Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care by StudyGuide

Solution and Answer Guide: Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879,

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 1, The Big Business of Health Care and You

Table of Contents Study Questions ..................................................................................................................................1 Cases For Discussion ...........................................................................................................................1

Study Questions 1.

2. 3.

4. 5.

Frontline health care professionals can help prevent medical malpractice lawsuits by:  Representing themselves and their employers in a professional manner.  Know the applicable laws and regulations.  Understand their scope of practice.  Maintain positive patient interactions.  Minimize the nonmedical and nonlegal variables involved in malpractice.  Abide by HIPAA's regulations regarding patient confidentiality. The owner of a sole proprietorship has unlimited personal liability and does not have the tax advantages of an LLC or a corporation. There is no legal separation between you and your business in a sole proprietorship. Unlike a partnership, a person’s interest in a corporation is represented by stock, and the risk for the corporation’s debt does not extend past the amount invested; except for very rare situations (called piercing the corporate veil), the personal assets of a corporation’s shareholder are not at risk to cover corporate liability. A provider may be tempted to achieve maximum financial reward by not ordering tests or procedures or prescribing medicine. Personal health information has become a lucrative target for illegal actions on the internet. Health care companies have more liability than just HIPAA violations, and they now need to be stalwart defenders of their technologies' security.

Cases For Discussion 1.

The Central Texas Medical Foundation and Brackenridge Hospital should be held vicariously liable for Dr. Villafani’s treatment of the plaintiff. The Foundation and Brackenridge Hospital had control over the details of Dr. Villafani’s work, so the court concluded he was the Foundation’s ―borrowed employee‖ when he treated plaintiff. Consequently, St. Joseph’s could not be vicariously liable under the theory of respondeat superior, in part, because St. Joseph’s had no control over Dr. Villafani’s work at Brackenridge. St. Joseph Hosp. v. Wolff, 94 S.W.3d 513 (Tex., 2002). Parkview may be held vicariously liable for Christian's misconduct even if the actions in question ran directly counter to Parkview rules or policies, such as the Confidentiality Agreement and the Acknowledgment Regarding Access to Patient Information. The employee’s conduct was likely incidental to her duties at work because it was "of the same general nature" as her authorized job duties, which included use of the electronical medical records, management of schedules and communication, and other tasks that required access to patients' charts. While this case was settled before trial, it is likely Parkview should be found vicariously liable given the facts in this case. SoderVick v. Parkview Health Sys., 148 N.E.3d 1124 (Ind. App. 2020).

Solution and Answer Guide: Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 2, Laws and Regulations You Will Encounter

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 2, Laws and Regulations You Will Encounter

Study Questions 6. 7.

8. 9.

Responses will vary. While it may not be a discriminatory question, it is ill advised as there is a lot of room for follow up questions that may be discriminatory. Instead, it is better to be clear during the interview as to the company policy. For example, you can mention that vaccination or a viable medical excuse is a requirement of employment. The Family Medical Leave Act. If a health care professional receives a needle stick at work, they should follow procedures in the office procedures/protocol manual. In addition, providers and their staff must comply with OSHA’s Bloodborne Pathogens regulation (29 CFR 1910.1030), which establishes standards for exposure incidents involving bloodborne pathogens.

Cases For Discussion 3.

The issue in this case is whether material written in a personnel manual may constrain an employer’s power to terminate an employment relationship that would otherwise be terminable at will. When the chief executive officer testified that Leikvold was terminated because of her requested transfer to a subordinate position, Leikvold argued that the employees’ handbook was part of her employment contract and that she could not be fired unless for a reason listed. Applying for a subordinate position was not listed as a cause for discharge. The court agreed with Leikvold and returned the matter to a lower court for trial on the facts. The court stated: ―If an employer does choose to issue a policy statement in a manual or otherwise, and by its language or by the employer’s actions, encourages reliance thereon: the employer cannot be free to only selectively abide by it. Having announced a policy, the employer may not treat it as illusory.‖ Leikvold v. Valley View Community Hospital, 688 P.2d 170 (Az. 1984). Markus' behavior would likely be deemed sexual harassment, which is unwelcome sexual attention at an employee's workplace that establishes a hostile work environment, negatively affects the employee's ability to do their job, or which results in a detrimental change in their job responsibilities. When Markus continued his conduct after his advances were declined, his conduct became harassment.

