In 1978, Walter Corley was diagnosed with neurofibromatosis, a genetic disorder that results in tumors of the nerves. In 1988, Mr. Corley developed back pain and sought treatment at E.A Conway, a teaching hospital that is part of Louisiana State University. During his treatment, Mr. Corley saw four different doctors from E.A. Conway. Medical records from those physicians rarely mentioned his neurofibromatosis, consisting for the most part of his back pain, the diagnostic tools used, and the treatments provided. In late 1988, Mr. Corley developed shortness of breath and significant weight loss. Upon examination, it was discovered that he had a large mass in his chest. Mr. Corley died shortly afterwards.

Mrs. Corley and her sons filed a medical malpractice and wrongful death lawsuit against the hospital, the doctors who treated him, Louisiana State University, and the State of Louisiana.

ISSUE: At trial, conflicting expert witnesses provided testimony on whether the Standard of Care was followed. The plaintiff's expert witness testified that doctors at E.A. Conway did not follow the required Standards of Care. The defendant's expert witnesses (most of whom were employees of E.A. Conway) testified that doctors at E.A. Conway did follow the required Standards of Care.

RULE: The court found for the plaintiff, determining that the doctors at E.A. Conway had deviated from the Standards of Care, based for the most part on the testimony of the plaintiff's expert witness in comparison with that of the defendant's expert witnesses.

EMPHASIS: The purpose for providing this case is to demonstrate how important the Standards of Care are in a malpractice claim. In this situation, the entire lawsuit hinged on the Standards of Care. In their written ruling, the appellate court wrote: "The physician will not be held to a standard of perfection nor evaluated with benefit of hindsight." And, "Physicians are obligated to rule out these imminent, serious and life-threatening causes first. Failure to eliminate these causes can subject a patient to a foreseeable risk of harm and would further constitute a breach of the applicable standard(s) of care."

2. Mr. Corley sought treatment for his back pain. Why should the doctors be held accountable for something unrelated to the back pain? Explain your answer.
4. As a healthcare professional, how are you supposed to know what your Standards of Care are?

COURT CASE TWO

FACTS: Daniel Poignon was a licensed pharmacist in the State of Ohio. While he was employed for Rite Aid pharmacy, Poignon stole 1,888 units of drugs. He was subsequently convicted of two felony counts of theft. Upon his conviction, the Ohio State Board of Pharmacy suspended his pharmacy license. He was given an opportunity to file an appeal, but missed the deadline to do so. Missing the deadline resulted in a permanent revocation of his license.

Three years later, Daniel Poignon applied for another pharmacist's license in the State of Ohio. In response, the Ohio State Board of Pharmacy denied his application indicating that his license had been permanently revoked. Mr. Poignon filed a lawsuit asking the court to force the Pharmacy Board to grant him a license, or in the alternative to allow him to appeal the previous license suspension.

ISSUE: The issue the court was asked to decide was whether Ohio's Board of Pharmacy had the authority to permanently bar him from obtaining a pharmacy license.

RULE: The court ruled that the Board of Pharmacy had the authority to determine what the requirements are for obtaining a license. That authority includes the procedures for suspending and revoking a license.

EMPHASIS: There are many aspects to this case that are relevant to our current discussion. The first is that criminal activity can result in you losing your license. The second is the authority a Medical Board has in determining the criteria for obtaining and keeping a license.

2. Should missing a deadline lead to such a drastic result, such as losing a license?Explain your answer.
4. Why do you think the Board of Pharmacy made their decision on such a minor detail? Explain your answer.

COURT CASE THREE

FACTS: O'Sullivan was employed as a radiology technologist by Dr. Mallon and his associates. O'Sullivan was ordered by Dr. Mallon to insert a urinary catheter in a patient for an imaging study of the patient's bladder. O'Sullivan informed Dr. Mallon that she did not have the education or training to perform such a procedure; and that catheterizations could only be performed by licensed nurses or physicians. O'Sullivan was fired from her job and filed a wrongful termination lawsuit.

ISSUE: The question before the court was whether an employer had the right to fire an employee who refused to perform an unlicensed act.

RULE: The court ruled that employers may not fire an employee in retaliation for refusing to perform outside of their scope of practice. In their ruling the court stated: "This rule is especially cogent where the subject matter is the administration of medical treatment, an area in which the public has a foremost interest and which is extensively regulated by various state agencies."

EMPHASIS: This case demonstrates the importance of working within your scope of practice. After this case, the State Board of Nursing issued a cease and desist order to the defendants, forbidding them to order non-licensed professionals to perform catheterizations.

2. Education and training is part of obtaining a license and the authorization to perform certain technical skills. Why can't that licensed professional provide the education and training by overseeing and supervising a non-licensed person perform that technical skill? Explain your answer.
4. Suppose that O'Sullivan did perform the catheterization at Dr. Mallon's order.If something went wrong, who would be responsible; O'Sullivan or Dr. Mallon? Explain your answer.

COURT CASE FOUR

FACTS: Dr. Guanzon was a licensed physician in West Virginia. He was notified by the state of West Virginia that ten patients had filed a complaint against him. He was ordered to appear before the State Medical Board of West Virginia's Complaint Committee. Part of this notification included a subpoena ducus tecum for copies of medical records of the ten patients who had filed complaints. Instead of facing disciplinary action, Dr. Guanzon voluntarily suspended his medical license.

During these proceedings, a reciprocity application to practice medicine was approved for Dr. Guanzon by the State Medical Board of Ohio. However, upon learning of the disciplinary proceedings in West Virginia and the suspension of his West Virginia license, the State Medical Board of Ohio revoked Dr. Guanzon's license to practice medicine.

The State Medical Board of Ohio determined that Dr. Guanzon's conduct constituted "fraud, misrepresentation [and] deception in applying for or securing a license or certificate issued by the board." Additionally, the Board found that Dr. Guanzon failed to provide proof of "good moral character" as required by Ohio licensing law. Subsequently, his license to practice medicine in Ohio was revoked as well.

ISSUE: The question before the court was whether or not the State of Ohio had the right to suspend Dr. Guanzon's license based on his actions in the state of West Virginia.

RULE: One of the requirements for obtaining a physician license in Ohio is that the application demonstrates "good moral character." The court determined that Dr. Guanzon was deceptive in applying for and securing an Ohio license, therefore he did not meet the requirements for obtaining an Ohio license.

2. Shouldn't people be granted an opportunity to redeem themselves after bad behavior? Explain your answer.
4. If you were sitting on the State Medical Board of Ohio, how would you determine what is and is not "good moral character?" Explain your answer