Medico-Legal Issues
Question
• Length: 1500 words; answers must thoroughly address the questions in a clear, concise manner.
• Structure: Include a title page and reference page in APA style. These do not count towards the minimum word count for this assignment.
• References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (3) scholarly sources to support your claims.
• Don’t forget your introduction and conclusion.
• Turnitin score must be less than 20%
Read the case study You be the Judge presented at the end of Chapter 18 which begins, “The older adult male patient was admitted…” (Guido, p. 363) and answer the following questions:
• Was the nurse negligent for not questioning the use of morphine for a patient with blunt abdominal pain before administering the dose of morphine?
• Would knowing that the patient’s blood pressure was 148/94 when the morphine was administered impact the finding of the trial court?
• What evidence would you argue in the nurse’s defense regarding the care of this patient?
• How would you decide this case?
Read the case study You be the Judge presented at the end of Chapter 19 that begins, “An 82-year-old patient…” (Guido, p. 394) and answer the following questions:
• What initial care should the patient have received in the emergency center?
• Did the emergency department staff meet the standards of care for a patient with these presenting signs and symptoms?
• Was the admission to the intensive care area a violation of the EMTALA law?
• How would you decide this case and what provisions of the EMTALA law would you anticipate the court enumerated in its holding?
Read the case study You be the Judge presented at the end of Chapter 20 (Guido, p. 415) beginning with, “The patient was a detainee,…” and answer the following questions:
• Should the nurses have followed the physician’s orders and continued the ordered medications, which varied significantly from his pre-jail medications, specifically his medications for pain?
• Was it deliberate indifference to the patient’s medical needs to change his pain medications in the belief that he needed to withdraw from narcotics?
• What more could the nurse have done to prevent a lawsuit from being filed for an Eighth Amendment violation?
• How would you expect the court decided this case?
Read the case study You be the Judge presented at the end of Chapter 21 (Guido, p. 440-441) beginning with, “An elderly woman was admitted to the hospital…” and answer the following questions:
• What types of questions should be asked of the social worker and the other individual who witnessed her signature on the will?
• What other evidence should be requested of the nursing staff to best ascertain her cognitive ability at the time she dictated how she wanted the will drafted and at the time she signed the document?
• Does the fact that she had been estranged for many years from the sibling whose children are now suing factor into the final decision of the court?
• How would you decide this case?
You be the Judge Chapter 18 (Guido, P. 363)
The older adult male patient was admitted to the hospital emergency center with major blunt abdominal trauma following a car crash. In the emergency center, the nurse carried out the physician’s order for a dose of morphine for the patient’s pain, which he said was an 8 on a scale from 1 to 10. After being given the morphine, the patient’s blood pressure dropped significantly, and the patient went into cardiac and respiratory arrest after lapsing into uncon-sciousness. The nurse alerted the physician, who immediately intubated the patient and sent him to the operating room to be resuscitated and then for exploratory surgery to determine the extent and cause of the abdominal bleeding. The patient was never revived, and he died the next day in the facility’s intensive care unit. The family has brought a wrongful death lawsuit, alleging that the morphine was the cause of the patient’s demise. In the lawsuit, there were no allegations of excessive dose, improper administration of the medication, or inattentive monitoring by the nurses in the emergency center.
1. Was the nurse negligent for not questioning the use of morphine for a patient with blunt abdominal pain before administering the dose of morphine? 2. Would knowing that the patient’s blood pressure was 148/94 when the morphine was administered impact the finding of the trial court?
3. What evidence would you argue in the nurse’s defense regarding the care of this patient?
4. How would you decide this case?
You be the Judge Chapter 19 (Guido, P.394)
An 82-year-old patient who was herself a retired physician was admitted to a rehabilitation facility after surgery to repair a broken hip. During her stay at the rehabilitation facility, she woke one morning feeling nauseous and began vomiting blood. The rehabilitation physician believed that the patient had an upper gastrointestinal bleed for which she needed to be hospitalized. She was immediately taken to the emergency department at the acute care hospital located on the same campus as the rehabilitation facility. She was evaluated and monitored in the hospital emergency department for two hours and then moved to the hospital’s intensive care area for continuous monitoring and treatment. Complications caused her death in the early hours of the subsequent morning. Her estate subsequently filed a lawsuit for an EMTALA violation, alleging that the patient was not stabilized as mandated by the Act.
1. What initial care should the patient have received in the emergency center? 2. Did the emergency department staff meet the standards of care for a patient with these presenting signs and symptoms? 3. Was the admission to the intensive care area a violation of the EMTALA law? 4. How would you decide this case and what provisions of the EMTALA law would you anticipate the court enumerated in its holding?
