Instructions

Please read the hypothetical case and respond to the questions.

Hypothetical Scenario:

Facility A is a teaching hospital affiliated with the medical school of a nationally accredited university ("University A"). Facility A, a city-center hospital, and a Level 1 Trauma center, has cutting-edge technology and a robust marketing budget that it uses to publicize its rankings and ratings on various healthcare metrics. It has a large physical campus, located on Facility A Drive right across the street from one of University A's most prominent buildings. Within Facility A's main building are also physician group offices, but not all the physician groups are faculty at University A (some just rent space).

Jane, a patient at Facility A, has presented for monitoring of a high-risk twin pregnancy. Facility A has policies and procedures regarding electronic fetal monitoring, but nothing specific to the type of high-risk twin pregnancy Jane is experiencing. A physician at Facility A's prenatal OB/GYN location ordered thrice daily electronic fetal monitoring for the remainder of Jane's pregnancy (multiple months if the pregnancy was to be to term).

The Labor and Delivery Unit's Nurse Manager (the "Nurse Manager") assigns nurses to monitor Jane. All the nurses involvedthe Nurse Manager, the Charge Nurse, and Nurse Mare employees of Facility A.

Several weeks into her admission, Jane reports to Nurse M that for multiple hours she has not felt one of her twins move. Using a fetal monitor, Nurse M locates Twin 1, but is unable to locate Twin 2. After 10 minutes of searching, she asks the Charge Nurse for assistance. Charge Nurse is also unable to locate Twin 2, and after 8 minutes, she calls in the Nurse Manager. Nurse Manager spends another 12 minutes looking for Twin 2, but to no avail. And so, she pages the on-call resident physician (the "University Resident"). (As it turns out, Jane's specific type of twin pregnancy makes it difficult to locate both fetal heartbeats simultaneously. In fact, this failure to detect both heartbeats simultaneously using a fetal monitor has occurred multiple times during first couple of weeks of Jane's admission.)

University Resident returns the call 10 minutes later and is told in detail what is going on. Or at least that is what Nurse Manager, Charge Nurse, and Nurse M now claim. Unfortunately, there is no record of the conversation or its contents. Sixteen minutes after the call, University Resident arrives with an ultrasound device. She proceeds to use it to try to locate with more precision Twin 2's heart so that the fetal monitor can be placed more effectively. The University Resident is unsuccessful and instead visualizes fetal demise. She immediately calls the attending physician (the "Attending Physician"), also a University A employee, to confirm fetal demise.

While waiting for the Attending Physician, University Resident observes that the monitor is continuously alarming for deceleration (assume for our purposes that this means a general decline in heart activity and increased urgency). When the Attending Physician arrives, she confirms fetal demise of Twin 2 and orders a STAT C-section delivery of Twin 1.

Twin 1 is delivered without incident and has no health issues. Jane is understandably bereft, and her family joins her to greet Twin 1 and mourn Twin 2. Also on site is Larry, Jane's boyfriend, and the father of her children. While Jane is still coming out of anesthesia, University Resident explains to Jane's family and Larry what she believes happenedin short, that there was fetal demise of Twin 2 in utero.

Jane and Twin 1 remain at Facility A for several days for routine post-natal care. On the second day, Larry visits and attempts to enter into the post-natal wing using the "Exit-Only" door. He can see through the door to the nursing station, and yells for the nurses to admit him. They explain to him that they are not allowed to do so. Larry becomes irate, slamming his fists into the door and screaming that he will burn the hospital down. The nurses call security, which is staffed by independent contractor security personnel employed by Security Company. Although it is against Facility A's policy, security personnel proceed to physically move Larry. In the process, they break his arm.

Outside the hospital, Larrystill irate, and, now screaming in paincontinues to spew profanity about how Facility A has treated Jane and him. A police officer directing traffic observes Larry's behavior and institutes a Baker Act, delivering Larry to Facility A's General Receiving Center. Note: Facility A is NOT a Baker Act receiving facility. Larry passes out from the pain in his arm, and behavioral health unit nurses admit him while he is unconscious. Upon regaining consciousness, Larry discovers that his arm is now in a cast, which he quickly proceeds to use to beat up the patient care tech serving him food.

An hour later, Jane and her baby are discharged. Jane wants Larry to drive them home. Facility A's Behavioral Health Physician, who is employed by Facility A, explains to her that Larry has been admitted under the Baker Act for 10 hours and cannot be discharged.

Jane and Larry file a lawsuit.

They list as defendants:

Facility A;

The nurses involvedNurse Manager, Charge Nurse, and Nurse M;

The physicians involvedthe prenatal OB/GYN location's physician, University Resident, Attending Physician, and Behavioral Health Physician; and

Security Company and the security personnel involved in Larry's injury.

The main legal causes of actions are:

Medical malpractice related to the fetal demise; and

False imprisonment and battery related to Larry's outburst.

Jane and Larry also claim that Facility A is ultimately responsible for all their claimed damages.

When the pre-suit notice is received, you learn that Jane and Larry are seeking:

All records of employment of the involved individuals; and

All adverse incident reports related to Jane, Larry, or any other patient or guest who had any similar experience.

Please Answer the Following Questions:

1. Based on the concepts discussed in this course, identify the (1) risk management, (2) patient safety, and (3) quality improvement issues present in this hypothetical.

2. To the extent that any issues fall in one or two disciplines but not the other(s), identify why.

3. Discuss the risk/safety/quality implications and considerations of the issues you identify, and any suggestions you have as to the treatment or resolution.