Responses to Physical Therapist's Involvement

Responses to Physical Therapist's Involvement

Robert Schiff

4/30/2004

Hello Listserve,
    Thanks for the responses...I will post any more that I receive at a later date. The overwhelming majority was ABSOLUTELY NOT!!! I was glad to see this. Thank you for your input. Here is a summary of the first day's responses. I will also repost the original inquiry.

Robert Schiff C.P.O., L.P.O.

Original Inquiry:
    I would like to know other prosthetist's opinions about physical therapists making actual adjustments to prosthetic devices. In particular, what would your feeling be if a therapist wanted to make an actual adjustment to the prosthesis with allen wrenches (i.e. flexion, extension, toe out, abduction, adduction), would you be comfortable with this? To take in a little further, would you instruct the therapist on how to make these adjustments if he or she needed to?

     For those answering YES they would feel comfortable with this and
would instruct the therapist:

         What are your feelings of liability with respect to a component failing. Who is liable if the therapist adjusted something and did or did not put loctite. Does
            your relationship with the therapist have any bearing on your decision or would you just instruct any therapist? Are you doing this to remain on good terms with that therapist?

     For those answering NO they would not feel comfortable with this and
would not instruct the therapist:
         Why wouldn't you? Is it a feeling of therapist infringment on our scope of practice? Is it lack of trust? Or do you just feel that it is just not their job. Would
            you be more inclined to instruct a therapist that you have known for 5 years how to make adjustments? 10 years? 20 years?

All input would be appreciated and confidentially posted on the listserve.

Thanks

Responses:
More important....what if the patient lived 100 miles from the O&P shop and
only 5 miles from the their PT

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I always like to make the adjustments myself and talk
with the PT if needed.

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No. Good therapists will tell you that they are not trained for this and smart ones will tell you they are not comfortable with it. I am thankful for the pleasure of working with many talented therapists who prefer to work as a team instead of stepping on each others toes or undermining other professionals. As a side note, we aslo work in a state where a jury awarded millions for a bad paint job on a car. CYA, baby.

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NO.
At that point they are overstepping their scope of practice as defined by
their licensure.
I would very kindly, but very pointedly advise them that THEY will assume
PRODUCT LIABILITY from the point that THEY adjust that device and THEY will
absolve me of liability for it from that point forward. And if they
persist.. Hand 'em the allen wrenches, bending irons and plumb bobs...and
the phone book to refer them an attorney.
Recently Al Pike made the observation that every prosthetist has received
basic training in amputee gait training. Where are we as prosthetists
overstepping OUR bounds?

I recently had a patient transfer to our area - 61+ yo female 4yrs s/p BKA
PVD with established hip and knee flexion contracture (15%+) bilateral
rotator cuff syndrome with corresponding stride length assymetry,
trenedelenburg and LBP. Was I wrong in advising her to maintain a stretching
program? instructing her to prone? strengthen gluteals? and maintain knee
extension will seated to stretch hamstrings while watching TV? Am I, since I
am in a non licensed state subject to malpractice? I did refer her out to
PT...in a capitated environment... she was provided with....two visits by
her health plan - first as assessment, second to provide a home program and
self directed stretching. At the second visit she was provided with
instruction sheets by a PT assistant. The visit lasted 35 minutes. The PTA
was unsure whether to do the exercise with or without the prosthesis. She
(the patient) called me to ask for guidance...

Never a dull moment.

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If they touch it then they are responsible to what
happens to the patient, I no longer stay involved, if
at a later date they want my involvement both
orthotically or prosthetically, then I get in writing
of what action they have taken and why they are
effectively passing the buck back to me, in addition
inform them that they still be held responsible for
anything that does goes wrong with any adjustments
that they have carried out in the past or else they
can go ahead and order a new orthosis or prosthesis.
Yes it pisses them off but then I don't get the same
problem again and I usually have the patient present
when I am making this statement so that we are all
clear, and I don't essentially get sued. I hope this
helps, of course this is all carried out with a
professional approach. Hope this helps.

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I would have the Therapist, the Rehab department and the hospital (if any
are involved as employers, etc.) sign a release for your malpractice and
product liability insurance placing the responsibility for any negative
results in their laps. I would also require a copy of their insurance to be
sure they are covered for such adjustments on their malpractice and product
liability insurance.

In 33 years of patient care I was caught up in only one liability case and
it involved physical injury following an ill-advised alignment change. Watch
your back
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I'll look forward to hearing the results. As a PT who has worked extensivly in prosthetic rehab, I would never consider adjusting the mechanical components.