Process Essay: Does This Make Good Public Policy?

In many ways, the hospital system in America is set up mirroring our government. They are similar in the way that checks and balances have been set in place to ensure the best possible care is delivered to patients. With these checks and balances there are three main bodies; the governing board, medical staff, and executive management (Showalter, 2017). The duties and responsibilities of each body many times is to oversee and continually check the others. A prime example of this system can be seen through the case of Moore v. The Board of Trustees of Carson-Tahoe Hospital, which took place in Nevada and was heard before the Supreme Court of the state in 1972 (Moore v. Board of Trustees of Carson-Tahoe Hospital, 1972). Specifically, in this case, the duty of the governing board to “exercise reasonable care in selecting and retaining medical staff” is questioned in contrast with the right of the physician to have “due process… when disciplinary action is taken” (Showalter, 2017). In hopes of changing a decision by the governing board, and attempting to reverse the decision of a lower court, the appellant, Dr. Moore, brought the case against Carson-Tahoe Hospital (Moore v. Board of Trustees of Carson-Tahoe Hospital, 1972).

Charleston Community Memorial Hospital proved a corporate negligence doctrine in the case (Pozgar, 2013). The court found a jury could reasonably find negligence due to the fact that staff did not test for circulation as often as needed, it was concluded that skilled nurses would have been aware of circulation problems, informing attending staff promptly (Law School Case Briefs,2013). There was no argument that the defendant, the hospital in this case, failed to review physicians work, or require a consultation. A jury found that this failure was within reason to assume a negligent act was performed, or not performed in this case (Law School Case Briefs,2013). A person goes to a hospital and within reason expects the hospital to treat them (Pozgar, 2013). There is a legitimate basis in this case to hold the hospital vicariously responsible for torts of its employed staff (Law School Case Briefs,2013). In Darling v. Charleston Community Memorial Hospital, the jury found negligence by both the doctor and the nursing staff, this was supported with evidence during the trial (Law School Case

When considering the legalities of this scenario, negligence, vicarious liability, and physician- patient relationship are a few components that affect the outcome of a lawsuit. The amount of legal torts that were violated in this case was enough to cause disputes between patients and healthcare staff. Negligence is a familiar tort that occurs much more than it needs too. Unfortunately in this case, vicarious liability and patient-physician relationship are two considerations that influence this case as well.

This case is extremely relevant to what is known as the four D’s of negligence; duty, dereliction, direct cause and damages. Duty is when a doctor and a patient have formed a relationship and said doctor has taken on the responsibility of taking care of the patient. Dereliction or failure to perform a duty, there must be some kind of proof that the doctor somehow neglected the doctor neglected the patient. Direct cause, there must be some kind of proof that what happened to the patient was a direct cause of how the doctor conducted himself or his failure to act which resulted in injury. Damages a patient must prove that harm was incurred by the direct result of the physicians actions.

According to Chief Justice Phillips’s opinion, the plaintiff, Sampson, needed to raise “a genuine issue of material fact that defendant Hospital was vicariously liable under the theory of ostensible agency for an emergency room physician’s negligence.” For that reason, we grant the BMHS’s request for writ of error due to the failure that the plaintiff was unable to establish vicarious liability based on the facts that the hospital had taken the reasonable and necessary steps to show its patients that the practicing physicians at the hospital were not employees or agents of the hospital (Phillips, 1997).

The nurse that originally noticed the shortage in anesthesia, in my opinion should have filed a formal compliant against the chief of anesthesia for not executing an investigation due to her speculation and evidence. If it was determined to be true that Dr. Johnson illegally using the anesthesia than he could have gotten some help. His illness could be in final stages not because he neglected to receive treatment. Instead of covering up the pain there is a possibility that he could have received treatments to help him through his illness. I think the employees of this hospital are at fault along with Dr. Johnson because they did not practice integrity and inform anyone of the incidents that they were noticing. Everyone gave excuses and the one that did say something should have complaint to someone who would have listened. A hospital mission is to care for their patients and the mission was not followed by any one who noticed Dr. Johnson’s actions.

