Kolmac’s purpose for this ethics policy is to provide clarity on our standard of conduct. This policy makes it clear that the Kolmac Outpatient Recovery Centers is dedicated through the professional and ethical behavior of its staff to provide the best possible clinical treatment for people suffering from substance use disorders. Kolmac constantly works to improve the quality of its treatment program and business operations. This policy serves as a guide to help staff, interns, and volunteers to understand the ethical considerations of their actions and how they impact service delivery and overall impact our business.
The Kolmac Outpatient Recovery Centers is committed to protecting employees, patients, vendors and the company from illegal or damaging actions by individuals, either knowingly or unknowingly. In addition to abiding by Kolmac’s ethical codes of conduct, clinical and medical staff members are expected to abide by the codes of conduct for their given profession, as well as the codes of conduct for their respective licensing or certifying board. This ethical code of conduct policy will be kept readily available so any staff member may access it quickly and easily. No illegal or unethical conduct on the part of any employee will be tolerated by Kolmac.
In order to maintain trust and good standing in the community, it is imperative that all persons representing Kolmac in business matters do so in an open and honest manner. They should act responsibly and with respect towards others in all of their dealings, regardless of the person’s age, gender, sexual orientation, physical ability or disability, race, religion, culture, beliefs, political affiliation, financial means or nationality. They must abide by all Federal and State rules and regulations at all times.
Staff may come into contact with, or have possession of, proprietary, confidential or business-sensitive information and must take appropriate steps to assure that such information is strictly safeguarded. This information, whether it is on behalf of Kolmac or any of its patients or stakeholders, could include patient records, personnel records, financial reports or payroll reports. Confidential and sensitive business information about Kolmac or stakeholders should be treated with sensitivity and only be disseminated to appropriate personnel.
Any staff member dealing with financial information pertaining to Kolmac, patients or stakeholders will seek to report all information accurately and honestly, and as otherwise required by applicable reporting requirements. Staff must ensure that all patient and insurance billing accurately reflects the services that were provided to the patient.
Kolmac’s marketing program focuses on maintaining a high level of community involvement by providing support for its patients, education for community treatment professionals, and ongoing communication and coordination of treatment with its referral sources. Kolmac’s primary marketing efforts are geared towards building a positive relationship with its referral sources and the recovery community.
Marketing and communications activities, including but not limited to promotions, financial relations, educational events and correspondence with community referral sources, shall endeavor to present Kolmac, its activities and, where applicable, its financial condition, fairly and consistently to all stakeholders, including patients, employees, insurance companies, licensing bodies, governmental agencies and community referral sources.
Potentially intrusive marketing programs, including e-mail correspondence and physical letter mailings, will be targeted rather than indiscriminate. Each such marketing program will avoid deceptive communications tactics and offer the recipient an honest opportunity to decline further contact.
In order to provide the best possible educational service to the community, all educational events hosted by Kolmac will be conducted by a licensed or certified clinical or medical professional who is well qualified to speak about the topic at hand.
Marketing communications will not disparage or attack the products, services, or reputation of another company. Kolmac does not use or condone the use of marketing enticements to gain patients, referral sources, vendors or insurance carriers.
3. CONTRACTUAL ETHICS
Kolmac may enter into contractual agreements with patients and stakeholders, including employees and vendors. Staff’s primary objectives when entering into any contract on behalf of Kolmac should be to establish a durable, legally binding agreement with clear terms and conditions, which is beneficial to Kolmac, its patients or its stakeholders. Staff should give consideration to Kolmac’s mission, philosophy and other policies when entering into any contract. Contracts should clearly state financial agreements and adhere to any applicable Federal and State laws.
Only duly authorized staff may enter into any contractual agreement on behalf of Kolmac. Staff members authorized to enter into contractual agreements and the type of contractual agreements are below:
Authorized Employee Type of Authorized Contractual Agreement
Board Chair/Medical Director Any and all vendor, patient or other stakeholder contracts
Present & CEO Any and all vendor, patient or other stakeholder contracts
Clinical Staff Members Financial and other clinical agreements with patients only
Administrative Staff Members Financial agreements with patients only
To avoid any conflicts of interest, contractual agreements with current patients, other than the contracts pertaining to their treatment at Kolmac, may not be entered into under any circumstances.
