be all-inclusive, but are offered to stimulate thinking about approaches to risk management.
1. Hearing Aid Selection, Fitting, and Dispensing (Procedure-Specific)
a.Associated Policies
?Vanderbilt/VA Hearing Aid Conference 1990 Consensus Statement (Hawkins et al.,
1991)
?Amplification as a Remediation Technique for Children with Normal Peripheral Hear-
ing (ASHA, 1991a)
?Definition of and Competencies for Aural Re-habilitation (ASHA, 1984)
?Hearing Aid Fitting (ASHA, 1993f)
?Assistive Listening System/Device Selection (ASHA, 1993a)
?Aural Rehabilitation Assessment (ASHA, 1993d)
?Product Dispensing (ASHA, 1993k)
b.Related Risk Management Strategies May In-
clude:
?Assessing status of external and middle ear structures prior to and immediately follow-
ing preparation of an earmold impression ?Obtaining a “hold harmless” agreement with manufacturers of hearing aids and
assistive listening devices that are evaluated
and dispensed in order to prevent practitio-
ner liability for “defective” products
?Advising clients about specific risks from possible battery ingestion and providing
written instructions signed by practitioner
and client
?Developing a checklist of related regulations
(e.g., Food and Drug Administration, state li-
censure requirements) and steps for compli-
ance for each client record
2. Intraoperative Monitoring (Procedure-Specific)
a.Associated Policies
?Neurophysiologic Intraoperative Monitor-ing (ASHA, 1992c; 1993g)
?AIDS/HIV: Implications for Speech-Lan-guage Pathologists and Audiologists
(ASHA, 1990a)
b.Related Risk Management Strategies May In-
clude:
?Obtaining written orders from the attending physician for evaluation and treatment ser-
vices to the client
?Following universal precautions to prevent the risk of disease from blood- and/or air-
borne pathogens
?Following infection control policies for ma-terials and equipment
?Ascertaining that the informed consent of the client has been obtained for your services 3. External Auditory Canal Examination and Ceru-men Management (Procedure-Specific)
a.Associated Policies
?External Auditory Canal Examination and Cerumen Management (ASHA, 1992d)?Cerumen Management Policy and Practice -
A Continued Discussion on Two Fronts
(ASHA, 1993c)
?AIDS/HIV: Implications for Speech-Lan-guage Pathologists and Audiologists
(ASHA, 1990a)
b.Related Risk Management Strategies May In-
clude:
?Obtaining case history and inspecting ear canals to rule out signs of acute disease that
contraindicate performing specific proce-
dures
?Checking medical policy, institution insur-ance coverage, and delineation of practice
privileges for the specific institution to en-
sure that there are no restrictions applicable
to an audiologist performing these proce-
dures, and becoming formally privileged if
hospital or medical center has a mechanism
to do this
?Following universal precautions to prevent the risk of disease from blood- or air-borne
pathogens
?Having a specific contact and procedure for medical emergencies posted in a visible lo-
cation
?Maintaining complete documentation of in-formed consent
4. Dysphagia Evaluation and Treatment (Disorder-Specific)
a.Associated Policies
?Swallowing Screening (ASHA, 1993n)
?Swallowing Function Assessment (ASHA, 19931)
?Swallowing Function Treatment (ASHA, 1993m)
?Instrumental Diagnostic Procedures for Swallowing (ASHA, 1992e)
?Sedation and Topical Anesthetics in Audi-ology and Speech-Language Pathology
(ASHA, 1992f)
?Knowledge and Skills Needed by Speech-Language Pathologists Providing Services to
Dysphagic Patients/Clients (ASHA, 1990c)?Ad Hoc Committee on Dysphasia Report (ASHA, 1987)
?Dysphagia position statements of state speech-language-hearing associations
b.Related Risk Management Strategies May In-
clude:
?Obtaining written orders from the attending physician for evaluation and treatment ser-
vices to the client
?Checking the medical policy of the institu-tion, as well as institution and self-insurance
coverage, for use of diagnostic instrumenta-
tion
?Advising clients about the possibility of spe-cific risks in the use of instruments in the
evaluation process and during treatment ?Documenting informed consent of client and/or family for evaluation with instru-
ments
?Following guidelines for specific instrumen-tal diagnostic procedures and materials, in-
cluding application of topical anesthetics (to
be performed with a physician) and the use
of associated suspension materials during
videographic assessments
?Designating specific contact persons and procedures for handling of medical emergen-
cies posted in a visible location
?Documenting instruction of direct caregivers in swallowing strategies and supervision of