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 3, From the Constitution to the Courtroom

Solution and Answer Guide:

Table of Contents Study Questions ..................................................................................................................................1

Study Questions 10.

11. 12. 13. 14.

The Supremacy Clause ensures that the federal government can legislate certain matters that fall under one of its enumerated powers, including interstate commerce and foreign relations. Consequently, when there is a conflict between federal and state law, the Constitution Supremacy Clause tells us that federal law will govern. There are, however, exceptions to this rule. The three branches of government are the executive, the legislative, and the judiciary. There are checks and balances, so no one branch can gain too much power. The three levels of the judiciary are the trial court, the mid-level appellate court, and the highestlevel appellate court. The name of the highest court in the United States is the Supreme Court. Federal agencies can make their own rules and prosecute those who violate the rules, provided Congress gives them this power. The major distinction between criminal and civil law is that criminal law involves the prosecution of cases by the state against a defendant who has been charged with violating a specific criminal statute, and, if found guilty, the defendant may face time in prison. Civil law generally involves a dispute between individuals or legal entities such as corporations, and even though the state (or federal government) can be a party in a civil lawsuit, the defendant in a civil lawsuit will not face the possibility of prison.

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 4, Criminal Acts and Intentional Torts

Table of Contents Study Questions

Cases For Discussion 1

Study Questions 15. 16. 17. 18. 19.

The element of intent differentiates murder from euthanasia. Often courts are more lenient with people charged with euthanasia if the objective of the killing was to spare a terminally ill person additional pain. Statutes and regulations on child and elder abuse affect the medical office because the reporting of suspected child or elder abuse is mandatory. The difference between robbery and larceny, both of which involve the theft of another's property, is that robbery involves the victim being physically injured or being put in fear of bodily injury. Larceny is a theft that does not involve the use of force. The patient can file a complaint against the hospital for a claim of false imprisonment. Which ae examples of insurance fraud and which are examples of insurance abuse: a. Insurance Fraud

Solution and Answer Guide: Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 5, What Makes a Contract

Insurance Fraud

Insurance Abuse

Insurance Fraud

Cases For Discussion 5. 6.

In most states, each one of the hypothetical situations would be identified as child abuse and should be reported. If it can be proven that the provider had an intent to defraud for purposes of collecting additional billings or other unsound or unprofessional reasons, the patient would likely be successful in a civil fraud suit. Such fraud can also be criminal. The important facts are that there was intent and that the purpose was to obtain payment. Venner was found guilty of possession of marijuana with an intent to distribute. In this case, the police did not confront or even see Venner at the hospital. There was nothing in the record to suggest that when the nurses, in the normal routine, took the bedpans from Venner’s bed to the place for disposition of their contents that it was a place where Venner had a constitutionally protected right of privacy. Nor was there anything to suggest that Venner exercised or attempted to exercise any right of possession or control over the balloons. They were abandoned by Venner, and their subsequent retrieval on behalf of the police was lawful. Venner v. State, 30 Md. App. 599. 354 A.2d 483 (1976). The court held against the defendant surgeon and stated that it could not be concluded that the article was written solely for scientific purposes stating that ―even a scientific publication may be nothing more than someone’s advertisement in disguise.‖ Griffin v. Medical Society of New York, 11 N.Y.S.2d 109 (N.Y. 1939). The court ruled against the provider. The provider’s refusal to correct or retract his error and the injury that it inflicted on the patient were considered sufficient for the jury to award substantial damages. Vigil v. Rice, 397 P.2d 719 (N.M. 1964).

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 5, What Makes a Contract

Table of Contents Study Questions

Cases For Discussion 1

Study Questions 1.

