Dr. Spring, a board-certified obstetrician and gynecologist, has been in practice for more than 10 years. He is licensed to practice medicine in both New York and Pennsylvania. Dr. Spring employs a staff that includes two medical assistants.On Monday one of the medical assistants, Nancy Watts, took a history on a new patient who was referred to Dr. Spring. The 40-year-old, married patient has had vaginal spotting for more than six weeks.As part of the history, Nancy learned that the patient has been under the care and supervision of a fertility specialist for more than two years. In fact, although not always compliant, the patient has been on a medication treatment regimen for fertility problems.

After examining the patient, Dr. Spring ordered a uterine biopsy to be performed in the office. The patient returned the following week, underwent the biopsy, and was sent home. Soon after, the patient's husband telephoned the office, requesting to speak to Dr. Spring immediately. His wife had just been admitted to the hospital because of intense vaginal bleeding.

1. Was there anything in the patient's history that the physician would take into consideration regarding performing the uterine biopsy?

2. How should Nancy have handled the husband's telephone call?

4. Would it violate patient confidentiality to fax the patient's records to the emergency room physician, if requested?

5. Is this a potential case of medical negligence and malpractice? Could Nancy, as the medical assistant, have complicity (being an accomplice in wrongdoing) in this particular case?