client eating
?Ensuring availability of emergency services
5. Pediatric Audiologic Testing (Population-Specific)
a.Associated Policies
?Sedation and Topical Anesthetics in Audi-ology and Speech-Language Pathology
(ASHA, 1992f)
?Joint Committee on Infant Hearing 1993 Po-sition Statement (in progress)
?Guidelines for the Audiologic Assessment of Children from Birth through 36 Months of
Age (ASHA, 1991c)
?Pediatric Audiologic Assessment (ASHA, 1993h)
?Auditory Evoked Potential Assessment (ASHA, 1993b)
b.Related Risk Management Strategies May In-
clude:
?Parent/caregiver observation/collaboration
?Documenting recommendations and compli-ance with recommendations
?Documenting attempts at recall efforts
?Maintaining a hard copy of recommenda-tions, signed and dated by parent/caregiver
when possible
6. Speech-Language Services to Geriatric Clients (Population-Specific)
a.Associated Policies
?Guidelines for the Delivery of Speech-Lan-guage Pathology and Audiology Services in
Home Care (ASHA, 1991d)
?Roles of Speech-Language Pathologists and Audiologists in Working with Older Persons
(ASHA, 1988b)
?Provision of Audiology and Speech-Lan-guage Pathology Services to Older Persons
in Nursing Homes (ASHA, 1988a)
?Conditions of Participation for Skilled Nurs-ing Facilities (Office of the Federal Register,
1985)
b.Related Risk Management Strategies May In-
clude:
?Obtaining written orders from the attending physician for evaluation and treatment ser-
vices to the client within hospital, skilled
nursing home, or home health care agency
for Medicare, Medicaid, and other insurance
reimbursement
?Discussing the treatment plan with the fam-ily in lay terms to determine treatment ration-
ales that are congruent with the client and
family needs and environment to achieve the
highest level of compliance
?Providing treatment at level of client’s cog-nition
?Securing safe and adequate space and equip-ment for evaluation and therapeutic sessions
with client
?Limiting the use of invasive oral-motor pro-cedures in treatment to secure the trust of the
client
?Maintaining current documentation for each home health care treatment session
?Obtaining written consent from client or fam-ily for their decision to withdraw treatment
from the client and documenting reasons for
their decision
7. Infection Control in School Setting (Setting-Specific)
a.Associated Policies
?Chronic Communicable Diseases and Risk Management in the Schools (ASHA, 1991b)?AIDS/HIV: Implications for Speech-Lan-guage Pathologists and Audiologists
(ASHA, 1990a)
?Preamble to Preferred Practice Patterns for the Professions of Speech-Language Pathol-
ogy and Audiology (ASHA, 1993i)
b.Related Risk-Management Strategies May
Include:
?Following universal precautions to prevent the risk of diseases from blood- and/or air-
borne pathogens
?Checking medical history in student’s records
?Checking federal, state, and local laws and regulations regarding the provision of ser-
vices to children with communicable dis-
eases
?Complying with ASHA Code of Ethics re-garding confidentiality of a client’s medical
diagnosis and refusal to treat
?Referring questions regarding legal issues or confidentiality to local public health depart-
ments, ASHA’s National Office, state attor-
ney generals’ offices, or state speech-lan-
guage-hearing associations
?Following the infection control policies and procedures of local and state education agen-
cies
?Working to establish school district policy on risk management
?Informing parents of procedures and policies
VII. Recommendations
The Ad Hoc Committee on Professional Liability and Risk Management recommends that ASHA’s fu-ture involvement in risk management include:?The development of a data collection system of complaints at state and national levels. This
would require the cooperation of State Licen-
sure Boards and ASHA’s Ethical Practice Board;
?The development of an ongoing data collection system of claims statistics from insurance com-
panies that cover both professions of speech-
language pathology and audiology;
?The establishment of a committee with continu-ing status to develop a survey instrument for
data collection and to:
1. report circumstances surrounding profes-
sional liability cases and the reasons defen-
dants won or lost,
2.monitor and report trends,
3.advise on risk-management guidelines and
approaches, and
4.monitor tort and health care reform;
?The provision of continuing education for members by identifying “high risk” areas of
practice; and
?The encouragement of graduate programs to include professional liability and management
for all future practitioners and program admin-
istrators.
