Ethical and Legal Issues, Essay Example

Introduction

This paper provided detailed submissions of medical law and ethics issues from the case study provided. The paper identifies the issues whether ethical or legal and provides rationale for identity. Further it provides the plan of action in dealing with each subsequent issue. Goldim, (2009) suggests that Medical law and ethics provides instructions and insights into:

• the responsibilities, rights, and concerns of health care consumers
• Ethical and legal matters facing the society, healthcare professionals and patients as technology changes.
• Effects of increased medical costs in provision of medical care.

Law and ethics differ in the following manner: law is a rule of conduct and it is enacted by the government to maintain public safety and order. Care practitioners are associated with either criminal or civil laws. On the other hand, ethics is defines as a standard of behavior. Usually, moral values act as the basis for ethical conduct. The society where one lives, family and culture help in forming ones moral values (Goldim, 2009).

As a risk manager of the hospital I was able to identify the following legal and ethical issues and provided the plan of action to deal with each issue.

Issue: medical negligence

Type of issue: legal

Rationale

Nurse Cusack reported to work when tired as noted by Nurse Albert. This has been a continued malpractice that nurse Cusack was fond of doing. Despite nurse Albert explaining to nurse Cusack the urgent need of intensive checks of vital signs and ICP reading of Mr. Lawson condition, nurse Cusack become attentive for the first few hours of the shift and neglected his duty of checking Mr. Lawson condition after every 15 min then 30 min. Negligence of nurse Cusack to monitor Mr. Lawson condition for over 40 minutes resulted into harming/ damaging of Lawson brain. Nurse Minor noted that nurse Cusack had not recorded vital signs and ICP reading for over 40 min. In addition, she was not in the room when the charge nurse, nurse Minor was making rounds. Medical malpractice practiced by nurse Cusack amounts to medical negligence which can be attributed to professional’s responsibility of patient’s medical care or managed care. It is a legal issue because it amounts to tort of negligence (Goldim, 2009).

Plan of action

Medical negligence of a professional may lead to suit of the hospital. In fact Mr. Lawson lawyer has filed suit against Dr. Belmont our employee and the hospital. I will ask our hospital legal officer prepare submissions which will proof for lack of negligence from our employees. So that we evade that tort of negligence which our employee committed, I will ask our defense team to provide prove of the following four elements (Goldim, 2009).

1. There was care of duty owed and was faithfully granted.
2. Medical care professionals did not violate the standards of care required by the patient but provided professional care that eliminates any claim of negligence.
3. Suffering of harm was as a result of the effects of the disease and drugs to cure the disease. Harm did not result from medical professional negligence.
4. Any form of compensation/ damages should be lifted from the hospital.

Issue: battery

Type of issue: ethical

Rationale

After the ICU alarm sounded, nurse Cusack began assessing the unresponsive Mr. Lawson who had shown signs of one pupil being larger than the other a sign of pressure buildup in the brain this was battery. Centre for Law, Ethics and Risk in Telemedicine (2001) provides that battering of patients especially post operative patients is ethically wrong. Touching patients without permission from the physician is not recommended in medical ethics. The nurse was supposed to monitor vital signs and record ICP readings and in case of abnormal signs and abnormal records of pressure to inform the physician. Instead, nurse Cusack was found touching unresponsive Mr. Lawson after the ICU alarm sounded by the ICU staff. She then exclaimed that the ICP alarm did not sound and yet on examination it was found to be far above the standards set by Dr. Belmont in the post operative order. This is what she was supposed to check and she did not do it. Later Dr Belmont was called and initiated appropriate treatment for the elevated ICP after the incident and the rest of Mr. Lawson stay was very ok till his discharge from the hospital. Battery may result into patient harm the reason why it is a healthcare ethical issue.

Plan of action

I will organize for a forum to teach moral ethics in healthcare.

Issue: deposition of nurse Cusack and nurse minor

Type of issue: legal

Rationale

Deposition is a testimony provided by an individual out of court. Because Mr. Lawson has filed suit over his brain damage, nurse Cusack, and nurse minor who were present when the incident that lead to the damage of Mr. Lawson brain should provide a testimony of what happened. Deposition will help my lawyers to scrutinize the case and identify if our employees and facility has any legal liabilities. Failure to process deposition of nurse minor makes it a health care issue because she is the one with information about nurse Cusack morphine addiction (Centre for Law, Ethics and Risk in Telemedicine 2001).

Plan of action

Ask the facility attorney to process the deposition of nurse Cusack and Minor. The testimonies they will provide will help our defense against Mr. Lawson.

