MHA6060: Health Law and Ethics

Week 5 Assignment

APPLICATION OF ETHICS TO LEGAL ISSUES

Please review the following case:

The defendant in State v. Cunningham, the owner, and administrator of a residential care facility housed thirty to thirty-seven mentally ill, mentally retarded, and senior residents. The Iowa Department of Inspections and Appeals conducted various surveys at the defendant’s facility between October 1989 and May 1990. All of the surveys except one resulted in a fifty-dollar daily fine assessed against the defendant for violations of the regulations.

On August 16, 1990, a grand jury filed an indictment charging the defendant with several counts of wanton neglect of a resident in violation of the Iowa Code section 726.7 (1989), which provides, “A person commits wanton neglect of a resident of a healthcare facility when the person knowingly acts in a manner likely to be injurious to the physical, mental, or moral welfare of a resident of a healthcare facility. . . . Wanton neglect of a resident of a healthcare facility is a serious misdemeanor.”

The district court held that the defendant had knowledge of the dangerous conditions that existed in the healthcare facility but willfully and consciously refused to provide or to exercise adequate supervision to remedy or attempt to remedy the dangerous conditions. The residents were exposed to physical dangers and unhealthy and unsanitary physical conditions and were grossly deprived of the much-needed medical care and personal attention.

The conditions were likely to and did cause injury to the physical and mental well-being of the facility’s residents. The defendant was found guilty on five counts of wanton neglect. The district court sentenced the defendant to one year in jail for each of the five counts, to run concurrently. The district court suspended all but two days of the defendant’s sentence and ordered him to pay $200 for each count, plus a surcharge and costs, and to perform community service. A motion for a new trial was denied, and the defendant appealed.

The Iowa Court of Appeals held that there was substantial evidence to support a finding that the defendant was responsible for not properly maintaining the nursing facility, which led to prosecution for wanton neglect of the facility’s residents. The defendant was found guilty of knowingly acting in a manner likely to be injurious to the physical or mental welfare of the facility’s residents by creating, directing, or maintaining hazardous conditions and unsafe practices.

The facility was not properly maintained (for example, findings included broken glass in patients’ rooms, excessive hot water in faucets, dried feces on public bathroom walls and grab bars, insufficient towels and linens, cockroaches and worms in the food preparation area, no soap available in the kitchen, and at one point, only one bar of soap and one container of shampoo found in the entire facility). Dietary facilities were unsanitary and inadequate to meet the dietary needs of the residents. There were inadequate staffing patterns and supervision in the facility, and improper dosages of medications were administered to the residents.

The defendant argued that he or she did not “create” the unsafe conditions at the facility. The court of appeals disagreed. The statute does not require that the defendant create the conditions at the facility to sustain a conviction. The defendant was the administrator of the facility and responsible for the conditions that existed.

Please address the following questions drawing support from your course resources and credible scholarly resources cited in APA format :

Analyze this case from the perspective of the four ethical theories presented throughout the course—consequential ethics, utilitarian ethics, deontological ethics, and nonconsequential ethics.

• Discuss how ethics and the law are intertwined in this case.

• Present your assessment of the court’s finding and whether it was just.

References

MHA6060 WEEK 5 LECTURE, DISCUSSION, AND PROJECT INSTRUCTIONS 1

Physician Ethical and Legal Issues

Physicians are heavily guided by the elements of the Hippocratic Oath and code of medical ethics outlined by the American Medical Association. When it comes to ethical practice in the treatment of patients, both ethics and law intertwine. For example, the law stipulates that preventable harm warrants compensation, that is, when a physician injures a patient due to negligence, that physician must be penalized and that patient must be compensated. Such malpractice cases are, of course, an egregious violation of a physician’s ethical and legal responsibilities. Of similar importance are training physicians and their staff to show professionalism and compassion to build honest and trusting relationships with their patients. As healthcare administrators, you are likely to see cases of physician negligence involving patient assessments, medical diagnoses, and treatment, that is, the most common medical errors involve the following:

· Patient assessments encompass all processes that collect patient data needed to create appropriate and effective care plans. A myriad of healthcare professionals must work together to gather accurate information. A physician who performs a substandard patient assessment is more likely to misdiagnose health issues or provide incomplete care.

