Final Project I Guidelines and Rubric Overview Healthcare professionals must have a strong working knowledge of ethics and law to be competent and successful. A qualified professional knows how to provide safe, quality healthcare to a population of culturally diverse consumers. To address the needs of all patients, you can apply models such as shared decision making, where patients are encouraged to share their preferences and needs. The application of this model requires that healthcare professionals know how to apply ethical theories such as patient autonomy, beneficence, nonmaleficence, justice, and fidelity when caring for patients. On a daily basis, healthcare professionals face ethical dilemmas involving patients and colleagues. Understanding how to effectively apply the code of ethics in your field, and various other codes of professional conduct, is an important skill required of all healthcare professionals. By applying ethical decision making, you positively impact the delivery of safe, quality healthcare. Under certain circumstances, healthcare professionals can be sued by patients for malpractice; it is more common for physicians to be sued when patients are injured or die as a result of their medical care. Healthcare professionals need a clear understanding of the elements of medical malpractice (standard of care, breach, causation, and damages) and how they are applied by a judge in a court of law. Healthcare professionals play a critical role due to the nature of their relationship with both patients and physicians. To remain competent and grow in the field, healthcare professionals are expected to understand how their professional responsibility includes a wide-ranging accountability to self, their profession, their patients, and the public. Your final case study for this course will require you to analyze a court decision in which a physician was found liable for medical malpractice. You will focus on facts pertaining to the medical standard of care, breach of care, and causation, and explain how they were applied to law. You will then use the facts of the case to identify an ethics issue and determine an ethical theory that would help provide a safe, quality healthcare experience for the patient. Next, you will apply a clinician–patient shared decision-making model to describe how the ethics issue could be resolved. You will also include a discussion about possible violations of the code of ethics in your given field. Lastly, you will augment or vary the facts of the case to create a hypothetical scenario that changes the outcome so that the physician is no longer liable for medical malpractice. Final Project I is divided into two milestones, which will be submitted at various points throughout the course to scaffold learning and ensure quality final submissions. These milestones will be submitted in Modules Three and Five. The final product will be submitted in Module Seven. In this assignment, you will demonstrate your mastery of the following course outcomes: Analyze the impact of healthcare-related policy and legislature with regard to culturally diverse healthcare consumers and providers 1 Determine ethical theories and decision-making models appropriate for healthcare providers to use for providing a safe, quality healthcare experience for the patient Analyze the role of professional regulation, the standard of care, and codes of ethics in determining healthcare providers’ wide-ranging accountability to self, their profession, their patients, and the public Prompt In this project, you will analyze a court case involving medical malpractice. Using your analysis of the case, you will address the facts pertaining to the medical standard of care, breach of care, and causation. Further, you will use the facts from the original case to identify an ethics issue, determine an ethical theory that would help provide a safe and quality healthcare experience for the patient, apply a clinician–patient shared decision-making model, and augment or vary the facts of the case to change the outcome. You will use the following case to analyze for Final Project I: Surgery: Iturralde v. Hilo Medical Center USA • Hawaiian jury finds doctor liable for inserting screwdriver in patient’s spine (Supplemental article) Specifically, your case study must address the following critical elements: I. Introduction: A. Summarize the selected case, including information on the stakeholders involved, the problem, and the time period the incidentoccurred. II. Medical Malpractice Component: In this section, you will evaluate the case to address the legal components, the malpractice policies similar to this case, and the standard of care given to the patient and how it was breached. Then, you will draw connections to how this malpractice case impacted stakeholders and healthcare consumers outside of the case. A. Explain the key legal components of the case, including the nature of the issue and the rules that applied. B. Determine relevant malpractice policies in place for addressing the issues within the case. C. Analyze the malpractice case for the standard of care provided to the victim. Be sure to apply what the law states about standard of care to support whether or not it was breached in the case. D. Analyze how the malpractice case would impact healthcare consumers from different cultural backgrounds. For example, would this case have a similar impact on a person from a culture different from the one in the case? How could this incident change the views of these healthcare consumers toward the healthcare system? E. Assess the malpractice case for accountability based on its severity. To what extent was the healthcare provider held accountable? 