References
American Speech-Language-Hearing Association (1984).
Competencies for aural rehabilitation. Asha, 26(5), 37-
41.
American Speech-Language-Hearing Association (1987).
Ad hoc committee on dysphagia report. Asha, 29(4), 57-
58.
American Speech-Language-Hearing Association (1988a), Provision of audiology and speech-language pathology services to older persons in nursing homes. Asha, 30(3), 72-74.
American Speech-Language-Hearing Association (1988b).
The roles of speech-language pathologists and audiolo-gists in working with older persons. Asha, 30(3), 80-84. American Speech-Language-Hearing Association (1990a).
AIDS/HIV: Implications for speech-language patholo-gists and audiologists. Asha, 32(12), 46-48.
American Speech-Language-Hearing Association (1990b).
Scope of practice. Asha, 32(Suppl. 2), 1-2.
American Speech-Language-Hearing Association (1990c).
Knowledge and skills needed by speech-language pa-thologists providing services to dysphagic patients/cli-ents. Asha, 32(Suppl. 2), 7-12.
American Speech-Language-Hearing Association (1991a).
Amplification as a remediation technique for children with normal peripheral hearing. Asha, 33(Suppl. 3), 22-
24.
American Speech-Language-Hearing Association (1991b), Chronic communicable diseases and risk management in the schools. Language-Speech-Hearing Services in the Schools, 22(1), 345-352.
American Speech-Language-Hearing Association (1991c).
Guidelines for audiologic assessment of children from birth-36 months of age. Asha, 33 (Suppl. 5), 37-43. American Speech-Language-Hearing Association (1991d).
Guidelines for the delivery of speech-language pathol-ogy and audiology services in home care. Asha, 33(Suppl. 5), 29-34.
American Speech-Language-Hearing Association (1992a).
Guidelines for meeting the communication needs of persons with severe disabilities. Asha, 34(Suppl. 7), 1-46. American Speech-Language-Hearing Association (1992b).
Asha Professional Practices Desk Reference. (Available from American Speech-Language-Hearing Association, 10801 Rockville Pike, Rockville, MD, 20852).
American Speech-Language-Hearing Association (1992c).
Neurophysiologic intraoperative monitoring. Asha, 34(Suppl. 7), 34-36.
American Speech-Language-Hearing Association (1992d).
External auditory canal examination and cerumen man-agement. Asha, 34(Suppl. 7), 22-24.
American Speech-Language-Hearing Association (1992e).
Instrumental diagnostic procedures for swallowing.
Asha, 34(Suppl. 7), 25-33.
American Speech-Language-Hearing Association (1992f).
Sedation and topical anesthetics in audiology and speech-language pathology. Asha, 34 (Suppl. 7), 41-46.American Speech-Language-Hearing Association (1993a).
Assistive listening system/device selection. Asha, 35(Suppl. 11), 49—50.
American Speech-Language-Hearing Association (1993b).
Auditory evoked potential assessments. Asha, 35(Suppl.
11), 40-44.