In order to claim that a doctor or hospital was negligent in a medical malpractice case, there must be specific requirements present. First off a doctor-patient relationship must have existed (Boeschen, 2014). An individual making the claim must show that there was a physician-patient relationship with the doctor being sued. This means the doctor was hired and agreed to be hired for the medical care provided. If a doctor began seeing you and treating you, it is easy to prove a physician-patient relationship existed. Second the plaintiff must show the doctor was negligent. Regardless of if the patient is unhappy with their treatment or results, does not determine the doctor is liable for medical malpractice. The doctor must have been negligent -- not reasonably skillful and careful -- in a diagnosis or treatment (Boeschen, 2014). To sue for malpractice, you must be able to show that the doctor caused you harm in a way that a competent doctor, under the same circumstances would not have (Boeschen, 2014). In many cases, the doctor's care is not required to be the best possible, but simply "reasonably skillful and careful” (Boeschen, 2014). Whether or not the doctor was reasonably skillful and careful is often up to the medical malpractice claim.

And the fact he deemed it unnecessary to speak to the patient is a huge violation of the doctrine of consent and portrayed him to be an insufficient health leader by not following the guidelines put forth in all hospitals to abide by to ensure it’s best to the patients. His incompliant ways can affect the future of the hospital putting in jeopardy many jobs and lives.

In cases were no legal cases have bearing on the issue, courts should turn to other disciplines for authority if, and only if, the alternative authority has expertise and knowledge on the issue beyond that of the court. In this case, the court could have looked at an outside discipline, such as a hospital ethics committee, for authority.

“Hospitals are not only required to care for emergency patients, but they also are required to do so in a timely fashion” (Pozgar, 2010, p. 272). “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” (Pozgar, 2010, p. 271). Under the doctrine of Respondeat Superior, hospitals are also liable for the actions of physicians working or on-call in their emergency department.

This can be read as a key ethical question to many healthcare case studies because of the errors and situations that occur. One of the explanations for this occurrence may be the overwhelming workload, chaotic environment and lack of individual attention prescribed to each patient. These issues can cause a disruption to the ethical principle of Beneficence. The principle of Beneficence calls to action the act of helping others and having compassion for the patients. This principle can be threatened when a doctor or caretaker is overworked and unable to effectively manage the series of patients and work they are assigned to take on. I believe that the admitting doctor did not initially catch the error of not calling for the specific drug need because he was more focused on getting Mr. Londborg stable and on the medication to treat his initial and present condition before worrying about the preventative medication. In addition, the doctor was so focused on helping everyone all at once that he was blind to the small details and loose ends that needed to be taken care

While this is a serious error by institutional standards, it fails to meet the tort definition of negligence. There was a duty of care to this patient who was admitted to the hospital. A breach of that duty occurred when the patient was given the incorrect medication. The requirement of injury necessary to meet the definition of negligence was not me. There was no reported adverse outcome reported from the single dose of the incorrect medication. Due to lack of injury, there appears to be no risk to the institution from negligence surrounding the medication

In that situation, the negligence perpetrated by the anesthesiologist was an error—possibly an honest mishap or a consequence of carelessness but not deliberate or criminal. One of the primary reasons the patient’s sister filed the lawsuit was the absence of communication and information surrounding what happened when her sister was permanently injured. If the anesthesiologist and archdiocese had spoken honestly and openly to the patient’s sister, it might have safeguarded them from litigation. In this case study, the archdiocese and the anesthesiologist could have “come clean” from the beginning. They could have taken responsibility for their mistakes, apologized sincerely, and offered to financially and medically support the patient for the rest of her life. In turn, the patient’s sister may not have sued them, the anesthesiologist would not have covered up his mistake (thereby committing a criminal act), and the admitting nurse would still be a nurse.

The court system does not seem to base their judgment on legal elements and legal facts but a major consideration on public policy and interest. This can be seen in Barnett v Chelsea & Kensington Hospital , where the ratio is that the patient would have died anyway in spite of the doctor’s examination. To impose a liability on the doctor would give rise to many claims, involving many unnecessary claims. However, doctors’ duty is to examine a patient and decide on the plan of treatment, where in this case, the doctor did not even examine the patient. The reluctance of the court to impose a liability on public bodies can also be seen in Alcock v Chief Constable of South Yorkshire Police . The court was reluctant to impose a liability on the police force, even when the Taylor Report reported that the accident was caused by the negligence of the police force, as they let too many supporters in. There are enough facts in these two cases to impose a liability on the doctor and the police department respectively, however, the reluctant approach from the court towards public bodies have resulted in unsuccessful claims in these two cases.