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Medical Ethics and Developing a Policy

Scenario:

Ocean Health is a nonprofit, community-based, healthcare delivery network in Medford, Oregon, which includes three acute-care hospitals, a network of more than 1500 physicians, a broad ambulatory care network, home healthcare, and associated support services. The organization has a compliance department that is staffed with a director for compliance and several professional staff. You have a lead role on the compliance team. The responsibility for the Compliance Department includes, but is not limited to, the following:

Ensuring that all departments and lines of business are in compliance with all contact requirements; accreditation standards; and all applicable federal, state, and local laws.

Developing and implementing a policy that is consistent with the organization's mission and goals while ensuring compliance with all external regulatory agencies.

Providing technical support to all departments and lines in business regarding compliance issues.

Case Study

You are the risk manager of the Risk Management Department at Lincoln Terrace Community Hospital. You are responsible for providing training for newly hired employees, and in-service training of current staff. After a negative publicity of Lincoln Terrace Community Hospital in the community's newspaper, the chief executive officer requested an immediate training. You are given the details of the case, but told to observe the health insurance portability and accountability (HIPAA) standards of privacy, security, and confidentiality of the patient in the case. You are asked to address the ethical, legal, and regulatory considerations of patient care, and the goals, standards, and requirements of effective health provider/patient relationships in a scholarly manner.

J. R. vs. Lincoln Terrace Community Hospital

J. R., a 35 year old woman, at 37 weeks pregnant began feeling intense pain in her lower abdomen. Upon arrival at the emergency room (ER), she was assessed and then sent home. Over the next 2 weeks Karrlei returned to the ER three times with complaints of pressure in her lower pelvic area and pain at level 7. On all three occasions J.R was assessed and sent home. Three days later the pain became unbearable and J. R. once again returned to the ER. This time her blood pressure was 180/130, and her pain level was 9. She was immediately admitted. Nine hours after her admission was completed, J. R. still had not dilated. The decision for cesarean was made, which was successful. While in the hospital she received custodial care from a patient care associate (PCA), but never saw a physician. Once she saw a woman with a badge, â??RNâ??. But no one cleaned the wound site, nor did J. R. receive instructions on how to clean her wound. The education checklist J. R. received upon discharge from the maternity unit indicating areas requiring patient education was blank, but signed by the registered nurse. Three days after discharge from the hospital J. R. returned to the ER with infection at the post surgical wound site.

A month later J. R. contacted a lawyer who requested her medical records. After the third request to the medical records department was unsuccessful, the lawyer requested a subpoena for the medical records. An unidentified woman representing the hospital left a detailed message of the specifics of the subpoena and the status of the release of the medical record on the lawyer's office voice mail. A week later, finally J. R.â??s medical records arrived at her lawyer's office. The education checklist was found after a thorough review of the medical record. The signature on the education checklist in the medical records was the same on the education checklist J. R. produced to the lawyer, the dates were the same. The difference was, the education checklist in the medical record was complete, indicating J. R. received proper care for her wound site while in the hospital, and received instructions on how to clean her post surgical wound site.

Part I
1. Identify the Law that will govern this case, and discuss.

2. Identify the following:

a. Plaintiff

b. Defendant

3. How may the defendant's lawyer use the defense of the following?

a. Comparative negligence

b. Contributory negligence

4. Were the 4 D's of negligence evident in the case? Discuss.

a. Duty of care

b. Dereliction (Breach of duty of care)

c. Damage

d. Direct Cause

5. Define Breach of Contract and discuss how it relates to this case.

6. Discuss the Physician/Patient relationship as it relates to this case.

What are goals, standards, and requirement for an effective physician/patient relationship?
7. Define and discuss the following:

a. Duty-Base Ethics

b. Beneficence

c. Justice

8. Define Standard of Care.

9. Was standard of care practiced in this case? Was the principle of Prudent Person observed? Why/Why not?

10. Discuss HIPAA standards of privacy, security, and confidentiality relating these standards to the case.

Part II

Part II should include a 15-20 slide PowerPoint Presentation discussing the following:

