Post on 15-Apr-2017
transcript
Organizational Responsibilities When A Physician Is Troubled
MMHA 6025-1 Week 4 Application Walden University 2015
Danielle Tate
Liability and Negligence
Liability relates to one’s legal obligation that is incurred due to damages incurred
via negligence. Negligence is defined as, “omission or commission of an act that a
reasonably prudent person would or would not perform under given circumstances. It is a
form of heedlessness or carelessness that constitutes a departure from the standard of care
generally imposed on members of society” (Pozgar, 2013). Joint and several liability
could play a part in this situation where Dr. Smith has been drinking excessively,
operating the morning after heavy drinking, and making mistakes in the OR that could or
could not be related to drinking. The hospital and physicians could be jointly liable and
this could be a case of several liability, for Dr. Smith’s actions, and other healthcare
professionals; i.e. nurses, peers and other hospital employees, if a negative outcome were
to result from his drinking. Joint liability refers to concurrent tort-feasors where each
party is independently responsible for their own part in the wrongful acts. A nurse
reported her concerns about Dr. Smith to administrators, so if the hospital administrators
fail to act, they can be held liable. Dr. Smith can be held liable for any issues that may
arise due to his drinking if it is determined that alcohol was the cause of any negative
outcomes. Nurses and other medical staff could also be liable if they have knowledge of
Dr. Smith’s unethical and potentially dangerous actions, and they do not report this
(Pozgar, 2014). Hospitals are required to protect patients from unreasonable risks. Failing
to do so can be seen as corporate negligence and the hospital can be liable for this
(Pozgar, 2013). As seen in Mduba v. Benedictine Hospital, even though Dr. Smith is not
an employee of the hospital per se, the hospital could still be liable for damages incurred
via the community-based physician with privileges at the hospital (Mduba v. Benedictine
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Hospital, 1976). . In 1965, Darling v. Charleston Community Memorial Hospital, became
a benchmark case that determined that “A hospital is responsible, in conjunction with its
medical staff, for establishing policies and procedures for monitoring the quality of
medicine practiced within the hospital” (Pozgar, 2014). The hospital would be held with
direct responsibility for Dr. Smith’s action if he was an employee of the hospital, because
then he would be under contract with the hospital. Hospitals and their staff are
responsible for building and maintain trust and integrity; “Trust must begin within the
organization between management and employees” (Pozgar, 2013).
As an administrator of the hospital proof of a negative outcome that was proven to
be caused by Dr. Smith’s drinking would be needed. The specific technical errors that
occurred in surgery would need to be researched, and staff that was present during the
surgery should be questioned. The medical staff and governing body are responsible for
the credentialing process, medical staff bylaws, and also monitoring physicians via peer
review to ensure quality of care. If unethical or suspicious behavior was reported, the
governing body could investigate and potentially limit or suspend a physician’s privileges
(Pozgar, 2014). “It is the responsibility of each organization’s governing body, and not
the legal system, to provide appropriate staffing and provide adequate supplies and
equipment for patients” (Pozgar, 2013). The governing body of a healthcare organization
is also responsible for complying with all federal, state, and local rules and regulations,
along with any Join Commission standards. They must provide a safe environment for
patients, visitors, and their staff that fosters respect, trust, integrity, and honesty (Pozgar,
2013).
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Ethics
The American College of Healthcare Executives (ACHE), created a Code of
Ethics to act as a standard of conduct for ethical behavior of healthcare workers,
healthcare organizations, and relationships. If the physician would become partner in the
cardiovascular institute, his responsibilities and ethical responsibilities would be even
greater, and his actions would need to be evaluated accordingly. “The fundamental
objectives of the healthcare management profession are to maintain or enhance the
overall quality of life, dignity and well-being of every individual needing healthcare
service and to create a more equitable, accessible, effective and efficient healthcare
system. Healthcare executives have an obligation to act in ways that will merit the trust,
confidence, and respect of healthcare professionals and the general public. Therefore,
healthcare executives should lead lives that embody an exemplary system of values and
ethics” (American College of Healthcare Executives [ACHE], 2011). These codes
include; I. The Healthcare Executive’s Responsibilities to the Profession of Healthcare
Management, II. The Healthcare Executive’s Responsibilities to Patients or Others
Served, III. The Healthcare Executive’s Responsibilities to the Organization, IV. The
Healthcare Executive’s Responsibilities to Employees, V. The Healthcare Executive’s
Responsibilities to Community and Society, and VI. The Healthcare Executive’s
Responsibility to Report Violations of the Code (ACHE, 2011). Hospitals and healthcare
staff have the ethical responsibility to maintain a high standard of care and integrity when
assisting patients and also to report any unethical behavior and address it as soon as
possible. Before firing Dr. Smith, the administrators must evaluate his actions, offer
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assistance in getting help for his mental distress and potential drinking problem, and may
even offer a leave of absence. “There are two primary sets of laws which are immediately
brought into play when discussing possible workplace protections for an alcoholic
worker: (1) Americans with Disabilities Act, (2) Family Medical Leave Act. These
federal laws, which might protect an alcoholic worker from being fired, can conflict with
the so-called at-will doctrine that allows an employer to terminate an employee for
virtually any reason. Because alcoholism can be considered a disease, an employer must
consider the circumstances of the employee and any of the above mentioned laws that can
preclude an at will termination depending on the situation… Neither federal nor state law
mentioned above protects employees who abuse alcohol while at work, or whose alcohol
abuse prevents them from performing any part of their job. If an employee abuses alcohol
while on duty, or has some necessary license or authorization (such as a driver's license)
revoked due to their drinking then an employer may terminate them without the
accommodations required by law” (Employment-Law, 2015). Having an ethics
committee and legal advice can help healthcare administrators decide if laws or ethical
principles have been violated and what to do if this occurs. “Justice can be advanced and
enacted through the development of morale agency on the part of both practitioners and
patients” (Edwards, Delaney, Townsend, & Swisher, 2011). Human Resources can also
be consulted to see what options are available.
