As part of a quality-assurance program being initiated by Community Hospital, each vice president personally interviewed every staff member under his or her jurisdiction to determine what actions should be taken to improve the hospital. Atsushi was the vice president for outpatient services, a division that was responsible for generating a significant percentage of the hospital's annual operating budget. As part of his interviewing schedule, he arranged to speak with each member of the physical therapy department, including Marta, an athletic trainer who had worked in the department for three years. When Marta met with Atsushi, she indicated that she was fairly satisfied with the way the department operated. She particularly enjoyed the fact that there was less bureaucracy than there had been at the clinic she used to work for. She enjoyed having her own caseload and being able to make her own decisions, in accordance with the referring physicians, about patient care. The one thing that bothered her, however, was that she thought the new department head viewed her in less favorable terms than the physical therapists she worked with. Marta told Atsushi that she had a good one-on-one relationship with each of the PTs, but that the new director seemed to want to establish a pecking order. When the interview was finished, Atsushi thanked her for her time and honesty. Six months later, a report issued by the hospital contained a list of directives for new procedures intended to help improve the quality of care provided by the hospital. Among the procedures that applied to the physical therapy department were the following: All progress and discharge notes dictated by an athletic trainer shall be countersigned by a physical therapist. All athletic trainers, physical therapist assistants, and physical therapy aides shall carry out their duties under the supervision of a physical therapist. Only physical therapists shall conduct initial patient evaluations. Athletic trainers may conduct follow-up evaluations, but only under the supervision of a physical therapist. When Marta saw the directives, her heart sank. For the past three years, Community Hospital had been a great place to work. She had felt fulfilled both personally and professionally. Now it seemed that this job was about to become much like the one she thought she had escaped. Questions for Analysis 1. Do the new procedures initiated by the hospital adequately support the policy of improved health care delivery for patients? Is patient care likely to be improved? Why or why not? 2. Are the new procedures consistent with the law governing the practice of medicine, physical therapy, and athletic training in your state? Why or why not? 3. What are the implications for third-party billing in this case? Do the new procedures support the practices normally associated with third-party billing in your state? 4. What is the likely effect of the new procedures on department members' commitment to accomplishing the mission of the department? How will the PTs be affected? How will the ATCs be affected? 5. What actions, if any, would you take if you were in Marta's position? What are the possible benefits of such actions? What are the risks