4. SERVICE DELIVERY
To remain a leader in the substance use disorders field and continue providing the best possible medical and clinical care, Kolmac expects its staff to put forth their best effort clinically and professionally to provide all patients with reasonable, necessary and clinically appropriate care. All patient care must be provided by properly qualified personnel. Clinical decisions will never be based solely on financial issues but will be based on the needs of the patient and what is morally and ethically appropriate.
A. Conflicts of Interest
Employees of the company must never permit their personal interests to conflict, or appear to conflict, with the interests of Kolmac, its patients or stakeholders.
Clinical staff should not facilitate group or individual therapy for any patient with whom they have an outside personal, professional or therapeutic relationship.
Clinical, administrative or medical staff should not have any interest in a Kolmac patient that conflicts with their clinical obligations, for example, personal feelings toward a patient.
Clinical, administrative or medical staff should not have a secondary agenda that interferes with the treatment of a Kolmac patient, for example, interest in selling items to a patient or in using information the patient possesses.
Maintaining appropriate boundaries regarding the transition of Kolmac patients into the private practices of Kolmac staff has always involved some complexity. The following is intended to attempt to clarify some of the ambiguous areas:
i. Licensed clinicians can only do private practice with active Kolmac patients if;
1. The patient is not attending the same office the clinician works in, and;
2. It is approved by the Clinical Director in each office
ii. This rule does not apply for:
1. Patients being medicated by Kolmac psychiatrists when the patient does not already have an outside psychiatrist.
2. Patients who are seen individually as part of the Relapse Prevention Continued Care group protocol.
3. Clinicians who are working less than 4 hours per week. These clinicians may do private practice with Kolmac patients if it is approved by the Clinical Director.
iii. Clinical Directors and Assistant Directors may not do private practice with any active Kolmac patient, regardless of what office the patient is in unless they originally referred the patient to Kolmac.
B. Exchange of Gifts, Money or Gratuities
Staff may not accept gifts from patients, vendors, referral sources or treatment providers in exchange for goods, services, business or favoritism of any kind.
There are two circumstances an employee may be permitted to accept a gift:
1. If a patient, referral source or vendor made or purchased a nominal, unsolicited “thank you” gift for Kolmac. That gift could be shared among the staff.
2. Staff members are permitted to voluntarily exchange gifts with peers as long as the gifts are unsolicited and of nominal value.
Employees may not give gifts to patients, vendors, and insurance companies, licensing bodies, governmental agencies, referral sources or other treatment providers.
Only gifts purchased by Kolmac may be given to patients or stakeholders. Examples of gifts Kolmac may purchase for a patient include; books, buttons or other nominal items in recognition of milestones made during the course of treatment with Kolmac. Examples of gifts Kolmac may purchase for stakeholders include; cards, food, gift baskets or other nominal gifts in appreciation for their services.
Patients may not exchange gifts of any kind with other patients.
Kolmac will not pay, by any means, a referral source to encourage the referral of patients to Kolmac. Alternately, it will not accept payment by any means in exchange for placing referrals to any other healthcare professional.
Under no circumstances should gifts be given to or accepted from pharmaceutical companies by any staff member.
Patients should not give to, or accept money from, other patients or staff of Kolmac, other than for the purpose of paying for the cost of their treatment with Kolmac.
Staff should not give to, or accept money from, other staff, patients, vendors, insurance companies, referral sources, other treatment programs or licensing bodies.
One exception to that rule would be if an employee wanted to “chip-in” a nominal amount of money for gift for a peer or a charitable cause.
Patients should not give to, or accept gratuities from, other patients, employees or other stakeholders.
Staff should not give to, or accept gratuities from, other employees, patients or stakeholders. One exception to that rule would be if an employee gave gratuity to a vendor on Kolmac’s behalf. Gratuities may be given to a vendor for services provided, such as the moving, delivery or installation of furniture. Gratuities paid by a staff member in that instance should be of a reasonable amount and should be reported to Kolmac so the staff member may be reimbursed.
C. Personal Fund Raising
Kolmac does not currently participate in, or sponsor any fundraising activities to raise funds directly for Kolmac or its patients.
Patients of Kolmac may not raise funds of any kind while they are in Kolmac.
Staff may not raise funds to benefit themselves, Kolmac or its patients. Staff may raise funds for causes such as a child’s school fundraiser or a non-profit charitable organization as long as it is done in a reasonable, unobtrusive manner.