Specific ethics regarding the consumption of alcohol, “The American Medical
Association (AMA) Code of Medical Ethics section E-8.15 entitled ‘Substance Abuse’
states that ‘It is unethical for a physician to practice medicine while under the influence
of a controlled substance, alcohol, or other chemical agents which impair the ability to
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practice medicine.’ The AMA House of Delegates has also offered a policy (H-30.960)
that ‘(1) urges that physicians engaging in patient care have no significant body content
of alcohol and (2) urges that all physicians, prior to being available for patient care,
refrain from ingesting an amount of alcohol that has the potential to cause impairment of
performance or create a ‘hangover’ effect’” (Peterman & Desbiens, 2005).
The physician took the Hippocratic Oath, which requires healthcare providers to
avoid doing harm and do what is best for the patient in the healthcare provider’s medical
opinion. Performing medicine when not of sound mind is putting the patient at undue risk
and can cause harm (Pozgar, 2013). This also violates the ethical principle of
nonmaleficence “Nonmaleficence refers to the maxim of primum non nocere, which
translates to ‘above all, do no harm’…This principle of nonmaleficence prohibits causing
of harm” (Friend, 2011).
Synthesis
Staff should be trained on alcohol and substance abuse evaluation to use clinically
for patients and also so they are aware of signs to look for in colleagues (Cohagan, 2013).
To avoid this type of negligence, administrators can ensure that all staff receive
continuous training regarding ethics, hospital protocols, Federal rules and regulations,
and all policy and procedures. “The identification of all risks and associated hazards, and
an element of reasonable control needs to be implemented, particularly in the medical
field, so as to avoid the incident of high cost clinical medical negligence.” (O’Donovan,
1997). Emphasizing the importance of ethical behavior, possible consequences for
violations, and the dangers patients can face because of it may help prevent malpractice.
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OHSA (Occupational Safety & Health Administration) recommends periodic testing to
maintain a drug and alcohol free work environment. “OSHA strongly supports measures
that contribute to a drug-free environment and reasonable programs of drug testing within
a comprehensive workplace program for certain workplace environments, such as those
involving safety-sensitive duties like operating machinery. Such programs, however,
need to also take into consideration employee rights to privacy.” (United States
Department of Labor, 1998).
References:
American College of Healthcare Executives [ACHE]. (2011, November 14). American
College of Healthcare Executives Code of Ethics. Retrieved from the ACHE website:
http://www.ache.org/abt_ache/ACHECodeofEthics-2011.pdf
Cohagan, A. (2013). Alcohol and substance abuse evaluation. Retrieved from Medscape
website: http://emedicine.medscape.com/article/805084-overview
Edwards, I., Delaney, C., Townsend, A., & Swisher, L. (2011). Moral agency as enacted
justice: A clinical and ethical decision-making framework for responding to health
inequities and social injustice. Physical Therapy, 91 (11), 1653-1663. Retrieved from:
http://search.proquest.com.ezp.waldenulibrary.org/pqcentral/docview/
904409830/3E7A49DD093441C7PQ/1?accountid=14872
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Employment-Law. (2015). Employment/Labor: Firing employees with a drinking
problem. Retrieved from the Free Advice website: http://employment-
law.freeadvice.com/employment-law/firing/firing-employee-alcoholism.htm
Friend, M. (2011). Physician-assisted suicide: death with dignity? Journal of Nursing
Law, 14 (3), 110-116. Retrieved from:
http://search.proquest.com.ezp.waldenulibrary.org/pqcentral/docview/913146489/
DEC9C4738E33459CPQ/16?accountid=14872
Mduba v. Benedictine Hospital, 52 A.D.2d 450. Appellate Division of the Supreme Court
of the State of New York, 3rd Department (1976). Retrieved from:
http://www.leagle.com/decision/197650252AD2d450_1417/MDUBA%20v.
%20BENEDICTINE%20HOSP.#
O’Donovan, M. (1997). Risk engagement and the medical profession. The Journal of
Management Development, 16 (2), 125-133. Retrieved from:
http://search.proquest.com.ezp.waldenulibrary.org/pqcentral/docview/
216356136/56864FB5344D4848PQ/11?accountid=14872
Peterman, J., & Desbiens, N. (2005). Should physicians be allowed to use alcohol while
on call? Journal of Medical Ethics, 31 (1), 21-26. Retrieved from:
http://jme.bmj.com/content/31/1/21.full
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Pozgar, G. (2013). Legal and Ethical Issues for Health Professionals (3rd Ed.).
Burlington, MA: Jones & Bartlett Learning.
Pozgar, G. (2014). Legal and Ethical Essentials of Health Care Administration (2nd Ed.).
Burlington, MA: Jones & Bartlett Learning.
United States Department of Labor. (1998). Occupational Safety & Health
Administration. Retrieved from the OSHA website:
https://www.osha.gov/pls/oshaweb/owadisp.show_document?
p_table=INTERPRETATIONS&p_id=22577
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