Question A (Research Questions)
Right of Individuals vs Right of the State
What are effective policy guidelines for the implementation of EMR in public and private health institutions?
The cost of Healthcare
The federal Patient Protection and Affordable Care Act increases health insurance covers to individuals. What are the priority considerations for federal and state governments in regards to the Affordable Care Act?
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Global Pandemics
Global pandemics such as Covid-19 hits hard, especially on low-income families. Consequently, the medical treatment costs for the diseases are often high for families to afford. Should health institutions provide free treatment for global pandemics?
Human Testing
The issue of exposing health results have both legal and ethical perspectives. Some argue that test results such as individual HIV status should be made public for other health reasons. However, most people are against the issue of exposing individual test results. Should individual health test results be exposed to the public?
Vulnerable Populations
Vulnerable populations are often exposed to issues such as homelessness. Some health institutions have taken it upon their duty to provide services like homeless shelters. What is the corporate role of health institutions in supporting vulnerable populations in society?
Question B
Medicare
Since the creation of Medicare in 1965, the eligibility age has been 65 years for individuals without disabilities (McGuire et al., 2011). There is a need for some proposals to gradually raise the eligibility age from the current 65 years to 67 years so that elder people aging 65 years and above can enroll in the Medicare coverage through an employer plan or government program like Medicaid or buy their health insurance coverage using health insurance exchange or individual market. Both social security funds and Medicare were designed for retired citizens. Therefore, setting the normal eligibility age of the program at the age where the nation has decided that retirement should typically begin would make sense.
Proposal to revise the traditional Medicare benefit design has been raised in both Medicare reform discussions and the federal budget, including the House Republican health plan of 2016 as a wider set of proposed modifications to Medicare. Some of the benefit design proposals include a single deductible for Part A and B of Medicare services, revised cost-sharing guidelines, and a new yearly cost-sharing limit, alongside limitations on “first-dollar” Medigap coverage. Other proposals include more financial protections for low-income individuals who are beneficiaries of the program. These proposals are aimed at reducing federal spending, clarifying Medicare cost-sharing, and providing individuals in the traditional Medicare program with protection against high medical costs, providing low-income beneficiaries with more and better financial protections, and minimizing the need for Medicare beneficiaries to purchase supplemental health coverage. Other issues that need to be reflected on Medicare includes finding payment systems for supporting parts of clinical research, technological innovation, medical education, and also care for the medically impoverished population.
Healthcare Quality Improvement Act of 1986 (HCQIA)
U.S. Congress in 1968 passed the Federal Health Care Quality Improvement Act in partial response to Patrick v. Burget, et al., and also as a response to what was discerned to be a massive health malpractice crisis in the United States. There was a significant rise in medical malpractice lawsuits during the years before the ratification of HCQIA. The argument was that health professionals with a history of medical malpractices could easily move from one state to another without any interstate reporting mechanism in place. The HCQIA was intended to provide a solution through peer review. To promote effective peer review in the healthcare profession, the Act protects against damages to physicians participating in peer review. Peer reviews are meant to discipline unethical or incompetent health professionals to protect the public against them. Under HCQIA, peer reviewers and hospitals are granted immunity from litigations made by appropriately sanctioned physicians. However, HCQIA has been criticized for extending the immunities to false peer reviews.
One of the issues that have been brought up about HCQIA is that action of hospitals can have factual errors, yet still be unsusceptible from liability. This seems to fully contradict the training offered to health practitioners, who learned during their medical studies that they should uphold the truth and their ability in medical practice should be based on facts rather than fictions. Various organizations have recommended some desperately needed modifications in regards to Health Care Quality Improvement Act.
The HCQIA, as currently used in the private healthcare setting, does not seem to adequately serve its intended objective of protecting the public and enhancing quality care (Nowakowski et al., 2016). Moreover, due to poorly defined standards in the peer-review process and lack of enforcement of due process, the possibilities of violating the liberty and property rights of targeted doctors are high. Because of the risk of injury, the HCQIA is unnecessary or outdated. Therefore, it needs some modifications in the current healthcare setting. There is a need for better-defined care standards and ensuring that due procedures and processes are followed by either repealing or amending some sections of HCQIA. This would help in preserving the constitutional rights of American physician caretakers, thus help improve healthcare quality.
