The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. Likewise, the American College of Cardiology ("ACC") recognizes that its members have certain ethical obligations to their patients, profession, each other, as well as to the community and world at large. As a member of the medical profession and ACC, an ACC member must recognize, respect, and adhere to these obligations.
The ACC Code of Ethics (the "ACC Code") strives to set standards and provide guidance for members of the American College of Cardiology acting within the organization, in their clinical practice, and in their professional activities, generally.
The ACC Code sets forth the governing principles, values, and beliefs shared by the members of the American College of Cardiology, as well as the ethical behavior and standards of conduct expected in conformance with these principles and beliefs.
Adherence to the ACC Code is a condition of ACC membership. A member may be admonished, censored, placed on probation, suspended or expelled for violating the ACC Code. Allegations of violations of the ethical principles set forth in this ACC Code may be brought in accordance with the procedures described in the ACC Professional Conduct Program Procedures set forth below. Any judicial review of an ACC disciplinary action adversely affecting membership status shall take place in, and be governed exclusively in accordance with the laws of, the District of Columbia. The ACC Code may be revised or replaced periodically and it is the obligation of members to be informed of and adhere to these changes.
1. Relationship with Patients
1.1 A member shall ensure that patients and the interests of patients are placed at the center of all care and all care decisions, and shall ensure care equity.
1.2 In all dealings with patients, a member shall act fairly, in good faith, and with compassion and respect for a patient's dignity and rights.
1.3 Patient welfare must be paramount. Under no circumstances shall a member place his or her self-interest above patient welfare.
1.4 Any conflict of interest must be resolved in the best interests of the patient.
1.5 A member shall use his or her best efforts to protect patients from harm by recommending and providing care that maximizes anticipated benefits of care and minimizes possible risks of harm from such care.
1.6 A member must strive to make pertinent medical information available to the patient to enable the patient to make informed choices about their health care.
1.7 Consistent with a member's legal duty to maintain the confidentiality of patient health information, a member should provide pertinent medical information to the patient's family, professional colleagues, and the public only with the appropriate consent and permission of the patient.
1.8 A member shall respect the confidential health care professional-patient relationship and safeguard it consistent with the law.
1.9 A member shall not discriminate on the basis of sex, gender identity, race, color, national origin, sexual orientation or other basis that would constitute illegal discrimination.
1.10 A member has an obligation to responsibly steward the use of healthcare resources under his or her supervision without compromising patient care and welfare.
2. Relationship with Other Professionals
2.1 A member shall uphold the standards of professionalism, be honest in all professional interactions, and shall report to the appropriate legal, regulatory or peer-based entity, healthcare professionals whose competence or professional conduct affects or could adversely affect the health or welfare of a patient or patients.
2.2 A member shall act fairly, in good faith, honestly, and with respect in all his or her professional and public dealings.
2.3 A member experiencing substance abuse or physical or emotional/psychological impairment should seek the appropriate assistance and limit practice and professional obligations to ensure the impairment does not adversely affect the member's institution, colleagues, or the health or welfare of patients.
2.4 A member shall cooperate in the legal, regulatory or peer-review process in connection with alleged incompetence or unprofessional conduct of the member or that of another member and accept the profession's final disciplinary action.
2.5 A member shall not discriminate on the basis of sex, gender identity, race, color, national origin, sexual orientation or other basis that would constitute illegal discrimination.
2.6 A member shall not engage in any form of discrimination, harassment, or retaliation, including but not limited to, sexual harassment; harassment on the basis of any other protected characteristic; denial of opportunity or unfair treatment resulting from bias or prejudice; or action taken with the intent to negatively impact another individual based on the reporting of an act of discrimination or harassment, where the likely result of such action would be an objective material detriment to the individual who reported such an act of discrimination or harassment and/or his or her career.
3. Relationship with ACC
3.1 A member serving on behalf of ACC or in any other professional capacity shall endeavor to base his or her opinions on objective data and avoid personal bias.
3.2 A member shall honor his or her fiduciary, legal, and professional obligations in serving his or her respective professional organizations.
3.3 A member shall work to ensure the attainment of the organizations' mission and objectives.
4. Relationship to the Community and to Government
4.1 A member shall comply with state and federal laws and regulations governing the practice of medicine and any state and federal laws and regulations governing the acquisition and maintenance of the relevant professional license of the member.
4.2 A member practicing medicine or intending to practice medicine in an international jurisdiction shall comply with all laws and regulations governing the practice of medicine in such international jurisdiction, and any laws and regulations governing the acquisition and maintenance of the relevant professional license of the member, and shall not misrepresent ACC membership as a credential that demonstrates a right to practice medicine in any jurisdiction.
