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American Academy of Emergency Medicine

Code of Ethics

AAEM board approves new ethics policies that take effect January 1, 2010

Ethics Policy Sign Off Form (PDF)

Code of Ethics Policy

  1. All members will comply with:
    1. General principles of medical ethics as enumerated by the American Medical Association as of November 1, 2008 (http://www.ama-assn.org/ama/pub/category/2512.html)
    2. Applicable rules
      1. AAEM Constitution and bylaws
      2. Applicable requirements under federal and state laws and regulations relating to Members' status as a physician, scientist, allied health professional or other healthcare worker
      3. Applicable rules and requirements of each and every of the following bodies to whom such Member is subject (a "Governing Body")
        1. Healthcare entities and governing bodies and committees thereof which conduct professional review activities
        2. Boards of medical examiners and comparable bodies with responsibility for licensing of physicians or allied health professionals
        3. Other self-regulatory organizations and professional societies
        4. Any other body which is a "board of professional examiners" or a "professional review body" under the Healthcare Quality Improvement Act of 1986.
    3. AAEM Policy Ethical Business Practices in Emergency Medicine
    4. AAEM Position Statement on Ethical Expert Conduct and Testimony
    5. AAEM Policy on Conflict of Interest and Disclosure (for Officers, Board of Directors, Task force and Committee Chairs)
  2. Following actions may constitute a violation of this policy:
    1. Failure to comply with AAEM constitution, bylaws and policies listed above
    2. Discipline by licensing boards, other professional societies or hospitals for violations of applicable rules and requirements described in section 1.b
    3. Conviction of felony related to medical activities
      1. treatment of patients
      2. billing activities
      3. illegal prescribing of controlled substances
    4. False certification of eligibility for AAEM membership, or any office or position in AAEM.
  3. Procedures for handling submissions regarding the Ethics Policy are described in AAEM Ethics Policy Administrative Procedures.

Policy on Ethical Business Practices in Emergency Medicine

Background
A fundamental motivation underlying the creation of the American Academy of Emergency Medicine was a need to protect emergency physicians from unfair and possibly illegal employment and business practices. The Academy has steadfastly held that such business practices can directly interfere with patient care. As such, its core mission "supports fair and equitable practice environments necessary to allow the specialist in emergency medicine to deliver the highest quality of patient care . . ."

Despite the Academy's record of advocacy for emergency physicians and patients since its inception, the need for specific actions to counter unethical business practices in emergency medicine continues. Building on its prior work, the following policy provides specific guidelines for fair and ethical business practices for emergency physicians.

Policy

  1. No member shall excessively profit from the professional fees of another physician. Excessive profit is defined as reimbursement clearly in excess of fair market value.
  2. If an emergency physician business group provides payment to physicians for non-clinical activities, financial accounting of such payments shall be made readily available to all physicians in that group whose professional fees are used to fund such activities.
  3. No member shall engage another emergency physician in a contract that includes restrictive covenants, due process waivers, or a non-reciprocal right of termination without cause.
  4. No member shall offer contracts, establish business operations, or create rules or other procedures that violate federal, state, or local laws. Similarly, no member or group shall offer contracts requiring emergency physicians to violate rules of their local or state licensing boards or otherwise jeopardize their medical licenses.
  5. No member will impede another physician from obtaining information relating to his or her individual professional charges, fees, and collection history.
  6. No member shall knowingly give or accept commission fees for patient referrals.
  7. No member may have any significant financial interest in a practice that violates corporate practice of medicine laws.

AAEM Policy on Conflict of Interests and Disclosure

Background
The American Academy of Emergency Medicine ("the Academy") depends upon its members and some laypersons to provide vital leadership, decision making and administrative functions. These persons have a fiduciary duty to act in the best interest of the membership.

Some persons providing these vital functions may have outside interests that conflict, or appear to conflict, with the activities of the Academy. This policy, part of the overall ethics construct of the Academy, has the following goals:

  • To identify conflicts between personal interests and the interests of the membership;
  • To ensure that persons in leadership positions act in the best interest of the membership when engaged in activities related to their position with the Academy;
  • To ensure full disclosure of any potential conflicts of interest; and,
  • To establish guidance for appropriate handling of conflicts of interest.

