Code of Ethics

The AAEM board approved ethics policies effective November 12, 2020

AAEM Principles of Ethics

Preamble

The ethics of the physician do not begin, nor do they end at the bedside. The pursuit of an ethical professional life is aspirational. That life is grounded in the behaviors and ideals that are present at home and in the community. While ethical behaviors are most on display when caring for patients, that behavior is required in all facets of the physician’s being.

The reputation of the American Academy of Emergency Medicine and its ability to act beneficially for its members, and society as a whole, is dependent upon each individual member acting in an ethical manner in public, private, and at the bedside.

To that end, the American Academy of Emergency Medicine affirms these principles (duties) of ethical behavior.

AAEM Principles of Ethical Practice

Emergency physicians shall always function as a patient advocate and place the interest of patients and the vulnerable as their primary duty.
Emergency physicians shall evaluate and treat all patients to the best of their ability regardless of a patient’s ability to pay.
Emergency physicians will not use race, color, national origin, ethnicity, gender, religion, sexual orientation, or age to be a determining factor in providing the best care given available resources.
All patients will be treated with dignity and respect. Patient privacy, autonomy, and confidentiality shall be respected and maintained.
All emergency physicians shall obtain informed consent prior to performing non-routine procedures or treatments unless emergency conditions exist where delay would cause harm.
Emergency physicians shall treat all colleagues and coworkers with honesty, dignity, and respect.
Emergency physicians shall respect professional boundaries and shall not let them influence any relationships outside the medical setting.
Emergency physicians shall act as stewards of medical resources in the best interests of their patients.
Emergency physicians have the duty to continually educate themselves to provide the best care for their patients.
Emergency physicians have a duty to intervene on behalf of patients in the event a colleague or co-worker is suspected of being unable to practice with reasonable skill and safety.

Code of Ethics Policy

All members will comply with:
1. General principles of medical ethics as enumerated by the American Medical Association as of November 1, 2008 (AMA Code of Medical Ethics Overview)
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)
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.
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

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.
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.
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.
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.
No member will impede another physician from obtaining information relating to his or her individual professional charges, fees, and collection history.
No member shall knowingly give or accept commission fees for patient referrals.
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

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.
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.
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.
Personal conflicts of interest exist when officials are unable to separate personal interests from their obligation to objectively serve the interests of the membership.
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.
The Academy's president shall make the final determination of situations representing actual conflicts of interest.
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.
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.
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

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.
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.
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.
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.
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.
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.
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.

Code of Conduct & Ethics Policy: BOD, Executive Committee, Committee Charis, IG Chairs, Section Chairs and Division Leadership

Rationale
Principles and practices of the American Academy of Emergency Medicine (AAEM) board of directors, executive committee, committee and section chairs and Division leadership are to provide guidance and direction for effective governance.

Code
embers of the board of directors, executive committee, committee and section chairs and division leadership are committed to observing and promoting the highest standards of ethical conduct in the performance of their responsibilities to AAEM. Members of these groups pledge to accept this code as a minimum guideline for ethical conduct and shall:

Accountability

Faithfully abide by the articles of incorporation, bylaws and policies of the Academy.
Exercise reasonable care, good faith and due diligence in governing and managing affairs.
Fully disclose, at the earliest opportunity, information that may result in a perceived or actual conflict of interest.
Fully disclose, at the earliest opportunity, information of fact that would have significance in board of directors, executive committee section and division decision-making.
Remain accountable for prudent fiscal management to AAEM members, the nonprofit sector, and, where applicable, to government and funding bodies.

Professional Excellence - Integrity

Maintain a professional level of courtesy, respect, and objectivity in all matters and activities.
Strive to uphold those practices and assist other members of the board of directors, executive committee, committee chairs, section chairs and division leadership in upholding the highest standards of conduct.

Personal Gain – Self-Dealing

Exercise the powers invested for the good of all members of the AAEM and the emergency medicine community rather than for personal benefit.

Equal Opportunity – Diversity - Inclusivity

Ensure the right of all members to access benefits and services without discrimination on the basis of culture, gender, sexual orientation, geography, political, religious or socio-economic aspects.
Ensure the right of all members to access benefits and services without discrimination on the basis of the Academy’s volunteer or staff make-up in respect to gender, sexual orientation, national origin, race, religion, age, political affiliation or disability, in accordance with all applicable legal and regulatory requirements.

Confidential Information

Respect the confidentiality of sensitive information and member contact information known to board and committee members and used for the purposes of governance and management. Understand and support the concept that what is learned or heard as a representative of AAEM will remain the intellectual property of AAEM.

Collaboration and Cooperation

Respect the diversity of opinions as expressed or acted upon by the committees and membership, and formally register dissent as appropriate.

Violations

Violations of the Code of Conduct & Ethics Policy may result in disciplinary action in accordance with AAEM’s governing documents. Discipline may include removal of a board member, executive committee member or committee chair from his or her position.

AAEM Code of Conduct and Ethics Violations Procedure

The AAEM Ethics Committee shall receive and be responsible for the administration of all Complaints, which must be in writing and signed by the Complainant. The committee shall be appointed by the president unless the Ethics is against the president. In that instance, the committee shall be appointed by the immediate past president. The Ethics Committee shall initially review each Complaint to ascertain whether it (1) contains insufficient information upon which to base an investigation and/or corresponding determination; (2) would be better suited for consideration by another body (i.e., a health care 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; or (3) is patently frivolous or inconsequential.
In the event of the Ethics Committee ascertains that the Complaint falls within any of the above three standards, the Complaint shall be dismissed by written notice from the Ethics Committee to the Complainant. The Ethics Committee shall also report such dismissal to the AAEM board of directors.
If the Ethics Committee ascertains that the Complaint is not within any of the three standards described in above, the Ethics Committee shall then investigate the facts and/or circumstances to whatever extent it deems necessary or appropriate in order to evaluate the information provided by the Complainant and the allegation(s) of the Complaint. Respondent shall be notified in writing at the beginning of such investigation of the following: (i) the allegation(s); (ii) those provisions of the Code of Member Conduct which, if true, would be violated thereby; (iii) the sanctions to be imposed in the event of a violation; and (iv) the opportunity to request a hearing on the Complaint before the Ethics Committee prior to the time a determination is made with respect to the Complaint. An investigation may consist of such actions as the Ethics Committee shall determine are necessary or appropriate in order to determine the veracity of the allegation(s) in the complaint and may, include, among other things, one or more informal interviews with the Respondent, the Complainant and any witnesses or others relevant or potentially relevant to the allegations in the Complaint.
Upon completion of the investigation and hearing (if one is conducted) with respect to the Complaint, the Ethics Committee shall recommend to the AAEM board of directors a determination with respect to the Complaint, and, as applicable, any recommended sanctions. Such recommendation shall be in writing and shall include a statement setting forth the basis for, and the rationale supporting, such recommendation.
The AAEM board shall make a determination with respect to the Complaint by accepting, rejecting or modifying such recommendation based solely on the record provided by the Ethics Committee.

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