PREAMBLE

This Code of Ethics is based upon the fundamental principle that the ultimate end and object of the chiropractor’s professional services and effort should be:

“The greatest good for the patient.”

This Code of Ethics is for the guidance of the profession with respect to responsibilities to patients, the public and to fellow practitioners and for such consideration as may be given to them by the state legislature, state administrative agencies and also by the Indiana State Chiropractic Association to the extent that they are authorized under state law to exercise enforcement or disciplinary functions.

A. RESPONSIBILITY TO THE PATIENT.

A(1) Doctors of chiropractic should hold themselves ready at all times to respond to the call of those needing their professional services, although they are free to accept or reject a particular patient except in an emergency (a situation where the patient’s life is threatened).

A(2) Doctors of chiropractic should take reasonable steps to protect their patients prior to withdrawing their professional services; such steps shall include: due notice to them allowing a reasonable time for obtaining professional services of others and delivering to their patients all papers and documents in compliance with A(5) of this Code of Ethics.

A(3) Doctors of chiropractic should be honest and endeavor to practice with the highest degree of professional competency and honesty in the proper care of their patients.

A(4) Doctors of chiropractic should comply with a patient’s authorization to provide records, to those whom the patient designates as authorized to inspect or receive all or part of such records. A reasonable charge may be made for the cost of duplicating records. A doctor of chiropractic shall not refuse to release a patient’s records because that patient has an outstanding bill for services.

A(5) Subject to the foregoing Section A (5), doctors of chiropractic should preserve and protect the patient’s confidences and records, except as the patient directs or consents or the law requires otherwise. They should not discuss a patient’s history, symptoms, diagnosis, or treatment with any third party until they have received the written consent of the patient or the patient’s personal representative. They should not exploit the trust and dependency of their patients.

A(6) Doctors of chiropractic owe loyalty, compassion and respect to their patients. Their clinical judgment and practice should be objective and exercised solely for the patient’s benefit.

A(7) Doctors of chiropractic should recognize and respect the right of every person to free choice of chiropractors or other health-care providers and to the right to change such a choice at will.

A(8) Doctors of chiropractic should terminate a professional relationship when it becomes reasonably clear that the patient is not benefiting from the care.

A(9) Doctors of chiropractic should maintain the highest standards of professional and personal conduct, and should refrain from all illegal conduct.

A(10) Doctors of chiropractic should consult and seek the expertise of other health-care professionals when such consultation would benefit their patients or when their patients express a desire for such consultation.

A(11) Doctors of chiropractic should employ their best good faith efforts so that the patient possesses enough information to enable an intelligent choice in regard to proposed chiropractic treatment. The patient should make his or her own determination on such treatment.

A(12) Doctors of chiropractic should utilize only those laboratory and X-ray procedures, and such devices or nutritional products that are in the best interest of the patient and not in conflict with state statute or administrative regulations.

A(13) Sexual intimacies with a patient.

There have been requests for clarification relative to the ethical implications of sexual intimacies between a doctor of chiropractic and a patient he or she is treating. This advisory opinion is intended to resolve any misunderstanding and to state that it is the opinion of the Committee that sexual intimacies with a patient is unprofessional and unethical based on the existing ethical provisions in the ISCA Code of Ethics: A(6), A(7), A(10) and C(2).

The physician/patient relationship requires the doctor of chiropractic to exercise utmost care that he or she will do notion to “exploit the trust and dependency of the patient.” Doctors of chiropractic should make every effort to avoid intimate relationships that could impair their professional judgment or risk the possibility of exploiting the confidence placed in them by the patient.

B. RESPONSIBILITY TO THE PUBLIC.

B(1) Doctors of chiropractic should act as members of a learned profession dedicated to the promotion of health, the prevention of illness and the alleviation of suffering.

B(2) Doctors of chiropractic should observe and comply with all laws, decisions and regulations of state governmental agencies, and cooperate with the pertinent activities and policies of the association to the extent they are authorized under Indiana law to assist in the regulation of the chiropractic profession.

B(3) Doctors of chiropractic should comport themselves as responsible citizens in the public affairs of their local community, state and nation in order to improve law, administrative procedures and public policies that pertain to chiropractic and the system of health-care delivery. Doctors of chiropractic should stand ready to take the initiative in the proposal and development of measures to benefit the general public health and well-being, and should cooperate in the administrative and enforcement of such measures and programs to the extent consistent with the law.

