Week 8 Health Law &Ethic

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Week 8

Improving Patient Outcomes

Throughout this course, you have studied the theoretical underpinnings of ethics and the

laws and regulations associated with healthcare, as well as useful applications for both.

In Week 1, you read about the costs of unethical behavior. This week, you will

review cases, based on actual events that further explore the level of damage due

to unethical and illegal actions in healthcare settings.

In Week 2, you gained an understanding of the sources and function of U.S. law.

This week, you will need to revisit those concepts to determine whether there are

legal precedents and legal opinions for cases similar to the ones presented below.

In Week 3, you learned about legal violations, whether they were civil (i.e.,

contracts, torts, and specifically, medical negligence) and/or criminal law (i.e.,

misdemeanors, felonies) and ways to avoid such violations. Similarly, this week you

will provide recommendations to help prevent future violations.

In Week 4, you researched the roles, responsibilities, and possible liabilities of

healthcare professions and healthcare organizations. Now, you need to determine

who was at fault of the violations that occurred in the cases you’ll read about in

this week’s resources.

In Week 5, you analyzed a national policy related to the allocation of resources and

access to care. This week, you will consider how these cases impacted the issues of

resource allocation and access to care.

In Week 6, you explained the issues that may arise as a result of advanced health

technology, and in Week 7, you developed a tool to asses organizational readiness

for corporate compliance. This week, you will decide if your organization has the

structure and systems in place to address the challenges that result from bioethics

and possible fraud and abuse violations.

Be sure to review this week's resources carefully. You are expected to apply the

information from these resources when you prepare your assignments.

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Books and Resources for this Week

Holyoak, J. (2017). Rethinking denial

management. Most organizations take an

administrative approach to managing denials.

Maybe that’s why they’re... Link

Miller, R., & Chalapati, N. (2015). Utilizing

lean tools to improve value and reduce

outpatient wait times in an Indian hospital.

Leadership... Link

Shor, R. (2015). Using appropriate use criteria

to address pre-authorization. Journal of the

American College of Cardiology, 66(11),

1300-1302. Link

American Medical Association. (2011).

Standardization of prior authorization process

for medical services. Link

American Medical Association. Council on

Medical Services. (2017). Report 7 of the

Council on Medical Service (A-16). Prior auth PDF document

Gateway Health. (2005). Medical payment

and prior authorization policy. Link

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HPSO. (2018). Sample risk management plan

for healthcare businesses & practices. Link

Week 8 – Signature Assignment: Facilitate Changing of

Corporate Culture to Improve Patient Outcomes Assignment

Due August 11 at 11:59 PM

Medical and other healthcare-related scandals are too often reported in the news. We

often read of individuals purchasing a unique pharmaceutical, then raising the price

dramatically, massive Medicare fraud schemes, poor security or tracking measures at

hospitals allowing a baby to go home with the wrong family or be stolen by a stranger,

major leaks of or unauthorized access to confidential patient data, and clinicians and other

healthcare professionals paying kickbacks for referrals or engaging in self-referral

activities.

Below are three different sample cases that you can select from when completing your

assignment.

Case 1: Medication Error and a Lack of Patient Monitoring

You are the risk officer at a community hospital. About six weeks ago, a patient with flu-

like symptoms arrived at your hospital. They had tried self-medicating for several days but

received no relief from a persistent cough and shortness of breath. They complained of

general fatigue, body aches, and chills. Their recorded temperature was 102°F. The patient

was prescribed IV fluids and the standard medication but did not see an improvement in

their condition after 24 hours. The attending physician gave the nurse orders to adjust the

patient’s medication. It was later discovered that the nurse didn’t administer the correct

dose. Furthermore, there was a lack of documentation to determine how often the

patient’s condition was monitored after the last modified dose of the medication was

administered. You see a gap in time of more than an hour when the nurse was requested

to monitor the patient closely. The patient suffered cardiac arrest. The patient was

successfully resuscitated but has suffered from brain damage that has left them

permanently disabled. The family sued for $1.2 million but settled out of court for a lesser

amount. The CEO has requested that you present a risk-management plan to the hospital

board that will reduce the likelihood of a similar situation occurring again.

Case 2: Insurance Company Fraud

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You are part of the leadership team at an insurance company that was

recently sued by a patient for breach of contract. The patient stated that the company’s

failure to authorize treatments for their condition had near-fatal results. Upon further

investigation, you discover the patient failed to provide your company the laboratory

results it requested, and that the patient was non-compliant with their physician’s

prescribed course of treatment. However, the investigation has also revealed that your

company’s medical director denied the patient’s treatment without having ever looked at

the patient’s medical records. In fact, your medical director is not even familiar with the

patient’s rare disease. You and other members of the leadership team uncover a culture

where there is an overdependence on nurses to review patient records and determine a

course of treatment. For some diseases, particularly those as rare as the plaintiff’s, a nurse’s

clinical expertise may not be sufficient. The litigation is still pending, but you have been

asked to present a new pre-authorization policy and procedures to mitigate potential future

suits.

Case 3: Extremely Long Wait Times to Be Scheduled for Medical Visits

You are an officer in a federal organization responsible for providing care to veterans of

the U.S. armed forces. An investigation has revealed that a local hospital within your

organization has hidden paperwork documenting that the average wait time for a veteran

to be scheduled for a primary care visit is 115 days. An even greater tragedy is that 40

veterans have died while waiting for an appointment. It has come to your attention that

administrators and staff were motivated to hide the evidence documenting the wait times

because the hospital would lose financial incentives linked to timely scheduling of

appointments. The main office in Washington DC is coming to the local hospital to extend

the investigation. In anticipation of the main office administrators’ arrival, you have been

asked to explain the root cause of the deception and develop a plan and standard

operating procedure to prevent further delays in providing care.

Assignment Instructions:

Select one of the cases to analyze according to the following considerations:

What is the organizational structure of the company or agency with which you

work? Who are the influencers? (Provide titles, not names.)

How are organizational policies drafted, approved, and disseminated?

Which ethical principles and theories apply to the scenario you selected?

Which constitutional, statutory, and/or case law could apply to the scenario you

selected?

Presentation: After researching your selected scenario, taking into account the

considerations listed above, you will prepare a presentation which you will present at your

organization’s board meeting. The slides will have notes consisting of 100-150 words per

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slide and you will provide a voice-over narration of your PowerPoint

presentation. Due to the urgent nature of your presentation, you have been placed on an

already full board agenda. Consequently, you must strictly adhere to 15 minutes.

Supporting Document: You will also develop a handout (risk-management plan brief, pre-

authorization brief, or wait-time standard operating procedure brief) for the board

members that corresponds to the case you have selected.

Length: The slide presentation will consist of 12-15 slides, not including the first slide as

your title slide and the last slide as your reference slide. The handout should be an

executive summary of no more than 2 pages that summarizes the components of the risk

management plan, pre-authorization procedures, or wait-time SOP.

References: A minimum of 10 credible and scholarly references are required for this

Signature Assignment.

Your presentation should demonstrate thoughtful consideration and integration of the

ideas and concepts that have been presented throughout the course. Additionally, your

presentation should provide new thoughts and insights relating directly to this topic. Your

response should reflect graduate-level writing and APA standards.