The American Foundation for Surgery of the Hand (“AFSH”) is dedicated to advancing research and education for the field of hand and upper extremity surgery. To accomplish that mission, it provides support, directly or indirectly, for a variety of activities in the areas of research and education. The integrity of AFSH, and the activities it undertakes, depends on the avoidance of conflicts of interest, or even the appearance of such conflicts, by the individuals involved in the decision-making process regarding support of such activities.
At the same time, AFSH recognizes that the elected and appointed leaders of AFSH, as well as other individuals acting on its behalf, also have significant professional, business and personal interests and relationships. Therefore, AFSH has determined that the most appropriate manner in which to address actual, potential or apparent conflicts of interest is initially through complete disclosure of any relationship or interest which might be construed as resulting in such a conflict. Disclosure under this Policy should not be construed as creating a presumption of impropriety or as automatically precluding someone from participating in AFSH leadership or decision-making process. Rather, it reflects AFSH’s recognition of the many factors that can influence one’s judgment and a desire to make as much information as possible available to other participants in AFSH-related matters.
Any individual involved in AFSH leadership or decision-making process shall disclose any conflicting or potentially conflicting personal, professional or business interest he or she may have, directly or indirectly, with the affected activity or decision. Potentially conflicting interests may relate to AFSH-funded grants and programs (e.g., educational grants, research grants and awards, scholarship and fellowship programs) or its operations (e.g., contracts with third parties).
In particular, participants in AFSH leadership roles are obligated to disclose the positions they hold or relationships they have within AFSH and with other organizations or entities that may conflict, directly or indirectly, with AFSH decision-making processes. They also have an obligation to disclose any significant financial interest in, or other relationship with, an entity having a “commercial interest” in the Foundation. A commercial interest may exist not only where the entity’s products or services are under consideration by AFSH, but also where the entity’s products or services are in competition or potential competition with those under consideration. By the disclosure of such interests, the Board of Trustees will be in a better position to determine whether the participant may have an interest in conflict with the interests of AFSH.
AFSH primarily is concerned with potential conflicts of interest involving those individuals participating directly in AFSH leadership roles. Potential conflicts of interest also may arise, however, if an individual with whom the participant directly shares income (e.g., a spouse, minor child, or business partner) or a third party whose interest may affect the participant’s decision-making (e.g., a sibling or adult child) has an interest in, or relationship with, an entity having a commercial interest in a matter under consideration by the AFSH. As a result, participants should disclose not only their own interests or relationships but also those of their spouse or minor children. In addition, participants should disclose interests or relationships held by others that may affect their decision-making, but only to the extent they are aware of such information. Participants are under no obligation to determine the nature of every interest held by a sibling, business partner, etc. if they have no independent knowledge of such interests.
Comparable principles apply to participants’ obligations to disclose research grants received by the institution(s) with which they are affiliated. In addition to grants received for their own research, participants are presumed to know what grants have been received by other members of their department engaged in upper extremity-related research. Therefore, those grants also should be disclosed. In contrast, participants have no affirmative obligation to ascertain the nature of grants received by others in their institution. If they are aware of such grants, however, those also should be disclosed.
In general, participants should err on the side of disclosure if in doubt as to whether it is required under the Policy. Examples of relationships or interests related to AFSH or hand surgery which should be disclosed include:
Positions in AFSH - All positions currently held or sought in AFSH (e.g., Board of Trustee, committee member, campaign chair), as well as any other current or proposed relationship with AFSH (e.g., service provider, paid consultant) must be disclosed.
Relationships with Other Organizations/Entities - Any leadership role in, or other relationship with, another organization or entity (e.g., board member) directly or indirectly related to AFSH or hand surgery must be disclosed.
Employment - Any current or proposed full- or part-time employment, as well as any employment within the previous three (3) years, must be disclosed.
Consultancies - Any current or proposed consulting arrangements with a commercial interest as well as any consulting performed or paid for within the previous year must be disclosed.
Royalties - Any individual or entity that is currently paid or has paid or is about to pay, royalties or similar payment, must be disclosed.
Ownership Interests - Any ownership interests (including stock options but excluding indirect investments through mutual funds and the like) in a company, the stock of which is not publicly traded, must be disclosed. Ownership interests in companies that are publicly traded also must be disclosed. In addition, any other ownership interests in an entity having a commercial interest in an activity or matter under consideration by AFSH must be disclosed.
Honoraria - Honoraria or other reasonable payments for seminar presentations, speeches, or appearances from a commercial interest paid within the last year must be disclosed.
Research Funding - Receipt of funds for conducting research must be disclosed.
The Disclosure of Relevant Financial Relationships Form shall be considered a part of the Conflict of Interest Disclosure Policy and must be submitted by any individual participating in AFSH leadership. The disclosure form is found on the ASSH website in the “My Account” section. Click on “Disclosures” in the upper right corner.
Initially, a participant’s obligation to report actual, potential or apparent conflicts is discharged by completing the Disclosure Form. Participants remain under a continuing obligation, however, to report such conflicts as they arise, including those that were not reported on the Disclosure Form, but which later become relevant to the AFSH decision making processes.
All participants in AFSH decision-making processes must comply with the AFSH Conflict of Interest Policy. It is the responsibility of the members of the AFSH Board of Trustees or designated committee and campaign chairs. to apply and abide by this Policy. And, inasmuch as the Policy is stated in general terms, they should use their best judgment in doing so.
In order to facilitate implementation of the Conflict of Interest Policy, the AFSH Board of Trustees or its designee(s) shall determine, based on the disclosure form and other relevant information, when an individual engaged in, or about to engage in, an AFSH leadership role or role affecting AFSH decision-making processes has an actual, potential, or apparent conflict of interest requiring some response. Specifically, subject to the procedures set forth herein, AFSH Board of Trustees or its designee(s) may require any action they deem appropriate, including, but not limited to, the following:
(1) Disclosure of the interest to the other participants in the decision- or policy-making body (e.g., board of trustees).
(2) Recusal from voting on a matter and limitation of the individual’s participation only to the provision of factual information of benefit to the group discussion.
(3) Complete recusal from a portion of a meeting or from other consideration of the subject matter.
(4) Replacement of the individual in the affected position or activity.
In most instances, disclosure of the conflicting or potentially conflicting interest will itself suffice to protect AFSH’s interests. In other words, once such a conflict is fully disclosed to the relevant parties, they generally will be able to evaluate the possible influence of the disclosed interest. However, in other situations, disclosure alone is not deemed to be sufficient. In situations where disclosure does not adequately deal with actual or potential problems, additional action, including denial of participation in the affected activity or consideration of the matter, may be necessary.
The ASSH Executive Committee has primary responsibility for interpreting and applying this Conflict of Interest Policy. As such, the Executive Committee will regularly review all conflict of interest disclosure forms and will be available to provide advice to AFSH on managing conflicts of interest including, without limitation, policies, practices, and procedures on disclosure, recusal, and/or denial of participation. In the special circumstance of the AFSH Nominating Committee, the Executive Committee shall not influence the recommendations coming from the Nominating Committee, but may review specific candidate recommendations and advise the ASSH Council on potential conflict and duality of interest issues with respect to nominees.