American Speech-Language-Hearing Association (1993c).
Cerumen management policy and practice - a contin-ued discussion on two fronts. Audiology Update, 12(1 ), 3.
American Speech-Language-Hearing Association (1993d).
Aural rehabilitation assessment. Asha, 35(Suppl. 11), 21-
22.
American Speech-Language-Hearing Association (1993e).
Code of ethics of the American Speech-Language-Hear-ing Association. Asha, 35(3), 17.
American Speech-Language-Hearing Association (1993t).
Hearing aid fitting/orientation. Asha, 35(Suppl. 11), 53-
54.
American Speech-Language-Hearing Association (1993g).
Neurophysiologic intraoperative monitoring. Asha, 35(Suppl. 11), 42-43.
American Speech-Language-Hearing Association (1993h).
Pediatric audiology assessment. Asha, 35(Suppl. 11), 32-
34.
American Speech-Language-Hearing Association (1993i).
Preamble to preferred practice patterns for the profes-sions of speech-language pathology and audiology.
Asha, 35(Suppl. 11), iii.
American Speech-Language-Hearing Association (1993j).
Preferred practice patterns for the professions of speech-language pathology and audiology. Asha, 35(Suppl. 11), 1-102.
American Speech-Language-Hearing Association (1993k).
Product dispensing. Asha, 35(Suppl. 11), 25-26. American Speech-Language-Hearing Association (19931).
Swallowing function assessment. Asha, 35(Suppl. 11), 73-
74.
American Speech-Language-Hearing Association (1993m).
Swallowing function treatment. Asha, 35(Suppl. 11), 85-
86.
American Speech-Language-Hearing Association (1993n).
Swallowing screening. Asha, 35(Suppl. 11), 11-12. Graff, L. (1992). Speech-language pathologists and audiolo-gists: Professional liability. Poster session presented at the 1992 annual Convention of the American Speech-Language-Hearing Association, San Antonio. Hawkins, D., Beck, L., Bratt, G., Fabry, D., Mueller, H., & Stelmachowicz, P. (1991). Vanderbilt-VA hearing aid conference 1990 consensus statement. Asha, 33(4), 37-
38.
Joint Commission on Accreditation of Healthcare Organi-zations. (1993). 1994 accreditation manual for hospitals (1, p. 278). Oakbrook Terrace, IL: Author.
Joint Committee on Infant Hearing. (In progress). Joint com-mittee on infant hearing 1993 position statement.
Kooper, R. & Sullivan, C. (1986). Professional liability: Management and prevention. In K. Butler (Ed.), Pros-pering in private practice (pp. 59-80). Gaithersburg, MD: Aspen.
Miller, T. (1983). Professional liability in speech-language pathology and audiology: Unprofessional conduct and unethical practice. Doctoral dissertation: State Univer-sity of New York at Buffalo.
Miller, T. & Lubinski, R. (1986). Professional liability in speech-language pathology and audiology. Asha, 28(6), 45-47.Muraski, A. (1982). Legal aspects of audiological practice.
In M. B. Kramer & J. Armbruster (Eds.), Forensic audiol-ogy (p. 14). Baltimore: University Park Press.
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Government Printing Office.
Appendix
Scope of Practice,Asha, March 1990 (Suppl. 2), pp. 1-2 Code of Ethics, Asha, March 1994 (Suppl. 13), pp.
Position Statements
Audiology
Balance System Assessment, Asha, March 1992 (Suppl. 7), pp. 9-12
Electrical Stimulation for Cochlear Implant Selection and Rehabilitation, Asha, March 1992 (Suppl. 7), pp. 13-16 External Auditory Canal Examination and Cerumen Man-agement, Asha, March 1992 (Suppl. 7), pp. 22-24 Neurophysiologic Intraoperative Monitoring, Asha, March 1992 (Suppl. 7), pp. 34-36
The Audiologist’s Role in Occupational Hearing Conser-vation, Asha, April 1985, pp. 41-45
Speech-Language Pathology
Position Statement and Guidelines for Oral and Oropha-ryngeal Prostheses, Asha, March 1993 (Suppl. 10), p. 14 Position Statement and Guidelines for the Use of Voice Prostheses in Tracheotomized Persons With or With-out Ventilatory Dependence, Asha, March 1993 (Suppl.