Scope
This policy applies to the following persons (or their designated temporary replacements) within the Academy:

  • Members of the executive committee
  • Members of the board of directors, including ex officio members
  • Candidates running for the AAEM board of directors
  • The executive director and associate executive director
  • The chairpersons of all committees and taskforces
  • The editor of Common Sense

The Academy's president may request other persons to comply with this policy if (1) s/he deems that such persons hold important roles within the Academy, and (2) the president, executive committee, or the board of directors authorizes any member to represent the Academy. Such a request must be made in writing.

Definitions
"Official" shall mean any person to whom this policy applies.

"Immediate family member" shall mean spouse, domestic partner, parent or child. "Extended family member" shall mean spouse, domestic partner, parent, mother-in-law, father-in-law, child, spouse of child, grandchild, brother, sister, or spouse or child of a brother or sister. Guidelines relating to interests held by an immediate family member or extended family member shall apply to the extent that such interests are known to the official.

"Significant financial interest" shall mean at least one of the following

  • Ownership of 5% or more of a company;
  • Annual income from a given company of $10,000 or greater;
  • Receipt of gifts, travel or other benefits worth $10,000 or greater.

"Subsidiaries of the Academy" shall mean any business in which the Academy has an ownership interest (e.g., AAEM Services) or any foundation affiliated with the Academy (e.g., the AAEM Foundation).

"Entity" shall mean financial institutions, professional firms, companies, and individuals providing goods or services.

Policy

  1. Financial conflicts of interest exist in the following scenarios:
    1. An official or extended family member owns a significant financial interest in any entity that
      • provides goods or services to the Academy or its subsidiaries;
      • seeks to provide goods or services to the Academy or its subsidiaries; or
      • engages in business negotiations with the Academy or its subsidiaries.
    2. An official or extended family member holds a leadership position (such as a medical directorship in a medical services company) that does not comply with relevant corporate practice of medicine laws.
    3. An official earns $10,000 or more annually for personal activities (such as legal consulting), sales, or other non-clinical services related to medicine that may overlap with Academy interests.
  2. Legal conflicts of interest exist when an official or immediate family member has a significant financial interest in any entity involved in a lawsuit, legal complaint, personal claim for damages, or formal grievance involving the Academy.
  3. Conflicts arising from current or prior service to another organization exist when officials serve other organizations with goals and objectives that are not aligned with the Academy. Examples of such service include:
    1. Serving on a board of directors for another organization;
    2. Chairing a committee or taskforce for another organization.
  4. Personal conflicts of interest exist when officials are unable to separate personal interests from their obligation to objectively serve the interests of the membership.
  5. Academy officials will disclose in writing all conflicts or potential conflicts of interest.
    1. Candidates must complete their conflict of interest form prior to the nomination deadline and this information will be included in the candidate statement publications.
    2. Disclosures will be made at the commencement of a position;
    3. Updated disclosures will be made when changes occur to alter conflicts of interest;
    4. Updated disclosures will also be made every year following the annual scientific assembly;
    5. Written disclosures are to be made using the "Conflict of Interest Disclosure Form" attached to this policy.
  6. The Academy's president shall make the final determination of situations representing actual conflicts of interest.
  7. Officials with conflicts of interest will recuse themselves from the following activities:
    1. Discussing or voting on issues related to the conflicts of interest;
    2. Participation on committees, subcommittees, or taskforces charged with addressing issues involved in the conflicts of interest.
  8. Academy officials shall not offer, solicit, or accept gifts (including money, benefits, loans, or other payments) from any entity with which the Academy does or seeks to do business, or from any entity seeking to do business with the Academy. However, the following gifts are acceptable:
    • nominal gifts, social amenities, and entertainment which are given in normal business practice and which would not create the appearance of undue influence
    • gifts for a non-business reason, which are motivated by a family relationship or personal friendship;
    • books, journals, media, software, and other informational material provided to assist the officials in performing their duties for the Academy.
  9. Disclosure of confidential or proprietary information
    1. When in the course of performing services to the Academy, officials have access to information that is confidential or proprietary to the Academy, officials shall
      • maintain the confidentiality of such information;
      • use their best efforts to prevent unauthorized disclosure of confidential or proprietary information.

