NCCAOM Code of Ethics & Grounds for Professional Discipline, Part II

The NCCAOM’s call for comments on the Code of Ethics and Grounds for Professional Discipline ends September 12, 2015 .We owe it to ourselves and our profession to share our thoughts with them.

Here’s what I’ll tell them —

Dear NCCAOM,

Thank you for the opportunity to comment on the Code of Ethics and Grounds for Professional Discipline. My significant concerns with these documents can be traced to three overarching issues —

  1. The NCCAOM credential is required to maintain state licensure for many acupuncturists. You advocate for this arrangement. Yet the current Code of Ethics is more suitable for a voluntary exceptional standard adopted by choice.
  2. States that require NCCAOM credentials have their own regulatory boards, ethical codes, and disciplinary process. The NCCAOM Grounds for Professional Discipline empowers you to pull a practitioner’s credential, removing them from practice, even when a state board would allow continued practice for the same violation. This turns the NCCAOM into de facto regulators and creates double jeopardy for practitioners.
  3. The NCCAOM reserves the right to take disciplinary action against any practitioner who violates the Code of Ethics. The Code covers behaviors ranging from serious threats to the public safety to those in the realm of Public Relations. The NCCAOM should explicitly limit the use of disciplinary action to violations that risk the public safety.

A few specific examples —

  • “Exceeding the scope of practice as defined by law or certification” is grounds for discipline. Scope is defined by the state, and may not be accurately determined by written language in code or regulation. Since state regulatory boards ultimately rule on whether or not a procedure is within scope, and since that board would determine proper discipline for any violation, no action from the NCCAOM is needed. References to scope should be removed from the NCCAOM document.
  • “I will continue to work to promote the highest standards of the profession” is listed in the Code. Must practitioners promote the FPD or DAOM, the addition of herbal exams to licensure requirements, and the expansion of the NCCAOM credential requirement to all states? Who determines the highest standard? This language is coercive at best.
  • The Code of Ethics requires credential holders to report peers who violate the Code. It is untenable to expect Diplomates to report every peer in violation of any aspect of this far-reaching code, and it is unfair to wield the power to hold us responsible for any failure to do so.

I support rigorous professional ethics and respect the NCCAOM’s intent to establish high standards for the benefit of our patients and our profession. However, your role for the profession is to validate entry-level competency. Much of the current Code of Ethics and Grounds for Professional Discipline goes far beyond this role. Continued overreach into areas best left to regulators and voluntary affiliations puts at risk the NCCAOM’s position as a credentialing organization.

Thank you for your consideration of these comments,

Elaine Wolf Komarow, L.Ac, Dipl. Ac. (NCCAOM)

Those of you who would like more background on the role of the NCCAOM in our profession should look at Part I of this post.  I encourage those who are interested in another viewpoint of the NCCAOM and its impact on the profession to review these comments and consider signing this petition.

Copyright —

© Elaine Wolf Komarow and The Acupuncture Observer, 2013-2018. Unauthorized use and/or duplication of this material without express written permission from Elaine Wolf Komarow is prohibited. Excerpts and links are encouraged, provided that full and clear credit is given with specific direction to the original content.

7 thoughts on “NCCAOM Code of Ethics & Grounds for Professional Discipline, Part II

  1. Very interesting observations. Thanks, Elaine, Edna, et al., for keeping an eye on the regulatory ball. I submitted my comments earlier today. I definitely think that the NCCAOM is trying to legitimatize operating in an increasingly more comprehensive scope, and I believe that most of what they propose does NOT serve the profession. A previous example would be holding up credentialling of new grads by inserting a ‘background check’ into the process (which many states already include in their own licensure process, right?). Or, changing the availability of the testing provided in other languages or otherwise disenfranchising native speakers of other languages. The state of Virginia’s board deliberations on previous NCCAOM proposed scope changes indicated that some of their proposals could not be legally implemented in the Commonwealth, since the state protected the licensure of practitioners who were able to serve non-English-speaking communities (if memory serves).

    These power grabs are NOT well-thought out, and the only reason I believe that they are able to slip through is that we acupuncturists have abdicated our power and oversight. Thank goodness for the folks who are shedding light on the shenanigans, and who are serving as board presidents in their states, and in communities such as POCA.