10), p. 17
Evaluation and Treatment for Tracheoesophageal Fistuli-zation Puncture, Asha, March 1992 (Suppl. 7), pp. 17-21 Instrumental Diagnostic Procedures for Swallowing, Asha, March 1992 (Suppl. 7), pp. 25-33
Vocal Tract Visualization and Imaging, Asha, March 1992 (Suppl. 7), pp. 31-40
The Role of the Speech-Language Pathologist in Assess-ment and Management of Oral Myofunctional Disor-ders, Asha, March 1991 (Suppl. 5), p. 7 Augmentative and Alternative Communication, Asha, March 1991 (Suppl. 5), p. 8
The Role of Speech-Language Pathologists in Service De-livery to Infants, Toddlers, and their Families, Asha, April 1990 (Suppl. 2), p. 4Knowledge and Skills Needed by Speech-Language Pa-thologists Providing Services to Dysphagic Patients/ Clients, Asha, April 1990 (Suppl. 2), pp. 7-12
Delivery of Speech-Language Pathology Services in Home Care, Asha, March 1988, pp. 77-79
The Role of Speech-Language Pathologists in the Identifi-cation, Diagnosis and Treatment of Individuals With Cognitive-Communicative Impairments, Asha, March 1988, p. 79
Language Learning Disorders (Statement of the American Speech-Language-Hearing Association and the Na-tional Association of School Psychologists), Asha, March 1987, pp. 55-56
Clinical Management of Communicatively Handicapped Minority Language Populations, Asha, June 1985, pp. 29-32
Social Dialects (and Implications), Asha, September 1983, pp.
23-27
Language Learning Disorders, Asha, November 1982, pp.
937-944
Position Statement on Nonspeech Communication, Asha, August 1981, pp. 577-581
Tongue Thrust, Asha, May 1975, pp. 331-337
Both Professions
Position Statement on National Health Policy, Asha, March 1993 (Suppl. 10), p. 1
Professional Performance Appraisal by Individuals Outside the Professions of Speech-Language Pathology and Audiology, Asha, March 1993 (Suppl. 10), p. 11 Preferred Practice Patterns for the Professions of Speech-Language Pathology and Audiology, Asha, March 1993 (Suppl. 1), pp. 1-110
Providing Appropriate Education for Students with Learn-ing Disabilities in Regular Education Classrooms, Asha, March 1991 (Suppl. 5), pp, 15-17
The Need for Subject Descriptors in Learning Disabilities Research: Preschool Through High School Years, Asha, March 1991 (Suppl. 5), pp. 13-14
Learning Disabilities: Issues on Definition, Asha, March 1991 (Suppl. 5), pp. 18-20
Scope of Practice, Speech-Language Pathology and Audi-ology, Asha, April 1990 (Suppl. 2), pp. 1-2
The Role of Speech-Language Pathologists and Audiolo-gists in Service Delivery for Persons with Mental Retar-dation and Developmental Disabilities in Community Settings, Asha, April 1990 (Suppl. 2), pp. 5-6 Interdisciplinary Approaches to Brain Damage, Asha, April 1990 (Suppl. 2), p. 3
Issues in Learning Disabilities: Assessment and Diagnosis, Asha, March 1989, pp. 111-112
The Delivery of Speech-Language Pathology and Audiol-ogy Services in Home Care, Asha, March 1988, pp.