AAEM Ethics Policy: Administrative Procedures

  1. Submission
    1. A submission involving this code of ethics (a "submission") may consist of:
      1. A request for issuance by the board of directors of an advisory opinion interpreting any provision of this code of ethics (an "inquiry"); or
      2. A request for a finding by the board of directors that a member of the Academy has failed to observe any provision of the rules of ethics under this code of ethics (a "complaint)
    2. Submissions may be considered without regard to their means or form of submission.
    3. Submissions relating to information not in the public domain are not considered unless they are submitted in writing and signed by their submitters.
    4. Submissions may be made by any person or entity, regardless of whether an Academy member, including without limitation, other physicians, healthcare institutions, healthcare payors, allied health professionals, and patients or organizations representing any of the above.
    5. The board will not take action against a member in the case of an anonymous complaint, as due process requires a right to challenge one's accusers.
  2. Preliminary Review
    1. Upon preliminary review of a complaint the president may conclude, that the submission:
      1. contains insufficient information upon which to base an investigation;
      2. would be better suited for consideration by another body (i.e., a healthcare entity or governing body or committee thereof, a governmental or quasi-governmental administrative body, a board of medical examiners or comparable body, or another self-regulatory organization) which conducts peer review activities and has jurisdiction over such matter;
      3. is patently frivolous or inconsequential.
    2. In the event of any such conclusion by the president, the complaint shall be disposed of by notice from the president to its submitter.
  3. Investigation
    1. For each complaint involving this code of ethics that is deemed valid and actionable the president shall appoint a task force of three board members to conduct an investigation into its specific facts or circumstances to whatever extent is necessary in order to clarify, expand or corroborate the information provided by the complainant.
    2. A member of the Academy who is the subject of a complaint shall be informed in writing at the beginning of the investigation as to:
      1. the nature of the complaint
      2. the obligation to cooperate fully in the investigation of the complaint
      3. the opportunity to request a hearing on the complaint before the board of directors.
    3. Investigations shall
      1. be conducted in confidence, with all written communications sealed and marked as "personal and confidential";
      2. be conducted objectively, without any prejudgment;
      3. be directed toward any aspect of an inquiry or complaint which is relevant or potentially relevant;
      4. include (too costly) interviews with the member who is the subject of the complaint.
  4. Determination of Complaint
    1. Determination will occur at a closed hearing of a regularly scheduled meeting of the board of directors. Those board members who investigated the submission may not vote at the hearing. The hearing must satisfy the fair hearing requirements of the Health Care Quality Improvement Act of 1986.
    2. Information shared with the board of directors will include both the original complaint and findings and recommendation of the investigatory task force.
    3. In the case of a complaint, the Academy member will have the opportunity to make a statement in writing or in person to the board of directors.
    4. Decisions shall be issued by the board to the complainant after passage by a simple majority of the voting board members present. Decisions will be sent in writing to the member under investigation within 30 days after completion of the hearing. Decisions shall be sent by certified mail with a return receipt.
    5. Decisions shall be issued by the board to the complainant after passage by a two-thirds majority of the entire board in one of the following four forms:
      1. Complaint is dismissed without sanction;
      2. Reprimand, with publication of the decision but not the member's name;
      3. Academy suspension of the member for a designated period, with publication (at the discretion of the board of directors) of the member's name;
      4. Academy termination of membership, with publication of the decision and the member's name.
    6. If the board fails to reach a 2/3 majority decision, then the complaint shall be dismissed.
  5. Additional Sanctions
    1. In addition to the foregoing, in any case in which the board of directors determines that a member of the Academy has breached the rules of ethics, the board of directors may impose further sanctions prohibiting the sanctioned member from sponsoring, presenting, and otherwise participating in activities sponsored by the Academy.
    2. Members of the Academy who are suspended are deprived of all benefits of membership during the period of suspension.
  6. Appeal
    1. Within 30 days after receipt of notice of a decision by the board of directors, the affected member may submit in writing a request for an appeal to the board. In such event, the board of directors shall establish an appellate body consisting of at least three but not more than five fellows of the Academy who did not participate in the investigation or in the board of directors' decision .The appellate body shall conduct and complete the appeal within 90 days after receipt of the request for an appeal.
  7. Overriding Reporting Requirement
    1. Notwithstanding anything to the contrary contained in this code of ethics, the Academy shall report information to the necessary agencies, in such form and frequency as is prescribed by the Healthcare Quality Improvement Act of 1986 as necessary for the Academy to afford the protection from liability for damages afforded by this Act.