Ethical and Legal Analysis of a Patient Case
Jill is a physical therapist and Director of Rehabilitation Services in a Skilled Nursing Facility (SNP). Mary is a 75-year-old female who was admitted to the facility for the continuation of rehabilitation secondary to a total hip replacement. After treating Mary one Sunday afternoon, Jill wheeled her back to her room. She documented the treatment performed, and then went to another facility to treat a few more patients.
The following day, Jill received a call from Edith, the Director of Nursing Services in the facility. Edith stated that a few minutes after Jill left, Mary evidently tried to get up from her wheelchair to turn down the volume of the television and fell, hitting her head on the floor. When asked why she tried to get up on her own despite previous instructions not to do so, Mary stated that Jill did not put her call light within reach and that there was no one around to call. Edith relayed that Mary’s condition deteriorated over a 12-hour period, and she was subsequently sent out to the acute hospital (immediately after the incident Mary’s physician was called and he ordered them to keep Mary in the facility for observation). Mary suffered an intracranial hemorrhage and died early the following day.
That same day, Jill, Edith, and Betty (the facility administrator) met to review Mary’s chart. When asked if she made sure Mary had her call light, Jill stated that she was not sure if she did. Jill admitted to being preoccupied that day because of her heavy caseload and other personal problems. However, Jill stated that she had always placed the call light within reach of her patients in the past. Edith and Betty then asked Jill to revise the PT note that she did the day before to reflect that she had given Mary the call light. Edith, who was also the charge nurse on the day of the incident, had already “reconstructed” her chart entries accordingly. Betty was afraid of a big lawsuit coming from Mary’s family, so she ordered everyone involved in Mary’s care to “strengthen” their documentation to reflect that the facility was not responsible for her injury and consequent death.
Jill was pressured by Betty to change her documentation, implying that she might be terminated if she did not agree to make the revisions. Betty wanted Jill to completely revise the whole note. Consequently, Mary’s family sued the facility for negligence. Provide an ethical and legal analysis of this case. Ensure each of the following components is included in your analysis:
Definition of the problem(s)
Identification of ethical, legal, and professional principles/standards that were violated in the case
A plan to:
Right the identified ethical, legal, and/or professional principles/standards that were wronged in the case.
Minimize the suit that Jill and the hospital now face.
Definition of Problems
The problems highlighted in the case study include a case of negligence that leads to the wrongful death of a patient. Across the US, the negligence of hospital administration will also make the healthcare facility to be liable for any treatment mistake made by employees (Dahlawi et al., 2021). Various forms of negligence in healthcare facilities lead to medical malpractice, which includes physician malpractice, nursing malpractice, and malpractice by a physical or occupational therapist. In the case study highlighted above involving Jill, who is a physical therapist and an elderly patient known as Mary, it is therefore evident that Jill is liable for negligence. This form of negligence is therefore in line with personal injury law which highlights that employers, including healthcare facilities, can be held liable for the negligence of the employees. A healthcare facility will therefore be responsible for medical malpractice that is committed by nurses, physicians or other healthcare professionals contracted or employed at the hospital, such as physical therapists (Mello et al., 2020). The case study highlighted the healthcare facility could be liable for the negligence of Jill, who does not place the patient’s call light within reach and is not sure if she did. The lack of a call light makes Mary, who is a patient who had undergone a hip replacement, try to stand up on her own and eventually fall and sustain head injuries. The head injuries result in intracranial haemorrhage and eventually cause the patient’s death the following day.
Identification of Ethical, Legal, and Professional Principles/Standards That Were Violated in the Case
The ethical standards that were violated in the case study that eventually led to the death of the patient included beneficence and nonmaleficence. In the case study Jill, the physical therapist, unintentionally made a mistake that led to placing the patient in danger and went against the ethical principle of nonmaleficence. Through their mistake, the physical therapist also went against the principle of beneficence. On the other hand, the physical therapist also violated the professional principle of providing appropriate safe and responsive quality of care to patients (Moukalled & Elhaj, 2021).
Finally, the legal principle that was violated in the case study involving Jill and her patient Mary was related to negligence. State laws allow plaintiffs to obtain recovery when careless or negligent action by a healthcare provider causes injury to the plaintiff or the plaintiff’s descendant’s representatives (Dahlawi et al., 2021).
Approaches to right the identified legal, ethical and professional standards that were violated in the case study
To address the ethical principle of beneficence and nonmaleficence that were violated in the case study, the healthcare administrator and Jill, the physical therapist, need to provide accurate documentation to the plaintiff and necessary authorities so as to prove whether they follow the ethical principles of beneficence and nonmaleficence and the legal standard required in caring for a patient. The provision of the right documentation to the necessary authorities would also help to right the professional standards related to providing health care services to patients.
Minimizing the Suit That Jill and the Hospital Faces
To minimize the suit that Jill and the hospital face, both Jill and the hospital administrator should not be involved in unethical practices such as trying to change Jill’s documentation but rather provide the necessary documentation to investigating authorities. The hospital administrator should also try to talk to Mary’s family that is suing the hospital for negligence and make them understand the situation surrounding her death. Finally, the healthcare administrator can push for an out-of-court settlement with the involved family in the case where Jill is found liable for negligence.
Dahlawi, S., Menezes, R. G., Khan, M. A., Waris, A., Saifullah, -, & Naseer, M. M. (2021). Medical negligence in healthcare organizations and its impact on patient safety and public health: a bibliometric study. F1000Research, 10, 174. https://doi.org/10.12688/f1000research.37448.1
Mello, M. M., Frakes, M. D., Blumenkranz, E., & Studdert, D. M. (2020). Malpractice Liability and Health Care Quality. JAMA, 323(4), 352. https://doi.org/10.1001/jama.2019.21411
Moukalled, T., & Elhaj, A. (2021). Patient negligence in healthcare systems: Accountability model formulation. Health Policy OPEN, 2, 100037. https://doi.org/10.1016/j.hpopen.2021.100037