Stark Law
Stark Law, also known as the “ethic in patient referral Act” is attributed the legislative prowess of Pete Stark, (D) California. The original purpose of the act was to bar healthcare professionals from referring patients to specific health service institutions or entities in which they had a financial interest (Sutton, 2011). In some instances, doctors can refer their patients to certain health institutions. However, in reality, the physicians may do so out of self-interests. Put another way, the physicians may have vested interests and stakes in such health institutions, therefore, they can benefit financially from the referrals. Critics of this practice argue that an intrinsic conflict of interest provides a healthcare professional’s position to benefit from such referrals. They allege that such arrangements may promote excessive and unwarranted use of services which results in higher healthcare costs. Moreover, they argue that it would result in the captive referral system, which restricts competition by other healthcare providers.
At the time Stark Law was enacted, Medicare was using the fee-for-service payment method. However, the program has undergone some changes to emphasize quality instead of quantity of health services provided. This has sparked debates around how Stark Law discourages value-based and care coordination arrangements. After acknowledging that the law blocks coordination of patient care and incentivize healthcare professionals in providing high-quality care, the Department of Health and Human Services recommended changes to address these particular concerns.
The healthcare industry has transformed and shifting towards a value-based care model. The Stark Law Regulations are likely to hinder the move towards value-based care. The old federal guidelines that expound and implement this particular health law was created for a healthcare system that compensates healthcare providers for a fee-for-service basis, with the financial incentives aimed at delivering more services. However, the modern health care system is constantly shifting towards financial arrangements that reimburse healthcare providers who achieve success in keeping patients healthy and out of healthcare units, where payment is associated with value instead of volume.
QUESTION C
Subjecting patients to a mandatory Body Mass Index (BMI) evaluation and surcharge would violate both the legal and ethical obligations of the hospital. The healthcare organization would be basing their assumption on the argument that a patient’s behavior solely contributes to their BMI level, and hence, they should be held responsible for it. This is, however, not true because obesity is a multifactorial chronic illness with complex environmental (cultural and social), physiologic, psychological, metabolic, behavioral, and environmental causes. The hospital should consider the legal and ethical aspects of this decision. Furthermore, subjecting patients to mandatory BMI testing would compromise their privacy. Obesity-related illnesses are health conditions often associated with bias among physicians and other healthcare professionals, and this bias may lead to inadequate care for patients with obesity or disrespect towards them. The organization should concentrate on patient-centred counseling programs regarding medical risks related to obesity, and also on goals and strategies for improving patients’ overall health.
Organ donation should be a personal decision, thus forcing such consent on an individual in exchange for shelter sound quite unethical. Furthermore, the hospital should not force its religious beliefs on residents of homeless shelters. There are other means that the hospital can explore to fund its operations rather than exploiting homeless individuals for services such as free labor. The health organization needs to obtain consent from the individuals regarding organ donation rather than “blackmailing” them in exchange for homeless shelters. Many bioethicists and physicians believe that invading an individual’s body without their ‘informed consent’ amounts to absolute disrespect of the deceased. Ensuring that a patient provides informed consent before participating in a clinical intervention or procedure is considered a legal and ethical requirement of healthcare
Reducing staff members would likely compromise the quality of services offered by these particular departments, hence contributing to the overall low quality of service delivery by the hospital. The hospital risks losing competent employees working in these non-revenue generating departments. Moreover, the organization should be mindful of wrongful termination laws. A fired staff can file a lawsuit against the organization on the basis that the dismissal breached an employment contract or a public law. Various state and federal laws prevent employers from dismissing employees without a ‘lawful’ reason. Usually, these termination laws apply whether the employee is working under a contract or at will.