Implied: rolling up a sleeve to accept an injection; taking a pill given to you; following instructions during an examination; describing symptoms and history. Express: completing admission documentation or an informed consent form; verbally saying ―yes‖ to a provider’s recommended course of treatment. Without an express contract, providers typically do not warrant the results of their work. An express contract can be written or oral. If the patient’s comments were inaccurate and the results of the surgery not as described, the patient would feel as if the provider did not do what he or she stated. Here, it would be worthwhile to discuss the patient’s understanding of what the

Solution and Answer Guide: Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 5, What Makes a Contract

provider stated and make any needed corrections. Such a situation should be noted in the patient’s chart. Generally, parents are responsible for the financial needs of their minor children. In this case, the issue of confidentiality must be addressed. Because the minor was pregnant, she is able to consent to medical care, which implicitly suggests the parents do not know about the pregnancy. A provider may be deemed to have breached the patient’s confidentiality by seeking payment from the parents. A provider may dismiss a patient for nonpayment of fees, but you must do so in a way that allows the patient to obtain other care. In addition, depending on the facts, the patient–provider relationship established during the first pregnancy may be deemed concluded, so at the time the patient requested an appointment the provider could have refused to accept her as a new patient. If after the first pregnancy, the provider chose to terminate the patient, they should send detailed letter to the patient confirming discharge using certified mail and allowing time for the patient to find a new provider. A conservator is a person appointed to care for another’s financial matters. A legal guardian would be appointed to make health care decisions for someone who did not have the legal capacity to contract. Because the woman is a conservator, rather than a legal guardian, she would not be able to consent to medical treatment on behalf of the minor. I would explain the difference between the two and help the woman identify the appropriate person to consent to medical treatment. The federal Fair Debt Collections Practice Act (FDCPA) governs collections practices. The FDCPA prohibits many different collection practices—for example, threats of violence, use of abusive language when trying to collect the debt, harassment by means of phone calls, and deception and unfair methods of collection (e.g., threatening to deposit a postdated check before the date of the check, intentionally causing the debtor’s other checks to be dishonored).

Cases For Discussion 10.

11. 12. 13.

14. 15. 16.

The gynecologist was right to refuse to enter into a contract to perform the abortion. The court would not require the 16-year-old female have an abortion and would likely consider the teenager a mature minor, who is legally capable of making such decisions for herself. As a result, the teenager had the legal capacity to choose not to enter into a contract for abortion. In making this determination, the court would consider the age of the pregnant teenager, and her emotional maturity, intelligence, and ability to comprehend the decision when making this decision. If the 16-year-old could not be considered a mature minor, it’s likely that a doctor would not perform the abortion without a court order. The court would likely agree with the father. When the provider allowed the patient to be admitted to the hospital under his name, the provider established a patient–provider relationship. The radiologist took the X-rays that were ordered by the provider and likely prepared a report as to the patient’s diagnosis. The radiologist undertook to treat the patient by taking and reading Xrays, so there was a contractual relationship with the patient even though he never saw her. The court would not find the consultant provider liable for the gauze in the patient’s abdomen. The consultant provider was not present during the surgery, and there was no reason to think he should have known about the gauze left in the patient’s abdomen. It is also possible that there was no consideration, which would allow for a contract to be formed, since the consultant provider was not expecting a fee. The surgeon would not be liable for breach of contract. Assuming there was informed consent that would have explained that the procedure may not work, the husband’s vasectomy not preventing conception would be a risk. If the surgeon warranted specific results, he or she would be liable for breach of contract. Here, the surgery was to improve the patient’s appearance, not worsen the appearance, so the surgeon would be liable for breach of contract. If the surgeon warranted specific results, the surgeon would be liable for breach of contract. Here, the surgery was to sterilize the patient, but one of the fallopian tubes was left intact, so the

Solution and Answer Guide: Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 6, Medical Malpractice and Other Lawsuits

17.

18.

surgeon would be liable for breach of contract. No, the provider did not have the right to discharge the patient from the hospital because he could not pay his bill. The provider abandoned the patient when he discharged him too soon after the electroshock treatment. When a provider enters into a patient–provider relationship, the provider is obliged to attend the case as long as it requires attention, unless the patient is given reasonable notice of the provider’s intention to withdraw, or the patient informs the provider that the services are no longer desired. A contract was formed when the patient scheduled the appointment. The provider’s actions constitute abandonment, and damages should be awarded. If the provider desires to withdraw from the case, the reasonableness of notice becomes an issue that depends on the patient’s condition, the availability of other competent providers, the manner of notice, and, indirectly, the patient’s educational and economic status. Here, it was unreasonable of the provider to refuse treatment based upon the patient’s need for a guide dog. And the provider made no effort to arrange for alternative care for the patient.

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 6, Medical Malpractice and Other Lawsuits

Table of Contents Study Questions

Cases For Discussion 8

Study Questions 6. 7. 8. 9. 10.

