In July 2015, an elderly woman being treated for several health issues attended a local health clinic. The medications for her chronic diseases placed her in an immuno-compromised status. While waiting to be seen by her primary care physician, a child came in with his mother, sneezing and coughing. Nothing more was thought of it until the woman died from pneumonia—caused by measles. This was the first death in the U.S. from measles in 12 years.

DISCUSSION QUESTIONS

1. What are the facts of this case?
2. What would have been the potential impact on the woman if the child had the following diseases: pertussis, polio, influenza, or Ebola?
3. What are the management implications of this case? Should there be separate waiting rooms for people with an immunocompromised status?
4. What are the legal and ethical obligations of the parent of the unvaccinated child?
5. What are the legal and ethical obligations the clinic has to its patients and how do they apply to this case? Should the woman’s family seek legal remedies?
6. An RN who works at the clinic refuses to have an influenza vaccination. She does not have allergies, nor does she have religious objections. She “doesn’t believe in them.” Create a script for a conversation with this employee, urging her to reconsider, and detailing the consequences of her continued refusal.