You be the Judge Chapter 20 (Guido, P. 415)
The patient was a detainee, not yet proven guilty, who was being held in the county jail pending trial on felony charges of dealing controlled substances and creating a public nuisance. The patient suffers from a blood clotting disorder that causes him chronic pain. He was prescribed OxyCon-tin for this pain by his current physician. The patient was seen and evaluated as part of his booking into the county jail. Instead of prescribing the OxyContin for him, the jail physician prescribed Vistaril, clonidine, and Donnatal to manage his narcotic withdrawal, started ibuprofen and Tylenol for his pain management, and continued the metroprolol, Coumadin, and Nexium that he had been taking. The jail nurses administered these medications per the physician’s orders. The patient continued to suffer chronic and debilitating pain while in the county jail and, on his transfer to the state prison system, he brought a lawsuit against the county jail physician and nurses for violation of his Constitutional rights.
1. Should the nurses have blindly followed the physician’s orders and continued the ordered medications, which varied significantly from his pre-jail medications, specifically his medications for pain? 2. Was it deliberate indifference to the patient’s medical needs to change his pain medications in the belief that he needed to withdraw from narcotics?
3. What more could the nurses have done to prevent a lawsuit from being filed for an Eighth Amendment violation? 4. How would you expect that the court decided this case?
You be the Judge Chapter 21 (Guido, P. 440-441)
An elderly woman was admitted to the hospital from home, then admitted to a skilled nursing facility for rehabilitation, and then to an assisted living facility. She had chronic kidney failure that required dialysis. Sometimes her mental status deteriorated into confusion, usually just before her dialysis appointments. At some point, she also suffered a stroke, which seemed to affect her cognitive status. Over the course of a few weeks, she spoke with an attorney several times on the phone, discussing with him how to write her last will and testament. She had had a life-long rift with one of her siblings and chose not to give any-thing in her will to the now deceased sibling’s children. She also wanted to give substantial amounts to charity rather than to her other two siblings and their children. The attorney mailed her will to her at the assisted living facility. The social worker and a second individual from the facility’s staff witnessed her signature on the document in her room at the assisted living facility. When she died, the children of her estranged sibling contested the will and sued in court to have the will vacated.
1. What types of questions should be asked of the social worker and the other individual who witnessed her signature on the will? 2. What other evidence should be requested of the nursing staff to best ascertain her cognitive ability at the time she dictated how she wanted the will drafted and at the time she signed the document.
3. Does the fact that she had been estranged for some years from the sibling whose children are now suing factor into the final decision of the court? 4. How would you decide this case
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Solution
Medico-Legal Issues
Due to technological advancement, the conduct of medical practitioners operates under laws just in case anything goes wrong during or after treatment. The laws are meant to protect the patients and the practitioners from abuse and violations of the provided guidelines. For instance, there emerge problems during the administration of medication and conflicting roles between the practitioners and patients, and this is where the laws come in (Nkanta, 2018). The laws ensure the solution of the conflicting roles and ensure justice for the mistreated party through court processes. This paper below seeks to find solutions to several medico-legal issues by reviewing presented case studies.
Chapter 18 Case Study
The nurse was not negligent for not asking about the administration of morphine for the patient with abdominal pain. Morphine belongs to the opioid class of medication that is generally used to relieve moderate to severe pain (Murphy et al., 2022). From the provided case study, the admitted patient experienced severe pain that recorded 8 on a scale of 1 to 10. In the interpretation of the pain scale, the higher the value, the more severe the pain. The patient, therefore, had severe abdominal pain, and morphine was the drug of choice at that time. Therefore, the failure of the nurse to ask about the use of morphine for abdominal pain is not considered negligence.
Not knowing the patient’s blood pressure level during medication can impact the court trial. According to Murphy et al. (2022), morphine can reduce hypertensive patients’ respiratory rate and blood pressure. Injection of morphine can reduce arterial and systolic blood pressure within the patients. Reduced systolic blood pressure is an insinuation of the reduced pumping mechanism of the heart, and the low blood pressure prevails. Reduced blood pressure then leads to cardiac arrest due to the hypoxic condition of the body, and if the condition is not rectified, death can prevail. From the information provided in the case study, the patient had high blood pressure, and subjection to morphine reduced the functionality of the heart and cardiac arrest resulted. Prior knowledge of the blood pressure could have prevented the medication administration and may have reduced the severity. Therefore, the judge’s ruling impacts the lack of knowledge of the patient’s blood pressure.
Before beginning any medication within any facility, there are some significant components whose values need to be taken; allergies, blood pressure, and age. Blood pressure being among the monitored components of these values needs monitoring before the start of medication to allow for any alternatives in case the presenting medication may be hypersensitive regarding the blood pressure. The nurses never considered the blood pressure that resulted in the patient’s death from the case study.
I would decide the case in favor of the family. Keeping track of the patient’s vitals is critical before subjecting the patient to any form of medication. From the information provided in the case study, the practitioners did not consider the blood pressure, and the failure led to the patient’s death.