11. 12.

Examples of negligence: putting a patient’s medical record in the trash; sending a medical record to someone not authorized to receive it; spilling liquid on the floor and not cleaning it, among many others. Examples of malpractice: not using a new needle for an injection; improperly recording a patient’s vital signs, among others. An expert witness in a legal action involving a medical assistant who works in a pediatrician’s office should have experience in the field of pediatrics and know what tasks medical assistants perform in such an office and how those tasks are performed. A patient–provider relationship is required before a patient may claim that a provider owed a duty of care. To have a medical malpractice lawsuit, the patient must show the following:  There was a patient–provider relationship.  This relationship established duty by the provider to the patient.  The duty had been upheld at a professional standard of care.  The provider breached the duty to the patient.  The patient had a resulting injury.  The provider’s breach was the proximate cause of the patient’s injury. Advise the patient that you can schedule additional time for the patient to speak with the provider and clear up remaining questions. Then, ensure you make a note or inform the provider that the patient seems to have remaining questions about options and, thus, consent. Common defenses available to a defendant in a medical malpractice cause of action include

Solution and Answer Guide:

statute of limitations, contributory negligence, comparative negligence, assumption of risk, and emergency.  Statute of Limitations - The statute of limitations sets forth a particular number of years within which one person can sue another. Attorneys representing providers who have been sued for malpractice will typically first determine whether the statute of limitations has run out by determining how much time has passed since the time the patient knew or should have known there was an injury and the time the lawsuit was filed. Different causes of action have different statutes of limitations. For example: A patient had pain in her leg which began immediately following surgery on her gallbladder. For several years following surgery she knew that she had phlebitis. She went to another surgeon, who informed her that a vein in her leg had been severed at the time of her gallbladder surgery. She filed a malpractice action against the first surgeon. The court determined that the pain in her leg and other symptoms put her on notice that something was wrong and that she should have filed an action immediately. The surgeon raised the defense of statute of limitations, and the patient’s failure to file a lawsuit within the statutory period eliminated her right to sue.  Contributory Negligence - Contributory negligence is a term used to describe any unreasonable behavior on the part of the patient that contributed, in part, to the cause of injury. In other words, if a patient does anything that contributes to his or her suffering and constitutes behavior that is non-self-preserving, the patient is contributorily negligent. For example: A patient undergoes surgery and does not follow any of the provider’s post-surgery instructions, including instructions for care of the incision. The patient develops a significant infection and other complications. The patient sues, and the provider raises the defense of contributory negligence since the patient’s failure to follow the provider’s post-surgery instructions was the cause of the infection.  Comparative Negligence - Under comparative negligence, the plaintiff is allowed to recover damages proportionate to the defendant’s fault, at least in a situation in which the plaintiff’s negligence is less than that of the defendant. For example: A patient goes to the hospital and is diagnosed with pneumonia. The provider advises the patient to stay in the hospital but does not warn of the risks of not staying in the hospital. The patient decides to leave against the advice of the provider and develops serious complications. The patient sues, and the provider raises the defense of comparative negligence since the patient’s failure to follow the provider’s advice was, in part, responsible for the injuries. The court may find the patient was 60 percent responsible for his injuries (for failing to follow the advice of the provider), and the provider was 40 percent responsible (for failing to warn of the risks associated with leaving the hospital against medical advice).  Assumption of Risk - Assumption of risk is defined as voluntarily accepting a known danger. The consent to assume risk may be express or implied. This is a defense similar to the doctrine of informed consent in that the only way a patient may assume the risk of a procedure is if the patient is informed of it by the provider. For example: A patient provides informed consent to a surgery knowing that one of the risks of the surgery is blindness. The risk of blindness occurs as a result of surgery, and the patient sues. The provider would have the defense of assumption of risk, as the patient knew that, even with the utmost care, that blindness was a risk of undergoing the surgery.  Emergency - Both common law and Good Samaritan acts protect health care professionals when they respond to an emergency situation. Under common law, the elements of a medical malpractice action are applied to the emergency situation. For example: if a medical assistant witnesses an automobile accident and no one else is available, is the medical assistant liable for what happens to the victim? o Relationship: No contractual relationship exists between the medical assistant and the victim as long as the medical assistant does not stop to give help. As soon as help is offered—merely stopping a car may prevent someone else from coming to