  2. Thanks for this post, Elaine. I just filled out the NCCAOM survey. Besides your points above, I added that I don’t want to see the NCCAOM renewal costs go up because the NCCAOM is trying to do a regulatory function that is already covered well by the state professional boards.

    • FWIW, (and the NCCAOM doesn’t explain this well), these documents and procedures have already been in place and are impacting practitioners. They are asking for comments on the already existing documents as they prepare to review and perhaps change them. One scary thing to think about — the NCCAOM could raise their fees at any time for just about any reason and we’d have no way to do anything about that. It’s not like a government agency that has to justify their fees. Being a non-profit doesn’t mean they can’t give themselves a juicy raise.

  3. Who really needs ethics?

    I have been meaning to comment on this issue for a couple of weeks. As you know, Elaine, I spent it composing a rather lengthy document in which I ask the question, “Who really needs ethical codes?” There, I do not argue that ethical considerations have no place in professions but instead I ask what I consider to be a very reasonable question. Why does the NCCAOM, itself, not have an ethical code by which it abides? When, as you point out, the NCCAOM, in a number of states, virtually usurps the authority of state governments to determine who is qualified to practice, are they not acting as a surrogate government? I would argue that they are.

    State governments do not write laws and regulations based on a priori rational considerations. Historically occupational licensing laws, rules, and regulations are requested by, driven by, and ultimately enforced by the occupation itself. For various reasons the NCCAOM examinations are accepted as a determinant of competency to practice in some jurisdictions. That they should be seen in this way is debatable and there is no question that the contention that they should be considered the sole arbitrar of competency is highly questionable.

    When the NCCAOM is granted de facto power to enlist the services of our legal apparatus to enforce their will by conscripting the efforts of supportive and compliant state licensing board members they are given far too much power and authority. The point is that federal and state government employees are required to comply with codes of ethics, which vary only slightly from jurisdiction to jurisdiction. The purpose of these codes is to prevent conflicts of interest and, indeed, the appearance of conflicts of interest.

    There are instances in which the NCCAOM has acted in ways that suggests they may harbor agendas other than establishing “entry level competency” or “protection of the public”. In Delaware a representative of the NCCAOM contributed to the derailing of what started out as an acupuncture law and ended up as an Oriental Medicine law. She did not when asked, produce data she could easily have provided that would have proven that requiring OM certification would have shut out the vast majority of practitioners in the US. At that time the exclusion rate approached 80%. In New York the NCCAOM wrote a letter of support for an initiative that would have, if unopposed, resulted in a comparable law.
    https://drive.google.com/file/d/0B0bO1cR6ClJRVXNUZXd1eHJHdjg/view?usp=sharing
    I would require, no demand, that the NCCAOM and indeed all institutions and individuals who are part of our educational-certification-accreditation complex write, adopt, and adhere to codes of ethics comparable to those required of government employees. Acting based on conflicts of interest must be strictly forbidden. Codes of discipline for violations must be strictly enforced. They must also adopt transparency policies that require developing mechanisms to receive complaints, and publicly acknowledge their receipt. If a complaint turns out to have merit they must publish the original letter as well as the results of the investigation of allegations of misconduct. This must be followed by the publication of whatever actions will be taken as a result of a legitimate complaint. All of this must be prosecuted in an open, civil, and timely manner and monitored by members of the profession, appointed by the profession, and who have been determined to have no conflicts of interest of their own.

    How is that for a piece of ethical pie? For those who have an interest in looking at the lengthier document mentioned in the first paragraph it can be found at the link below. It is, however still, a work in progress.
    https://drive.google.com/file/d/0B0bO1cR6ClJRUEZzN3dlMEt3UDA/view?usp=sharing

    • You make an excellent point. Does the NCCAOM have its own code of ethics? I can’t find one. They have a set of “Core Values” but I don’t see any process for what we can do if it seems they are not abiding by them. I also believe the issue of conflicts of interest is significant indeed.