Chapter 19 Case Study
At the emergency Centre, the patient ought to be screened to identify the reason for the vomit of blood. At the onset of the bleed, the physician only states he believed the patient had upper gastrointestinal bleeding rather than confirming through screening.
The patient should be given short-acting medication to reduce the bleeding as the patient is reported to be bleeding.
The emergency department did not reach the standards for care for a patient presenting similar signs and symptoms. The emergency department is responsible for helping in saving lives for patients in critical conditions. From the information provided within the case study, the patient needed short-acting medication to reduce the bleeding and reduce the experiences of nausea, but this is not the case (Murphy et al., 2022). We are only informed that the patient was monitored rather than given medication to suppress the symptoms experienced at the moment. Therefore, the emergency department staff did not meet the care standards to attend to such a patient.
The patient’s admission to the intensive care unit violated the EMALA law. The EMTALA law states that the emergency department calls or contacts the receiving hospital or facility to arrange successful admission. From the information provided from the case study, no contact is made. We are only informed that the patient was transferred to the intensive care unit after intensifying the signs and symptoms.
I would rule the case in favor of the patient’s estate in violation of the EMTALA principles by the facility. I would anticipate the Court to enumerate the policies and principles of the EMTALA in its holding as the estate had sued the facility over the violation of the EMTALA laws and guidelines.
Chapter 20 case study
One of the core roles of the nurses is following up and ensuring that correct medication is given to the patient. We are witnessing the physician discontinue the patient’s pain medication and opt for an alternative medication from the case study without any serious considerations rather than only presenting claims. The nurses should therefore look into the prescribed medication if they are recommended. Therefore, the nurses should not blindly follow the instructions provided by the physician.
The change of the patient’s medication did not consider his need for withdrawal from medication intake. The previously assigned medication is used together with the withdrawal medication, which is significant. Therefore, the change in the medication does not consider the patient’s needs. Although, it is stated that the patient was not willing to listen to instructions provided by medical personnel. The nurse should have carried out further investigations before blindly following the physician’s orders. We are only informed that he refused to attend outpatient treatment, but we have not been informed of details of the refusal.
The eighth amendment states that a prisoner’s deliberate indifference to illness or injury can constitute a violation of the eighth amendment. From the provided case study, the patient Is reported to have serious pain (Haddad & Geiger, 2021). However, instead of rectifying his condition, the physician changed his medications in claimed that the medication could effectively work with his withdrawal medication as the patient was previously under narcotics. Therefore, the nurses could have focused on the patient’s well-being by keenly analyzing the medication rather than blindly following the physicians’ instructions, preventing lawsuits from being filed.
The Court would decide the case in favor of the patient who is a detainee. The favor is because his rights are violated, and most medication is changed without consent. The nurses and physicians do not consider his health a significant issue despite protecting patients’ health being the sole function of nurses.
Chapter 21
The social worker and the other individual need to be asked whether they understand anything about privacy. Patient privacy is one of the ethical considerations of healthcare, and therefore no one, even the practitioners, is allowed to see patients’ private information, and a will is considered one of private information.
The social worker and the other individual should be asked whether they know the penalties for violating a patient’s privacy. The violation of rights has repercussions, and the social worker should be asked whether they are aware of any repercussions related to such violations.
The patient is aware of the differences she had with her diseased children and confirms that she would not write anything in the favor based on the difference they had.
The patient knows that will-writing requires several processes and further confirms the needed steps. The patient considers giving the substantial value of her will to charity home rather than relatives that she had disagreements with.
She was estranged from her children for several years does not affect the Court’s final decision. Writing a will is a personal decision and should not be interfered with in consideration of the time difference. The Court does not consider the time difference between when she was estranged from her children and when she wrote the will. The act of writing a will is personal, and therefore her decision cannot be interfered with in consideration of the time factor. Yes, it affects the Court’s final decision since the argument provided was on whether the patient could write a will.
I would decide the case in favor of the will. The will state that the relatives should receive nothing, and I will obey that regardless of the presented complaints. I will not take the case because it does not concern me, and I do not want to harm or benefit either party. I would request evidence of the emotional connections between the patient and her children before making a decision
Conclusion
In conclusion, the medical-legal guidelines provide guidelines for medical practitioners and patients to feel that their rights are valued and respected. The case studies presented several legal issues in healthcare whose solutions depend on critical and significant internalization of the principles of medical-legal issues.
References
Haddad, L. M., & Geiger, R. A. (2021, August 30). Nursing ethical considerations. NCBI; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526054/
Murphy, P. B., Bechmann, S., & Barrett, M. J. (2022). Morphine. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526115/#:~:text=Morphine%20can%20decrease%20heart%20rate
Nkanta, C. (2018). (PDF) Medico-Legal Issues in Clinical Practice: An Overview. ResearchGate. https://www.researchgate.net/publication/336402648_Medico_-Legal_Issues_in_Clinical_Practice_An_Overview
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