1. Identify types of Tort, and discuss the tort applicable to this case.

2. Identify types of Law, and identify the Law that will govern this case.

3. Identify the following parties in a case:

a. Plaintiff

b. Defendant

4. Discuss types of defenses and how may the defendant's lawyer use the defense of the following?

(i.e. Comparative negligence, Contributory negligence)

5. Were the 4 D's of negligence evident in the case? Discuss.

a. Duty of care

b. Dereliction (Breach of duty of care)

c. Damage

d. Direct Cause

6. Identify types of contract and discuss Breach of Contract and how it relates to this case.

7. Discuss types of relationships in healthcare settings and discuss the Physician/Patient relationship as it relates to this case.

8. Define and discuss the following:

a. Duty-Base Ethics

b. Beneficence

c. Justice

9. Define Standard of Care, and discuss whether or not standard of care was practiced in this case?

10. Was the principle of Prudent Person observed? Why/Why not?

11. Discuss HIPAA standards of privacy, security, and confidentiality relating these standards to the case.

12. Discuss the history of malpractice insurance and its current impact on the healthcare industry.

Solution Preview

***Please See Attached

Part I

1. Identify the Law that will govern this case, and discuss.

This case will be classified as a Medical Malpractice lawsuit. "Medical Malpractice refers to improper, untimely or otherwise negligent performance, diagnosis or treatment by a doctor, hospital staff or other medical professional" (Expert Hub, 2011). The hospital was negligent in caring for the patient when they failed to conduct a thorough examination. A similar situation happened at UMC Medical where a pregnant woman had severe abdominal pain, however the hospital staff left the patient in the ER waiting room for over eight hours in spite of the patients complaint of severe abdominal pain. To make a long story short the pregnant woman and her husband left the hospital and shortly after that she miscarried. "Medical malpractice can happen in a wide variety of ways, including misdiagnosis, late diagnosis, surgical mistakes, injuries during child birth, prescription errors, anesthesia errors and more" (ExpertHub, 2011). A similar situation happened to me once: I woke up one morning about to get ready for work, however when I woke up my blood pressure was astronomically high which was weird because I normally don't have high blood pressure. When I tried to get out of bed, I collapsed to the floor, it was then that I realized that something was terribly wrong. My family called an ambulance and they delivered me to the ER. The physician assessed me, and told me that everything looks fine. He prescribed me with some pills for dizziness and was about to discharge me. I stood up and collapsed again in the presence of the physician, he caught me so I wouldn't fall to the floor. Apparently I couldn't walk. The physician said "perhaps there is something much more serious, we are going to run more test on you." The physician later discovered that I was having a stroke and I ended up staying in the hospital for a month. If the hospital staff didn't conduct a thorough examination to accurately assess a patient's complaint, a malpractice lawsuit could have ensued just for a mere misdiagnosis. Keep in mind, the physician prescribed dizzy pills for stroke symptoms.

2. Identify the following:

a. Plaintiff
J.R.

b. Defendant
Lincoln Terrace Community Hospital

3. How may the defendants lawyer use the defense of the following?

a. Comparative negligence

In the case of Petrovich v. Share Health Plan of Illinois, Inc., 188 Ill. 2d 17, 719 N.E.2d 756 (Ill. 1999). "Petrovich (P) alleged that Freidman, her doctor, and Share Health Plan (D), her HMO, were liable for the negligent and tardy diagnosis of her tongue cancer. Share Health Plan operated as a financing entity in arranging and paying for health care treatment by contracting with independent medical groups and practitioners. Share did not employ physicians directly, operate or maintain health care facilities, or supervise the administration of medical treatment." Similar to the J.R. case against Lincoln Terrace Community Hospital, Share Health neglected to provide Petrovich with appropriate educational documentation. ...

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