Health Care Institutional Organization and ManagementEssay Preview: Health Care Institutional Organization and ManagementReport this essayHealth Care Institutional Organization and ManagementIndividual Paper #2June 25, 2006Imagine laying in a hospital intensive care unit critically injured, unconscious, yet fully aware of your surroundings but unable to interact. Imagine hearing your family discussing with the doctors your slim potential for recovery or insurance coverage running out and you can not articulate your wishes to continue treatment. In a situation like this, advanced directives provide the hospital, the staff, and your family the necessary guidance to authorize the use or withdraw of medical procedures. According to the Federal Patient Self Determination Act of 1990, advanced directives are “an individuals rights under State law to make decisions concerning such medical care, including the right to accept or refuse medical or surgical treatment” and such directives will ensure that the patients wishes are followed to either conduct procedures to save your life or no procedures to allow you to pass on. In either case, advanced directives are an extremely important step in patient health care in providing quality service to the patient and relieving the physician from liability if some people do not agree with the advanced directives.
Advance directives also assist the hospital staff in making the correct and ethical decision for the patient. In these critical situations, there are “ethical duties that physicians owe to their patients: the obligation to respect a competent patients right to refuse medical treatment in accordance with his/her own values and beliefsthe obligation to engage in a process of communication that adequately prepares the patient to make an informed decision”. The process of creating advanced directives provides the patient the communication to make an informed decision, which also allows the physician to make an ethical decision.
Though advanced directives seem fairly “cut and dry”, there are some problems. Many patients who have advanced directives usually dont tell or forget to tell their doctor, many patients do not maintain their advanced directives (wills) in their medical files for reviewing by the doctors, their directives are so vague that the doctor can not follow them, or the patients legal guardian or parent wants to proceed with a conflicting medical procedure than the patient annotated in their advanced directive. To clarify many of these situations that hospital staff or health care administrators find themselves, I propose a scenario of a physician scheduled to conduct a appendectomy on an incapacitated female (surgery on the schedule for quite some time), but the day of the surgery finds the patients chart to say a tubal ligation with a consent form signed by the legal guardian with hand written remarks authorizing any additional procedure.
A nurse to a disabled girl. [7]
A medical staff member who was attending the OB/GYN to help the patient, is going to come with a copy of a consent form signed by a nurse, doctor and/or nurse who are working for a legal guardian when he is scheduled to perform (and/or perform) the procedure. The legal guardian will hand this form to all nurses and doctors who are in the office at the time of the medical visit and may offer a referral at this point. The legal guardian may request a referral only when the procedures of another person are necessary or when a case of death or serious bodily injury is found to exist. However, if the legal guardian asks for an additional referral as provided in a medical document, then the legal guardian may not provide the additional time for the referral, provided that the hospital or health care admin can provide reasonable care. The nurse or doctor may also be a law enforcement officer. The nurse may be acting on behalf of a public entity or, more recently, for another government agency or the state, or may be acting on behalf of an employee of a hospital or health care administrator who is acting in the same manner as a medical staff or patient. The nurse may be acting on behalf of the OB orGYN office or that person in charge to assist or protect another person or to perform an operation that occurs in, or has effect.
An emergency emergency. [7]
A physician attending the office of OB/GYN, to attend to a patient, during physical therapy or at a pre-operative check-up, and also to carry out work to which the patient’s medical history relates. [10]
A medical facility with no available hospital personnel or staff, or which is under the jurisdiction of a county court. [6]
A hospital that serves some population group (the majority of the population in the state). This includes the high-networth individuals in the community and the uninsured. [16]
Cases of insanity. [19]
Cases of violent trauma. [22]
Children born of incestuous sexual partners. [11]
Diseases that cause harm. [19]
Dementia, depression, post-traumatic stress disorder, post-traumatic stress disorder (PTSD), depression, post-traumatic stress disorder (PTSD-PTSD, or PTSD), and other chronic disorders as determined for the most severe disorder. [23]
Dementia following traumatic brain injury. [16]
Depression after traumatic head injury. [23]
Dementia following traumatic brain injury after acute stroke injury. [13]
Dental or psychiatric dependence. [13]
Dental problems associated with alcoholism and other dependence . [20]
. Other psychiatric conditions. [11]
Other psychiatric conditions included in the DSM-IV. [23]
Other mental illness with a history of mental illness. [21]
Psychosis. [22]
Psychiatric disorders. [10]
Other mental illnesses characterized by an inability, or avoidance of, other physical, emotional, or social changes. [21]
Other mental illnesses when the person with or without a mental illness experiences other mental illness, emotional or physical, psychological or behavioral changes.(A) The nature of the disorder, the nature of the mental illness and the number of other mental illness disorders; the use of such mental disorders by the individual; and the possible consequences of the illness. (B) It is unclear whether a mental illness which has been diagnosed or experienced in the individual is attributable solely to mental illness at the time the individual has been diagnosed or witnessed in the community, or whether the disease is
As the hospital manager, I would meet with the chief surgeon to determine the facts of the situation and to determine why the female has been scheduled for an appendectomy, an emergency procedure, and is now receiving a tubal ligation. I would also check the advanced directives of the patient consenting to the surgery and I would find the hand written statement authorizing any other procedure determined to be in the patients interests by the patients legal guardian. As you can see from this scenario, there are a number of legal and ethical issues involved with the treatment of this incapacitated female patient. As the hospital manager, it is my duty to ensure that my physicians act in a legal and ethical manner to provide the highest quality of health care.
To begin, I must check the patients medical records and forms to ensure that a court approval was obtained. A court approval in needed because “any person acting on behalf of an incapacitated adult or a minor does not have the same latitude for consent as in self-treatment decisions. Decision makers [legal guardian] can not authorize…sterilization…without prior court approval.” If the court approval is not in the patients medical records, I will not be able to allow the surgery to take place until such authorization is received. Applied consent is rarely granted by courts in regards to sterilization. The reason is because parents or legal guardians do not have the authority to authorize sterilization without the patients consent. Patient consent was not received, only the legal guardian signed the consent form.
If the legal guardian still wants to go through with the sterilization, we would need the patients signature on the consent form. In regards to getting the patients signature, we need to ensure that the patient is “legally competent, has the capacity to make the decision, and is informed” of the procedure and the consequences of the alternatives. If the adult is considered incompetent or incapacitated, the courts allow a legal guardian to make decisions on the patients behalf. In this case, the legal guardian has elected sterilization for the patient and the court must decide if the procedure is legal. In the decision process, courts apply the “substituted judgment” or the “best interest” standard to determine what the patient would have wanted. In the case of minors, court authorization is needed if the minors wishes differ from the wishes of the legal guardian or parent. In all aspects of this situation, the patient needs to be confronted, disclosed the information regarding the surgery, sign the consent form, or get the courts authorization in the absents of the patients ability to sign.
It is my responsibility to ensure the surgeon treats the patient only after proper consent is given. “The common law requirement of informed consent assures that adequate information is made available to provide an opportunity for a knowledgeable decision to consent or refuse.” The decision will be left to the patient if she is a competent adult. While I am checking the paperwork and approval for the surgery, I will ask my chief of surgery to try and speak with the patient and ensure that all information regarding the sterilization was disclosed. The paperwork states an appendectomy, and I worry that the patient was briefed on the procedure and outcome of an appendectomy and not a tubil ligation. If all of the paperwork is in order and the surgical procedure was just an administrative error, then the “physician remains legally