Code of Conduct

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patient’s bedside to administer any medication. Should a patient unwittingly be administered another patient’s medication, the attending physician should be notified, and appropriate documentation placed in the patient’s chart.

Failure to Note an Order Change Failure to review a patient’s record before administering a medication to ascertain whether an order has been modified may render a nurse liable for negligence. The physician in Larrimore v. Homeopathic Hospital Association wrote an instruction on the patient’s order sheet changing the method of administration from injection to oral medication. The nurse mistakenly gave the medication by injection. Perhaps the nurse had not reviewed the order sheet after being told by the patient that the medication was to be given orally; perhaps the nurse did not notice the physician’s entry. Either way, the nurse’s conduct was held to be negligent. The court went on to say that the jury could find the nurse negligent by applying ordinary common sense to establish the applicable standard of care.

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Failure to Follow Instructions Failure of a nurse to follow the instructions of a supervising nurse to wait for her assistance prior to performing a procedure can result in the revocation of the nurse’s license. The nurse in Cafiero v. North Carolina Board of Nursing failed to heed instructions to wait for assistance before connecting a heart monitor to an infant. The incorrect connection of the heart monitor resulted in an electrical shock to the infant.

[6] Ms. Cafiero put the leads on Jami’s [sic] chest, and inserted the end of the leads into a cord attached to the back of the monitor. Ms. Cafiero then plugged the machine into the wall. A click was heard, and Jami [sic] was noted to be balled up in a fetal position, trembling, with a red color, and “looked hard.” Mrs. Moss screamed and told Ms. Cafiero to turn the monitor off, that she was shocking her baby. Ms. Cafiero told her everything would be o.k. in a minute. Mrs. Moss then saw a black cord on the bed next to Jami [sic] and she unplugged the leads from this black cord. Jami [sic] then fell back on the bed. Ms. Moss went into the hall calling for assistance from a physician.

Gretchen Baughman, RN, Charge Nurse on this shift, came to the room and initiated cardio-pulmonary resuscitation. Jami [sic] was successfully resuscitated, and transferred to the Pediatric Intensive Care Unit (PICU). She did sustain two burns on her chest and one burn on her stomach from this incident. Jamie’s parents were later told by the Risk Manager that Jami [sic] was electrocuted by the Neonatal Monitor. …

The North Carolina Board of Nursing, under the Nursing Practice Act, revoked the nurse’s license. The board had the authority to revoke the nurse’s license even though her work before and after the incident had been exemplary. The dangers of electric cords are within the realm of common knowledge. The record showed that the nurse failed to exercise ordinary care in connecting the infant to the monitor.

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Failure to Report Physician Negligence An organization can be liable for the failure of nursing personnel to take appropriate action when a patient’s personal physician is clearly unwilling or unable to cope with a situation that threatens the life or health of the patient. In a California case, Goff v. Doctors General Hospital, a patient was bleeding seriously after childbirth because the physician failed to suture her properly. The nurses testified that they were aware of the patient’s dangerous condition and that the physician was not present in the hospital. Both nurses knew the patient would die if nothing was done, but neither contacted anyone except the physician. The hospital was liable for the nurses’ negligence in failing to notify their supervisors of the serious condition that caused the patient’s death. Evidence was sufficient to sustain the finding that the nurses who attended the patient and who were aware of the excessive bleeding were negligent and that their negligence was a contributing cause of the patient’s death. The measure of duty of the hospital toward its patients is the exercise of that degree of care used by hospitals generally. The court held that nurses who knew that a woman they were attending was bleeding excessively were negligent in failing to report the circumstances so that prompt and adequate measures could be taken to safeguard her life.

Failure to Question Patient Discharge A nurse has a duty to question the discharge of a patient if he or she has reason to believe that such discharge could be injurious to the health of the patient. Jury issues were raised in Koeniguer v. Eckrich by expert testimony that the nurses had a duty to attempt to delay the patient’s discharge if her condition warranted continued hospitalization. By permissible inferences from the evidence, the delay in treatment that resulted from the premature discharge contributed to the patient’s death. Summary dismissal of this case against the hospital by a trial court was found to have been improper.