Issue: Medicare abuse

Type of issue: legal

Rationale

Nurse Cusack is an addict of morphine which nurse Minor had been assisting her cope up with. Nurse Minor should have reported the case to HR so that nurse Cusack is relieved from duty till she is rehabilitated. It is illegal to use patient’s drugs to quench addiction lusts. Using Mr. Lawson morphine to inject her with it was a professional misconduct. The fact that nurse Cusack signed out drugs meant for Mr. Lawson (IV morphine) and used them to inject herself due to addiction is professionally unethical and illegal. These actions require serious legal disciplinary actions against nurse Cusack. The use of patient drug is an abuse of Medicare which is a crime prosecutable in the court. Nurse Cusack practice directly resulted in unnecessary costs to the Medicare program. Her practice was not consistent with the goals of providing patients with services that are medically necessary and meeting professional recognized standards. The misconduct of nurse Cusack is classified under ethical and legal issues (Centre for Law, Ethics and Risk in Telemedicine 2001).

Plan of action:

To deal with this issue, I will ask the HR to suspend the services of nurse Cusack immediately and process her deposition. After deposition, I will ask the hospital lawyer to file suit against nurse Cusack to prove why any legal actions should not be taken against her.

Issue: forging of medical reports and providing wrong ICP readings

Type of issue: legal

Rationale

Nurse Cusack was not keen on Mr. Lawson intensive checks for vital signs and ICP reading after every 30 min. After noting that she has been being monitored on the same and that serious medical problem has arisen due to her carelessness or lack of attention she decides to fabricate/ guess medical reports and vital signs. Fabrication of the vital signs and ICP readings to cheat or make it look like she had been attentive is a serious legal issue. Forging of medical reports and giving false ICP readings could lead to wrong medication or avoidance of important medical intervention hence putting the health of Mr. Lawson in jeopardy. Forgery and cheating in medical maters is a serious legal issue. Honesty and integrity are compromised in this scenario making it an issue that needs addressing.

Plan of action

I will take serious disciplinary actions against nurse Cusack. I will recommend that she be suspended from duty pending legal prosecution. if it is proved that she did forge ICP readings and vital signs for Mr. Lawson, a suit will be filed against her for professionally misbehaving. Forgery of medical results is a serious crime and I will recommend that nurse Cusack license be with held till her case is finished.

Issue: Compensation for Mr. Lawson

Type of issue: legal

Rationale

Given that the circumstances surrounding Mr. Lawson case were as a result of employee’s intentional acts, the insurance policy will not cover such a case. This will insure a legal issue over who will be responsible for the damaged suffered by Mr. Lawson. In case the insurance policy providers fail to compensate Mr. Lawson, legal suit will be set up to determine who is responsible for the damages. Dr. Belmont, nurse Cusack, nurse minor, the ICU staff and the hospital as a whole will be examined through legal processes to identify the party responsible for the damages. This case cannot be solved ethically hence a legal issue.

Plan of action:

I will inform insurance claims officer to write a report about Mr. Lawson stay in the hospital and employee actions to prove that misfortunes that found Mr. Lawson after surgery were not intentional employee actions. The report should also provide that It was accidental for Mr. Lawson brain to suffer major damages after surgery. the report will be prepared to convince the insurance company that incase Mr. Lawson is entitled by court to compensation, then they should pay since it was not intentional for the employees to damage Mr. Lawson brain.

Issue: Inclusion of Dr. Belmont in the case

Type of issue: legal

Rationale

Inclusion of Dr. Belmont in the case is a legal issue. Dr. Belmont carried surgical procedures on Mr. Lawson successfully and he provided all the guidelines to the nurses responsible for his care in ICU. After noting that Mr. Lawson may swell in his brain as a result of surgery, he inserted an ICP into his verticals to monitor the pressure so that incase of any rise above the standards set, he will take appropriate action to save Lawson from brain damage. Including Dr. Belmont in the case requires legal procedures to vindicate him. Also, his inclusion in the case raises suspicion or provides grounds for insurance cover providers to consider Mr. Lawson incident an intentional employee act and thus refuse to pay any compensation (McCullough, 2005). Despite the fact that Dr. Belmont has his own defense team, the hospital support is very important in his case. It is an issue to include Dr. Belmont in the case because his inclusion may lead intentional tort that may hinder insurance cover from compensating Mr. Lawson incase the hospital is found guilty of the offence.