B(4) Doctors of chiropractic may advertise but should exercise utmost care that such advertising is relevant to health awareness, is accurate, truthful, not misleading, false or deceptive, and scrupulously accurate in representing the chiropractor’s professional status and area of special competence. Communications to the public should not appeal primarily to an individual’s anxiety or create unjustified expectations of results. Doctors of chiropractic should conform to all applicable state laws, regulations and judicial decisions in connection with professional advertising.

(4a) It will be considered a breach of ethics, as well as law, to practice (N.O.P.E.) no out of pocket expense as defined by Indiana statutes.

B(5) Doctors of chiropractic should continually strive to improve their skill and competency by keeping abreast of current developments contained in the health and scientific literature, and by participating in continuing chiropractic educational programs and utilizing other appropriate means.

B(6) Doctors of chiropractic may testify either as experts or when their patients are involved in court cases, worker’s compensation proceedings or in other similar administrative proceedings in personal injury or related cases.

B(7) The chiropractic profession should address itself to improvements in licensing procedures consistent with the development of the profession and of relevant advances in science.

B(8) Doctors of chiropractic who are public officers should not engage in activities which are, or may be reasonably perceived to be in conflict with their official duties.

B(9) Doctors of chiropractic should protect the public and reputation of the chiropractic profession by bringing to the attention of the appropriate public or private organizations the actions of chiropractors who engage in deception, fraud, dishonesty, or otherwise engage in conduct inconsistent with this Code of Ethics or relevant provisions of applicable law or regulations within their states.

C. RESPONSIBILITY TO THE PROFESSION.

C(1) Doctors of chiropractic should assist in maintaining the integrity, competency and highest standards of the chiropractic profession.

C(2) Doctors of chiropractic should by their behavior, avoid event the appearance of professional impropriety and should recognize that their public behavior may have an impact on the ability of the profession to serve the public. Doctors of chiropractic should promote public confidence in the chiropractic profession.

C(3) As teachers, doctors of chiropractic should recognize their obligation to help others acquire knowledge and skill in the practice of the profession. They should maintain high standards of scholarship, education, training and objectivity in the accurate and full dissemination of information and ideas.

C(4) Doctors of chiropractic should attempt to promote and maintain cordial relationships with other members of the chiropractic profession and other professions in an effort to promote information advantageous to the public’s health and well-being.

D. ADMINISTARTIVE AND PROCEDURAL PROVISIONS

D(1) Ethics Committee: There is hereby created an Ethics Committee of the ISCA to administer and enforce this Code of Ethics.

(1a) The Committee shall consist of seven doctors of chiropractic who are members in good standing of the ISCA.

(i) The Members of the Committee shall be appointed by the President of the ISCA, subject to the confirmation of the ISCA Board of Directors.

(ii) Except as provided in subsection (v.) below the Members of the Committee shall serve three-year terms. No member may serve more than three successive terms.

(iii) Members of the Committee may be removed from office during their terms only for good cause shown.

(iv) If a Member is removed or resigns, the President shall appoint a successor to serve the balance of the term.

(v) Within thirty days of the adoption of this ethics procedure, the President of the ISCA shall appoint two Members of the Committee to one year terms, two Members for two-year terms, and three Members for three-year terms. The President of the ISCA shall designate one of the Members appointed to a three-year term as Chairmen of the Committee; this member and his or her successors in office shall have the powers and duties of the office of Chairmen as described in section (c) below.

(1b) The Committee shall:

(i) investigate and adjudicate charges that any member of the ISCA has violated a provision of this Code of Ethics;

(ii) offer its services as an arbitration panel or arbitrator where an informal adjudication of a complaint is appropriate;

(iii) develop and disseminate materials and programs to educate the chiropractic profession on matters of ethics;

(iv) periodically assess and review this Code of Ethics and recommend charges, if warranted, to the ISCA Board of Directors;

(v) maintain all records required by this Code of Ethics; and

(vi) conduct its business at regular meetings no less frequently than once every three months.

(1c) The Chairmen of the Committee shall:

(i) initiate informal arbitration proceedings when appropriate.

(ii) Make probable cause determination, and appoint investigators and presiding officers to review charges that any ISCA member has violated a provision of this Code of Ethics;

(iii) Supervise employees, volunteers, or independent contractors acting in the services of the Committee; and

(iv) preside over all meetings of the Committee; and

(v) make other appointments and determinations as required in this Code; and

(vi) communicate with the executive committee or the ISCA and seek approval of any expenditure of moneys that are necessary in the operations of the Ethics Committee.