Solution and Answer Guide:

the aid of the victim—a relationship is established with the victim. Duty: As long as the medical assistant passes the accident, he or she has no legal duty to assist the victim. After a medical assistant stops, the victim cannot be abandoned unless care is being provided by someone with comparable or better training, or until the first responders arrive on the scene and assume responsibility for the victim. This reasonable person duty applies whether the Good Samaritan is a health care professional or a layperson. o Standard of care: In an emergency situation, to encourage trained people to stop and assist, states have enacted Good Samaritan statutes to protect the rescuer from liability. The level of training of the Good Samaritan and the standard of care are important to the person being rescued, but the rescuer will only be held liable for reckless behavior. o Breach of duty: If a person passes an accident, no breach of duty exists because no relationship with the victim from which a duty arises has been established. If a helper stops and assists, he or she will be held to a standard of care appropriate to the individual’s training and experience. If the procedures are performed below standard, the usual question of the court is whether the actions increased the injury of the victim. o Injury: The victim is already injured. The Good Samaritan has a responsibility to help the victim, but for the helper to be held liable for the injury, the helper’s acts must cause a considerable amount of additional harm. o The breach was the cause of the injury : Under negligence law, the victim must prove by a preponderance of the evidence that the help offered caused injury. Since the victim is already injured, the helper’s behavior would have to be grossly negligent to increase the victim’s injuries. You are under no obligation to assist in an emergency, but once you begin to help you may not stop until first responder help arrives or comparable or better care than you can provide. Does your malpractice insurance cover a health care professional working in this office? The medical office landlord knew of the defect in the floor and should have fixed it. At the same time, the injured person may also be partly responsible for not observing a known defect because he was drunk. If the medical office knew or should have known about the defective chair, it would be liable for any foreseeable injury that flows from it, possibly including pneumonia. Equipment found in a medical office that could give rise to a product liability claim includes exam tables, hypodermic needles, forceps and other tools, chairs and rolling stools, medical devices and medications, among many others. o

13. 14. 15. 16. 17.

Cases For Discussion 19.

20.

21.

Yes. A defendant may be held liable to a person whose existence was not apparent at the time of the act. The sensitization of the mother’s blood at 13 years of age was a negligent act. At that time, it could be foreseen that the mother would become pregnant and bear a child with incompatible blood, resulting in defects in the child. There is a right to be born free from prenatal injuries. Renslow v. Mennonite Hospital, 67 Ill. 2d 348. 10 Ill. Dec. 484 (1977). No. When a provider enters into a professional relationship with a patient, the provider is not at liberty to withdraw until replaced by an equally qualified provider. Hospital records revealed that the defendant abandoned the patient before another provider was called in; therefore, there was sufficient evidence for a jury to conclude that the defendant had abandoned the patient. Typically, the informed consent obtained is not specific to one provider and it covers all who might provide care. Ascher v. Gutierrez, 175 U.S. App. D.C. 100. 533 F.2d 1235 (1976). The court found the hospital liable for the nurse’s negligence and held that a reasonably prudent nurse would have paid closer attention to the patient. The nurse was held to have violated the nursing standard of care. Hiatt v. Groce, 523 P.2d 320 (Kan. 1974).

Solution and Answer Guide: Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 7, The Health Record

22.

23.

24. 25.

26.

Expert testimony revealed that the provider’s failure to examine the boy more thoroughly was negligence, but the charges were dismissed because none of the experts could testify that the patient more than probably would have survived such a severe head injury with treatment. Cooper v. Sisters of Charity, 272 N.E.2d 97 (Ohio 1971). The defendant was not guilty in the manner of operating but was guilty of not informing the patient about the risk of surgery. Because the risk was not explained and the patient was not given the opportunity to decide as to whether he wanted to take the risk, the matter was remanded for a new trial on that issue. Barnette v. Potenza, 79 Misc. 2d 51. 359 N.Y.S.2d 432 (N.Y. 1974). Yes. The general rule is that the consent of a parent is necessary for an operation on a minor. There are exceptions, but this case does not fall within an exception. Bonner v. Moran, 75 U.S. App. D.C. 156. 126 F.2d 121 (1941). Yes. The common-law rule that any extension of an operation without either the patient’s consent or the consent of one with authority to consent for him or her constitutes a battery or trespass. Because of the use of anesthesia, it is impractical to obtain the patient’s consent. Usually, someone else who is in the family or otherwise designated by the patient will make the decision. In situations of abdominal surgery, it is well known that an exact diagnosis cannot be made until the patient is under anesthesia and the incision made. It is better to extend consent to allow the surgeon to extend the operation to remedy any diseased condition around the original incision without further consent. Kennedy v. Parrott, 243 N.C. 355. 90 S.E.2d 754. 56 ALR 2d 686 (N.C. 1956). This is a matter of product failure. The forceps are expected to do the job they were designed to do. The patient, the surgeon, and the hospital depended on the forceps performing a task they were designed to perform. There is nothing extraordinary in their use. Taking all these factors into consideration, the medical supply distributor is liable for furnishing the defective instrument to the hospital under a warranty theory and the manufacturers on a strict liability theory for making a defective product. The surgeon and the hospital were not found liable for this latent defect.

