You are the CEO of a 300-bed regional hospital. As is common in most rural areas, there are many migrant workers, who work for farmers and ranchers. This population often does not have legal documentation and, as a result, most employers pay them poorly and almost never provide any type of health insurance. If injured at work, most migrant workers will either present at the local hospital for care or self-treat. If badly injured, they frequently end up returning to their country of origin.

One day your chief medical director (CMO) and chief financial officer

(CFO) come to your office to let you know that three weeks ago Juan Lopez was admitted to the hospital. Juan was working on a farm 150 miles from your hospital and had a tragic and traumatic accident that almost killed him.

Your hospital was the closest regional facility that could save him. In the past two weeks the doctors were able to stabilize him, but he is now paralyzed below the neck and will need constant rehabilitation for the next four to five months. Juan lacks health insurance and his employer refuses to take any responsibility for Juan’s expenses, which is his legal right. Juan’s hospital bill is now approaching $200,000, which he would never be able to pay if he were healthy.

Your CMO and CFO state that Juan now needs to be transferred to a rehabilitation facility, services which your hospital does not provide. Every rehabilitation facility in the state has been contacted (along with a few outside the state) to see if it would accept Juan as a patient. Almost all have refused the transfer, but two said they would agree only if your hospital would guarantee the charges for Juan. Your CFO does not recommend guaranteeing a patient’s bill, as this would set a bad precedent and Juan’s care might last for years. On the other hand, your CMO feels strongly that the hospital needs to ensure that Juan receives quality patient care............

Case Questions 1. How would you make such a decision? What factors should you consider?

2. What cultural considerations are involved?

3. What ethical principles would you apply to this situation?

4. What would you do? Why?