(1d) Meetings

(i) A meeting may be called by the Chairman, or by any two Members, upon seven days written notice to all Members of the Committee and the President of the ISCA.

(ii) If the Chairman is unable to attend a meeting, he or she shall designate a Member to serve as president officer.

(iii) A quorum shall consist of four Members.

(iv) All questions shall be decided by a majority vote of the Members attending. No Member may vote by proxy. However, the Committee may adopt an internal management rule by majority vote permitting Members to attend meetings (other than adjudicative hearings) by telephonic means.

(v) The Chairman shall, after each meeting of the Committee, make a report in writing to the President of the ISCA summarizing the business transacted at the meeting.

(1e) Upon the approval of the Executive Committee of the ISCA, the committee shall have the power to:

(i) employ staff or independent contractors and purchase or lease equipment and office space, with funds provided by the ISCA for this purpose; and

(ii) adopt rules and guidelines not consistent with this Code to govern proceedings before the Committee.

(1f) Members of the Committee, and all employees, volunteers, or independent contractors serving the Committee on official business, shall be indemnified and defended by the ISCA against all liability arising from Committee business, to the extent provided in the ISCA Constitution for Directors. The ISCA shall maintain D & O insurance to carry out this provision.

D(2) Investigation and Adjudication of Charges:

(2a) Any person may file a written charge with the Committee alleging that an ISCA member has violated a provision of this Code of Ethics. The charge shall include the following information:

(i) the name and address of the charging party;

(ii) the name and address of the charged member, and

(iii) a narrative description of the alleged violation,

The Committee may by rule prescribe a standard form to be used for written charges.

(2b) Within thirty days after the charge is filed, the Chairman (or his or her designee) shall review the charge to determine if there is probable cause to conduct an investigation. “Probable cause” exists where the facts stated in the charge, if true, would establish a violation of this Code of Ethics.

(i) If the Chairman (or his or her designee) determines that probable cause does not exist, the charging party shall be informed in writing.

(ii) Within thirty days of being notified that the Chairman has determined that probable cause does not exist, the charging party may appeal this decision in writing to the full Committee.

(iii) If the Committee reverses a probable cause determination, the case shall proceed as if probable cause had been found.

(iv) The Committee shall inform the charging party of its decision in writing.

(2c) If it is determined that probable cause exists, the Chairman shall appoint a disinterested person, who may be a Committee member, to act as investigator with respect to the charge. Such an investigator may be a member of the Ethics Committee.

(i) The investigator shall conduct the investigation in confidence. All written communications shall be sealed and marked “Personal and Confidential.”

(ii) The charged party shall be informed by the investigator in writing:

a. that a charge has been filed and is being investigated;

b. that he has the obligation to cooperate fully in the investigation; and

c. that he has a right to a hearing in accord with section (d) below.

The investigator shall provide the charged party with a copy of the original written charge, and a copy of the hearing request form.

(iii) Upon completing the investigation, the investigator shall make a confidential written report to the Chairman.

(iv) If the investigator discovers reason to believe that a violation of law or of professional licensing standards has occurred, he shall inform the Chairman who shall also inform the ISCA President. Upon consultation with the ISCA Executive Committee, the ISCA President or designate shall provide the appropriate authorities with all relevant information pertaining to the investigation.

(2d) Within thirty days of being informed that a charge is being investigated, the charged party may request a hearing in writing. The writing shall be directed to the Chairman, and the Committee shall by rule provide for a standard form to be used.

(i) The Chairman shall schedule a hearing date and designate a panel of three members or more to serve as a hearing toward with one member serving as presiding officer.

(ii) Notice of the hearing date shall be given to the investigator and the charged party at least thirty days in advance.

(iii) The charged party shall be provided a copy of the investigator’s report at least fourteen days before the hearing date.

(iv) The charged party may withdraw the request for a hearing at any time. The charged party may also request a continuance, which shall be granted by the presiding officer for good cause shown.

(v) The charged party and the investigator may enter into stipulations which will be binding on both.

(2e) Procedure at hearings.

(i) The hearing shall be closed to all except the hearing board, the investigator, the charged party, the witnesses ISCA legal counsel, and legal counsel retained by any participant.

(ii) The charged party has the right to be represented by legal counsel in all phases of the proceeding.

(iii) If there is any dispute on evidentiary matters, they will be resolved by the presiding officer in the course of the hearing although formal rules of evidence shall not apply.

