Reference no: EM133448104

Case Study: Spousal Abuse

An elderly woman is seen in the clinic and appears to have injuries consistent with spousal abuse. In that her husband is her primary caregiver, she feels very dependent on him. When you question her, she begs you not to say anything to him.

1. Google and review the function of "Adult Protective Services."

2. How would you handle this situation?

Legal Case Study: Wrong Person, Wrong Place, Wrong Time!

In this early (1881) classic case, a physician was called to the home of a female patient in labor. The physician was accompanied by a non-physician friend who remained in the delivery area and held the woman's hand providing her comfort during the birth. When the woman became aware that the individual was not a healthcare provider, she sued the physician for a breach of individual privacy. The court held that having a nonessential person present during the labor violated the woman's legal right to privacy at the time of her child's birth.

1. Which class of tort action associated with privacy fits this case?

2. Do you agree with the court that the standard of a hypothetical "person of ordinary sensibilities" would be offended is met in this case?

In the News: Why Doctors Are Demoralized

According to an article in the Washington Post (June 2015), physicians are becoming demoralized by the loss of traditional professional autonomy as they are forced to attend to ever-increasing demands and interference from insurers, lawyers, and the government. A major point of grievance is the federal electronic health record (EHR), which mandates that all medical offices go paperless by the end of 2015. While it is thought that this change will save lives by reducing medical errors, and result in cost savings of billions of dollars, it is also having the effect of turning physicians into typists rather than healers. If doctors are spending their time tapping data into computers, this comes at the expense of listening to patients, eye contact with patients, and time with patients. One study found physicians spending 44 percent of their time completing what might be considered secretarial duties.

1. Do you feel this is governmental overreach into health care practice?

2. Are the benefits of electronic health care records in cost savings and reductions in medical errors important enough to alter traditional medical practice?

3. If we assume both sides are correct here-how can we make the transition easier?

Case Study: Did She Gives Informed Consent?

An elderly female patient hospitalized for dementia is asked to participate in a clinical study testing a new drug designed to slow the progress of the condition. She has periods of time when she is quite lucid. It is during such a period that the trial was explained to her and she signed the informed consent form. However, when the investigator meets with her again to begin the study, she stares at him blankly, seemingly not remembering anything about it.

1. What should he do?

a. In that she signed the consent when she appeared to understand, and given that she might benefit from the clinical trial, he should go forward with the study.

b. Perhaps there is a surrogate who could give a valid consent for her participation?

c. Given her level of vulnerability, he should cancel the previously signed document.

Case Study: Tainted Data

Your secretary is a person of Jewish descent who recently read a book about medical experiments conducted in the Nazi concentration camps. In that you teach bioethics as part of your course work, she asks you whether you think it is appropriate for scientists to use the data collected from these experiments. In the conversation, you learn that a recent scientific paper references the material. It also becomes clear that your secretary feels that it is an outrage for the information gained in these experiments to be used.

1. Is she correct? Is the information gathered in the experiments tainted beyond use by the process?

2. Is the information gathered morally neutral?

3. If this information was used, should it be referenced differently from other data?

Review Exercises

A. Unauthorized versus authorized disclosure: In this exercise, state whether you think the disclosure of information was appropriate or inappropriate and defend your position.

1. A young father brings his child into the emergency room for treatment of an arm injury. The family has brought the child in several times for similar injuries with the excuse that she is somewhat clumsy and is having difficulty learning to ride her bike. The child shows no fear of the parent and, upon questioning, confirms the parent's version of the events. The staff reports the injury as a possible child abuse case.

2. In the course of caring for a patient, a school bus driver, the physician notes that she is at risk for having a heart attack and recommends that she cease driving, since she may be placing the children at risk. The driver asks that the physician not notify the school district because it would put her at risk of losing her job. The physician notifies the district.

C. You are a student radiographer and are assigned to the surgery suite to assist another technician in performing an X-ray during a surgical procedure. You gown up, assist, and are present during much of the surgery that was being performed on Mrs. Jones by Dr. Perez.

The next day you are in Mrs. Jones's room, and you comment that her choice of Dr. Perez was excellent in that he is a fine surgeon. "Dr. Perez?" she replies, "My physician was Dr. Robinson! Call my lawyer!"

Have you breached confidentiality? In that it caused the hospital and physicians to be involved in a lawsuit, were you in error?

D. As the pharmacist of the local community pharmacy, you have been filling prescriptions for Mrs. Arthur for several years. She has an extensive medication profile that suggests that she has several chronic illnesses, including a psychiatric disorder. In her dealings with you, there has been nothing that indicated an inability to make competent decisions or to authorize appropriate treatment decisions. One day her husband, Bob, comes into the pharmacy and requests that you give him a copy of his wife's medication profile. He indicates that he wants to be sure that his wife is receiving the correct medications and was being compliant in taking the drugs as prescribed.

For this problem, we will use the RESOLVEDD method of problem solving developed by Dr. Raymond Pfeiffer. The steps of the process are:

(R) Review facts involved.

What are the relevant facts of the case?

Who, if anyone, is at fault?

How did the situation come about?

Who is charged with making the decision?

(S) State the solutions with initial credibility.

Group the options into a small number of potential choices.

Research

Search for an article that pertains to a breach in patient confidentiality. As you read through the article, answer the following questions:

• What is a summary of the article? What are the issues involved?
• How might you take what you learn from reading this article and apply it to working in the field of health care?
• How do you think health care organizations today could improve upon patient confidentiality, so that a breach similar to the one you read about would not occur again?