Establishing a fund for defraying patient expenses incurred due to a stay in the hospital is a good move. However, while it is part of the healthcare organization’s goodwill and community outreach measures, implementing a forced contribution to the hospital employees need ethical considerations. The decision to support contribute should be based on an employee’s willingness, rather than on a forced basis. By law, employers are not allowed to make a unilateral cut on an employee’s salary. Even in exceptional circumstances such as recession, the employee should be informed of the implications of any subsequent payments. The law prohibits employers from forcing employees to take a pay cut against their will.
On-job injuries and employee sick time should are normal misfortunes thus should be treated as such. Apparently, no employee would wish to have sick time or on-job injuries. Mandatory health screening should be done to promote the general health of an employee rather than to minimize sick leaves. The hospital must consider the cost of such decisions within the employee’s medical cover.
Any modifications of employment terms between the hospital and an employee should be done within the ethical and legal frameworks (Harris, 2014). Termination of an employment contract should be done from the perspective of signed agreements between the institution and the employee. Again, the organization should be mindful of wrongful termination laws. A fired staff can file a lawsuit against the organization on the basis that the dismissal breached an employment contract or a public law. Various state and federal laws prevent employers from dismissing employees without a ‘lawful’ reason. Usually, these termination laws apply whether the employee is working under a contract or at will.
Medical professionals have a medical obligation to protect the confidentiality of their patients. Seeking for a patient’s consent to use their treatment information or photographic images does not only attract ethical concerns but also legality issues of such conducts. Furthermore, a health institution should not deny any individual admission on such basis or any other reason whatsoever. Social media are web-based mobile technologies that are increasingly applied in healthcare to support patient-centred care. The use of social media can have related risks to nurses as a result of unprofessional conduct and privacy violations. The information posted on social media platforms such as Twitter, Facebook, Instagram, and others is often accessible to the public, and anyone can post information that is not verified or false information. There are also privacy concerns related to social media use as some nurses usually violate patient’s confidentiality by posting photographs and information of patients without their informed consent. Violation or breach of patient confidentiality often occurs when a nurse shares or posts information of a patient, including even slight details with an individual or group of people who are not authorized to access such information. For example, a nurse may post reflecting on the severity of an accident that a patient was involved and the victim’s injuries or making a comment on the medications that have been prescribed for a patient.
Question D
Mr Auritz’s conduct amounts to corruption, thus exposing patients to health risks of bacterial infection. The ethical issue of corruption in healthcare is multidimensional, and usually take various forms, for example, the purchase of equipment/instrument. The first step I would take in regards to this case is immediately recommended for the closure of the hospital’s surgery unit. Next, I would launch investigative efforts against the alleged ethical misconduct of the staff surgeon and recommend his suspension from the hospital due to the pending investigation. I would then advise the hospital management to reconsider their use of after-market cardiac implant devices and go for FDA approved ones.
Hospitals have an ethical obligation to admit to patients. The act of Admitting clerk, Alicia, to deny Finley admission was wrong both on legal and ethical grounds. The hospital risks. Denying a patient hospital admission is a breach of the hospital’s fundamental duty of care. As a compliance director, I would recommend for suspension of Alicia’s practice license for one year pending an investigation into her conduct. It is because of her negligence of duty that eventually led to Finley’s death. The hospital should follow ethical guidelines regarding Finley’s step father’s request to take the baby from the artificial life-support machine.
Dr. Reap and Dr. Hyde’s conduct of harvesting patient’s organs are both acts of theft and corruption. Hospitals must enter into agreements with patients before their death and seek their consent regarding organ donation (Stanford & Connor, 2014). I would first report the matter to the hospital’s top management and make recommendations for investigations into Reap and Hyde’s conduct. Their charity actions do not justify the illegal and unethical harvesting of dead patient’s organs without their consent.
There are four main ethical priorities in the use of electronic medical records (EMRs). These include patient privacy and confidentiality, security breaches, data inaccuracies, and system implementation. Patients have the right to keep their health information, and the hospital has a legal and ethical duty to protect this right. I will report and discuss the matter with the organization’s top management and propose policy guidelines regarding the use of EMR in the organization.