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 7, The Health Record

Study Questions 18. 19. 20. 21.

A health record includes past history, a statement of the current problem and diagnosis, and the treatment procedures used to solve the problem. The ownership of a health record is not absolute, and it may require that the owner must allow others to access it. Issues to consider: Who owns the record? What is the office’s policy on allowing patients to take home records, X-rays, etc.? Is there a medical need for the patient to show this information to others? Seek the provider’s guidance on what can be provided to the patient. Explain to the patient that you will pass along the request to the provider and will follow up shortly. There are

Solution and Answer Guide: Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 8, Introduction to Ethics

22. 23.

circumstances where information in a patient’s record can be withheld by the provider, and the provider should be involved in determining what should be withheld. When you testify in court, you are under oath and subject to penalties for lying. So, answer all questions truthfully and to the best of your ability. Determine if there is an office protocol for correcting medical records. If so, follow the protocol. If not, discuss alternative ways with the provider to correct the information that does not raise suspicion, or the appearance, of wrongdoing.

Cases For Discussion 27.

28.

29.

Yes. The plaintiff applied for insurance. He was an insurance broker and was fully aware, when he made the application, that the state of his health prior to issuance of any insurance policy was an important factor. Because he authorized the provider to release information about his past health, he has no case against the insurance company or the provider. The provider did only what the plaintiff authorized him to do. Millsaps v. Bankers Life Co., 342 N.E.2d 329 (1976). No. The court had adequately protected the 140 patients from disclosure of their identity and the surgeries performed on them. The court did not see how this disclosure in any way impinges on the confidential patient–provider relationship the statute was designed to protect. Schach v. Whalen, 581 E.2d 35 (1978). Yes. Destruction of records was evidence of negligence. The hospital did not have the right to destroy the records. Carr v. St. Paul Fire and Marine Insurance Co., 384 F. Supp. 821 (Ark. 1974).

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 8, Introduction to Ethics

Table of Contents Study Questions ................................................................................................................................ 10 Cases For Discussion ......................................................................................................................... 11

Study Questions 24.

25. 26. 27. 28.

Three situations that bring about ethical dilemmas in medicine include when religious beliefs of the provider or patient conflict with the application of best medical practice, when the cost of medical procedure is high and likelihood of success is low, and when the law requires medical action that invades a patient’s privacy. The identification of personal ethics that align with each dilemma will vary greatly amongst students, as will the methods used to separate their personal ethics from the ethical dilemma at hand. Many patients consider themselves to be at the mercy of providers or at a disadvantage because they rely upon providers for specialized information, so the ethical codes help protect patients’ rights and privacy. A code of ethics violation in health care may result in license suspension or revocation, or other negative repercussions from your employer, colleagues, patients, family, or friends. See Table 8-2. Personal morals develop and evolve throughout our lifetimes. Our family, friends, mentors, religious leaders, teachers, public figures, culture, and society, among others, expressly or through their actions, teach us what is and what is not acceptable behavior. People adopt some values because they appear as self-evident truths. Most values, however, develop as we mature

Solution and Answer Guide: Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 9, Laws and Ethics of Patient Confidentiality

from infancy. There are numerous theories that seek to explain how we develop our values. Lawrence Kohlberg expounded on the theories and research of Jean Piaget, which resulted in one of the more common and controversial theories of value development.

Cases For Discussion 30. 31. 32. 33.