4.3 A member involved in the conduct of research and investigation, including work involving human subjects, shall behave ethically.
4.4 A member is obligated to report patient abuse, neglect or harassment to the appropriate authorities.
4.5 A member must recognize the imperative of fairly distributing the benefits and burdens of research and other health care resources.
4.6 A member shall have a professional and social obligation to be involved in the community as well as to support policies and change in the best interests of patients and matters affecting healthcare generally.
5. Training and Continuing Medical Education Responsibilities
5.1 A member shall not practice or otherwise engage in professional obligations beyond the scope of his or her training, experience and license.
5.2 A member has an ongoing obligation to be actively involved in continuing medical education activities to ensure the continued development of his or her skills, training and expertise.
5.3 A member shall maintain his or her professional qualifications through continuous study consistent with evidence-based scientific practice.
6. Expert Witness Testimony
6.1 A member providing expert witness testimony must be an acknowledged expert, having the appropriate education and experience, in the specific area in which he or she is testifying. A member shall not misrepresent his or her education and experience.
6.2 Expert witness testimony provided by physician members is considered the practice of medicine and should be provided in an objective manner using medical knowledge to form expert medical opinions that are subject to peer review. Physician members acting as an expert witness must have a current, valid, and unrestricted license to practice medicine in the United States.
6.3 Any member providing expert witness testimony shall adhere to those principles set forth in any policies or statements governing the provision of expert witness testimony adopted by ACC.
6.4 A member providing expert testimony should be diligent in his or her preparation and should thoroughly review all pertinent medical records, as applicable, and all relevant information that has a bearing on the testimony.
6.5 Expert witness testimony should be fair, accurate, thorough, and objective.
6.6 Where the member's testimony varies from generally accepted standards, the member appearing as an expert witness must identify personal opinions not generally accepted by other healthcare professionals.
6.7 A member shall not knowingly give false expert witness testimony or testimony in deliberate ignorance of the truth or fail to perform adequate due diligence to determine the truth or falsity of the testimony.
6.8 Where appropriate, the member expert witness should establish the standard of proper professional skill or care in the matters testified to, whether there was a failure to conform to such applicable standard, and whether there is a causal relationship between any such failure to conform and the patient's medical outcome.
6.9 The member as expert witness should not act as an advocate or partisan but as a genuine expert and educator to the parties in litigation.
6.10 Compensation for expert testimony should be reasonable and commensurate with the time and effort expended. It is unethical for a member expert witness to accept compensation that is contingent upon the outcome of litigation. A member should not testify as an expert witness solely for financial gain because of the potential for such motivation to influence his or her testimony.
6.11 Any ACC Trustee providing expert testimony during his or her term as a Trustee on the Board of Trustees shall affirmatively state at the outset of any expert witness testimony that he or she is testifying solely as an individual and not on behalf of ACC in any way. He or she should make it clear in writing that his/her position within the ACC should be kept separate from the medical expertise that makes his/her testimony appropriate.
7. Conflicts of Interest
7.1 A member shall fully and accurately disclose all relationships with industry, all personal, organizational or financial conflicts, and any other potential conflicts of interest as requested by ACC or the Chairs of any committee, council, task force, or any other body on which a member serves in furtherance of service to ACC, and disclose any additional potential conflicts as they arise.
7.2 A member shall strive to identify, disclose and resolve potential and actual conflicts of interests in his or her professional practice and service to ACC. If a conflict cannot be adequately resolved consistent with the foregoing then the member should withdraw from the relationship.
7.3 A member should be aware of personal, institutional, organizational, or financial conflicts of interest in their relations with ACC and in other professional relationships.
7.4 A member shall comply with ACC's Relationships with Industry policy.
ACC Professional Conduct Program Procedures Hearing and Adjudication Rules
Automatic Suspension of Membership
The following shall be grounds for automatic suspension of membership:
- Conviction for a felony or
- Suspension or termination of the right to practice medicine in any state, province or country by reason of a violation of a medical practice act, other statute or governmental regulation, which shall include a voluntary relinquishment of the right to practice medicine in the context of a settlement or other agreement in connection with an alleged violation of a medical practice act, other statute or governmental regulation.
For purposes of clarity, the voluntary relinquishment of the right to practice medicine due to a temporary or permanent disability, retirement, or a change in geographic location is not grounds for automatic suspension of membership.
Hearing and Adjudication Rules
Any complaints or violations of the ACC Code that do not constitute grounds for automatic suspension of membership shall be governed by the following procedures for hearing and adjudicating charges alleging violations of the ACC Code and/or ACC Bylaws brought by an ACC member against another ACC member (the "Program Procedures").