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Failure to Observe Patient’s Changing Condition Failure to observe changes in a patient’s condition can lead to liability on the part of the nurse and the organization. The recovery room nurse in Eyoma v. Falco (who had been assigned to monitor a postsurgical patient) left the patient and failed to recognize that the patient had stopped breathing. Nurse Falco had been assigned to monitor the patient in the recovery room. She delegated that duty to another nurse and failed to verify that the other nurse accepted that responsibility.

Nurse Falco admitted she never got a verbal response from the other nurse, and, when she returned, there was no one near the decedent. She acknowledged that Dr. Brotherton told her to watch the decedent’s breathing but claimed that she was not told that the decedent had been given narcotics. She maintained that on her return she checked the decedent and observed his respirations to be eight per minute.

Thereafter, Brotherton returned and inquired about the decedent’s condition. Falco informed the doctor that the patient was fine; however, on his personal observation, Brotherton realized that the decedent had stopped breathing. Decedent, because of oxygen deprivation, entered a comatose state and remained unconscious for over a year until his death.

The jury held the nurse to be 100% liable for the patient’s injuries. The court held that there was sufficient evidence to support the verdict.

Charting Observations The patient’s care, as well as the nurse’s observations, should be recorded on a regular basis. The nurse should comply promptly and accurately with the physician orders written in the record. Should the nurse have any doubt as to the appropriateness of a particular order, he or she is expected to verify with the physician the intent of the prescribed order.

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Failure to Remove Endotracheal Tube The court in Poor Sisters of St. Francis v. Catron held that the failure of nurses and an inhalation therapist to report to the supervisor that an endotracheal tube had been left in the plaintiff longer than the customary period of 3 or 4 days was sufficient to allow the jury to reach a finding of negligence. The patient experienced difficulty speaking and underwent several operations to remove scar tissue and open her voice box. At the time of trial, she could not speak above a whisper and breathed partially through a hole in her throat created by a tracheotomy. The hospital was found liable for the negligent acts of its employees and the resulting injuries to the plaintiff.

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CHIROPRACTOR The Code of Ethics is based upon the acknowledgement that the social contracts dictates the profession’s responsibilities to the patient, to the public, and to the profession; and

upholds the fundamental principle that the paramount purpose of the chiropractor’s services shall be to the benefit of the patient. —Preamble: American Chiropractic Association Code of Ethics

Chiropractors are required to exercise the same degree of care, judgment, and skill exercised by other reasonable chiropractors under like or similar circumstances. They are expected to maintain the integrity, competency, and standards of their profession, as well as avoid even the appearance of professional impropriety.

Chiropractors have a duty to determine whether a patient is treatable through chiropractic means and to refrain from chiropractic treatment when a reasonable chiropractor would or should be aware that a patient’s condition will not respond to chiropractic treatment. Failure to conform to the standard of care can result in liability for any injuries suffered.

Although the American Chiropractic Association says that neck manipulation is a safe procedure, there are risks associated with chiropractic manipulation as with any medical procedure. Failure to conform to the standard of care can result in liability for any injuries suffered. Lawsuits against chiropractors often involve a failure to properly diagnose a patient’s medical condition and harm as a result of treatments, such as manipulation of the spine and neck. For example, a patient stated that she knew she was in trouble shortly after a chiropractor began to manipulate her neck. She said she knew what was happening, telling the chiropractor, “Stop. I’m having a stroke.” The patient stated that if she had been told that there would be a risk of a stroke, she would not have continued with the treatment. As with any medical procedure, the chiropractor should inform each patient as to the risks, benefits, and alternatives associated with a suggested procedure. All patients should sign a consent form acknowledging that they have been informed of the risks, benefits, and alternatives to the recommended procedure.

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Case Studies Poor Judgment

II. Doctors of chiropractic should maintain the highest standards of professional and personal conduct and should comply with all governmental rules and regulations. III. Doctors of chiropractic have an obligation to the profession to endeavor to assure that their behavior does not give the appearance of professional impropriety. Any actions that may benefit the practitioner to the detriment of the profession must be avoided so as not to erode public trust.