Responses will vary. Responses will vary. Responses will vary. Responses will vary.

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 9, Laws and Ethics of Patient Confidentiality

Table of Contents Study Questions ................................................................................................................................ 10 Cases For Discussion ......................................................................................................................... 11

Study Questions 29. 30.

31. 32.

While privacy is a right that emanates from the U.S. Constitution and common law, confidentiality is grounded in an ethical duty. HIPPA’s three main objectives: a. To protect and enhance the rights of consumers by providing them access to their health information and controlling the inappropriate use of that information. b. To improve the quality of health care in the U.S. by restoring trust in the health care system among consumers, healthcare professionals, and the multitude of organizations and individuals committed to the delivery of care c. To improve the efficiency and effectiveness of health care delivery by creating a national framework for health privacy protection that builds on efforts by states, health systems, and individual organizations and individuals. HIPAA’s Security Rule also requires that covered entities perform risk assessments, which include the identification of potential areas that may result in the disclosure of ePHI in violation of HIPAA’s Rules. Anyone who has reason to believe that a covered entity or business associate violated HIPAA’s Privacy, Security, or Breach Notification Rules may file a complaint.

Cases For Discussion 34. 35. 36. 37. 38.

A provider cannot deny you a copy of your records because you have not paid for the services you have received. However, a provider may charge for the reasonable costs for copying and mailing the records. Yes, there was a HIPAA violation. Yes, it matters. The supervision had no legitimate reason for having the employee's PHI. Yes, an authorization is needed. Revise the authorization to specify what records and/or portions of the files may be disclosed. Independent medical examinations contain PHI, and the patient is entitled to a copy. If a patient has requested that a covered entity communicate with them in a specific and confidential manner, such as by requesting calls only at work, the covered entity must

Solution and Answer Guide: Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 10, Professional Ethics and the Living

39.

accommodate that request, if reasonable No. The hospital failed to comply with the HIPAA Security and Privacy rules such as breach of confidential information of the patients and non-compliance to the standards.

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 10, Professional Ethics

and the Living

Table of Contents Study Questions ................................................................................................................................ 10 Cases For Discussion ......................................................................................................................... 11

Study Questions 33. 34. 35.

36. 37.

Consider: Inform the provider of the patient’s sentiments, so the provider and patient can discuss further; collect available written material on the procedure should the provider want to provide to the patient; you can provide empathy simply by letting the patient speak. Responses will vary. Ensure (1) that the patient wants you to work with the press; (2) that you have written authorization from the patient (or his parents, in this case) to ensure there are no HIPAA violations and no miscommunication; and (3) that you are clear about what information can be disclosed to the press. You do not want your employer to be sued for malpractice associated with the abandonment of this patient. Suggest a certified letter explaining the provider's position along with alternative providers, and suggest the patient go to the emergency room, if the infection is severe. Share with him that the sale of human organs is illegal.

Cases For Discussion 40.

41. 42.

No. The court denied him the request and stated that transporting him to Colorado for testing and then back later for surgery would require the services of guards and other personnel, which would be expensive to the state. The court also stated that moving a prisoner under a death sentence would be extremely dangerous for the public. Campbell v. Wainwright, 416 F.2d 949 (1969). Yes. Responses will vary.

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 11, Reproductive Issues and Early Life

Table of Contents Study Questions ................................................................................................................................ 10 Cases For Discussion ......................................................................................................................... 11

Solution and Answer Guide: Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 12, Death and Dying

Study Questions 38. 39. 40. 41. 42.

43. 44. 45.

Responses will vary. Responses will vary. Sanctity of life is a philosophy of life that holds living beings are inviolable. The decision not to remove life support from a person in a persistent vegetative state would be a sanctity of life argument. Quality of life is a philosophy of life that focuses on the standard of health, comfort, and joy experienced by an individual. The decision to remove life support from a person in a persistent vegetative state would be a quality-of-life argument. The three exceptions to the Baby Doe Law are: 1. When the infant is chronically and irreversibly comatose. 2. When treatment would merely prolong dying. 3. When the treatment would be futile either because the child would not survive, or the treatment would be inhumane. Responses will vary. Responses will vary. Testing for genetic information requires a DNA sample from solid tissues, blood, saliva, or other nucleated cells.

Cases For Discussion 43.

44. 45.

46.

