QUESTION:

Chapters 10, 11, and 12 of the Pozgar text each address a different area of practice within the healthcare environment. Identify the chapter that most closely applies to your personal area of practice (current or aspirational), read that chapter, and be prepared to explore the legal and ethical issues in that practice area.

· Chapter 10: Medical staff organization and malpractice

· Chapter 11: Nursing and the law

· Chapter 12: Hospital departments and allied professionals

Prompt: Based on the chapter you selected, your personal experience, and a biblical worldview, write a Discussion Board Forum thread identifying and analyzing the legal and ethical issues specific to your area of practice.

ANSWER:

Medical staff organization and malpractice

Medicine and healthcare in America have evolved and or improved dramatically over the last decade. Like everything in nature, this evolution in healthcare has its pros and cons. The evolution in healthcare has provided more access to healthcare. It has also provided a vast variety of diagnostic options for both the physician and the patient especially in cases of elective procedures. One of the greatest cons of the American healthcare system is the cost (Lyford & Lash, 2019). The United States spends a good amount of its GDP on healthcare and yet has very little to show for it. The burden of this cost is carried and or felt by every American irrespective of their socioeconomic status. Most of the contributors to this excessive healthcare cost are unnecessary and or excessive diagnostic tests and the high price of medications.

In every organization, their people or staff are designated to fulfill a specific task and the health care system is no different. The medical staff which is usually lead by a medical director is that part of the health care facility that is more prone to litigations. The medical director of every health care system or facility is responsible for the smooth running of that facility or system and his or her duties include but not limited to; making sure the bylaws of the facility or organization are enforced (Pozgar, 2019. And because he or she is responsible for making sure everything runs according to what has been determined by the various committees to be appropriate, he is also responsible for any failures that might arise as a consequence of following such orders and or recommendations. A great example will be the current ongoing investigation and charging of the superintendent and medical director of the Holyoke soldiers’ home in Massachusetts, Mr. Bennet Walsh, and Dr. David Clinton respectively (Diaz, 2020). They are both being charged with criminal negligence and this because of their leadership decision during the coronavirus (COVID-19). Their leadership decision cost 76 veterans their lives and a total of 164 positive cases of COVID-19, making it the largest outbreak in any nursing home facility. From the investigation conducted by the governor of Massachusetts, it was discovered that both positive and negative patients in this facility were cramped together in one part of the facility and this was against the center for disease control and prevention (CDC) guidelines and this was the orders the medical director and superintendent.

In the above, it is easy to conclude that the defendants Mr. Walsh and Dr. Clinton are liable for negligence and this is because, first, they must care once they accepted to take on that role and admitted the veterans into the facility, Secondly, their orders lead to injury which is death and infection of veterans and some staff of the Holyoke Soldiers home and thirdly, they failed to follow the guidelines set by the C.D.C.

The medical staff organization can easily be caught in malpractice and or litigations. Some of the areas in which the medical staff organization is very likely to commit errors and hence malpractice litigations are but are not limited to infections and dealing with psychiatric patients. Nosocomial or hospital-acquired infections which are infections a patient acquires whiles receiving care and are not present during the time of admission (Bello et al, 2020) are very detrimental to the healthcare system and the aim it hopes to accomplish. As many as seven out of every hundred patients in developing countries develop some kind of nosocomial infections and a double of that number develop it in developing countries. These infections can arise from failure to effectively manage infections such as the example stated above of the Holyoke Soldiers Home, poor infection control, and preventing the spread of infections. Infections in the healthcare system and or facility are inevitable, however, it can be minimized or prevented in some or most cases. Hand washing and proper hand hygiene have been proven by research to be the greatest tool against nosocomial infection. Hand hygiene includes handwashing with soap and water and the use of hand sanitizing rubs. Poor infection control and preventing the spread of infections go and in hand and that is, in this case, the infection has already happened, and one is just preventing more damage.

Psychiatric patients, especially suicidal patients are the hardest to manage by physicians (Melonas, 2011) and this is because, in addition to their not being in a healthy state of mind or altered state of mind, there could be third parties involved. The most common factor that leads to litigations in suicide cases is the inadequate suicide risk assessment. When a patient expresses that they are going to commit suicide, in most states in the United States, they are to be admitted either voluntarily or involuntarily. After they are admitted they are further assessed and treated. As a student on rotation, I observed firsthand how these types of medical cases involving a suicidal patient can become complex very quickly. The patient during the initial assessment expressed that he felt worthless and wanted to commit suicide and hence was admitted and per hospital policy, he was to be observed 24/7 by an assigned nursing assistant. After consultation with the psychiatrist, the patient was to be moved to the inpatient psychiatry unit for further evaluation. After a visit from the patient’s parent, the patient said he was fine, and he only said he wanted to commit suicide to seek attention and he would like to be discharged. And the attending physician was in a dilemma because on one side of the law, patients have the right to go home against medical advice, and on the other hand, patients who have expressed suicidal thought are to be admitted and evaluated and only discharged when they have been deemed safe to themselves and others.