· Patient diagnoses require physicians to identify the most likely disease or disease process in a patient to support further actions for additional testing or treatment. However, despite the improvements in medical imaging and diagnostic testing, an overdependence on the results can be harmful to the patient.

· Finally, patient treatment, or the strategies used to restore the patient to health, may result in more harm than good. Whether the treatment is conservative or palliative, it is important that physicians periodically review best practices in the field and follow currently prescribed guidelines based on evidence.

Legal Action against Healthcare Professionals

Review each tab to learn more.

· Supreme Court of Nevada

Piroozi, M.D., and Martin Blahnik, M.D., Petitioners, v. the eighth judicial district court of the state of Nevada, in and for the County of Clark; and the Honorable James M. Bdcler, District Judge.

Respondents: Tiffani D. Hurst; and Brian Abbington, Jointly and on Behalf of their Minor Child, Mayrose Lili–Abbington Hurst, Real Parties in Interest.

No. 64946.

Decided: December 31, 2015

Summary: An infant suffered brain injury as a result of untreated anemia.

Verdict: $14.5 million to parents of infant

· District of Columbia Court of Appeals

Sibley Memorial hospital, Petitioner, v. District of Columbia department of employment services.

Respondent: Ann Garrett, Intervenor.

No. 97-AA-263.

Decided: May 07, 1998

Summary: The surgeon failed to recognize inappropriate blood flow post-knee replacement, leading to amputation.

Verdict: $8.35 million to the plaintiff

· Superior Court of New Jersey, Appellate Division

Marquis A. Walker, Executor and Personal Representative of the Estate of Sabrina griffin.

Deceased: Plaintiff–Appellant, v. Ilmia Choudhary, M.D., Tara Kiger, M.D., Dominic Diorio, M.D., Frank Lasala, M.D., S.J.E.R. Physicians, P.C., South Jersey Regional Medical Center, and South Jersey Healthcare.

Defendants–Respondents.

DOCKET NO. A–1425–10T1.

Decided: March 30, 2012

Summary: Doctors failed to report suspected abuse of a child who later suffered a brain injury.

Verdict: $45 million to child via guardian

Additional Materials

From your textbook, Legal and Ethical Issues for Health Professionals, review the following chapter:

· Physician Ethical and Legal Issues

From the South University Online Library, review the following article:

· Expanding Access to Care: Scope of Practice Laws 

Patient Abuse

There are a number of ways that a healthcare professional may become involved in a case of abuse, which is pervasive. Hospital-based workers are most often confronted with patient abuse, which is any level of mistreatment of individuals receiving care from the agency. It is important to note that a physician may be the perpetrator of the abuse or the one to identify and report the abuse a patient experienced outside the facility. Such abuse may include any physical, psychological, medical, or financial abuse inflicted on a patient.

Child abuse is the abuse of a child under the age of eighteen years, and all states have child abuse statutes to mandate accurate reporting. Detecting child abuse may prove challenging, and any caregivers who suspect a pattern of abuse, such as repeated visits for broken bones or bruises, should report suspicions. In order to promote quick identification and intervention in child abuse cases, the caregivers are immune from liability for any good faith reporting.

Senior abuse is a significant concern as many older adults fail to report incidents out of fear. A majority of states mandate reporting of senior abuse, which may involve anything from emotional outbursts or malnourishment to unexpected bank activity or death. Caregivers who suspect abuse are encouraged to document accurately and extensively and report suspected abuse.

Case Study: Incidents of Patient Abuse

Review each case study to learn more

Case Study 1

Abusive Search

A nurse in People v. Coe (1988) was charged with a willful violation of the public health law in connection with an allegedly abusive search of an eighty-six-year-old resident at a geriatric center and with the falsification of business records in the first degree. The resident, Mr. Gersh, had a heart disease and difficulty in expressing himself verbally. Another resident claimed that two $5 bills were missing. Nurse Coe assumed that Gersh had taken them because he had been known to take things in the past. The nurse proceeded to search Gersh, who resisted. A security guard was summoned, and another search was undertaken. When Gersh again resisted, the security guard slammed a chair down in front of him and pinned his arms while the defendant nurse searched his pockets, failing to retrieve the two $5 bills. Five minutes later, Gersh collapsed in a chair gasping for air. Coe administered cardiopulmonary resuscitation but was unsuccessful, and Gersh died.