Kolmac and its staff may sponsor or donate time, money or other goods to outside fundraisers for charitable organizations or events designed to generate awareness of recovery-related issues. Kolmac currently raises funds for the Kolmac Foundation by offering its patients the opportunity to make donations to the Foundation. The Kolmac Foundation is a non-profit charitable organization designed to provide financial support to patients who cannot afford the full cost of treatment.
D. Personal Property:
Kolmac cannot be responsible for the damage or loss of personal property. Staff members are expected to treat the property of Kolmac, its patients and its stakeholders as they would their own property.
Staff should safeguard the patients’ personal property, health and well-being at all times.
Patient medications left in the possession of Kolmac must be stored in a locked storage area only accessible to authorized personnel. Medical and Clinical staff are expected to safeguard medications at all times.
Staff must use care when handling or using any equipment that belongs to Kolmac. Extreme care should be taken when handling items such as medications, computers, breathalyzers or other medical equipment.
Staff, who misuse, mistreat or intentionally damage Kolmac or patient property may be subject to discipline, up to and including termination.
Patients, who misuse, mistreat or intentionally damage Kolmac or staff property may be subject to discharge from the program.
Weapons, illicit drugs, alcohol and offensive or sexually suggestive items may not be brought into Kolmac at any time.
Staff may not solicit the use of a patient’s personal property, nor shall a staff member lend or give personal property to a patient.
E. Setting Boundaries:
Setting and maintaining boundaries between staff and patients is vital to the successful treatment of any patient. All Kolmac Staff will avoid dual relationships with patients and always maintain an appropriate and professional doctor/patient or counselor/patient relationship. Administrative Staff must also maintain a professional relationship with patients and not enter into personal relationships with them. Clinical and medical staff must adhere to the boundaries established below, in addition to any boundaries required of them by their profession or respective licensing board.
Kolmac Staff may not:
i. Condone or engage in discrimination based on age, color, culture, disability, ethnic group, gender, race, religion, sexual orientation, marital status, or socioeconomic status;
ii. Abandon or neglect patients in treatment; or
iii. Foster overly dependent counseling relationships; or
iv. Exploit trust and dependency in relationships with patients, supervisees, employees, students, or volunteers; or
v. Accept patients that are superiors or subordinates with whom a clinician has administrative, supervisory, or evaluative relationships.
F. Witnessing of Legal Documents:
Since Kolmac does not use powers of attorney, guardianship or advance directives forms, Kolmac staff should not be in a position to witness legal documents for a patient or patient’s family member. Staff is required to witness the signing of Release of Confidential Information forms and they may sign any Release of Confidential Information once they are satisfied the patient has filled it out correctly and in its entirety.
5. PROFESSIONAL RESPONSIBILITIES
In order to work towards Kolmac’s goal of providing the best possible treatment for its patients, we expect all staff, including interns, consultants, contractors or volunteers to maintain a high level of professionalism and integrity. They must work only within the bounds of their competence, based on education, training, supervised experience, and professional credentials. Medical and clinical staff must maintain their qualifications and licensure at all times in addition to participating in ongoing education relevant to their profession. Medical and clinical staff will engage in ongoing consultation with other relevant professionals to create a team environment that provides the best possible clinical care for our patients.
All staff must protect and maintain the privacy of every patient we treat. They must abide by Federal, State and Kolmac’s confidentiality guidelines and ensure that other staff members do the same.
6. HUMAN RESOURCES
Kolmac shall support and foster the fair and ethical treatment of all staff, including volunteers, interns, consultants and contractors. It will ensure that all staff are hired and supervised in a manner that is equitable and fair and not based on race, ethnicity, sexual orientation, age, gender or any other cultural difference.
Human resources will provide information regarding the benefits Kolmac offers to all eligible staff members. That information will be readily available and support will be provided to any staff member needing help related to the administration of benefits. Benefits will be administered fairly and without exception to all eligible staff members. Human Resources will ensure that all policies and procedures, including codes of ethics, are readily available for all staff members.
In addition to providing support to Kolmac’s staff, Human resources will ensure that all staff members are legally and professionally qualified to perform their required duties. They will verify that all medical and clinical staff are properly licensed and ensure that no staff member has had any adverse action taken against them, or has had any complaint recorded about them, by a licensing body. Human Resources will also ensure that all Medical and Clinical Staff members are meeting their continuing education requirements by maintaining a log of continuing education activities in an individual personnel file.