      • Hi Elaine:

        Here is the actual letter I sent to the NCCAOM…

        Ashley Wiper
        Licensed Acupuncturist
        204 Milltown Road
        Wilmington Delaware 19808

        Thank you for the invitation to provided stakeholder comments on your Code of Ethics and Grounds for Professional Discipline. To begin I would simply note that I agree with every comment made by Elaine Komarow which has also been published on her Acupuncture Observer website.
        https://theacupunctureobserver.com/nccaom-code-of-ethics-grounds-for-professional-discipline-part-ii/

        The NCCAOM has now usurped the role of the state by developing a multitude of reasons that NCCAOM certification can be suspended or revoked. When the loss of NCCAOM certification results in the loss of the license or right to work, as it now does in many states, this is obvious. This, as Elaine points out, can also result in confusion among practitioners and regulators where grounds for discipline or revocation stipulated by a certification agency and state law are in conflict. There is no legitimate reason for a certification body to impose rules or requirements that override state regulations. The potential for abuse is obvious.

        And here we have not even discussed the potential costs associated with legal challenges to this absurd state of affairs. But if the NCCAOM insists on proceeding with this, it should also recognize that when it usurps the role of government (as it does here) it must accept concomitant responsibilities and obligations. Insofar as most government entities and employees are required to adhere to a published code of ethics the NCCAOM should immediately develop and publish a code of ethics to which the organization and its employees must adhere. In addition, you should have a ‘grounds for discipline’ applicable to the organization and its employees which specifies the penalties for violation of this code. The most important role of ethics codes in government is to prevent conflicts of interest or the appearance of conflicts of interest. A task force appointed by the profession, the members of which have no demonstrable conflicts of interest shall have an active role in the authoring of this code. The profession itself shall also be asked to appoint a neutral board of arbitrars to adjudicate violations of this code once it is enacted.

        It would also be appropriate for the NCCAOM to publish its last three most current IRS Form 990s on the NCCAOM website, as soon as they are available, so the profession can monitor how you are spending your money. This is a very common practice among Tax Exempt organizations, since these forms are actually considered public information.

        The NCCAOM must, further, maintain a position of strict neutrality regarding the purported value of specific certifications they provide. They must never advocate or lobby for the adoption of any one standard (for example Dipl. OM over Dipl. Ac.) over another in letters written to state legislative bodies or when asked by state legislatures to clarify the purpose of their certification programs.

        Other observations based on quotes from your documents:

        Grounds for Professional Discipline

        The NCCAOM requires that we do not:

        “[Violate] prevailing standards of the certified profession relating to safe, ethical, and/or competent practice”.

        What in your view are the “prevailing standards of the certified profession relating to safe, ethical, and/or competent practice”–particularly those relating to incompetency? Who has decided these? What are they? And by what authority should they be considered ‘standards’ at all?

        Code of Ethics

        Our code of ethics requires that we:

        “Keep accurate records of each patient’s history and treatment”.

        There seems to be no uniformity of opinion about what an ‘accurate’ record of acupuncture treatment should contain. Since breeches could be considered grounds for discipline, please be very specific about what an “accurate record of treatment” must contain.

        Our code of ethics also requires us:

        “[to] continue to work to promote the highest standards of the profession”.

        What are these standards? Where exactly are they codified? Who has decided what these are, and by what authority? How do they qualify as ‘standards’ at all? Please be very specific. This requirement is too vague to be useful and potentially subject to abuse. How would a practitioner defend herself from accusations of failing to promote the “highest standards in the profession” without answers to these questions? ANSI (The American Standards Institute) states that “the role of standards is to ensure that the characteristics and performance of products are consistent, that people use the same definitions and terms, and that products are tested the same way. ANSI also accredits organizations that carry out product or personnel certification in accordance with requirements defined in international standards”. Do the ‘standards you advocate measure up to the role of ‘standards’ specified here? If not, why not? I suggest that you have to be far more specific than you have been when you demand this of practitioners if you intend that this requirement be considered either meaningful or credible.

        There are many more problems with these documents that should be discussed but I do not have the time to go further into this. As they are, I consider that these documents either authoritative or credible. I cannot support them in their current iteration, without considerable revision.

        Yours truly,
        Ashley Wiper

        • “As they are, I consider that these documents either authoritative or credible. I cannot support them in their current iteration, without considerable revision.”

          Should read:

          As they are, I consider that these documents neither authoritative or credible. I cannot support them in their current iteration, without considerable revision.

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