Health Care Managaement Question
ashby104
Chapter_8_Organizational_Ethics_and_the_Law11.pptxChapter 8 Organizational Ethics And The Law
There are lots of important concepts in this chapter, be sure to read it and take notes, as some are sure to be on the final exam.
Learning Objectives
Describe corporate structure.
Describe a code of ethics for organizations.
Discuss organizational misconduct.
Explain respondeat superior and corporate negligence.
Describe corporate duties and responsibilities.
Describe strategies to restore organizational trust.
Corporate Authority
Healthcare organizations are incorporated under state law.
Governing body.
Duties and responsibilities:
Described in a corporation’s articles of incorporation.
Day-to-day operations are delegated to the CEO.
Fiduciary Responsibility
Express corporate authority
Delegated by statute
Implied corporate authority
Corporate powers not specifically granted in articles of incorporation
Ultra vires acts
Acting beyond scope of authority
Corporate Ethics
Promote responsible behavior
Mission, vision, and values
Build trust
Increase awareness of ethical issues
Provide staff
Code of ethics
Training and education
Commitment by organization’s leadership
Corporate Compliance Program (1 of 2)
Appoint compliance officer.
Develop standards of conduct.
Assign duties, authority, and responsibility.
Communication and education.
Implement monitoring and auditing systems.
Corporate Compliance Program (2 of 2)
Consistency in enforcement of policies and procedures.
Reasonable steps in response to offenses.
Annual audit of compliance program.
Integrity and effectiveness.
Maintain management trust on all levels.
Unprofessional Conduct
Trust and integrity lacking
False advertisements
Concealing mistakes
Surgical procedure cover-up
Appearance may not be reality
Truthfulness in Advertising
Hospitals advertise their quality by how well a third party evaluates them.
Often a brief and cursory 3- to 5-day visit
Scores as high as 100 were often posted on billboards and/or in local newspapers.
One young lady told me, “This hospital [in a small rural town] scored 100. they have the nerve to publish this. They killed my mom. I wouldn’t take my dog there.”
Corporate Negligence
Occurs when a corporation fails to perform duties and responsibilities it owes directly patients, visitors, and staff.
If a duty is breached and a patient is injured as a result of that breach, the corporation can be liable for a patient’s injuries under the theory of corporate negligence.
Benchmark Darling Case
In Darling v. Charleston Community Memorial Hospital, the court enunciated a “corporate negligence doctrine” under which hospitals have a duty, for example, to provide adequately trained medical and nursing staff.
Respondeat Superior
Legal doctrine holding employers liable for wrongful acts of their employees.
Doctrine also referred to as vicarious liability.
For liability to be imputed to the employer:
A master–servant relationship must exist between the employer and the employee.
Wrongful act of the employee must have occurred within the scope of his or her employment.
Independent Contractor
Independent contractor is responsible for his or her own negligent acts.
Relationship established when principal has no right of control over manner in which agent’s work is to be performed.
Corporate Duties and Responsibilities (1 of 5)
Appointment of CEO
CEO licensure
CEO responsibilities and challenges
CEO code of ethics
Maintain moral integrity
Screen job applicants
Corporate Duties and Responsibilities (2 of 5)
Credentialing, appointments, and privileging
Ensure competency
False statements
Masquerading as a physician
Discipline of physicians
Physicians reluctant to discipline physicians
Physician privileges suspended
Don’t Let Hospitals Make You Sick
The problem is not that we have an epidemic of negligent doctors. Rather, it’s that the health-care system has grown so complicated that there is a greater chance than ever of things falling through the cracks. . . .
—Dr. Ranit Mishori, Parade Magazine, 2009
Corporate Duties and Responsibilities (3 of 5)
Provide adequate staff.
Provide adequate supplies and equipment.
Allocate scarce resources.
Provide quality patient care.
Comply with rules and regulations.
Corporate Duties and Responsibilities (4 of 5)
Comply with accreditation standards.
Accreditation and conflict of interest.
Provide timely treatment.
Avoid conflicts of interest.
Situations where one has opportunity to promote self-interests that could have a detrimental effect on an organization.
Corporate Duties and Responsibilities (5 of 5)
Provide a safe environment.
Prevent surgical errors.
Runaway elevator.
Prevent of falls.
Protect patients from sexual assault.
Example: Sexual assault in the recovery room.
Decisions That Collide with Professional Ethics
The principles of autonomy, beneficence, and justice and the ability to practice what is right according to such principles often collide when organizations have to, for example, ration scarce resources. Such rationing may require managers to cut costs at the expense of quality.
Case 1: Financial Incentive Scheme (1 of 2)
I am here primarily today to make a public confession. In the spring of 1987, as a physician, I denied a man a necessary operation that would have saved his life and thus caused his death. No person and no group has held me accountable for this, because in fact, what I did was I saved a company a half a million dollars for this.
—Dr. Linda Peeno, Congressional testimony
Case 1: Financial Incentives Scheme (2 of 2)
HMO failed to disclose financial incentive system it provided to its physicians to discourage referrals to specialists.