2 III. Ethical Component: In this section, you will evaluate the case to identify the specific ethical issues and determine ethical theories and shared decisionmaking models that would help resolve the issue and provide a safe, quality healthcare experience. Then, you will propose and defend ethical guidelines for healthcare providers to follow in order to avoid future incidents. A. Describe the ethical issues that led to the malpractice case and explain why the issues are credited with causing the incident. Support your response with research and relevant examples from the case. B. Describe an ethical theory that would help resolve the issue and provide a safe, quality healthcare experience for the patient. Support your response with research and relevant examples from the case. C. Select a physician–patient shared decision-making model and explain how it would provide a safe, quality healthcare experience for the patient D. Propose ethical guidelines that would have helped prevent the incident and would help the organization prevent futureincidents. E. Defend how your proposed ethical guidelines will hold healthcare providers accountable to themselves, their profession, their patients, and the public. II. Recommendations: In this section, you will utilize the knowledge you gained from your malpractice and ethical analyses to recommend and defend strategies that would help improve medical practices and avoid future liability. A. Recommend preventative strategies the healthcare provider could implement to avoid liability in the future. B. Defend how your recommended preventative strategies would assist the healthcare provider in avoiding liability and provide a safe, quality healthcare experience for the patient. Milestones Milestone One: Malpractice Case In Module Three, you will submit a 2- to 3-page paper. You will complete part of your analysis of the malpractice case. Using this analysis of the case, you will address the facts pertaining to the medical standard of care, breach of care, and causation. This milestone will be graded with the Milestone One Rubric. Milestone Two: Ethical Components of the Malpractice Case In Module Five, you will submit 2- to 3-page paper. You will use the facts from the original case to identify an ethics issue, determine an ethical theory that would help provide a safe and quality healthcare experience for the patient, apply a clinician–patient shared decision-making model, and augment or vary the facts of the case to change the outcome This milestone will be graded with the Milestone Two Rubric Final Submission: Malpractice Case Analysis In Module Seven, you will submit your final project. It should be a complete, polished artifact containing all of the critical elements of the final product. It should reflect the incorporation of feedback gained throughout the course. This submission will be graded with the Final Project I Rubric. 3 Final Project I Rubric Guidelines for Submission: Your case study should be a 4- to 6-page Microsoft Word document with 12-point Times New Roman font and one-inch margins. All citations and references should be formatted according to the most recent APA guidelines. Critical Elements Introduction: Summarize Exemplary Proficient Needs Improvement Not Evident Summarizes the case, including Summarizes the case, but Does not summarize the case (0%) information on the stakeholders summary is cursory or illogical, involved, the problem, and the time contains inaccuracies, or does not period of the incident that occurred include information on (100%) stakeholders, the problem, or the time period of the incident (55%) Medical Meets “Proficient” criteria, Explains the key legal components Explains the key legal Does not explain the key legal Malpractice and explanation demonstrates of the case, including the nature of components of the case, but components of the case (0%) Component: Legal sophisticated understanding the issue and the rules that applied analysis is illogical, contains Components of the key legal components of (85%) inaccuracies, or does not include the case (100%) the nature of the issue or the rules that applied (55%) Value 2.24 10.61 Medical Malpractice Component: Malpractice Policies Meets “Proficient” criteria and Determines relevant malpractice demonstrates a sophisticated