- Initiation of Complaint: Only a current member of the American College of Cardiology in good standing may initiate a complaint against another member of the American College of Cardiology. Complaints must specifically allege a violation(s) based on ACC's Bylaws or the ACC Code, which could be the basis for ACC to take disciplinary action against the member. All complaints must be dated and submitted in writing to the ACC Legal Affairs Department with all documentation and materials for review by the Ethics & Compliance Committee included, and under the signature of the member bringing the complaint (hereafter the "Complainant"). The complaint must site the specific section of the ACC Code and/or Bylaws that was allegedly violated by the ACC member. Information in the complaint should be provided consistent with HIPAA regulations and any other applicable laws and regulations. The Complainant must allege first-hand or actual knowledge of the alleged conduct and provide any related documentation and other evidence. Complaints alleging conduct in connection with any pending or appealable matters in connection with any litigation, arbitration, mediation, review by an institutional, state or federal review board or panel, or review by another peer review process will not be addressed until the final resolution of the process. Upon receipt of the complaint, the ACC Legal Affairs Department will confirm that the complaint meets the required format and other requirements for initiation of a complaint. If the complaint is deficient in any respect, the Legal Affairs Department will return it to the Complainant within thirty (30) days of receipt indicating the reason(s) for its return. The Complainant may resubmit an amended complaint. If the complaint is submitted by a Complainant without jurisdiction to submit a complaint under the Code of Ethics and these Program Procedures, the Legal Affairs Department will return it to the Complainant within thirty (30) days of receipt indicating the reason for return. If appropriate, the Legal Affairs Department may provide an alternative institutional, state, federal, or professional review board, panel or organization that may consider the complaint, but shall not in any manner represent or guarantee that such board, panel or organization will address the complaint.
- Receipt and Acknowledgement of Complaint: Within thirty (30) days of receipt of the complaint, the Legal Affairs Department will send a written acknowledgement to the Complainant to confirm ACC's receipt, the intention of the Complainant to proceed, and provide the Complainant with a copy of the Program Procedures, as well as to solicit any additional information or documentation regarding the complaint. ACC's Legal Affairs Department will forward the complaint and any accompanying materials to the Chair of the ACC Ethics & Compliance Committee for an initial review. The Ethics & Compliance Committee will keep the complaint and any related documentation and proceedings confidential, except as otherwise set forth in Section X of these Program Procedures.
- Initial Evaluation: The Chair of the Ethics & Compliance Committee (the "Chair") or his or her designee, with the assistance of the Legal Affairs Department and any outside expert(s) the Chair desires to consult on a confidential basis, will conduct an initial evaluation of the complaint. The initial evaluation will determine if the complaint alleges conduct requiring an automatic sanction pursuant to the Automatic Suspension of Membership section of this ACC Code, or if a prima facie case of a violation has been made. The Chair shall make a recommendation to the Ethics & Compliance Committee at the next meeting as to whether the Ethics & Compliance Committee shall review and investigate or dismiss the complaint on the basis of this evaluation. A simple majority vote of the Ethics & Compliance Committee members present at a meeting with a quorum will accept or reject the Chair's recommendation. If the Ethics & Compliance Committee accepts the Chair's recommendation to proceed, then the complaint is deemed "accepted" and will proceed. If the Ethics & Compliance Committee accepts the Chair's recommendation to dismiss or rejects the Chair's recommendation for further review and investigation, then the complaint will be dismissed. The Complainant will be notified in writing of the decision and grounds for the Ethics & Compliance Committee's decision within thirty days (30) days.
- Notice and Hearing: Within thirty (30) days of the Ethics & Discipline Committee's acceptance of any complaint, the subject of the complaint (the "Respondent") will be provided with a notice that: (i) states a disciplinary action that may adversely affect Respondent's ACC Membership has been proposed to be taken against the Respondent, and (ii) provides the reasons for the proposed action in the form of a complete copy of the complaint with any accompanying materials. The notice also shall contain: (i) a copy of the Program Procedures, the ACC Code, and the ACC Bylaws and (ii) a statement that the Respondent has thirty (30) days from receipt of the notice to request a hearing on the proposed action or, in the alternative, to waive the right to a hearing and request a decision based exclusively on whatever written response and supporting documentation or materials he or she provides the Disciplinary Review Panel, as described in Section VI herein, within sixty (60) days from the receipt of the notice. The Respondent will be further advised in the notice that failure to request a hearing within the thirty (30) day time limit is a waiver of the right to a hearing. Once notice has been provided to the Respondent, the Respondent may not resign his or her ACC membership until the resolution of the disciplinary process, including any hearing or appeals.
