Ethics Post

Impaired Health Care Provider

You are working the Emergency Department (ED) when a mother brings her son, Alex, in with a

large jagged laceration on his leg.

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Image of the crying boy and mother.

Voiceover

Mother (worried): We live in the country and my son and his friends love to play in the barn

and the barnyard area. Alex was playing outside this afternoon.

They were playing hide and seek. Alex slipped into the dark storage room of the barn where we

store gardening equipment and other dirty tools and things. As he was coming out, he stepped on

his shoelace from his untied sneaker, tripped, and knocked a gardening hoe off the wall rack

where it was stored. On the way down, it hit his leg and caused a large, jagged laceration with

one of its sharp edges. The hoe was dirty. (Pause) He was able to get out of the storage room

where his friend, Sam, found him bleeding and crying in pain.

The little boy’s leg is wrapped in a towel that is showing a small to moderate amount of red. It's

been a fairly busy afternoon and the ED physicians are all with other patients at the present time.

You anticipate a short wait and recognize from the amount of blood that there is not an arterial

laceration. The bleeding is under control at this time. They ask you to call their family physician.

You call the physician out of courtesy as it is the practice of your facility.

You finish admitting Alex to the ED while awaiting the physician, who true to his word, arrives

in about 15 minutes.

Voiceover:

Family Physician: What happened?

Mother (worried): We live in the country, and my son and his friends were playing in the barn

this afternoon.

They were playing hide and seek. Alex slipped into the dark storage room of the barn where we

keep all the gardening equipment. When he came out of the storage room, he stepped on his

shoelace. His sneaker was untied and he tripped, and knocked a gardening hoe off the wall rack.

It hit his leg, and he got a very large cut on his leg from one of its sharp edges. His friend, Sam,

told us he found Alex bleeding and in pain.

The physician then asks you for a few specific items which you proceed to prepare for him and

then he turns to the family.

Voiceover:

Family Physician (young): So, how did this injury happen?

Mother (surprised, worried): My son and his friends were playing hide and seek outside this

afternoon.

Alex hid in the barn. When he was coming out of the dark storage room where we keep the dirty

gardening tools on a rack on the wall, he stepped on his shoelace and tripped. He knocked a

gardening hoe off the wall rack. It fell and hit his leg. When he got out of the storage room, one

of his friends, Sam, found him and ran to the house to tell us that Alex had cut his leg and it was

bleeding.

This feels a little awkward to you as you think they provided adequate information already.

Would you intervene at this time?

Yes

No

You continue to prep the site and talk with the child and his mom about what to expect when you

hear the physician ask for the third time in less than 10 minutes…

Voiceover:

Family Physician: (asking as if this is the first time) So, what happened to your son?

Mother (a little bit irritated as she is saying this the 4th time already): Well, my son and his

friend Sam played in the barn this afternoon. Sam ran into the house and told us that they had

been playing hide and seek in the barn, and he found Alex bleeding and crying in pain.

Alex told us he had hidden in the dark storage room. When he was coming out, he tripped on his

shoelace and knocked a gardening hoe off the wall rack. The gardening hoe hit his leg. Alex felt

a sharp pain and saw his leg bleeding. When he dragged himself out of the storage room, Sam

found him and ran into the house to tell us.

Now, you are extremely uncomfortable and suspect that he is impaired in some way. You have

not been close enough to smell alcohol on his breath, but at this point you have a gut feeling that

something isn't right.

Would you intervene at this time?

Yes

No

Q. 1 In the text box, explain when and why you would choose to intervene. Also, describe what

you would have done.

Q. 2 “Food for Thought”

Would you report a colleague that you suspected of being impaired?

While most of us might check yes if asked to respond to this question on a survey, when it comes

right down to actually making a report, would you follow through?

Yes

No

Q. 3 “Food for Thought”

You said “yes”

To whom would you make your report?

Continue with activity

Q. 3 “Food for Thought”

You said “no”

What would you do, if anything?

Q. 4 Does your state’s department of professional regulation website publish a list of nursing or

physician licenses that were disciplined for substance abuse or drug diversion during any

reporting period (month, quarter, etc. depending on the practice of the department) in the past

calendar year?

Provide your state, how these data are reported (by period) and most frequent violation for the

period.

Q. 5 Does your state offer a program specifically designed to assist nurses or physicians with

addiction recovery?

Q. 6 Select an ethical principle and write a paragraph to apply it to the issue of reporting or not

reporting a physician. You may apply the principle to the patient, the physician or both, but your

answer must be defensible.

It is important to recognize that health care providers are not immune to addictive disorders.

Both nurses and physicians have addictions to drugs or alcohol at about the same rate as that of

the general population. When compared with other professionals, physicians are more likely to

suffer from addictions than other professionals.

Resource: http://www.impairedphysicians.org/

This concludes the activity.