77-79
Prevention of Communication Disorders, Asha, March 1988, p. 90
The Roles of Speech-Language Pathologists and Audiolo-gists in Working With Older Persons, Asha, March 1988, pp. 80-83
Learning Disabilities and the Preschool Child, Asha, May 1987, pp. 35-38
Clinical Supervision in Speech-Language Pathology and Audiology, Asha, June 1985, pp. 57-60
Adults with Learning Disabilities: A Call to Action, Asha, December 1985, pp. 39-41
Learning Disabilities: Issues in the Preparation of Profes-sional Personnel, Asha, September 1985, pp. 49-51 Competencies for Aural Rehabilitation, Asha, May 1984, pp.
37-41
Issues in the Delivery of Services to Individuals with Learn-ing Disabilities, Asha, November 1983, pp. 43-45
In-Service Programs in Learning Disabilities, Asha, Novem-ber 1983, pp. 47-49
Serving the Communicatively Handicapped Mentally Re-tarded Individual, Asha, August 1982, pp. 547-553 The Role of the Speech-Language Pathologist and Audi-ologist in Learning Disabilities, Asha, December 1979, p.
1015
Learning Disabilities, Asha, May 1976, pp. 282-290
The Role of the Speech-Language Pathologist and Audi-ologist in Meeting the Needs of Children and Adults with Disorders of Language, Asha, April 1975, pp. 273-278 Guidelines
Audiology
Guidelines for Audiology Services in the Schools, Asha, March 993 (Suppl. 10), pp. 24-32
Balance System Assessment, Asha, March 1992 (Suppl. 7), pp. 9-12
Electrical Stimulation for Cochlear Implant Selection and Rehabilitation, Asha, March 1992 (Suppl. 7), pp. 13-16 External Auditory Canal Examination and Cerumen Man-agement, Asha, March 1992 (Suppl. 7), pp. 22-24 Neurophysiologic Intraoperative Monitoring, Asha, March 1992 (Suppl 7), pp. 34-36Guidelines for Graduate Education in Amplification, Asha, March 1991 (Suppl. 5), pp. 35-36
Guidelines for Audiologic Assessment of Children from Birth-36 Months of Age, Asha, March 1991 (Suppl. 5), pp.
37-43
Competencies in Auditory Evoked Potential Measurement and Clinical Application, Asha, April 1990 (Suppl. 2), pp.
13-16
Guidelines for Screening for Hearing Impairments and Middle Ear Disorders, Asha, April 1990 (Suppl. 2), pp. 17-24
Guidelines for Audiometric Symbols, Asha, April 1990 (Suppl. 2), pp. 25-30
Audiologic Screening of Newborn Infants Who Are at Risk for Hearing Impairment, Asha, March 1989, pp. 89-92 Guidelines for Determining Threshold Level for Speech, Asha, March 1988, pp. 85-89
Identification Audiometry, Asha, May 1985, pp. 49-52 Speech-Language Pathology
Guidelines for Caseload Size and Speech-Language Service Delivery in the Schools, Asha, March 1993 (Suppl. 10), pp. 33-39
Definitions of Communication Disorders and Variations, Asha, March 1993 (Suppl. 10), pp. 40-41
Orofacial Myofunctional Disorders: Knowledge and Skills, Asha, March 1993 (Suppl 10), pp. 21-23
Position Statement and Guidelines for Oral and Oropha-ryngeal Prostheses, Asha, March 1993 (Suppl. 10), pp.
14-16
Position Statement and Guidelines for the Use of Voice Prostheses in Tracheotomized Persons With or With-out Ventilatory Dependence, Asha, March 1993 (Suppl.
10), pp. 17-20
Vocal Tract Visualization and Imaging, Asha, March 1992 (Suppl. 7), pp. 31-40
Evaluation and Treatment for Tracheoesophageal Fistuli-zation Puncture, Asha, March 1992 (Suppl. 7), pp. 17-21 Instrumental Diagnostic Procedures for Swallowing, Asha, March 1992 (Suppl. 7), pp. 25-33
Guidelines for Speech-Language Pathologists Serving Per-sons With Language, Socio-Communicative and/or Cognitive-Communicative Impairments, Asha, March 1991 (Suppl. 5), pp. 21-28
Caseload Size for Speech-Language Services in the Schools, Asha, April 1984, pp. 53-58
Both Professions
Guidelines for Gender Equality in Language Use, Asha, March 1993 (Suppl. 10), pp. 42-46
Guidelines for Meeting the Communicative Needs of Per-sons with Severe Disabilities, Asha, March 1992 (Suppl.