policies in place for a ddressing the awareness of which policies issues within the case (85%) address the issues within the case (100%) Determines malpractice policies, but response lacks detail, or the chosen policies are irrelevant or do not address the issues of the case (55%) Does not determine relevant malpractice policies in place for addressing the issues within the case (0%) 10.61 Medical Malpractice Component: Standard of Care Meets “Proficient” criteria and Analyzes the malpractice case for demonstrates astute ability in the standard of care provided to applying what the law states the victim, and applies what the about standard of care to law states about standard of care determine whether or not it to support whether or not it was was breached in the case breached in the case (85%) (100%) Analyzes the malpractice case for Does not analyze the malpractice the standard of care provided to case for the standard of care the victim, but does not apply provided to the victim (0%) what the law states about standard of care (55%) 6.37 4 Medical Malpractice Component: Cultural Backgrounds Meets “Proficient” criteria, Analyzes how the malpractice case and analysis makes cogent would impact healthcare connections between the consumers from different cultural incident and its impact on backgrounds (85%) healthcare consumers from different cultural backgrounds (100%) Analyzes how the malpractice Does not analyze how the case would impact healthcare malpractice case would impact consumers from different cultural healthcare consumers from backgrounds, but analysis is different cultural backgrounds cursory or c ontains inaccuracies (0%) (55%) 10.61 Medical Malpractice Component: Accountability Meets “Proficient” criteria, Assesses the malpractice case for Assesses the malpractice case for Does not assess the malpractice and assessment makes a accountability based on its severity accountability based on its case for accountability based on cogent connection to the level and explains the level of severity and explains the level of its severity (0%) of accountability held against accountability the healthcare accountability the healthcare the healthcare provider based provider was held to (85%) provider was held to, but on the severity of the case explanation lacks detail or is (100%) illogical (55%) 6.37 Ethical Component: Meets “Proficient” criteria, Ethical Issues and research and examples provided demonstrate a complex grasp of how the ethical issues led to the malpractice case (100%) Describes the ethical issues that led Describe the ethical issues that to the malpractice case and led to the malpractice case and explains why the issues arecredited explains why the issues are with causing the incident, and credited with causing the supports with research and incident, but description lacks relevant examples (85%) details or does not support with research and relevant examples (55%) Ethical Component: Meets “Proficient” criteria, Ethical Theory and research and examples provided demonstrate a complex grasp of how the ethical theory would help resolve the issue and provide a safe, quality healthcare experience for the patient (100%) Describes an ethical theory that would help resolve the issue and provide a safe, quality healthcare experience for the patient, and supports with research and relevant examples from the case (85%) 5 Does not describe the ethical issues that led to the malpractice case and does not explain why the issues are credited with causing the incident (0%) 7.96 Describes an ethical theory that Does not describe an ethical would help resolve the issue and theory that would help resolve the provide a safe, quality healthcare issue and provide a safe, quality experience for the patient, but healthcare experience for the description lacks detail, is patient (0%) illogical, or does not support with research or r elevant examples (55%) 7.96 Ethical Component: Meets “Proficient” criteria and Selects a physician–patient shared Shared Decision- demonstrates a nuanced decision-making model and Making Model understanding of appropriate explains how it would provide a physician–patient shared safe, quality healthcare experience decision-making models that for the patient (85%) would provide a safe, quality healthcare experience for the patient (100%) Selects a physician–patient Does not select a physician– shared decision-making model patient shared decision-making and explains how it would model and does not explain how it provide a safe, quality healthcare would provide a safe, quality experience for the patient, but healthcare experience for the explanation lacks detail (55%) patient (0%) 7.96 Ethical Component: Meets “Proficient” criteria and Proposes ethical guidelines that Ethical Guidelines makes a cogent connection would have helped prevent the between the proposed ethical incident and would help the guidelines and how they organization prevent future would prevent the current and incidents (85%) future incidents (100%) Proposes ethical