You are the manager of the Social Services Department. As part of the ethics committee for a rural 18-bed hospital, the CEO and CFO ask the student to contribute to an initial discussion on the decision to continue having labor and delivery in the hospital. You know that historically in this community, women seek late prenatal care. In discussions with the committee, you learn that the Ob/Gyn has no back-up specialty coverage, that the family practitioner really does not want to do obstetric services (late nights, insurance...), and that the community loves the service. Based on this information,you must make a recommendation whether to continue labor and delivery services at the hospital.

You will consider the following points:

• This is the only hospital in the county
• The entry into prenatal care historically has been late second and third trimester
• The cost of malpractice for the Ob-Gyn continues to increase
• There is pressure by the community to continue having the service
• There is only one Ob/Gyn in the county and there is no specialty backup
• The closest large hospital with NICU availability is approximately 80 miles away
• The one family practitioner does not really want to be involved in obstetric care
• There is a large percent of undocumented women living in the community; due to fear of deportation, they only seek allopathic medical care at time of delivery
• Historically, people in the community have been so happy to have obstetric service at the hospital that the hospital has not had a fear of being sued
• Although this discussion should be confidential, somehow word leaks and the student receives many phone calls and emails from concerned citizens.

• Identify the principles and legalities of ethical issues within the health care system
• Use technology and information resources to research issues in health care policy, law, and ethics.

Blake Hines, CEO of Bright Road Health Care System Blake is a woman in her mid-50s. She's been the CEO of Bright Road Health Care Systems for 3 years. Her most recent position before joining the Health Care System was that of the CEO of a large Pharmaceutical company. Blake is warm and caring, but expects results. She wants to expand the Health Care System into new markets, while maintaining patient loyalty.

Kimberly O'Neill, Chief Financial Officer of Bright Road Health Care System Kimberly is an African American woman in her late 50s. She joined one of the organizations that now form Bright Road as an internal auditor. Due to her drive and her seemingly innate analytical skills, she was quickly promoted to Vice President of Finance for the health care system. Kimberly is an important part of the team, not only for her great experience, but because she is able to present financial information in a manner in which people without a financial background can clearly understand.

Jeff Passmore, General Counsel for Bright Road Health Care Systems Jeff is in his mid-40s, and has been with Bright Road Health Care Systems for 5 years. Prior to working in health care, he was the general counsel for a pharmaceutical company, and prior to that, a large tobacco company. His experience is vast, and he's friendly and outgoing.

Ken Bloom, Chief Nursing Officer of Bright Road Health Care System Ken is in his mid-40s, and has held various positions of nursing departments in both small and large medical facilities. At Bright Road, he began his career in an urgent care facility, where he saw a lot of elderly patients. He had a natural inclination for assisting elderly patients, so he shifted his focus to geriatric care and took a position at one of the largest hospitals in the system as a geriatric care nurse. He's sympathetic, kind, and passionate about a nurse's ability to positively impact patient care.

Ms. Lozano, concerned citizen (phone only) Ms. Lozano is a citizen of the community. She herself is pregnant, and calls to discuss the issues faced by undocumented women, including lack of money and transportation to another city, fear of deportation.