7. PROHIBITION OF WASTE, FRAUD, ABUSE AND OTHER WRONGDOING
Staff will not be a part of, or participate in any waste, fraud, abuse or other wrongdoing. Staff members are expected to be vigilant and immediately report any suspected legal or ethical violations to a supervisor. Retaliation for reporting such instances is strictly prohibited by Kolmac. Kolmac takes the following actions to deter any waste, fraud or abuse;
A. Multiple staff are required to place orders for supplies and merchandise
B. Multiple staff are required to issue checks
C. Multiple staff review Kolmac’s financial records each month and an independent accountant reviews them at least quarterly
D. Charges for services provided are reviewed 3 separate times by at least two different staff members to ensure billings are correct.
E. Multiple clinical staff members oversee all therapy groups and participate in weekly interdisciplinary team meetings where the wellbeing and clinical progress of all patients are discussed.
8. VIOLATIONS OF ETHICAL CODES OF CONDUCT
Staff members are required to immediately report any suspected violations of these ethical codes of conduct. Staff who report suspected violations will under no circumstances be subject to reprisal from peers or supervisors. Staff members who are found to have violated these codes of conduct may be subject to disciplinary action, up to and including termination.
Staff members should report any suspected violations to their supervisor, who will then report to the Regional Kolmac Director, Medical Director or President and Chief Executive Officer. In the event that an individual suspects their supervisor of violating these codes, they should report the violation directly to the Regional Clinical Director, Medical Director or the President and Chief Executive Officer. All allegations will be investigated and reviewed by the Regional Clinical Director, Medical Director, Chief Executive Officer and appropriate managerial staff, who will then substantiate or negate the allegations. If it is determined that the safety of an individual is threatened, the alleged perpetrator will not work directly with patients until the investigation is completed.
Investigations will be initiated within 24 hours and will be completed within 10 days. If an extension of time is needed to complete an investigation, a written request will be sent to the appropriate State licensing agency (APRA for DC patients and OHCQ for Maryland patients), who will either concur or request that the investigation be completed in a shorter time frame. When an investigation is completed, a written summary will be submitted to the appropriate State licensing agency and, if applicable, licensing board within 24 hours. The medical director will be responsible for taking appropriate action, including steps to reduce the likelihood of recurrences of such incidents. Kolmac will cooperate with any investigations conducted by any licensing agency, licensing board or other accrediting bodies.
A secure file will be maintained with copies of all complaints, unusual incident reports, investigation findings, and actions taken, with a separate file for those that may be of a criminal nature.
9. EDUCATION ON ETHICAL CODES OF CONDUCT
All staff members will receive these ethical codes of conduct upon hire and annually thereafter. A signed acknowledgment of these codes of conduct will be kept in each staff member’s personnel file.
These codes of conduct will be made available to staff in multiple, easily accessible locations such as the company’s intranet and practice management database.
These codes of conduct will also be made publicly available on Kolmac’s website.
10. ADVOCACY EFFORTS AND CORPORATE CITIZENSHIP
Kolmac conducts or participates in multiple activities designed to educate the public, provide support for its patients and remain firmly rooted in the treatment community. Examples of these advocacy efforts are:
1. Hosting educational events to provide continuing education for other treatment professionals in the community. These events are free of cost for any treatment professionals that wish to attend. These events focus on educational topics related to the treatment of people with substance use disorders, as well as other current mental health-related issues. Typically, Kolmac hosts one or more of these events each month and a list of past and present events can be found online at http://www.kolmac.com/kolmac-school/.
2. Kolmac pays for its Clinical Directors to be members of the Employee Assistance Professionals Association (EAPA).
3. The Medical Director is a Board member of the Maryland Chapter of the National Council on Alcoholism and Drug Dependence (NCADD).
4. The President/CEO is a member of the DC Behavioral Health Association
5. The Medical Director and Clinical Directors participate in interviews, discussions or lectures regarding the treatment of people with substance use disorders. They also may publish articles related to substance use disorder treatment. A log of these types of advocacy efforts can be found online at http://www.kolmac.com/news.htm.
6. In an effort to provide better coordination of care, Kolmac strives to maintain a high level of communication with its referral sources and other treatment providers. Staff will routinely ask patients to sign a Release of Confidential Information form to allow us to communicate with their referral source or other treatment providers, such as a primary care physician. If the patient signs the Release of Confidential Information, staff may provide any number of the following types of communication; telephone calls, letters of admission, monthly or quarterly progress reports and letters notifying of discharge from the program.
