Reference no: EM133393694

Assignment:

In 1993, Miguel Rivera (11 years old) went to a smaller hospital in the outskirts of Albuquerque. Due to a vacancy in the emergency room manager position, there was an unforeseen overlap of vacations amongst the attending physicians. The hospital administrator accidentally overlooked the discrepancy and as such, approved overtime for one of the hospital's clinic physicians. It was this general practice physician who greeted Miguel when he arrived in the ER around midnight.

Earlier that day, Miguel and his friends were riding skateboards. Although his mom had repeatedly told him to wear his helmet, he did not want to appear weak in front of his friends. He left his helmet at the corner and raced to catch up. He didn't see his friends veer to the right and instead Miguel went straight. He found himself heading down a steep hill and his momentum increased significantly. Although he saw the pot hole, he did not have time to avoid it. When his friends caught up to him, they found him conscious but slightly confused. He didn't dare complain to them, but he hurt. In fact, he hurt all over. Miguel attempted to stay with his friends but his arm was beginning to swell and he didn't feel right.

When he walked in the door to his home, his mom could immediately tell that something was wrong. Miguel didn't want to be in trouble about not wearing his helmet so he lied and said that he was wearing it. He did tell his mom that his arm hurt. She called frantically to arrange for a ride as her husband had the car and was away on a business trip. Miguel's aunt made the trip from Santa Fe and drove him and his mother to Sandia Regional Hospital.

The emergency room was empty when Miguel arrived and as such was immediately placed into an examination room. After the vitals were collected, it was only a minute or two before Dr. Schmidt came into the room and introduced herself. Miguel, again not wanting to confess the no helmet rule violation maintained that he was wearing one. It was obvious to everyone that the arm was fractured. Dr. Schmidt asked Miguel if he hurt anywhere else. He said no - although he did mention that he was feeling a little nauseous. Dr. Schmidt wrote on the chart that she wanted to get an x-ray of the arm. She did note that Miguel mentioned that he felt ill and was attributing most of this to the pain.

Shortly after the examination, the orderly came to take Miguel to get an x-ray of his arm. As he was being wheeled down the hall, Dr. Schmidt noted that Miguel was rubbing his head and overheard him tell the x-ray technician that he had a "pretty bad headache." She made a mental note to re-examine Miguel and to more thoroughly examine his head. As she went to document this in the chart, she was interrupted by some commotion in the front of the emergency department. Two ambulances just arrived with several injured individuals. A large motor vehicle accident quickly ruled the ER.

1. What duty if any, did the hospital have in ensuring a fully staffed ER?

2. How did the hospital fail in its duty to provide care for Miguel?

3. Are Dr. Schmidt and the PA to be held at the same level of accountability?

4.What relevance, if any, does the fact that Miguel, a minor, did not disclose the fact that he was not wearing a helmet have on the case?

5. In retrospect, what should the hospital have done differently?