Reference no: EM133033887

Text: Questions:

The information presented in this scenario is entirely fictitious and is not based on any scientific reports of an association between car and truck seat manufacturing and bladder disease. Mary Ruiz is the HIM manager for an HMO in Autotown, Indiana. In 1999, she noticed an unusually large number of recorded cases of neurologic damage to the bladders of patients who were seen by several of the group's physicians. Mary alerted her supervisor, Mr. King, about the apparent increase in cases and proposed that she create special database to track the occurrence of this condition. Mr. King told her not to waste her time. Against her supervisor's directives, Mary developed the database. Upon analyzing the data, Mary realized that all the affected patients worked in the same plant-a facility that manufactured automobile and truck seats. Alarmed by this discovery, Mary again approached her supervisor, this time with the suggestion that health authorities be notified of the increased incidence of this rare form of bladder disease. Again Mr. King rejected her suggestion. He reminded Mary that her primary responsibility was to provide data management services to the HMO healthcare team and to protect the confidentiality of patient records. He also reminded Mary that the manufacturing facility had the largest employee enrollment of any of the HMO's clients and that the company was one of Autotown's largest employers.

1. Should Mary take it upon herself to notify the health authorities? Assume that Mary lives in a state with a law similar to that of Colorado, which requires "persons or employees having knowledge of exposure of large numbers or specific groups of persons to a known or suspected public health hazard [to] report such disease, outbreak or epidemic" (State of Colorado Rules and Regulations Pertaining to the Detection, Monitoring, and Investigation of Environmental and Chronic Diseases, 6 CCR-1009-7).

2. What if Mary's state does not have that kind of law on the books? Should Mary still take it upon herself to notify the health authorities? Are there any actions that Mary can take to fulfill her conflicting obligations to the HMO's patients, to her employer, to the automotive company, and to the public?

3. Does the HMO have an ethical duty to report the situation to governmental authorities?

4. Does Mary have an ethical obligation to come forward with the evidence, even though she was told not to by her supervisor? What are the consequences if Mary does so? If she fails to do so?

5. How would you resolve Mary's ethical dilemma?