The chief medical officer of the Nebraska Department of Health and Human Services Regulation and Licensure in Poor v. State entered an order revoking Poor’s license to practice as a chiropractor in the state of Nebraska.

Poor engaged in a conspiracy to manufacture and distribute a misbranded substance and introduced into interstate commerce misbranded and adulterated drugs with the intent to defraud and mislead. He was arrested for driving under the influence and was convicted of that offense. In addition, Poor knowingly possessed cocaine. He conceded that these factual determinations were understood as beyond dispute.

The district court’s determination that Poor had engaged in “grossly immoral or dishonorable conduct” was not based on “trivial reasons.” The appeals court found that Poor’s conduct clearly fell within the plain and ordinary meaning of grossly immoral or dishonorable conduct. In its order finding Poor to be unfit, the district court relied in part on Poor’s denial of conduct underlying a previous felony conviction. The court stated, “Poor’s denial now, after taking advantage of a plea bargain, that he committed any of the acts he admitted to in the United State[s] District Court is disturbing and is not consistent with the integrity and acceptance of responsibility expected by persons engaged in a professional occupation.”

Chiropractic medicine is a regulated healthcare profession. Patients necessarily rely on a chiropractor’s honesty, integrity, sound professional judgment, and compliance with applicable governmental regulations. Poor argued that there was absolutely no testimony or evidence

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to the effect that anything he did constituted a threat of harm to his patients.

The Supreme Court of Nebraska determined that due to the seriousness of Poor’s felony conviction and its underlying conduct, his subsequent lack of candor with respect to that conduct, as well as his lack of sound judgment demonstrated by his driving-under-the-influence conviction, revocation of Poor’s license was an appropriate sanction.

Ethical and Legal Issues 1. Did the chiropractor in this case violate his professional

code of ethics? Explain your answer. 2. Describe how an individual’s personal life can affect his or

her professional career.

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DENTISTRY

Hawaii Family Sues Dentist for Root Canal that Left 3-Year- Old Girl Brain Dead

A Hawaii family has sued a dentist for root canal gone horribly wrong that left a 3-year-old girl brain dead.

The lawsuit brought by the Boyle family against Island Dentistry in Honolulu alleges staff bungled the Dec. 3 procedure on little Finley Boyle and were unprepared for the emergency 26 minutes into her multiple root canal, local news station KITV reported.

The child “went into respiratory and cardiac arrest due to an overdose given to her during her treatment,” Finley’s family wrote on an online fundraiser.

—Stephen Rex Brown, New York Daily News, January 3, 2014

Dentists are expected to respect patient rights and to avoid harm to their patients. They are expected to treat patients within their scope of practice. Such did not occur in the following cases.

Case Studies Practicing Outside the Scope of Practice Practicing outside one’s scope of practice involves both ethical and legal issues. For example, plaintiff Brown, in Brown v. Belinfante, sued a dentist for performing several elective cosmetic procedures, including a facelift, eyelid revision, and facial laser resurfacing. He was licensed to practice dentistry in Georgia. Brown claims that after the

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cosmetic procedures, she could not close her eyes completely, developed chronic bilateral eye infections, and required remedial corrective surgery. Brown alleged that the dentist’s performance of the cosmetic procedures constituted negligence because he exceeded the scope of the practice of dentistry.

The primary purposes of the Georgia Dental Act are to define and regulate the practice of dentistry. The statute limits the scope of the practice of dentistry. Such limitation protects the health and welfare of patients who submit themselves to the care of dentists by guarding against injuries caused by inadequate care or by unauthorized individuals. Brown falls within that class of persons the statute was intended to protect, and the harm complained of was of the type the statute was intended to guard against. In performing the elective cosmetic procedures, the dentist violated the Dental Practice Act by exceeding the statutory limits of the scope of dentistry.

Ethical and Legal Issues 1. Describe the ethical issues presented here. 2. Describe the legal issues in this case.

Case Studies Inappropriate Sexual Conduct Revocation of a dentist’s license on charges of professional misconduct was properly ordered in Melone v. State Education Department on the basis of substantial evidence that while acting in a professional capacity the dentist had engaged in physical and sexual contact with five different male patients within a 3-year period. Considering the dentist’s responsible position, the extended time period during which the sexual contacts occurred, the age and impressionable nature of the victims (7 to 15 years of age), and the possibility of lasting effects on the victims, the penalty was not shocking to the court’s sense of fairness.