No. There is no cause of action existing for the unintentional infliction of harm to a person in this situation. Although the deciding judge agreed that the provider’s failure to properly advise as to the genetic possibility of the disease and to test for the disease did not actually cause the disease in the newborn, his negligent act may be said to be the proximate cause due to the parents’ statement that abortion would have been sought had they been aware of the child’s abnormality. Howard v. Lecher, 42 N.Y.2d 109, 397 N.Y.S.2d 363 (1977). Responses will vary. Yes. The state of New York requires the consent of both parents of a child born in wedlock for an adoption to take place. New York has a strong policy in favor of legitimacy. It is determined that a child born of consensual artificial insemination during a valid marriage is a legitimate child entitled to the rights and privileges of a naturally conceived child of the same marriage. The first husband is the father, and for the second husband to adopt the child, the first husband must consent. In re Adoption of Anonymous, 74 Misc. 2d 99, 345 N.Y.S.2d 430 (1973). The courts have consistently shown a policy favoring the requirement that a child be provided with a father as well as a mother. In a situation in which there is an anonymous donor, the courts have required that the person who consents to the use of sperm not his own be responsible for fathering the child. In this case, there is a known man who is the donor. There is no husband. If the couple had been married and the husband’s sperm was used artificially, he would be considered the father. The court found that the evidence supported C.M.’s contention that he and C.C. had a long-standing dating relationship and he fully intended to assume the responsibility of parenthood. He has shown a genuine interest in the child. He is a teacher and educationally able to aid the child’s development and is financially capable of contributing to his support. The court will not deny him the privileges of fatherhood. His motion for the right of visitation is granted. C.M. v. C.C., 152 N.J. Super. 160, 377 A.2d 821 (1977).

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 12, Death and Dying

Table of Contents Study Questions ................................................................................................................................ 10

Solution and Answer Guide: Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 12, Death and Dying

Cases For Discussion ......................................................................................................................... 11

Study Questions 46. 47. 48.

Responses will vary. A patient would want a DNR order to ensure the patient’s wishes are known. Responses will vary..

Cases For Discussion 47.

48.

49.

50.

51.

Death, as required by law, is cessation of life. Death is not merely the cessation of the heartbeat but occurs when the heart stops long enough to result in complete loss of brain function. In light of significant technological advances, the traditional principle must be modified. Brain death occurs when, in the opinion of a licensed provider, there has been a total and irreversible cessation of spontaneous brain functions and further attempts at resuscitation by continued supportive maintenance will not be successful in restoring such functions. Regardless of an ability to artificially maintain the heartbeat of the victim, proof of brain death satisfies beyond a reasonable doubt the element of the death of the victim. Commonwealth v. Golston, 366 N.E.2d 744 (1977). No. There is a constitutional right of privacy protecting against state action in this case. There is no compelling interest to justify the state to require the patient to continue existence. The prognosis is that the patient is doomed to the continuance of a mere biological vegetative existence. Such decisions should be controlled within the patient–provider–family relationship. Her father should be appointed as the patient’s guardian, and upon concurrence of the guardian and family of the patient, if the attending providers and hospital ethics committee or a similar body conclude that there is no reasonable possibility of the patient regaining a cognitive, sapient state, her life-support systems may be withdrawn. In re Quinlan, 70 N.J. 10, 355 A.2d 647 (1976). The trial court said yes and provided comment that there is more moral warrant for turning off a machine than for never having started it; that is, when the patient has been given the benefit of all known procedures and these prove unsuccessful in restoring health, they need not be uselessly continued. The case was appealed, and the appellate court restricted the medical criteria for activation of the patient’s right to terminate treatment to only those terminally ill who are in a permanent vegetative coma with extremely remote probability of regaining cognitive brain function (Paris, 1980, p. 876). The Supreme Judicial Court did allow the removal of the tube. The hospital stated that the patient would have to be removed from the facility if the procedure were to be performed. Another hospital in the area accepted the patient and worked with his wife to provide dignity in death for the patient. Brophy v. New England Sinai Hospital, 398 Mass. 417 (1986). Yes, the court upheld a substitute decision not to continue feeding the patient. The court stated that the primary focus should be the patient’s desires and experience of pain and enjoyment, not the type of treatment involved. In re Conroy, 98 N.J. 321, 486 A.2d 1209 (1985).