Chapter 4 Case Study

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key topics . We will be using “activities/cases” from the Pozgar textbook to illustrate legal and ethical issues throughout the semester. case study questions must be answered thoroughly using and citing information from the chapter to receive full credit.

mini-Case study: mediCal malPraCtiCe and the healthCare faCility’s resPonsibility


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Chapter 4: Stewardship 63 I practitioners performed their craft. The Darling ruling asserted, however, that hospitals did have a responsibility for the care of their patients and held Charleston Community Memorial Hospital directly liable (Wiet 2005,400). The hospital, in turn, appealed this Illinois Supreme Court's decision to the US Supreme Court, but its appeal was denied. The case was labeled the "Big Bang" event for hospitals. It caused hospitals to ensure that their providers were adequately trained; that their boards of directors played a more active role in overseeing policy on patient care quality; and that administrative positions, such as risk managers, were added to create and oversee a variety of quality/safety programs and tasks, such as event and incident management and regulatory and accreditation compli- ance. This case and the subsequent hospital actions helped define healthcare organizations fiduciary duty to their patients and their communities. MINI-CASE STUDY QUESTIONS 1. Identify the stakeholders in Darling v. Charleston Community Memorial Hospital. 2. Identify a hospital-based program designed to improve the quality of care. (One example is Yale-New Haven Hospital's [2014] Ruby Slipper Program, which is designed to protect high-risk patients from falling.) You may choose to search the databases at your university library to find a quality/safety program at a hospital of your choice, or you may contact the risk manager at your local hospital. Summarize the program and include an explanation of why and how it illustrates stewardship. U - GO LISTELLULOG the the lack of blood circulation to the improperly casted leg. After several surgical attempts to save the leg, Dr. Reynolds had to amputate Darling's leg below the knee (Wiet 2005). Because Darling was a minor, his father (acting on his behalf) sued Dr. Alexander and Charleston Community Memorial Hospital for negligence. (Dr. Alexander reached a settlement with the family.) The suit against the hospital contended that it should not have allowed Dr. Alexander to perform the orthopedic procedure in the hospital, that the medical and nursing staff did not perform appropriate follow-up care, and that a consulting physician was not brought in when complications arose (Marren, Feazell, and Paddock 2003, 197). Further, the suit argued that the hospital was responsible for the work of the medical staff who practiced in its facilities as well as for the quality of care provided to his son. The hospital responded that it was not liable (Marren, Feazell, and Paddock 2003, 197): only an individual properly educated and licensed, and not a corporation, may practice medicine. Accordingly, a hospital is powerless under the law to forbid or command any act by a physician or surgeon in the practice of his profession. A hospital is not an insurer of the patient's recovery, but only owes the patient the duty to exercise such reasonable care as his known condition requires and that degree of care, skill and diligence used by hospitals generally in the community. Charleston Community Memorial Hospital's defense relied on the historical assump- tion that hospitals were similar to hotels in that they are merely places in which independent Copying and distribution of this PDF is prohibited without written permission. For permission, please contact Copyright Clearance Center at www.copyright.com 6 2 Ethics and Professionalism for Healthcare Managers MINI-CASE STUDY: MEDICAL MALPRACTICE AND THE HEALTHCARE FACILITY'S RESPONSIBILITY In 1965, the Illinois Supreme Court ruled that Charleston Community Memorial Hospital was liable for negligent actions taken by the providers who practiced in the hospital (Darling v. Charleston Community Memorial Hospital, 33 ill.2d 326, 211, N.E.2d 253, 14 A.L.R.3d 860 [III. Sep 29, 1965). Before this decision, hospitals argued that because the organization itself did not practice medicine, it was not responsible for medical errors committed by its clinical staff-even though it provided credentials that allowed clinicians to practice medicine in their facilities. In 1960, a university student named Dorrence Darling II broke his right leg while playing football at Eastern Illinois University. He was taken to Charleston Community Memorial Hospital (a facility accredited by The Joint Commission), where Dr. Alexander casted his leg and, along with staff nurses, provided subsequent treatment and care. The next day, Darling complained of severe pain, and the toes visible outside the cast turned dark and became swollen. After a two-week stay at Charleston Community Memorial Hospital, he was transferred to Barnes Hospital in St. Louis, where Dr. Reynolds (the head of orthopedic surgery) took charge of his care. He found that the leg contained a “considerable amount of dead tissue" as a result of the lack of blood circulation to the improperly casted leg. After several surgical attempts to save the leg, Dr. Reynolds had to amputate Darling's leg below the knee (Wiet 2005). Because Darling was a minor, his father (acting on his behalf) sued Dr. Alexander & AD
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