Ethical and Legal Issues 1. Describe the ethical and legal issues of this case. 2. Describe what procedures could be implemented in a

dentist’s office to help reduce the likelihood of sexual

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abuses.

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Dental Hygienist Dental hygienists are expected to treat patients with respect and to disclose all relevant information so that they can make informed choices about their care. Patient information must be kept confidential. Dental hygienists have an obligation to provide services in a manner that protects all patients and minimizes harm to them.

Case Studies Unlawful Administration of Nitrous Oxide This case arises from a complaint by a dental hygienist against a former employer, Lowenberg and Lowenberg Corporation. The dental hygienist alleged that the defendant allowed dental hygienists to administer nitrous oxide to patients. Under state law, dental hygienists may not administer nitrous oxide. The Department of Education’s Office of Professional Discipline investigated the complaint by using an undercover investigator. The investigator made an appointment for teeth cleaning. At the time of her appointment, she requested that nitrous oxide be administered. Agreeing to the investigator’s request, the dental hygienist administered the nitrous oxide. There were no notations in the patient’s chart indicating that she had been administered nitrous oxide.

A hearing panel found the dental hygienist guilty of administering nitrous oxide without being properly licensed. In addition, the hearing panel found that the dental hygienist had failed to record accurately in the patient’s chart that she had administered nitrous oxide.

The New York Supreme Court, Appellate Division, held that the investigator’s report provided sufficient evidence to support the hearing panel’s determination. There is adequate evidence in the record to support a finding that the dentist’s conduct was such that it could reasonably be said that he permitted the dental hygienist to perform acts that she was not licensed to perform.

Ethical and Legal Issues 1. Discuss how the ethical values listed in the Pillars of Moral

Strength were violated in this case.

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2. Explain how both legal and ethical issues are intertwined in this case.

Case Studies Patient Injured During Procedure The plaintiff in Hickman v. Sexton Dental Clinic brought a malpractice action against a dental clinic for a serious cut under her tongue. The dental assistant, without being supervised by a dentist, placed a sharp object into the patient’s mouth, cutting her tongue while taking impressions for dentures. The court of common pleas entered a judgment on a jury verdict in favor of the plaintiff, and the clinic appealed. The court of appeals held that the evidence presented was sufficient to infer without the aid of expert testimony that there was a breach of duty to the patient. The testimony of Dr. Tepper, the clinic dentist, was found pertinent to the issue of the common knowledge exception in which the evidence permits the jury to recognize breach of duty without the aid of expert testimony. Tepper presented the following testimony regarding denture impressions:

Q. You also stated that you have taken, I believe, thousands? A. Probably more than that. Q. Of impressions? A. Yes, sir. Q. This never happened before? A. No, sir, not a laceration. Q. Would it be safe and accurate to say that if someone’s mouth were to be cut during the impression process, someone did something wrong? A. Yes, sir.

Ethical and Legal Issues 1. Do you see any ethical issues in this case? Explain your

answer. 2. Describe the legal issues of this case.

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DIETARY Healthcare organizations are expected to provide patients with diets that meet their individual needs. Some university hospitals stress the importance of good nutrition. University Hospitals in Cleveland describe the importance of nutritional services by promoting “the idea that proper nutrition can improve health and well-being. Our registered dietitians offer nutrition education and counseling for patients with conditions such as diabetes, seizure disorders or immune disorders, and work to incorporate dietary plans into the patients’ course of treatment.” Massachusetts General Hospital “experts from the Department of Nutrition and Food Services aid the general public with management of specific dietary needs in many different areas, including cardiac care, diabetes and childhood and adult obesity. They also provide nutritional care and advice about lifestyle maintenance and good nutrition, often through classes available on the hospital’s main campus and at community health centers.” New York-Presbyterian hospital in their nutrition program states:

Our vision is to go beyond the expectations of our patients and customers with the clinical expertise, service, compassion, education, and caring that one expects from a premier clinical nutrition and food service department. Networking, our team focuses on best practices in the spirit of unity where each team member autographs their work with pride and quality.