guidelines that Does not propose ethical would have helped prevent the guidelines that would have helped incident and would help the prevent the current and future organization prevent future incidents (0%) incidents, but proposal is cursory (55%) 7.96 Ethical Component: Meets “Proficient” criteria and Defends how the proposed ethical Defend makes cogent connections guidelines will hold healthcare among the proposed ethical providers accountable to guidelines and how to hold themselves, their profession, their healthcare providers patients, and the public (85%) accountable to themselves, their profession, their patients, and the public (100%) Defends how the proposed Does not defend how the ethical guidelines will hold proposed ethical guidelines will healthcare providers accountable hold healthcare providers to themselves, their profession, accountable to themselves, their their patients, and the public, but profession, their patients, and the defense lacks detail or is illogical public (0%) (55%) 6.37 Recommends preventative Recommends preventative Does not recommend strategies the healthcare provider strategies the healthcare provider preventative strategies the could implement to avoid liability in could implement to avoid liability healthcare provider could the future (85%) in the future, but implement to avoid liability in the recommendations are cursory or future (0%) illogical (55%) 6.37 Recommendations: Meets “Proficient” criteria, Preventative and recommendations Strategies masterfully demonstrate how the healthcare provider can avoid liability in the future (100%) 6 Recommendations: Meets “Proficient” criteria and Defends how the recommended Defends how the recommended Defend makes cogent connections preventative strategies would assist preventative strategies would among the recommended the healthcare provider in avoiding assist the healthcare provider in preventative strategies and liability and provide a safe, quality avoiding liability and provide a how they would assist in healthcare experience for the safe, quality healthcare avoiding liability and provide a patient (85%) experience for the patient, but safe, quality healthcare defense is cursory or illogical experience for the patient (55%) (100%) Articulation of Response Submission is free of errors Submission has no major errors related to citations, grammar, related to citations, grammar, spelling, syntax, and spelling, syntax, or organization organization and is presented (85%) in a professional and easy-toread format (100%) Does not defend how the recommended preventative strategies would assist the healthcare provider in avoiding liability and provide a safe, quality healthcare experience for the patient (0%) Submission has major errors Submission has critical errors related to citations, grammar, related to citations, grammar, spelling, syntax, or organization spelling, syntax, or organization that negatively impact readability that prevent understanding of and articulation of main ideas ideas (0%) (55%) Total 7 6.37 2.24 100% Running head: FINAL PROJECT MILESTONE ONE Final Project Milestone One: Malpractice Case Meryl Peasah IHP-420 Ethical and Legal Considerations Southern New Hampshire University September 18, 2022 FINAL PROJECT 2 Milestone One: Malpractice Case Summarize Iturralde vs Hilo Medical Center (HMC) No. 03-1-0017 was brought to the Intermediate Court of Appeals of Hawaii, presided over by Chief Judge Nakamura. Rosalinda Iturralde was the appellant, acting individually or on behalf of Arturo’s Estate. The defendants or cross-appellants were Robert Ricketson, Hawaii Orthopaedics, Inc., Hilo Medical Center, Medtronics Sofamor Danek, Inc., and Hawaii Health Systems Corporation. Arturo Iturralde (Arturo) was admitted to HMC on January 1, 2001, to examine his legs’ increasing weakness resulting in severe falls. Dr. Ricketson diagnosed Arturo with degenerative spondylolisthesis L4-5 with stenosis. He scheduled Arturo for spinal surgery to relieve the condition by placing two rods into the spin on January 29, 2001. Dr. Ricketson ordered the recommended kit from Medtronics through HMC, and the shipments were received on January 27, 2001. DR. Ricketson bypassed HMC’s inventory policy and commenced surgery only to find the two rods missing. He improvised by using screwdrivers without informing Arturo or his family. Arturo underwent many surgeries and succumbed to multiple conditions on June 18, 2003. Rosalinda sued HMC and Dr. Ricketson in the Circuit Court, which found the two liable for multiple and varied damages but acquitted Medtronic. Rosalinda appealed the decision arguing that the Circuit Court erred in the amount of damages against HMC and Dr. Ricketson, Medtronic’s liability, instructions to the jury on the cause for Medtronic, and joint liability against HMC for emotional distress to Rosalinda. Medical Malpractice Component Key Legal Components The primary legal aspect of the case is that Dr. Ricketson had a duty of care to Arturo owing to the Hippocratic