This memo outlines the NIH Policy regarding Special Volunteers providing clinical services at NIH.  By providing an exception to NIH policy, Special Volunteer are permitted to see former NIH patients for follow up in their own offices.  It also permits those patients who were not in a protocol to be seen by the Special Volunteer in his/her own practice.  This will be incorporated into the revised NIH Manual Chapter 2300-735-4.

Currently, NIH Manual Chapter 2300-735-4, Outside Work and Related Activities with Outside Organizations (effective 02/17/98), applies to persons who are not NIH employees, such as Special Volunteers. Because special volunteers are not employees of the Federal Government, they are technically not covered by the Standards of Ethical Conduct for Employees of the Executive Branch ("Standards").

It is routine practice for the ICs conducting research protocols at the Clinical Center to utilize the services of outside licensed health care professionals to provide clinical services, including consultation. These licensed health care professionals may provide those services as a volunteer or under contract. The provisions of the NIH Manual Chapter 2300-735-4 preclude volunteer health care providers from referring their own patients to the NIH, and from seeing an NIH patient for follow-up care. This significantly affects the continuity of care provided to patients and may compromise the patients’ follow-up care. In addition, these licensed health care professionals may not see a former NIH patient, even for care not related to the NIH visit. Thus, the patients’ future choice of a health care provider is restricted.

The use of special volunteers to provide clinical services is becoming more common at the NIH. The Standards of Ethical Conduct for Employees of the Executive Branch do not apply to persons who are not Federal employees. Special volunteers, and other non-employees at the NIH, were covered by the NIH Manual Chapter because it was determined, as a matter of policy, that individuals who spend time at NIH working side by side with NIH employees should be subject to the same rules and policies governing their conduct, including outside activities, as regular government employees. The next revision of the above manual chapter will consider whether to continue to subject special volunteers and other non-employees to the provisions of the chapter. The NIH policy of applying the restrictions for employees to these non-employees can be viewed as more restrictive than the Standards. In addition, applying the NIH policy to these persons has the undesirable effect of limiting patient care and follow-up for patients seen at the NIH.

Effective immediately, the provisions regarding professional practice contained in NIH Manual Chapter 2300-735-4 are removed for only those Special Volunteers who are providing clinical services (direct patient-care related services) at the NIH. The Special Volunteer agreement document, NIH Form 590-2 (6/98), paragraph 5, shall be annotated to indicate this exception. This exception is only for special volunteers providing clinical services at the NIH. Special volunteers remain subject to the remainder of the provisions of the manual chapter. This exception does not apply to employees and other non-employee individuals as designated in the chapter.

/s/

Stephen C. Benowitz