Healthcare organizations have traditionally failed to recognize or promote the importance of good nutritional care. However, The Joint Commission standards require that “Food and Nutrition products are consistent with each patient’s care, treatment, and services.” Failure to address the nutritional needs of patients can lead to negligence suits, as noted in the cases presented here.

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Patient’s Diet Order Inappropriate

Mom had colon cancer and was told she would be placed on a soft diet following surgery. One evening following surgery I was visiting mom. The diet aide entered the room, laid down mom’s food tray on her bedside table, and left the room. Mom lifted the cover off her plate. There on her plate laid a dried-out pork chop with mashed potatoes and broccoli. She looked up at me and said, “Do you want my meal? I can’t eat that.” I walked to the nurses’ station and asked, “Why does my mom have pork chops on her plate? She was told she would be on a soft diet following surgery.” The nurse said, “Let me look at her record.” After a few moments searching the record, the nurse looked up at me and said, “Yes, it’s right here written by the doctor. ‘Regular diet for Mrs. Dively.’ I can’t change her diet. I will have to get an order change from her physician.” The nurse continued, “Your mom will have to remain on a regular diet until the doctor writes a new order.” I asked, “And how long will that take?” The nurse replied, “When he comes in to visit her on rounds. Probably tomorrow because he just saw her earlier.” I then asked to speak to the dietitian. She came to the floor and said, “I understand your dilemma, but I can’t change your mom’s diet without an order from the physician.” I asked for the evening nursing manager, who eventually talked to me on the nursing station phone. She was eventually able to get an order change from the physician, who had not returned her call until later that evening.

—Anonymous

Dietitians are expected to exercise professional judgment and practice dietetics based on scientific principles and current practice. Yet few healthcare organizations have fully integrated them into their patient care teams. Although the participation of pharmacists in the patient care setting is becoming the norm on patient care units, participation of dietitians is yet to be at an optimal level.

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Case Studies Patient Suffers Malnutrition Healthcare organizations must provide each patient with a nourishing, palatable, well-balanced diet that meets the daily nutritional and special dietary needs of each patient. Failure to do so can lead to negligence suits. The deceased patient’s daughter in Lambert v. Beverly Enterprises, Inc., filed an action claiming that her father had been mistreated. The notice of intent to sue indicated that the deceased suffered various injuries and malnutrition as a direct result of the acts or omissions of dietary personnel, and that the plaintiff’s father suffered actual damages that included substantial medical expenses and mental anguish because of the injuries he sustained. A motion to dismiss the case was denied.

Ethical and Legal Issues 1. Identify the ethical issues in this case. 2. How might the dietitians’ professional ethical code have

been violated in this case?

The inability of hospitals and ambulatory care centers to provide adequate staff to address the nutritional needs of patients is due in part to financial constraints. Rural outpatient centers are generally understaffed and barely have time to address the patient’s presenting complaints. Staffing to address the unique nutritional needs of many patients often goes unaddressed. Frequently, patients with poor nutritional habits often return over the years with more severe, costly, and debilitating medical conditions (e.g., diabetes and heart disease), as discussed in the following Reality Check.

Patient’s Nutritional Status Not Addressed

Jeb, a 12-year-old, 175-pound boy, came with his mother to General Hospital’s ambulatory care clinic to be treated for poison ivy. When Brad, a physician’s assistant, had completed his assessment, he provided Jack’s mother with a

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prescription and gave instructions for caring for her son. He then asked, “Do you have any questions?” She replied that she had none. After she and her son left the treatment room, I asked, as a resident assigned to the clinic for training, “Brad, do you know if anyone ever discussed Jack’s nutritional status with his mother and the future risks associated with his weight?”

Brad looked in Jack’s medical record and noted that he had been a patient in the clinic since birth. He could not find any notations indicating there was any discussion over the years regarding his weight. He did note that there was a height and weight chart in the record by age and that Jack’s height was in the norm for his age; however, his weight was, as Brad put it, “Off the scale.” He looked at me and said, “The problem here is, the mother, as you may have observed, has a weight problem as well. We have been asking for a registered dietitian to schedule a morning once a week for referral purposes. It like singing in the wind, and nobody is listening.”

