A 65-year-old lady went into a large medical center for a general workup. She was first seen by a physician assistant (PA) who conducted her physical and history. The PA noted that the patient had a history of an allergic reaction to Sulfa, which he wrote down on the patient’s chart. He then sent the patient home with a follow-up with a physician for some problems he noted on her workup. The patient’s chart was sent to a medical records technician who transcribed the patient’s information into her computerized patient record. For some reason, though, the allergy to Sulfa did not get transcribed. A few days later, the patient was admitted to the medical center for another problem. When the physician discharged the patient from the center, she sent the patient to the nurse with a prescription for a Sulfa drug. The nurse failed to check the patient’s written record and sent the patient to the first floor pharmacy. The pharmacist who dispensed the drug did not note the allergy. After taking one dose of the sulfa drug, the patient had a severe allergic reaction that ultimately led to her death. The family sued the medical center, physician, nurse, pharmacist, and the medical records technician.
1. Which tort would this case fall under: Intentional or unintentional? Explain your answer, give examples, and references.
2. Do you feel this is a malpractice case? Explain your answer and give references to back them up.
3. Under what doctrine could the facility be sued? Explain your answer and give references.
4. Which of the defendants in the case met their professional standard of care and which did not? Explain your answers for each of the professionals and give references as to the reason you came to your conclusion. (Not sure)
Case Study #2: Aiken, T.D. (2002). Legal and Ethical Issues in Health Occupations. Philadelphia. PA: W.B.Saunders Company p. 170
A medical assistant is employed in an oncologist’s office. He greets a patient he knows well, a 62-year-old woman with leukemia. Her blood work shows that her white blood cell (WBC) count is down. The assistant gives this result to the doctor, who orders an infusion of fresh frozen plasma (FFP). The assistant reminds the doctor that the patient is a Jehovah’s Witness, a religious group who refuse all blood products, including FFP, in treatment. The doctor becomes angry. “Just tell her its medicine that I ordered. Don’t tell her it’s a blood product. It’s not red, so she’ll never guess. It’s the only thing I have that can help her right now.”
• Should the medical assistant lie to the patient at the request of the doctor?
• Must he obey the doctor and lie to the patient?
• Should he refuse to reveal to the patient that the doctor has ordered a blood product for her?
• Should he disobey the doctor and inform the patient that her treatment is a blood product?
• Is his only other option to leave the office?
• If he refuses to do as the physician ask/directed, can it cost him his job?
• What effect will his decision have on the patient?
• What is informed consent all about, and would it come into play in his decision?
• As the medical assistant, you would have to make a choice.
Case Study #3 (Complete the 7-Step Model to show your decisions regarding how you would fix the problem(s) in the case study.)
The hospital ethics committee was discussing an important and urgent case. A donor heart had become available, but an extremely rare thing had happened. Two heart-transplant candidates in the hospital were both matches for the donor heart. One patient was known to the committee as Mr. X, the other as Ms. Y.
For someone with heart failure, Mr. X had been on the transplant waiting list a long time. He had been waiting one year and was near death. Ms. Y had just been placed on the list and could be sustained with medication for quite some time, possibly until another heart became available. The answer seemed obvious-give the heart to Mr. X.
A number of the members of the committee did not agree with this answer. They argued that time on the transplant list should be only one factor considered. They saw a problem in Mr. X’s medical record.
Mr. X was 64 years old and had suffered from a heart condition for years. He had had two angioplasties and two bypass operations to correct a blockage of the heart’s blood vessels. The problem seen by some committee members was that Mr. X still smoked, ate fatty foods, and was very overweight. After each procedure, doctors had warned Mr. X that he must change his life-style, and that if he didn’t, his condition would worsen. He never stopped smoking, however, and never changed his diet. He said it was too hard.
Research has proven that smoking and high cholesterol are risk factors for heart problems. Blockage of the coronary arteries is directly attributed to these two factors. Treatments such as angioplasty (opening the blood vessels by passing a tube into the arteries) and bypass surgery (connecting new blood vessels that go around the clogged ones) can correct the problem, but they are not a total cure. To avoid further problems, patients must control their diet, stop smoking, and alleviate stress. This, of course, is not easy. Mr. X appeared not even to try.
The heart was about to be airlifted to the hospital. The committee had to make their decision very soon.
Describe, list, prioritize, and explain all of the problem(s) that you see in the case study.
1. What should the committee do?
2. How would you vote if you were on the committee?
3. In some cases, transplant operations are not successful, and a second operation is needed. Should someone be allowed two transplant procedures? Three? Why or why not?
4. In some hospitals, alcoholics are not allowed to receive liver transplants. In other hospitals, they are. Those who see alcoholism as a genetically determined condition argue that these people cannot help their addiction. Others feel that these people are responsible and should just stop. Should hospitals deny transplant livers to alcoholics?
5. What other factors should go into choosing who should get an organ when two people are eligible?
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