Coe was charged with violation of the New York Penal Law for falsifying records because of the defendant’s “omission” of the facts relating to the search of Gersh. These facts were considered relevant and should have been included in the nurse’s notes regarding this incident. The first sentence states, “Observed resident was extremely confused and talks incoherently. Suddenly this became unresponsive …” This statement is simply false. It could only be true if some reference to the search and the loud noise was included. A motion was made to dismiss the indictment at the end of the trial.

The court held that the search became an act of physical abuse and mistreatment, that the evidence was sufficient to warrant a finding of guilt on both charges, and that the fact that searches took place frequently did not excuse an otherwise illegal procedure.

Forcible Administration of Medication

The medical employee in In re Axelrod sought review of a determination by the commissioner of health that she was guilty of resident abuse. Evidence showed that the employee, after a resident refused medication, “held the patient’s chin and poured the medication down her throat.” There was no indication or convincing evidence that an emergency existed that would have required the forced administration of the medication. The court held that substantial evidence supported the commissioner’s finding that the employee had been guilty of resident abuse.

Deficient Care

In Montgomery Health Care Facility v. Ballard (1990), three nurses testified that the facility was understaffed. One nurse testified that she asked her supervisor for more help but that she did not get it. A nursing home resident, Mrs. Stovall, expired as the result of multiple infected bedsores. The estate of the patient brought a malpractice action against the nursing home. First American Health Care, Inc., is the parent corporation of the Montgomery Health Care Facility, a nursing home. The trial court entered a judgment on a jury verdict against the home, and an appeal was taken. The Alabama Supreme Court held that reports compiled by the Alabama Department of Public Health, concerning deficiencies found in the nursing home, were admissible as evidence.

Evidence showed that the care given to the deceased was deficient in the same ways as noted in the survey and complaint reports, which indicated that deficiencies in the home included:

· Inadequate documentation of treatment given for decubitus ulcers

· Twenty-three patients found with decubitus ulcers, ten of whom developed those ulcers in the facility

· Dressings on the sores were not changed as ordered

· Nursing progress notes did not describe patients’ ongoing conditions, particularly with respect to descriptions of decubitus ulcers

· Ineffective policies and procedures with respect to sterile dressing supplies

· Lack of nursing assessments

· Incomplete patient care plans

· Inadequate documentation of doctor’s visits and orders or progress notes not consistently documented

· Inadequate documentation of turning of patients

· Incomplete activities of daily living sheets

· Range of motion exercises not documented

· Patients found wet and soiled with dried fecal matter

· Lack of bowel and bladder retaining programs

· Incomplete documentation of ordered force fluids

From a corporate standpoint, the parent corporation of the nursing facility could be held liable for the nursing facility’s negligence, where the parent company controlled or retained the right to control the day-to-day operations of the home. The defendants had argued that the punitive damage award of $2 million against the home was greater than what was necessary to meet society’s goal of punishing them. The Alabama Supreme Court, however, found the award not to be excessive. The trial court also found that because of the large number of nursing home residents vulnerable to the type of neglect found in Mrs. Stovall’s case, the verdict would further the goal of discouraging others from similar conduct in the future.

References:

· People v. Coe, 71 N.Y. 2d 852 (1988).

· Montgomery Health Care Facility v. Ballard, 565 So. 2d 221 (1990).

Additional Materials

From your textbook, Legal and Ethical Issues for Health Professionals, review the following chapter:

· Patient Abuse

From the South University Online Library, review the following article:

· Using Forum Play to Prevent Abuse in Health Care Organizations: A Qualitative Study Exploring Potentials and Limitations for Learning 

Healthcare Ethics Committee

Many healthcare organizations create advisory bodies to help guide them in the discussions and decisions related to ethical healthcare practice. Such healthcare ethics committees are often comprises a number of stakeholders and are often in the position to offer an objective perspective on healthcare issues. While such advisory boards are critical elements in supporting relationships between the healthcare providers and their patients, members of the ethics committee must maintain some distance from that relationship. As such, the committee members are often tasked with discussing issues of morality and patient autonomy, as well as new and revised legislation at the state and federal levels.

As a healthcare administrator, there is a high likelihood that you may serve as a hospital representative, for example, on a hospital-based ethics committee. You will need to develop professional working relationships with others in your hospital such as nurses and physicians or patient advocates. Additionally, you will need to build trust between you and the community representatives on the committee, who may include ethical specialists, legal counsel, or community religious leaders. Many hospital-based ethics committee are relatively large to allow for multiple perspectives to be represented. This, however, may also present challenges for effective communication and appropriate conflict resolution.