oath doctors take. But he failed to uphold professional competence, FINAL PROJECT 3 which is the physician’s primary responsibility. He also failed to observe ethical responsibilities and conduct, including consent and nonmaleficence. Dr. Ricketson had a professional duty not to harm but proceeded with the surgery that harmed Arturo. He also had a duty to seek the patient’s consent before installing a screwdriver on his spine. Instead, he engaged in activities harmful to the patient. Still, he continued practising despite past legal actions against him due to professional misconduct. The nonmaleficence rule requires physicians not to harm, but Dr. Ricketson used an unrecommended tool. Malpractice Policies The primary policy for addressing malpractice is HMC’s inventory policy. Dr. Ricketson ignored his duty as a physician and acted negligently by ignoring HMC’s policy on inventory management. Besides, communication policy is also vital to addressing malpractice. Nurse Feldmeyer reported the issue to the management, but their communication policy required the doctor to report it. The doctor’s sweeping powers undermined teamwork and interdisciplinary collaboration (Kass & Rose, 2016). He should have informed the patient that he had installed a screwdriver on his spine and explained the decision. Standards of Care The standard of care used in the case was inappropriate. HMC demonstrated negligence when they rubbished the nurse’s report, undermining patient safety. Dr. Ricketson overlooked a state-approved device and improvised it after failing to perform due diligence on the shipment before beginning operation (Schweikart, 2018). Standards of care apply to approved devices for surgical procedures like titanium rods. Different Cultural Backgrounds One impact is that a person from a different culture may not have the money to pursue the lawsuit. Besides, one feels persuaded that the malpractice would not have occurred had the patient been from a rich cultural background. Also, HMC would lose patients to FINAL PROJECT 4 competitors due to fear of malpractice. Other lawsuits against the hospital would follow, especially for hiring a physician banned in other states. Consumers would view the hospital as a death trap and avoid using its services. Accountability The case features diminished accountability since the parties engage in blame games. The issues in the appeal reveal an attempt to paint who is more responsible for the damages arising from the negligence. No one accepts that a wrongful act was committed. Based on the court’s judgement, Dr. Ricketson and HMC are liable for the malpractice. But HMC would not have hired the physician due to a history of unethical conduct. Accordingly, HMC is primarily accountable since they hired a physician with questionable professional conduct (Kass & Rose, 2016). Still, the hospital gave him powers to report directly to the management, ignoring the nurse. Mr. Arturo would have lived longer had the hospital not hired Dr. Ricketson. FINAL PROJECT 5 References Iturralde v. HILO MEDICAL CENTER, No. 28792 (Haw. Ct. App. Mar. 30, 2012). https://www.casemine.com/judgement/us/5914f68cadd7b049349909af Kass, J. S., & Rose, R. V. (2016). Medical malpractice reform: historical approaches, alternative models, and communication and resolution programs. AMA Journal of Ethics, 18(3), 299-310. Schweikart, S. (2018). Plastic Surgery Overseas: How Much Should a Physician Risk in the Pursuit of Higher-Quality Continuity of Care? AMA Journal of Ethics, 20(4), 357365. Running head: MILESTONE TWO Final Project Milestone Two: Ethical Components of the Malpractice Case Meryl Peasah IHP-420 Ethical and Legal Considerations Southern New Hampshire University October 2, 2022 MILESTONE TWO 2 Milestone Two: Ethical Components Ethical Issues Healthcare professionals are bound by ethical values, principles, and beliefs in their service delivery. The primary principles are autonomy, beneficence, justice, and nonmaleficence. The Iturralde vs. Hilo Medical Center Case reveals ethical issues associated with these principles. The main ethical issue is that Dr. Ricketson failed to respect patient autonomy by seeking the patient’s informed consent before using screwdrivers. Another issue is HMC’s decision to hire a physician with questionable professional history. Besides, Dr. Ricketson violated the principle of nonmaleficence by implanting screwdrivers that harmed the patient, leading to death. Still, Nurse Feldmeyer’s supervisors undermined justice by ignoring her whistleblowing. The American Medical Association (AMA, 2016) Code of Ethics requires physicians to uphold professional standards and respect the law and patient rights. A surgical procedure is ethically acceptable if it has institutional stability, laboratory background, and field strength (Mazeikiene et al., 2020). The doctor violated this requirement by undermining patient autonomy and using an unrecommended medical procedure. Ethical Theory Immanuel Kant’s Deontological Ethics Theory