- Request for Hearing: If Respondent requests a hearing, the Respondent will be given a notice stating (i) the place, date and time of the hearing, which shall not be less than thirty (30) days nor more than six (6) months after the date of the notice unless all parties agree otherwise, and (ii) a list of the witnesses, if any, expected to testify at the hearing. The Complainant will be provided with a complete copy of the Respondent's submissions. If the Respondent fails to request a hearing or fails without good cause and prior notice to appear at the hearing, then the Respondent's right to a hearing is forfeited. Notwithstanding any forfeiture, the hearing shall proceed without the Respondent participating or possessing any of the hearing and appeal rights. However, the Disciplinary Review Panel Members shall consider any written statement and supporting documentation or materials that the Respondent previously supplied the Disciplinary Review Panel.
- Composition of Disciplinary Review Panel: The Chair will select three (3) members of the Ethics & Compliance Committee to constitute and serve on a Disciplinary Review Panel. If the Chair chooses not to serve as a voting member of the Disciplinary Review Panel, the Chair will serve as a non-voting ex-officio member of the Panel. The Disciplinary Review Panel members then shall unanimously select and invite two additional ACC members with relevant expertise in the subject matter of the case to sit on the Disciplinary Review Panel. None of the members of the Disciplinary Review Panel shall be in direct economic competition with the Respondent or Complainant or have other acknowledged or significant perceived conflicts of interest in connection with the Respondent or Complainant. The Respondent and Complainant will be provided with the names of the Disciplinary Review Panel members and have fifteen (15) days to challenge any Disciplinary Review Panel member on the grounds of acknowledged or perceived conflicts of interest. The immediate past ACC President, Board of Governors Chair, and General Counsel shall address the challenge.
- Adjudication and Hearing Process: Only the Disciplinary Review Panel members, each party and one representative or attorney representing each party, ACC General Counsel (and/or designee) and the court reporter shall attend the hearing. On the date, time, and place of the hearing, the proceedings will be recorded by a court reporter. Either party may obtain a copy of the transcript of the proceedings upon payment of any reasonable charges related to its preparation. The transcript will be the official and exclusive record of the hearing. Each party may make a presentation to the Disciplinary Review Panel of no more than thirty (30) minutes and provide written briefs. Rules of evidence shall not apply. The Chair of the Disciplinary Review Panel shall have the authority to reasonably extend presentation time upon request by a party during the hearing. Within the thirty (30) minute timeframe, the parties may call witnesses and they may also submit notarized affidavits from third parties. The Disciplinary Review Panel may ask questions directly of the Complainant or Respondent at any time during the hearing. The Disciplinary Review Panel may request additional information of the Complainant and Respondent and of outside experts. Cross examination of witnesses shall only be permitted at the sole discretion of the Chair. The Disciplinary Review Panel shall not consider additional complaints or allegations based on the same facts. At the close of the hearing, the parties may make a closing statement lasting no more than ten (10) minutes and may submit a written statement.
- Disciplinary Review Panel Action: Within forty-five (45) days of the hearing, the Disciplinary Review Panel will make its recommendation to the Ethics & Compliance Committee that the complaint be either sustained or not sustained, and if sustained, the appropriate disciplinary action and sanction, as set forth in Section IX. If there is a dissenting opinion from a member of the Disciplinary Review Panel, that also will be forwarded to the Ethics & Compliance Committee. The recommendation will include a statement of the basis for the recommendation for each allegation and any dissenting opinion. If the Disciplinary Review Panel sustains the complaint then one of five sanctions shall be recommended for each allegation for adoption by the Ethics & Compliance Committee. The Disciplinary Review Panel's recommendation (complaint not sustained, sustained and sanction) for each allegation must be approved by a majority vote of the entire Disciplinary Review Panel unless the recommended sanction is expulsion in which case the Disciplinary Review Panel's recommendation must be unanimous. If the Disciplinary Review Panel's recommendation is not to sustain the complaint and the Ethics & Compliance Committee accepts the recommendation, then the Respondent is exonerated and the complaint is dismissed. If the Disciplinary Review Panel's recommendation is to sustain the complaint then the Ethics & Compliance Committee may accept, reduce, or increase the Disciplinary Review Panel's recommended sanction for each allegation by a majority vote of the Ethics & Compliance Committee at a meeting with a quorum present unless the recommendation is expulsion in which case the entire Ethics & Compliance Committee must unanimously approve the Disciplinary Review Panel's recommendation. The Ethics & Compliance Committee will communicate the decision, and the basis of the decision, to the Respondent and the Complainant.
