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Case A - Patient's Legal Right #1:

The elderly patient has the legal right to Informed Consent, described in the Patient Self-Determination Act (PSDA) of 1990, a federal law under Title 42 U.S.C. 1395ss (Law.Cornell.edu.,n.d.). In Maryland, patients' right to informed consent is regulated by state laws, such as Health-General Article 19-342 and 42 CFR 482.13 (Maryland Department of Health, n.d.). Within the military, patients' rights to informed consent are found in the Department of Defense (DOD) Bill of Rights and Responsibilities; the DOD Bill of Rights and Responsibilities outlines patients' right to Informed Consent (Department of Defense. (2011). The Health Insurance Portability and Accountability Act of 1996 is a necessary federal law to mandate these patient rights, documented in Title 45 CFR 164.510 (U.S. Department of Health and Human Services, 2024). Patients are entitled to keep their information confidential.

In your own words, produce a statement as to how this law applies to this case;

In this case, the Patient Self-Determination Act (PSDA), found under Title 42 U.S.C. 1395ss (Law.Cornell.edu, n.d.), plays an important role in legally presenting the elderly patient with the right to informed consent. Under this law, patients are given the autonomy to make decisions regarding their medical care, giving them the legal right to consent or refuse treatment according to information obtained from their healthcare provider or collaborative team of providers. The federal law, PSDA, empowers patients to be a part of their care plan, and healthcare providers must respect their decision to accept or decline a treatment or procedure.

The HCO setting in which the violation of the Patient's Legal Right #1 occurs

The home healthcare setting described in case study 1 is a nursing home where an ethical violation may occur if the daughters elect to have their mom start dialysis treatment.

The penalty for the violation in Case A;

Legally, the daughters have not violated their mother's patient rights since there is no legally binding agreement, such as an Advance Directive, DPAHC, Living Will, or Power of Attorney. There may be an ethical violation because the mother had expressed her wish not to live with the comorbidity of senile dementia. The elderly mother may seem happy, but having this diagnosis can be devasting, and not having your memory can be lonely and scary most of the time. Not to mention, people change their minds every 5 to 10 years. The daughters will have to live with their decisions for the rest of their lives. People change their minds often when considering end-of-life care, and ongoing reevaluation of the care plan is important. I have had several patients over the years change their minds and either become a DNR or change to full code. HIPAA violations could result in penalties from hundreds to millions and imprisonmentMaryland Health Care Commission (2003).

The health care organization's responsibility.

The responsibility of healthcare organizations is to educate the importance of obtaining an Advance Directive to plan for unexpected situations that can result in incapacitation (Advance Care Planning & Advance Directives, n.d.).In this case, the provider could not do anything without a proxy or surrogate. One of the daughters would need to be appointed as the DPAHC. The case study does not indicate if the patient is married, divorced, or widowed. The spouse or partner would be first appointed as the DPAHC if not divorced and widowed. The healthcare organization is responsible for documenting all assessments and findings in detail and actively listening so as not to miss important signs or symptoms (physical, psychological, social, etc.). Inaccurate documentation will not hold up in court, and the healthcare organization could face legal consequences. Effective communication is needed to build trust with patients and staff. Language barriers create barriers, and it is essential for documentation of utilizing a translator. Healthcare organizations are seeing more patients with cultural diversity; patient education is paramount. Healthcare organizations that follow these responsibilities will have more safe patient outcomes.

Case B -Patient's Legal Right #2:

This patient has an ethical right to have their advanced directives honored according to the federal law, Patient Self-Determination Act (PSDA) of 1990 and cited under Title 42 U.S.C. 1395ss (Law.Cornell.edu.,n.d.).

In your own words, a statement of the "Right" and how the law applies to this case;

Patients have an ethical right to carry their advanced directives out, governed by federal and state laws. The Patient Self-Determination Act (PSDA) ensures that patients regarding their medical care are documented in advanced directives, considered legal and binding documents. In Maryland, these rights are regulated by state laws, including Health-General Article 19-342 and 42 CFR 482.13 (Maryland Department of Health, n.d.), which require hospitals to honor patients' rights to advanced directives without judgment. Healthcare providers and collaborative teams of health providers are obligated to carry out the advanced directives to ensure patients' legal rights are followed.

The HCO setting in which the violation of Patient's Legal Right #2 occurred;

If the healthcare provider does not perform CPR on this patient in the event he codes, this violation would have taken place in the hospital. The healthcare organization would be at fault for not adhering to the hospital's policy to mandate advance directives that were in place before this patient coding.

The penalty for the violation in Case B;

In this case, the penalty could result in lawsuits against the hospital and healthcare provider for violating legal and ethical laws governed by federal and state laws. The hospital and doctor could both potentially have legal consequences especially if the patient expires.

The health care organization's responsibility.

This healthcare organization's responsibility is to hold mandatory meetings and educate all healthcare providers on the importance of following all federal and state laws to ensure patients' rights are being met. Medical treatment is holistic and must be carried out as the patient wishes. Advance directives are a legal and binding agreement between the patient and the hospital; therefore, failure to adhere to this regulation will be a legal and ethical violation that may result in legal consequences. These legal consequences could be financial, loss of license, job, and negative community reputation.