7. Kolmac makes its office space available for use by community self-help groups, such as AA, NA, Smart Recovery and Women for Sobriety.
8. Kolmac maintains Alumni groups to help support their current patients.
9. Kolmac maintains a Patient Advocacy group to help guide its future direction and remain in touch with issues relevant to the recovery community.
10. Kolmac has formed a charitable organization called the Kolmac Foundation, which is designed to provide financial assistance to patients with substance use disorders who cannot afford the full cost of treatment. The Medical Director and President and Chief Executive Officer are members of the Kolmac Foundation Board, along with Kolmac Alumni and other community members who have an interest in the recovery community. More information regarding the Kolmac Foundation can be found at http://www.kolmacfoundation.org/.
11. Kolmac and its staff participate in charitable and/or awareness-raising events relevant to the recovery community.
11. ETHICAL GUIDELINES SPECIFIC TO PATIENT ADVOCATES
In addition to adhering to all of Kolmac’s ethical guidelines this policy will outline some specific guidelines for Patient Advocates.
Unlike clinicians, patient advocates regularly disclose personal aspects of their addiction and recovery. Disclosure of personal information can lead to personal connections on the part of both the advocate and the patient. Those connections present challenges to the professional relationship.
• It is never appropriate to develop social relationships with those that you provide services to.
• It is never appropriate to provide services to those with whom you have a pre-existing social relationship.
• It is never appropriate to discuss work concerns with patients.
Boundary violations occur when a professional, either consciously or unconsciously, use the professional-client relationship to meet personal needs. Boundary violations can damage a patient, a professional, and professional interaction. Boundary violations are a betrayal of the trust the patient places in the treatment provider.
Common Elements of Boundary Violations are;
Secrecy involves the Patient Advocate keeping critical knowledge or behavior from the client and/or clinical staff or sharing only selective information.
Ex. A Patient Advocate invites a patient to his or her home but keeps this information from staff and/or tells the patient not to tell staff or other patients about the visit.
• Role Reversal
Role reversal takes place when the Patient Advocate turns to the patient for his or her own needs, emotional or otherwise. As a result, the patient begins taking care of the advocate. This reversal can be subtle and the advocate may not be consciously aware that it is taking place.
• Double Bind
A double-bind consists of messages that contradict each other while discouraging the receiver of the message from noticing the difference and leaving the receiver caught in a conflict of interest.
Ex. The advocate informs the patient that they can have a personal relationship, but only if the patient were to leave treatment.
• Abuse of Professional Privilege
Abuse of professional privilege occurs when an advocate uses information obtained in the relationship for personal gain.
Ex. An advocate is aware of a patient’s financial struggles and offers to buy the patient’s car below market value.
Warning signs of boundary violations in the Patient Advocate/Patient relationship;
• Choosing sides
• Making exceptions
• Keeping secrets
• Giving or receiving gifts
• Borrowing or lending money
• Feeling that no one but you has interest in the patient
• Confiding personal or professional issues or troubles
• “Owning” a patient’s success or failure
Guiding Principles for Ethical Behavior
• Autonomy (Promote self-determination)
• Non-maleficence (Avoid harm)
• Beneficence (Do good)
• Justice (Be fair)
• Veracity (Be truthful)
• Informed consent (Assure understanding)
• Confidentiality (Respect rights)
• Competence (Be capable)
There can be more gray areas than black and white ones for Patient Advocates when thinking about boundaries. Not all boundary issues are boundary violations. When in doubt the advocate should seek guidance from their Clinical Director or Program Manager. It may be helpful for Patient Advocates to ask themselves some of the following questions;
• Is the relationship in the client’s best interest?
• Is this something another Patient Advocate would do?
• Can this affect my objectivity in providing care?
• Will this cause confusion in my role?
If you answer “no” to 1-2 or “yes” to 3-4, stop and evaluate your interaction.
Some potential trouble spots for Patient Advocates to consider are;
• Time: Are you spending more time with one patient than others? Are you spending “off duty” time with a particular patient?
• Location: Is the location of your patient interactions appropriate? Would you meet with other patients in this location?
• Gifts: It is Kolmac’s policy to not accept gifts from patients unless the gift can be shared with all of the staff. Is the gift of a personal nature or could it be shared with all facility staff?