Ethics Committee Group 1 - Ch 3 Medical Error: Paradise Hills Medical Center Case Study from The Tracks We Leave: Ethics and Management Dilemmas in Health Care, 3rd. ed.

1. Discuss requirements for Informed consent for treatment. Assume one of the 22 patients has Limited English Proficiency (LEP) How would this impact informed consent?

2.Discuss patient rights and medical error disclosure.

3. Discuss medical negligence and vicarious liability and how they would apply.

4. Discuss fraud law and how it would apply.

5. What are 4 questions I can ask other group?. Each question should relate to the impact of the proposed recommendation. The group should make it clear how each question relates to one of the categories listed below.

1. Legal
2. Financial
3. Hospital (Organization)
4. Reputation

For example, if the ethics committee group was discussing a bone marrow transplant case and proposed to proceed with a bone marrow transplant for a patient who is uninsured. The following questions might be asked.

1. Legal - What are the bone marrow transplant coverage requirements for health insurance companies, including Medicare and Medicaid, under federal and state law? If the patient could get health insurance, would bone marrow transplant coverage be required?

Case Study Below:

Paradise Hills Medical Center was a 500-bed teaching hospital in a major metropolitan area of the South. It was known throughout a tristate area for its comprehensive oncology program and served as a regional referral center for thousands of patients suffering from various forms of malignant disease.

Paradise Hills was affiliated with a major university and had residency programs in internal medicine, surgery, pediatrics, obstetrics and gynecology, psychiatry, radiology, and pathologyall fully accredited by the Accreditation Council for Graduate Medical Education. In addition, Paradise Hills had an oncology fellowship program, a university-affiliated nursing program, and training programs for radiology technicians and medical technologists. All of these teaching programs were highly regarded and attracted students from across the nation.

Paradise Hills enjoyed an enviable reputation. It was respected for its highquality care; its state-of-the-art technology; and its competent, caring staff. Although Paradise Hills was located in a highly competitive healthcare community, it boasted a strong market share for its service area. Its patients also provided significant referrals to the surgery, pediatrics, and radiology programs.

Paradise Hills was a financially sound institution with equally strong leadership. Its past successes could be attributed in large part to its aggressive, visionary CEO and his exceptionally competent management staff.

But all was not as well as it seemed at Paradise Hills. Although the oncology program still enjoyed a healthy market share of 75 percent, it had been slowly and steadily declining from a peak of 82 percent two years earlier. In addition, the program's medical staff was aging, and some of its highest-admitting physicians were contemplating retirement. The oncology fellowship program had been established a few years previously to address this situation, but unfortunately the graduates of this program had so far elected not to stay in the community. Of most concern to the CEO and his staff was the fact that the hospital's primary competitor had recently recruited a highly credentialed oncology medical group practice from the Northeast and had committed enormous resources to strengthening its own struggling cancer care program.

The previous week, Paradise Hills's board of trustees had held its monthly meeting, with a fairly routine agenda. However, during review of a standard quality assurance report, one of the trustees inquired about a section of the report indicating that 22 oncology patients had received radiation therapy dosages in excess of what had been prescribed for them. It was explained that the errors had occurred because of a flaw in the calibration of the linear accelerator and that the medical physicist responsible for the errors had been asked to resign his position. Another trustee then asked if the patients who had received the excessive radiation had been told about the errors. The CEO responded that it was the responsibility of the medical staff to address this issue, and they had decided not to inform the patients about the errors. The board did not agree that the medical staff were solely responsible for informing the patients about the errors and requested that the administrative staff review both the hospital's ethical responsibility to these patients and its liability related to the incident, and report back to the board within two weeks.

The CEO and his management staff responsible for the radiology department and the oncology program met with the medical staff department chairs for internal medicine and radiology, the program medical directors for oncology and radiation therapy, and the attending oncologists. The CEO related the board's discussion about the errors and the board's request that the actions taken be reviewed, specifically the decision not to inform the affected patients.

All of the physicians agreed that the adverse effects of the accidental radiation overdose on the patients were unknown. The oncologists argued that the patients should not be told of the incident, asserting that cancer patients did not want or need any more bad news. "Let's face itthese patients are terminal," they said. "Informing them about this error will only confuse them and destroy their faith and trust in their physicians and in the hospital." Furthermore, they claimed, informing the patients of the errors could unnecessarily frighten them to the extent that they might refuse further treatment, which would be even more detrimental to them. Besides, the physicians argued, advising the patients of potential ill effects just might induce those symptoms through suggestion or excessive worry. Every procedure has its risks, the radiology department chair insisted, and these patients signed an informed consent.

Physicians know what is best for their patients, the attending oncologists maintained, and they would monitor the patients in question for any ill effects. The department chair for internal medicine was of the opinion that the incident was clearly a patient-physician relationship responsibility and not the business of the hospital. Besides, the radiology chair added, informing the patients would "just be asking for malpractice litigation."

The medical director for the oncology program then suggested that the board of trustees and the management staff "think long and hard" about the public relations effect that disclosing the incident would have on the oncology program. "Do you really think patients will want to come to Paradise Hills if they think we're incompetent?" he asked.

The CEO conceded that he supported the position of the medical staff in this matter and that he, too, was concerned about preserving the image of the oncology program. But, he said, his hands were tied because the board clearly considered this an ethical issue that would have to be referred to the hospital's ethics committee for its opinion.

The physicians noted that if indeed the ethics committee subsequently recommended that the patients be informed, then realistically that responsibility would rest with the patients' primary care physicians and not with any of them.

Reference

Perry, F. (2020). The tracks we leave: Ethics and management dilemmas in healthcare. (3rd ed.). ACHE Management Series.