7), pp. 1-6
Suggested Competencies for Effective Clinical Supervision, Asha, December 1982, pp. 1021-1023
Guidelines for the Delivery of Speech-Language Pathology and Audiology Services in Home Care, Asha, March 1991 (Suppl. 5), pp. 29-34
Mental Retardation and Development Disabilities Curricu-lum Guide, Asha, March 1989, pp. 94-96 Employment and Utilization of Supportive Personnel in Audiology and Speech-Language Pathology, Asha, March 1981, pp. 165-169 (see “Utilization and Employ-ment of Speech-Language Pathology Supportive Per-sonnel With Underserved Populations” pp. IV-11 la) Preferred Practice Patterns
Asha, March 1993 (Suppl. 11), pp. 1-98
Audiology
Basic Audiologic Assessment, pp. 29-31
Pediatric Audiologic Assessment, pp. 32-34 Comprehensive Audiologic Assessment, pp. 35-37 Electrodiagnostic Test Procedures, pp. 38-39
Auditory Evoked Potential Assessment, pp. 40-41 Neurophysiologic Intraoperative Monitoring, pp. 42-44 Balance System Assessment, pp. 45-46
Hearing Aid Assessment, pp. 47-48
Assistive Listening System/Device Selection, pp. 49-50 Sensory Aids Assessment, pp. 51-52
Hearing Aid Fitting/Orientation, pp. 53-54 Occupational Hearing Conservation, pp. 55-56
Speech-Language Pathology
Swallowing Screening, pp. 11-12
Spoken Language Assessment, pp. 57-58
Written Language Assessment, pp. 59-60 Augmentative and Alternative Communication (AAC) Assessment, pp. 61-62
Cognitive-Communication Assessment, pp. 63-64 Articulation/Phonology Assessment, pp. 65-66
Fluency Assessment, pp. 67-68
Voice Assessment, pp. 69-70
Resonance and Nasal Airflow Assessment, pp. 71-72 Swallowing Function Assessment, pp. 73-74
Orofacial Myofunctional Assessment, pp. 75-76 Comprehensive Speech-Language Pathology Assessment, pp. 77-78
Prosthetic/Adaptive Device Assessment, pp. 79-81 Speech-Language Pathology Treatment, pp. 83-84 Swallowing Function Treatment, pp. 85-86 Augmentative and Alternative Communication (AAC) System Fitting/Orientation, pp. 87-88
Prosthetic/Adaptive Device Fitting/Orientation, pp. 89-90 Orofacial Myofunctional Treatment, pp. 91-92
Speech-Language Instruction, pp. 93-94 Communication Instruction, pp. 95-96
Both Professions
Hearing Screening, pp. 5-6
Speech, pp. 7-6
Language Screening, pp. 9-10
Follow-up Procedures, pp. 13-14Consultation, pp. 15-16
Prevention, pp. 17-18
Counseling, pp. 19-20
Aural Rehabilitation Assessment, pp. 21-22
Aural Rehabilitation, pp. 23-24
Product Dispensing, pp. 25-26
Product Repair/Modification, pp. 27-28
Reports
Audiology
Survey of States’ Workers’ Compensation Practices for Occupational Hearing Loss, Asha, March 1992 (Suppl. 8), pp. 1-6
Amplification as a Remediation Technique for Children with Normal Peripheral Hearing, Asha, January 1991 (Suppl.
3), pp. 22-24
Telephone Hearing Screening, Asha, November 1988, p. 53 Calibration of Speech Signals Delivered via Earphones, Asha, June 1987, pp. 44—48
Brainstorm Audiometry of Infants, Asha, January 1987, pp.