Plan of action

The hospital attorney and the insurance claims representative should liaise with Dr. Belmont defense team to prove how Dr. Belmont is professionally not involved in any of Mr. Lawson after surgery incidences. They should also provide a detailed report that is convincing about the expertise of Dr. Belmont and his record of services he has provided for the hospital. The report should prove beyond no reasonable doubt the services of Dr. Belmont and prove his concern for Mr. Lawson’s well being by giving ordered to be followed by nurses for his care (McCullough,2005). Both the hospital defense and Dr. Belmont defense should ensure that all legal responsibilities should be lifted from Dr. Belmont and be placed upon nurse Cusack and nurse minor for gross misconducts. The report should also prove that Dr. Belmont was very cautious and concerned about Mr. Lawson brain swelling the reason why he placed an intracranial pressure (ICP) monitoring line into the ventricles of his brain. Any pressure increases beyond the standards set by Dr. Belmont was to be communicated immediately. The dr. also ordered IV morphine for Mr. Lawson pain or agitation make Lawson calm post operatively. Dr. Belmont also requested that Mr. Lawson be placed in a quiet place to reduce stimulation. The responsibility was now left to the intensive care unit nurse to monitor the vital signs frequently and reports any anomalies to Dr. Belmont.

Issue: lack of disciplinary action in nurse Cusack employment file

Type of issue: ethical

Rationale;

Lack of any disciplinary action in nurse Cusack employment file is an ethical issue. Nurse Minor, the charge nurse, had noted many incidences of misconducts by nurse Cusack but she did not report them to HR. Additionally, the case of morphine addiction had not been recorded anywhere, ethically, nurse Cusack could have told HR of her addiction so that rehabilitation measures are taken on her. Or Nurse Minor could have told the HR about nurse Cusack morphine addiction so that she can be monitored during shifts of is not assigned critical patients during shifts (McCullough, 2005).

Plan of action

I will call for immediate disciplinary action against nurse Cusack for not reporting of her addiction. Nurse minor, the charge nurse will immediately follow suit. I will hasten deposition of nurse Cusack and call for serious disciplinary actions to be taken against nurse Cusack for abusing Medicare (McCullough, 2005).

Issue: professional misconduct

Type of issue: ethical

Why it is an ethical issue

The employment file of Nurse Minor was unremarkable and her deposition had not been requested. This action of HR still leaving Nurse Minor on employment without requesting her deposition raises ethical issues (Goldim, 2009). As a charge nurse she should have been strict on all nurses and made sure that nurses like nurse Cusack who were not keen and attentive on their duties are punished. At her position, her employment file should not have been ordinary because this raises significant ethical questions on her professional expertise.

Plan of action

To deal with this issue, I will commission the deposition of Nurse Minor and then set up a small commission to investigate the actions of Nurse Minor, her professional qualifications and her qualification for her job position. After the investigations she will either be reinstated

Or be sacked completely with fines for portraying professional misbehavior.

# Issue: Overcharging Medicare for services provided by your ICU

Type of issue: legal

Why it is a legal issue

It is illegal to overcharge Medicare for services offered by your ICU. Mr. Lawson a Medicare patient claims to be overcharged by our facility. This is a legal issue given that the complainant claims that the hospital program led the Medicare program to believe that its ICU had the capability of performing certain critical care services hence over-charging the patients when it was not doing so. According to Centre for Law, Ethics and Risk in Telemedicine (2001), Overcharging is a fraud case because it involves the facility obtaining value/ or benefiting from patients through misrepresentation and concealment of material facts. It is crime to defraud the federal government and its programs. The crime is punishable before the court and the punishment may include imprisonment, significant fines, the provider of health care losing license, or convictions may lead to exclusion from participation in Medicare for a specified period of time. Medicare fraud also leads to civil liability.

Plan of action to deal with the issue

The defense attorney to be asked to prepare a good report about the billing and the services our facility provides. The attorney to prove that our facility is aware of Medicare fraud and there is no way we could indulge in such a crime. Further, he should provide rationale for all the billings and charges that we charge our Medicare patients. The attorney should also prepare post operative charges of the facility for the patient so that the auditing firm may gauge to see if our facility is overcharging patients or conducting fraud.

Reference

Centre for Law, Ethics and Risk in Telemedicine (2001). The Legal, Ethical & Social Aspects of E-Health & Telemedicine. CLERT: The Legal and Ethical Aspects of Telemedicine.

Goldim, J. R. (2009). Revisiting the beginning of bioethics: The contributions of Fritz Jahr (1927). Perspect Biol Med, Sum, 377-380.

McCullough LB. (2005) Practicing preventive ethics-the keys to avoiding ethical conflicts in healthcare. Physician Exec. Mar-Apr 31(2):18-21.