—Anonymous

Discussion 1. Balancing the financial constraints of the clinic and the

long-term health risks that Jeb faces, discuss what creative action you would take in order to provide nutritional consultations for clinic patients, assuming the hospital has no available resources to provide for nutritional counseling.

2. What are the ethical issues of treating poison ivy and seemingly ignoring Jeb’s risks of developing diabetes and/or heart disease?

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Incidence and Recognition of Malnutrition The importance of diet is often not given sufficient consideration in healthcare settings, which was noted by J. P. McWhirter and C. R. Pennington in a study conducted to determine the incidence and recognition of malnutrition in a hospital. The results of the study were reported in the British Medical Journal. Although not totally conclusive of what the findings would be in a larger sampling, the results of this study are somewhat perplexing. The abstract of the McWhirter and Pennington study is presented here.

Abstract Objectives: To determine incidence of malnutrition among patients on admission to hospital, to monitor their changes in nutritional status during stay, and to determine awareness of nutrition in different clinical units. Design: Prospective study of consecutive admissions. Setting: Acute teaching hospital. Subjects: 500 patients admitted to hospital: 100 each from general surgery, general medicine, respiratory medicine, orthopaedic surgery, and medicine for the elderly. Main Outcome Measures: Nutritional status of patients on admission and reassessment on discharge, review of case notes for information about nutritional status. Results: On admission, 200 of the 500 patients were undernourished (body mass index less than 20) and 34% were overweight (body mass index >25). The 112 patients reassessed on discharge had mean weight loss of 5.4% with greatest weight loss in those initially most undernourished. But the 10 patients referred for nutritional support showed mean weight gain of 7.9%. Review of case notes revealed that, of the 200 undernourished patients, only 96 had any nutritional information documented. Conclusion: Malnutrition remains a largely unrecognized problem in hospital and highlights the need for education on clinical nutrition.

—J. P. McWhirter and C. R. Pennington, “Incidence and Recognition of Malnutrition in Hospital,” BMJ 308:945, April 9,

1994

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EMERGENCY DEPARTMENT

Wait Times Lengthen at Emergency Rooms

Emergency-room patients are waiting ever longer to see a doctor, a potentially dangerous development as rising numbers of uninsured and underinsured Americans turn to ERs for medical care.

—Theo Francis, The Wall Street Journal, January 15, 2008

Federal and state statutes impose a duty on hospitals to provide emergency care (FIGURE 9-1). The statutes require hospitals to provide some degree of emergency service. If the public is aware that a hospital furnishes emergency services and relies on that knowledge, the hospital has a duty to provide those services to the public.

FIGURE 9-1 Teamwork in Action. © ChameleonsEye/Shutterstock, Inc.

Treatment rendered by hospitals is expected to be commensurate with that available in the same or similar communities or in hospitals generally. In Fjerstad v. Knutson, the South Dakota Supreme Court found that a hospital could be

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held liable for the failure of an on-call physician to respond to a call from the emergency department. An intern, who attempted to contact the on-call physician and was unable to do so for 3½ hours, treated and discharged the patient. The hospital was responsible for assigning on-call physicians and ensuring that they would be available when called. The patient died during the night in a motel room as a result of asphyxia resulting from a swelling of the larynx, tonsils, and epiglottis that blocked the trachea. Testimony from the laboratory director indicated that the emergency department’s on-call physician was to be available for consultation and was assigned that duty by the hospital. Expert testimony also was offered that someone with the decedent’s symptoms should have been hospitalized and that such care could have saved the decedent’s life. The jury could have believed that an experienced physician would have taken the necessary steps to save the decedent’s life.

