John Parker, age 35, was a self-employed consultant. When he moved to Littlevill

Question

John Parker, age 35, was a self-employed consultant. When he moved to Littleville in 2012, he purchased health coverage for himself and his family from an MCO known as the Littleville Family Health Plan (the "Plan"). The Plan provides physician services to its enrollees through a participating physicians has entered into a written agreement with the Plan. The standard agreement explicitly provides that the physicians are not employees or agents of the Plan. The Plan does not provide copies of its participating physician agreements to the patients who are enrolled in the Plan. However, at the time that he enrolled, the Plan did send Parker an 87-page brochure. On page 54, the brochure from the Plan contained the following language: "We are very happy that you have chosen the Plan to meet all of your health care needs. To obtain services under the Plan, you will need to select a primary care physician (PCP) from the enclosed list of the Plan's participating physicians. Please note that these participating physicians are not employees or agents of the Plan."Parker did not know any doctors in the area, but he selected Dr. Susan Green as his PCP because she was on the list provided to him by the Plan. Dr. Green is a solo practitioner in private practice, and she leases office space for her practice in a shopping center in the suburbs of littleville. On July 15, 2013, Parker began experiencing dizzy spells. He called Dr. Green's office and made an appointment to see her the next day. On July 16, 2013, Dr. Green examined Parker in her office and made a diagnosis of Swinehausen's syndrome. The standard treatment for that medical condition is to prescribe one tablet of pentamite (10 milligrams) once a day for three weeks. In her discussion with Parker, Dr. Green explained the risks and benefits of pentamite as well as the alternative forms of treatment, and Parker consented to take the pentamite as recommended by Dr. Green. Dr. Green had a large supply of pentamite in her office, because a sales representative for a pharmaceutical company had given her several boxes as free samples. Rather than waste time and money by sending Parker to a pharmacy, Dr. Green simply gave Parker one of the sample boxes of pentamite. The dosage information from the manufacturer stated that the appropriate dose of pentamite was one tablet (10 milligrams), once a day for three weeks. However, Dr. Green misread the dosage information and instructed Parker, both orally and in writing, to take ten tablets ofetwork of independent physicians in private practice. Each of those pentamite (to milligrams each) once a day for three weeks. Parker did precisely as he was instructed by Dr. Green. At the end of the second week of taking the pentamite as instructed, Parker had a sudden heart attack and died. As the personal representative of his estate, Parker's wife filed a lawsuit in state court against Dr. Green and the Plan. According to the allegations set forth in the complaint, Dr. Green was negligent in her treatment of Parker by prescribing the wrong dosage of pentamite. In addition, the complaint alleged that Dr. Green had failed to obtain his informed consent to the pentamite treatment. Although Dr. Green had informed Parker about some of the risks of taking pentamite, she failed to inform him of the risk that she might prescribe the incorrect dosage and thereby cause his death. According to the complaint, if Dr. Green had properly advised Parker of the risk of prescribing an incorrect dose age of pentamite, he would not have consented to take that medication, and he would still be alive today. With regard to the Plan, the plaintiff alleged that it should be held liable for Dr. Green's negligence. In addition, the plaintiff claims that the Plan should be held liable for its own negligence in this case. question: Assess the case from the following perspectives: Ethical – identify the ethical principles involved in this situation from the perspective of the patient (John Parker), physician (Dr. Green), and the organization (Littleville Family Health Plan). Legal – what are the legal implications and what laws or statutes were involved? Provide two recommendations for how to manage this case from the perspective of the healthcare organization. What could have been done to prevent this situation? Recommend next steps to manage this case by the MCO.

Explanation / Answer

The interrelationships between biomedical ethics and the law are perhaps nowhere as starkly apparent as in the realm of medical malpractice. Although ethical and legal conduct and practices are often in harmony, in many areas ethical principles and the issues surrounding medical liability appear to come into conflict. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of futile care at the insistence of patients or families; and the various protections of Good Samaritan laws are just a few of these. In addition, the ethical principles governing the conduct of physicians serving as expert witnesses in medical malpractice cases have become a subject of intense interest in recent years.

Legally if observed patient provider relationship, there may be arguments to support both sides. The major supporting that the physician was negligent when prescribing the medication to Parker. The points that needs to be considered is that what was the physician involved when the negligence took place. Was he also juggling between taking care of another patient or was he into another work which is non-medical related causing him to be distracted from his duty to observe the medication dosage on the sample. The another point to be noted is the patient did oblige in following all the instructions properly but was he aware that any symptoms that he is not familiar with were cropping up due to over dose of the medication that would help him to avoid the heart attack at the end of the week.

Another point to be noted was that Parker being given the plan with a list of physicians. Parker was not aware of any physician in his area and hence randomly picked a physician without knowing his quality rating or past treatment or past treated patient ratio. These details would Parker to find an appropriate physician as affordable by the plan. Or the other way round would be that Parker would have done little research about the list that was provided by the plan and chose a physician as per his need. The blatant selection made him vulnerable to ill-treatment or mis-treatment. The plan being a defaulter one must have given the physician names along with the specialty and physician rating with their history information to make the patient easy to pick up a provider that suits his / her needs. But this was not provided as seen in this case, only a general list. The plan is at fault in this area of lack of information.

Manage this case from healthcare perspective:

To manage this case as a facility or healthcare perspective, the point to be noted is that facility was negligent in providing care within acceptable standards. This mishap would have been avoided only with little research and self-inspection. The fault being on both sides that the physician not reading dosage properly and the patient neglecting any strange symptoms till cardiac arrest. The physician is liable because only If he had given proper instructions and read the sample dosage properly, this could be avoided. The fact that the patient suffered symptomatic injuries which caused his death indicates that the negligence was on both parts causing the death of the patient making both liable.

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