Discuss the legal and ethical issues.
Case 2: Letter of Recommendation
A former employer who knew that an employee had committed offensive sexual acts gave a letter of recommendation that vouched for him without reservation. The employee after being hired by the new employer injured the student-plaintiff.
Discuss the legal and ethical issues.
Case 2: Legal Issues
Liability may be imposed
Recommendation letter misrepresented truth
Duty to care
Breach of duty
Injury incurred
Causation
Breach of duty was cause of injury
Injury was foreseeable
Case 2: Legal Issues (Foreseeability)
Randi W. v. Muroc Joint Unified School Dist., 14 Cal.4th 1066, 929 P.2d 582 (1997):
Defendants could foresee, had they not recommended the employee, the new employer would not have hired him.
Defendants could foresee that employer would read and rely on defendant's letters of recommendation and that employee after being hired by new employer might molest or injure a student such as the plaintiff in this case.
Case 2: Ethical Issues
First do no harm
Truthfulness
Case 3: Letter of Recommendation (1 of 2)
Mr. R’s supervisor had received several reports alleging misconduct between Mr. R and some of the female residents in the Lee Allan nursing home. The supervisor was unable to verify them.
Mr. R applied for a supervisory position with Parke County Nursing Home. Parke County was sent a preprinted reference form from Lee Allan. Form indicated Mr. R was eligible for rehire. Form reflected that Mr. R performed his job adequately.
Case 3: Letter of Recommendation (2 of 2)
Parke County hired Mr. R in part on the basis of a favorable recommendation from Lee Alan. The claim here is that Mr. R assaulted a patient at Parke County.
The plaintiff asserts that the former employer, Lee Allan, wrongly gave a favorable recommendation and thus should be liable for the injury.
Case 3: Legal Issues
Summary judgment was granted in favor of Lee Alan.
The facts did not reflect that Lee Alan had any substantial information indicating that Mr. R had committed sexual misconduct with residents at Lee Alan.
Case 3: Human Resources Issues
Passmore v. Multi-Management Svcs., Inc., 810 N.E.2d 1022 (Ind. 2004).
Recommendations should not be filled with rumors and innuendo instead of facts. Without substantial evidence, employers would subject themselves to possible defamation litigation.
Declaring employers liable for negligence in providing employment references will lead to employer reluctance to provide information.
Case 3: Ethical Issues
Beneficence
Justice
Fairness
Case 4: Surgical Site Infection
Operating room staff observe a 10-inch by 2-inch tear in a surgical table mattress. It is 2:00 PM and the room has been prepared for Mrs. Smith’s surgery. A surgical sheet is placed on the table. The sheet is worn and has several tears in it. Mrs. Smith is placed on the surgical table.
(Note: Prior to Mrs. Smith’s surgery, a bowel resection was performed on the same table.)
Discuss the legal and ethical concerns.
Case 4: Legal Issues
Legal issues
Negligence?
Consider the hospital’s responsibility.
Torn mattress is a known infection-control concern.
Body fluids can seep into the mattress.
Recurrent use of the mattress by various patients.
Case 4: Ethical Issues
Ethical Issues
Nonmaleficience (first, do no harm)
Professional codes of ethics
Case 4: Professional Ethics
Operating room staff recognized the mattress should have been taken out of service but failed to do so. It is common knowledge that body fluids can seep into a mattress pad and provide a breeding ground for infections.
Describe how hospital policy should address this issue.
Case 5: Defrauding the Government
In States v. Liveoak, 377 F.3d 859 (C.A. 8, Mo. 2004), the government filed an indictment against 11 individuals and 4 corporations.
In the indictment, the government alleged a healthcare fraud scheme that involved several residential care facilities and thousands of claims.
The government alleged that over at least 5 years 15 defendants, in various conspiracies, defrauded the government by falsely certifying patients as homebound and submitting false claims to Medicare and Medicaid.
Case 5: Defrauding the Government
Joinder of Medicare fraud was proper where the charges here were linked not only by common conspiracy members, but also by an overall scheme in which each conspiracy member participated to fraudulently charge the government for healthcare costs.
Case 5: Legal and Ethical Issues
Legal issues
Fraud
Ethical issues
Trustworthiness
Restoring Trust
Effective communication spawns trust and a harmonious organization.
All the players must work together and understand the role each plays.
Better the teamwork, better the care.
Results in satisfied patients, families, and staff.
Improving Organizational Performance
Board education
Policies and procedures
Search for best practices
Reduce variation
Ensure continuity of care
Partner with the community
Develop a culture of compassion and kindness
Review Questions
Discuss the governing body’s decision-making authority.
Explain what an ultra varies act is.
Describe the important aspects of a code of ethics for organizations.
Discuss the various forms of professional misconduct discussed.
Describe corporate negligence, respondeat superior, and independent contractor.
Describe the duties and responsibilities of healthcare organizations and how the failure to adhere to those duties and responsibilities can result in both legal and ethical issues.
Discuss how an organization’s decisions can collide with professional ethics.
Discuss importance of effective communications in building trust in the healthcare setting.
Review Questions