would help address the issue and provide a safe, quality healthcare experience for the patient. Arturo died because Dr. Ricketson failed to adhere to rules, duties, and obligations vital to the delicate surgery. The patient died following a wrong procedure, implying that the means justified the end. Accordingly, deontological ethics is the best ethical theory to resolve similar issues in future. Kant envisioned a patient care setting where a practitioner would maintain a duty of care by stringently following pre-set rules (Humphrey et al., 2022). Hence, Dr. Ricketson was unethical in using screwdrivers instead of the recommended titanium rods regardless of the patient’s recovery or death. Deontology bases morality on the action and not the outcome. A MILESTONE TWO 3 harmful step like an unrecommended procedure is ethically wrong, notwithstanding the result. Deviating from standards and ethical guidelines (including the AMA Code of Ethics) contributes to medical negligence. Thus, Dr. Ricketson would have avoided harming the patient by following deontological theory. Shared Decision-Making Model The selected shared decision-making model (SDM) is deliberation, a patient-centered interdisciplinary approach to care. It involves collaboration between the patient or their family and a multidisciplinary team in planning and implementing care (Morris et al., 2022). Still, Dr. Ricketson would have informed Arturo of the wrong shipment and discussed alternative medical procedures, including effects, risks and safety. Arturo would have settled for safer and more practical treatment tools and procedures, ensuring a safe surgery to avoid revisional surgeries. Besides, Rr. Ricketson would have collaborated with Nurse Feldmeyer and considered her opinion. The AMA Code of Ethics requires physicians to promote interdisciplinary team collaboration by listening respectfully and taking seriously the concerns a nurse raises regarding the physician’s decision (AMA, 2016). Dr. Ricketson was also expected to recognize Feldmeyer’s professional duty not to follow orders that contravene good medical practice. These requirements support deliberation as the most effective SDM for Arturo’s safe, quality healthcare experience. Ethical Guidelines Based on the identified ethical issues, HMC would have prevented the incident and would prevent future ones by: ➢ Not hiring a physician facing disciplinary actions in other states for professional misconduct. ➢ Ensuring that its medical inventory policy is followed and taking disciplinary action against violators like Dr. Ricketson; and MILESTONE TWO ➢ 4 Acting on whistleblowing and not vesting reporting powers to the surgeon. Surgeons/physicians like Dr. Ricketson would avoid/have avoided it by: ➢ Abiding by rules, regulations, and policies, including HMC’s inventorying policy. ➢ Practicing under stringent supervision or avoid practicing when facing disciplinary action. ➢ Respecting patient autonomy by seeking informed consent; and ➢ Listening to and respecting nurses’ concerns regarding their orders. Defined The Joint Commission requires healthcare organizations to proactively improve patient care while minimizing costs. Based on the Commission’s quality goals, HMC would have acted on Nurse Feldmeyer’s report to ensure that Dr. Ricketson used the recommended tool since miscommunication is a leading cause of malpractice (Humphrey et al., 2022). Subjecting Mr. Arturo to multiple surgeries led to hospital readmission, undermining the Commission’s quality standards. Also, HMC would have hired competent and ethical doctors and required them to follow its inventory policy. Still, doctors are bound by the AMA Code of ethics regarding professionalism, patient autonomy, and relationship with nurses (AMA, 2016). Observing these standards and principles would ensure the correct procedure is performed. MILESTONE TWO 5 References American Medical Association. (2016). Code of Medical Ethics: Principles of Medical Ethics. Retrieved September 30, 2022, from https://www.ama-assn.org/sites/amaassn.org/files/corp/media-browser/principles-of-medical-ethics.pdf Humphrey, K. E., Sundberg, M., Milliren, C. E., Graham, D. A., & Landrigan, C. P. (2022). Frequency and Nature of Communication and Handoff Failures in Medical Malpractice Claims. Journal of Patient Safety, 18(2), 130-137. Iturralde v. HILO MEDICAL CENTER, No. 28792 (Haw. Ct. App. Mar. 30, 2012). https://www.casemine.com/judgement/us/5914f68cadd7b049349909af Mazeikiene, S., Stasiuniene, J., Vasiljevaite, D., Laima, S., Chmieliauskas, S., Fomin, D., … & Jasulaitis, A. (2020). Deontological examination as a criterion for the assessment of personal healthcare professional quality: A Strobe compliant retrospective study. Medicine, 99(3). Morris, M., Mulhall, C., Murphy, P. J., & Eppich, W. J. (2022). Interdisciplinary collaborative working on surgical ward rounds: reality or rhetoric? A systematic review. Journal of Interprofessional Care, 1-15.
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