(iv) The investigator shall present the results of this investigation.

(v) The charged party may present evidence or argument on any relevant matter.

(vi) Each party may call witnesses, and may cross examine witnesses called by the opposing party. Witnesses shall be sworn.

(vii) The charged party may present evidence of mitigating circumstances without waiving the right to contest whether a violation has occurred.

(viii) A written or audio transcript of the hearing shall be made and added to the case file.

(ix) Upon conclusion of the hearing, the hearing board shall meet and ocmpile recommended findings:

a. whether violation has occurred; and

b. if so, what sanction should be imposed.

(2f) After receiving the report of the investigator and, if the charged party has requested a hearing, the recommended findings of the hearing board, the Committee shall, by majority vote, recommend a disposition of the case to the Board of Directors.

(i) If the Committee finds that no violation of the Code of Ethics has occurred, it shall recommend that the case be terminated.

(ii) If the Committee finds that a violation of this Code of Ethics has occurred, it shall recommend a sanction to be imposed on the charged party. The possible sanctions shall be:

a. a private reprimand;

b. a public reprimand;

c. suspension from ISCA membership for a period designated by the Committee, or

d. expulsion from the ISCA;

e. other appropriate sanction.

The recommended sanction shall be reasonably related ot the nature and severity of the violation.

(iii) The Committee may also recommend that the imposition of sanctions be suspended on condition that the charged party commits no further violations of this Code of Ethics for a specified period of probation.

(iv) The Committee shall inform the ISCA Board of Directors and the charged party its recommendation in writing. Any Member of the Committee who does not concur in the recommendation may attach a brief written statement outlining his or her reason for disagreement.

(v) The Committee shall transmit the record of the case to the ISCA Board of Directors along with its recommendation.

(2g) The ISCA Board of Directors shall consider the case at its next regular meeting following receipt of the Committee’s recommendation. No additional evidence shall be heard by the Board.

(i) The Board shall have the power to accept, modify, or reject the Committee’s recommendations; provided, however, that the Board may not impose sanctions where the Committee has found that no violation occurred. The Board may return the case to the Ethics Committee for further consideration.

(ii) The Board shall notify the charged party of its decision in writing.

(iii) The sanction imposed by the Board, if any, shall take effect on the date the notice is sent.

(iv) Except where the Committee has found that no violations has occurred, a private reprimand has been imposed, or the imposition of sanctions has been suspended on condition of probation, the Board shall publish a notice of its action and distribute it to all ISCA members. The notice shall contain the following information:

a. the name of the charged party;

b. a brief statement describing the violation; and

c. a brief statement of the sanction imposed.

(v) The ISCA Board of Directors may refer any matter under review to the appropriate authority such as the State Board of Chiropractic Examiner.

(vi) The decision of the Board shall be final.

(vii) After the Board completes its consideration of the case, it shall return the record to the Committee for safekeeping.

(2h) The Committee shall keep all records of completed investigations for at least five years.

(2i) The ISCA Board of Directors of Ethics Committee may suspend any action on a complaint or suspend the imposition of any penalty if a matter is before any sanctioning authority, such as the State Board of Chiropractic Examiners, or is to be referred to such an authority for review pursuant to section 3(c)(iv).

(2j) No Member or Director shall participate in the consideration of a case where he or she has a personal association with either the charged party or the charging party, or otherwise is unable to objectively consider the case due to a conflict of interest or other personal factor. Such a “personal association” must be more than a familiarity or knowledge of the charged party. If, because of this section, one or more Members excuse themselves from the consideration of a case, the President shall appoint up to three temporary Members of the Committee for the purpose of considering that case only.

D(3) Informal Arbitration – The Ethics Committee, as determined by its Chairman or through a vote of three of its members, may offer its services to informally arbitrate any complaint or case brought before it. The procedures used to informally arbitrate such a dispute are within the sound discretion of the Ethics Committee.

D(4) Cooperation – All members of the Indiana State Chiropractic Association are required to comply with these administrative procedures; failure to cooperate with the Ethics Committee, the Executive Committee or the Board of Directors in a proceeding or a complaint may be considered according to the same procedure and with the same sanctions as failure to observe the Code of Ethics.

D(5) Referral to Deliberations Committee – Where appropriate, the Chairman of the Ethics Committee may refer a case to the Chiropractic Deliberations Committee for its review and comment. In those instances, all of the rules applicable to the Deliberations Committee shall be in effect.