47-55
Tinnitus Maskers: Report of the Committee on Amplifica-tion for the Hearing-Impaired, Asha, October 1980, pp.
892-693
Speech-Language Pathology
Role of the Speech-Language Pathologist and Teacher of Singing in Remediation of Singers with Voice Dis- or-ders, Asha, January 1993, p. 63
Augmentative and Alternative Communication, Asha, March 1991 (Suppl. 5), pp. 9-12
A Model for Collaborative Service Delivery for Students
with Language-Learning Disorders in the Public Schools, Asha, March 1991 (Suppl. 5), pp. 44-50
Ad Hoc Committee on Dysphagia Report, Asha, March 1989, pp. 63-67
Ad Hoc Committee on Labial-Lingual Posturing Function, Asha, November 1989, pp. 92-94
Competencies for Speech-Language Pathologists Provid-ing Services in Augmentative Communication, Asha, March 1989, pp. 107-110
Issues in Determining Eligibility for Language Interven-tion, Asha, March 1989, pp. 113-118
Utilization and Employment of Speech-Language Pathol-ogy Supportive Personnel With Underserved Popula-tions, Asha, November 1988, pp. 55-56 (see “Employ-ment and Utilization of Supportive Personnel in Audiology and Speech-Language Pathology,” pp. 1-33) The Role of Speech-Language Pathologists in the Habilita-tion and Rehabilitation of Cognitively Impaired Indi-viduals: A Report of the Subcommittee on Language and Cognition, Asha, June 1987, pp. 53-55
Ad Hoc Committee on Dysphagia Report, Asha, April 1987, pp. 57-58
Both Professions
Sedation and Topical Anesthetics in Audiology and Speech-Language Pathology, Asha, March 1992 (Suppl. 7), pp.
41-46
Consideration in Screening Adults/Older Persons for Handicapping Hearing Impairment, Asha, August 1992, pp. 81-67
Considerations for Establishing a Private Practice in Audi-ology and/or Speech-Language Pathology, Asha, Janu-ary 1991 (Suppl. 3), pp. 39-45
Utilization of Medicaid and Other Third Party Funds for “Covered Services” in the Schools, Asha, March 1991 (Suppl. 5), pp. 51-58
Report on Private Practice, Asha, September 1991 (Suppl.
6), pp. 1-4
Major Issues Affecting the Delivery of Speech-Language Pathology and Audiology Services in Hospital Settings: Recommendations and Strategies, Asha, April 1990, pp.
67-70
AIDS/HIV: Implications for Speech-Language Pathologists and Audiologists, Asha, December 1990, pp. 46-48 Communication-Based Services for Infants, Toddlers, and Their Families, Asha, May 1989, pp. 32-34Report of the Ad Hoc Committee on Instrument Evalua-tion, Asha, March 1988, pp. 75-76
Preparation Models for the Supervisory Process in Speech-Language Pathology and Audiology, Asha, March 1989, pp. 97-106
Deinstitutionalization: Its Effect on the Delivery of Speech-Language- Hearing Services for Persons With Mental Retardation and Developmental Disabilities, Asha, March 1989, pp. 84-87
ASHA Work Force Study, Asha, March 1989, pp. 63-67 Provision of Audiology and Speech-Language Pathology Services to Older Persons in Nursing Homes, Asha, March 1988, pp. 72-74
American Speech-Language-Hearing Association Classifi-cation of Speech-Language Pathology and Audiology Procedures and Communication Disorders, Asha, De-cember 1987, pp. 49-53
The Autonomy of Speech-Language Pathology and Audi-ology (Report of the Ad Hoc Committee on Professional Autonomy), Asha, May 1986, pp. 53-57
Report of the Ad Hoc Committee on Cochlear Implants, Asha, April 1986, pp. 29-52
Organization and Maintenance of Records for Clinical Ser-vice Delivery, Asha, April 1984, p. 49