Case Studies On-call Physician Fails to Respond Hospitals are expected to notify specialty on-call physicians when their particular skills are required in the emergency department. An on-call physician who fails to respond to a request to attend a patient can be liable for injuries suffered by the patient because of his or her failure to respond. In Thomas v. Corso, a Maryland court sustained a verdict against the hospital and physician. The patient had been brought to the hospital emergency department after being struck by a car. A physician did not attend to him even though he had dangerously low blood pressure and was in shock. There was some telephone contact between the nurse in the emergency department and the physician who was providing on-call coverage. The physician did not act on the hospital’s call for assistance until the patient was close to death, and the patient did die. The court reasoned that expert testimony was not even necessary to establish what common sense made evident: that a patient who had been struck by a car may have suffered internal injuries and should have been evaluated and treated by a physician. Lack of attention in such cases is not reasonable care by any standard. The concurrent negligence of the nurse, who failed to contact the on-call physician after the patient’s condition had worsened, did not relieve the physician of liability for his failure to come to the emergency department at once.

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Rather, under the doctrine of respondeat superior, the nurse’s negligence was a basis for holding the hospital liable as well.

Ethical and Legal Issues 1. Describe how both the physician and nurse failed in their

ethical responsibilities to the patient. 2. Describe what actions the hospital can take to prevent

future occurrences of this nature. 3. What are the legal and ethical concerns for the physician,

nurse, and hospital?

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Timely Response May Require a Phone Call Hospitals are not only required to care for emergency patients but also required to do so in a timely fashion. In Marks v. Mandel, a Florida trial court was found to have erred in directing a verdict against the plaintiff. It was decided that the relevant inquiry in this case was whether the hospital and the supervisor should bear ultimate responsibility for failure of the specialty on-call system to function properly. Jury issues had been raised by evidence that the standard for on-call systems was to have a specialist attending the patient within a reasonable time of being called.

Emergency rooms are aptly named and vital to public safety. There exists no other place to find immediate medical care. The dynamics that drive paying patients to a hospital’s emergency departments are well known. A sudden, acute ailment or injury occurs: a child breaks his arm, an individual suffers a heart attack, an existing medical condition such as the flu or asthma worsens abruptly, a patient with diabetes lapses into a coma—any of these situations demand immediate medical attention at the nearest emergency department. The catchphrase in legal nomenclature “time is of the essence” takes on real meaning. Generally, one must choose the nearest emergency department, and after arrival, it would be a mistake to depart in hope of finding one that provides services through employees rather than independent contractors. The patient is there and must rely on the services available and agree to pay the premium charged for those services.

The public not only relies on the medical care rendered by emergency departments but also considers the hospital as a single entity providing all of its medical services. A set of commentators observed:

[T]he hospital itself has come to be perceived as the provider of medical services. According to this view, patients come to the hospital to be cured, and the doctors who practice there are the hospital’s instrumentalities, regardless of the nature of the private arrangements between the hospital and the physician. Whether or not this perception is accurate seemingly matters little when weighed against the momentum of changing public perception and attendant public policy.

The change in public reliance and public perceptions, as well as the regulations imposed on hospitals, has created an

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absolute duty for hospitals to provide competent medical care in their emergency departments.

Given the cumulative public policies surrounding the operation of emergency departments and the legal requirement that hospitals provide emergency services, hospitals must be accountable in tort for the actions of caregivers working in their emergency departments.

Emergency Department Lifeline

Emergency departments are the lifelines for millions of people around the nation each day. For those with and those without insurance, each day, we know someone out there cares. Often forgotten is the compassion that caregivers show each day. One such occurrence was observed when a young man walked into the emergency department at General Hospital. He described symptoms of severe chest pain. He was afraid, but he was soon rushed to a room where he was attended to by a physician, a nurse, an ECG technician, and a laboratory technician. He had blood drawn, an ECG, and a history and physical. As I watched, his fear turned to gratitude as treatment was administered and his pain alleviated. Fear faded away and the young man left with instructions for follow-up care. Fear turned to happiness for this young man. His smile spoke a million words.

—Anonymous

In the Marks v. Mandel case:

Extensive trial testimony proved that the local and national standard for on call systems is to have a specialist actually attending to the patient within thirty minutes of the call to the physician. Palmetto General had a published policy which adopted this standard. In the case at bar, however, the fact that a thoracic surgeon eventually attended to Marks was a matter of coincidence and not a result of the on-call system. The system failed. A jury should decide whether the failure was a breach of the standard of care owed to Michael Marks.64

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