Ultimately, a role on any hospital-based ethics committee will demand attention to the following goals:

· Promotion and protection of patient rights

· Promotion and protection of shared decision making

· Promotion and protection of the patient-physician relationship

Ethics Committees: Goals and Functions

Review each component to learn more.

Goals of Ethics Committees

· Promote the rights of patients.

· Promote shared decision making between patients and clinicians.

· Assist the patient and family in coming to consensus when faced with ethical dilemmas.

Functions of Ethics Committees

 Policy and procedure development.

 Staff and community education.

 Consultation and conflict resolution.

· A resource tool in resolving ethical dilemmas.

· Patients and family should be encouraged to participate in addressing ethical dilemmas.

community education.

CAdditional Materials

From your textbook, Legal and Ethical Issues for Health Professionals, review the following chapter:

· Health Care Ethics Committee

From the South University Online Library, review the following article:

· Ethics by Committee: A Textbook on Consultation, Organization, and Education for Hospital Ethics Committees 

· coWeek 5 Discussion

Discussion Topic

Top of Form

 Due September 16 at 11:59 PM

Bottom of Form

Before beginning work on this discussion forum, please review the link “Doing Discussion Questions Right” and any specific instructions for this topic.

Your initial posting should be addressed at 300–500 words. Make your post to this Discussion Area by the due date assigned.

Before the end of the week, begin commenting on at least two of your classmates’ responses. You can ask technical questions or respond generally to the overall experience. Be objective, clear, and concise. Always use constructive language, even in criticism, to work toward the goal of positive progress. Submit your responses in the Discussion Area.

ETHICAL ISSUES IN HEALTHCARE

Review the following case study and address the questions that follow:

Mark was waiting to be seen by his physician in a multispecialty physician office practice. As Mark was waiting to see his physician, he observed a woman, most likely in her late seventies, limping into the office. She had a large leg brace that ran from her thigh to the calf of her leg. She struggled to push her husband in a wheelchair into the office. She carefully parked the wheelchair and approached the check-in counter. She apologized for being late for her appointment as she was late getting out of another physician’s office. The patient was told, “You are late for your appointment. The office has a fifteen-minute late arrival rule. You will have to reschedule your appointment.” She apologized for being late and said that she did tell the office staff she would be late.

She was then told, “You can wait, and I will try to squeeze you into the schedule, but I don’t know how long you will have to wait.” The lady said, “I don’t want to bother anyone. I will reschedule my appointment.” She was directed around the corner to another desk to reschedule her appointment. Mark got out of his chair, walked over to the scheduler, and said, “I don’t believe this. Her husband is sitting in a wheelchair, and she is having difficulty walking. She can have my appointment, and I can reschedule.” The lady suddenly turned to Mark and gave him a big hug. The scheduler asked, “Who is your physician?” Mark told her, and he was told, “I am sorry, but this lady has a different physician.” The lady, now a bit teary eyed, continued to make her appointment.

Tasks:

1. Describe the ethical issues involved in this observation.

2. Consider and discuss how this event could have had a more pleasant outcome.

To support your work, use your course and textbook readings and also use the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

· Week 5 Project

Assignment

Top of Form

 Due September 20 at 11:59 PM

Bottom of Form

Before beginning work on this assignment, please review the expanded grading rubric for specific instructions relating to content and formatting.

APPLICATION OF ETHICS TO LEGAL ISSUES

In each of the previous weeks, you had the opportunity to explore an ethical theory—consequential ethics, utilitarian ethics, deontological ethics, and nonconsequential ethics—in the context of a case scenario from your textbook. In this week, the focus will be on how those ethical paradigms apply to legal issues involving patient abuse.

Tasks:

1. Download and save the assignment template to your computer and update the file name to include your last name.

2. Review the assigned case in its entirety.

3. Address the questions posed in detail and with appropriate scholarly support.

To support your work, use your course and textbook readings and also use the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Submission Details

. By the due date assigned, submit your document to the Submissions Area.

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· A resource tool in resolving ethical dilemmas.

· Patients and family should be encouraged to participate in addressing ethical dilemmas.