- Sanctions: Disciplinary action, if imposed, shall take one of the following forms:
- Admonition - A written notification, warning, or serious rebuke.
- Censure - A written judgment, condemning the member's action as wrong. This is a firm reprimand.
- Probation - A punitive action, for a stated period of time, during which a member is subject to the following: (i) loses the right to hold office or participate in any membership programs; (ii) retains other privileges or obligations of membership; (iii) is observed by ACC for continuing eligibility for membership; and (iv) shall be reconsidered by the Ethics & Compliance Committee at the end of the stated term of probation. At the end of the stated term of the probation, the Ethics & Compliance Committee shall, on its own motion, review the record and determine whether the probation shall be removed.
- Suspension - A severe punitive action for a stated period of time during which the member is subject to the following: (i) removal of his/her name from the ACC Membership Directory and from the mailing list of ACC; (ii) if a Fellow, return of the Certificate to ACC; (iii) obligation to pay non-member registration fee when attending ACC meetings; and (iv) relief from annual dues. The Board of Trustees, in imposing a suspension shall set a minimum time before which no petition for removal may be entertained.
- Petition for Removal of Suspension: A petition for removal of suspension shall be addressed to the Ethics & Compliance Committee. A petition for removal of suspension shall conclusively demonstrate that the suspended member meets the requirements for membership in ACC in effect at the time of his/her first acceptance into membership, and that during the period of his/her suspension he/she has demonstrated a faithful adherence to the ethical principles of ACC. The Ethics & Compliance Committee shall consider the petition for removal of suspension when properly submitted according to rules it may from time to time prescribe. It may, at its sole discretion, hold a hearing on the petition. Only the petitioner shall be notified of a denial by the Ethics & Compliance Committee. If a petition for removal of suspension is denied by the Ethics & Compliance Committee, the suspended member may submit a new petition no earlier than twelve (12) months after the previous denial, unless the terms of the denial state otherwise. There shall be no right of a suspended member to appear before the Board of Trustees or otherwise have a right of appeal. When suspension is lifted, the member is returned to full privileges and obligations of ACC membership.
- Expulsion - A permanent severance of relationship with ACC. If a Fellow (or MACC or AACC), the Certificate of Fellowship (or of MACC or AACC) and all other indicia of Fellowship, MACC or AACC previously issued to him/her by ACC must be returned forthwith to ACC. He/she shall not hold himself/herself out as, or pretend to be, a Fellow of the American College of Cardiology (or MACC or AACC if applicable), thereafter. He/she shall not be eligible for reapplication for membership in ACC.
- Admonition - A written notification, warning, or serious rebuke.
- Appeal to the Board of Trustees: Only the Respondent may appeal a decision of the Ethics & Compliance Committee for disciplinary action. A request for an appeal to the Board of Trustees must be made within thirty (30) days of the date on the notification of the Respondent of the decision of the Ethics & Compliance Committee. The Respondent's appeal request to the Board of Trustees may include a written brief with any supporting materials. An appeal request shall not contain any new factual material or new documents, or raise new arguments that were not presented in the initial hearing process and made part of the official record of the Disciplinary Hearing proceeding. The appeal will not consider any matters not included as part of the official record of the Ethics & Compliance Committee's investigation and the Disciplinary Review Panel's deliberations. The appeal is limited to a review of the Ethics & Compliance Committee and the Disciplinary Review Panel's application of the ACC Code and the Program Procedures. The Chair of the Ethics & Compliance Committee and Chair of the Disciplinary Review Panel shall be present when the Board of Trustees considers an appeal. Three representative members of the Board of Trustees appointed by the Board of Trustees shall serve as the appeals panel and shall vote by a majority vote to accept, reject, or modify the determination of the Ethics & Compliance Committee. Any member of the Ethics & Compliance Committee or Disciplinary Review Panel who also is a member of the Board of Trustees shall not serve on the Board of Trustees appeal panel or otherwise participate in the appeals process or deliberation. The Respondent shall be promptly notified of the Board of Trustees' decision, including the basis of the decision. Decisions of the Board of Trustees are final and not appealable.
- Disclosure and Reporting: Any sanction imposed on a Respondent shall be made available to the public by posting the sanction on the public section of the ACC website along with the general category and a summary of the violation for the duration of the sanction. The final written disposition of the case shall be made available upon written request by ACC members. ACC Governors and/or Chapters shall be officially notified of all actions resulting in the probation, suspension, or expulsion of an ACC member in the respective state of the Chapter. The complaint file shall be retained by ACC for three (3) years and treated as confidential. After three (3) years the file will be destroyed. If required by law, the sanction will be reported to the National Practitioner Data Bank and state licensing boards as applicable to the Respondent.