John, a 34-year-old father of two children, is a member of a health

maintenance organization (HMO) in Texas. John has made several

trips to an area clinic recommended by his HMO to seek medical

attention since finding blood in his bowel movements. He has

been taking large amounts of aspirin for persistent headaches but

did not realize that this could cause internal bleeding. John was

always seen at the clinic by a physician assistant, Robert M., but

never by a physician. Robert didn't ask John about taking any

nonprescription medications. John didn't realize that he should

mention his over-the-counter medication (aspirin) consumption.

Robert tells John to take an antacid preparation to control the

bleeding, but does not order any tests. He tells John to return it

he is not any better. Two days later, John is rushed to the area

emergency department with a bowel hemorrhage.

1.

What responsibility, if any, does Robert have for John's

emergency condition?

2.

Does the clinic have a responsibility to provide its HMO

members with the services of a physician?

3.

What responsibility, as a health care consumer, does John

have for his own medical condition?