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Case Study on Ethical Decision Making

The Office of the CEO Monday Morning 9 am
Prologue. Sarah Jones was discharged from the hospital after a two week inpatient stay. During her time in the hospital it was determined that she had suffered permanent damage to her kidneys. Though the extent of the damage was unknown, the specialist who had treated her was not optimistic about Sarah’s long-term prognosis.
Background: West Texas Community Hospital (WTCH) is located in a rural area of west Texas and is part of a three hospital system. The nearest Level III hospital is 50 miles away, however due to the rigorous terrain, travel time to the facility can be up to 90 minutes. The nearest trauma hospital is three hours away. The CEO of this hospital is also the President of the three hospital system. While unable to offer emergency services, the WTCH does offer 24-hour acute care coverage with a nurse on site and a physician on call after normal working hours. Physician call is rotated among three family practice physicians each of whom resides within a 15 minute drive of WTCH.
WTCH maintainssix inpatient beds, but the hospital census is typically between one and two patients, none of whom have serious conditions. Patients with more serious medical conditions are typically transferred to the Level III hospital the next town over. Since WTCH is the only hospital in town, most of the population is empanelled to one of WTCH’s three family practice physicians. Empanelled individuals with non-emergent situations require a referral to be seen by specialists or other non-WTCH physicians.
The small hospital is staffed by four nurses and a pharmacist. Laboratory and radiology functions are performed under the immediate supervision of an experienced laboratory and radiology technician respectively with oversight from the trauma hospital. The culture of the hospital system emphasizes interprofessional collaboration which has been a hallmark of WTCH work environment.
In The Office of the CEO Monday morning 9 am.Dawn Rodriguez, Vice President and CEO of West Texas Community Hospital (WTCH) was reviewing her notes from the Sarah Jones case asJohn and Susan Jones, Sarah’s parents, would be in her office in less than 10 minutes. One question from the Jones’ which was certain to come up would be: “Why did WTCH wait almost 12 hours before transferring Sarah to a Level IIIhospital?” If this wasn’t enough, Dawn’s Assistant called on the intercom to say that Dr. Garcia,the WTCH physician who had first examined Sarah three weeks ago,was very concerned about speaking with Dawn prior to her meeting with the Jones.’ He was heading toward her office now.
Dawn took a deep breath and took a final look at her notes.
Saturday morning three weeks ago. It had been a busy week for Dawn Rodriguezand she and her staff were looking forward to the upcoming three day holiday weekend. Like the rest of the staff Dr. Benny Garcia, one of the three family practice physicians, was looking forward to some down-time during the long-holiday weekend. He and his wife had two small children and even though he was on-call he anticipated the opportunity to enjoy plenty of quality family time—toinclude a family picnic Saturday afternoon as the weekends had been relatively quiet for the past month.
Dr. Garcia had worked at WTCH for the past three years was well-liked and highly respected in the WTCH community and by his fellow physicians. Consequently, his patients and the hospital staff were saddened by the news that Dr Garcia and his family would soon be leaving the rural community and moving back to the “big city.” Dr. Garcia was the frontrunner for a position within a highly successful and growing multi-specialty group practice in Houston, TX, Dr. Garcia’s hometown.
At 9:30 am on thatSaturday morning, Susan and John Jones presented to WTCH with their two year old daughter, Sarah. She had been sick with flu-like symptoms for the past two days and according to her mother seemed to be increasingly lethargic.Once Sarah and her parents had been checked into the acute care clinic and placed into an exam room, the nurse on duty took an initial assessment and determined that Dr. Garcia should be called in. Dr. Garcia came into the hospital to evaluate the child within 20 minutes of being called. Sarah’ssymptoms were similar to those associated with the flu and flu season had just started.
Primarily to allay the concerns of Sarah’s parents, but also to be safe, Dr. Garcia ordered appropriate lab tests. The lab technician was having difficulty recalibrating the lab equipment and so could not process the blood work quickly. The technician did note that the request from Dr. Garcia was routine and not a Stat request. Given that Sarah most likely had the flu, Dr. Garcia decided that he could check the lab results later—he was already late to his picnic.
Before leaving he provided follow-up instructions to the parents who then took Sarah home.Once the laboratory technician completed calibration of the lab equipment—she had been petitioning the hospital for a new machine as the current unit was increasingly proving difficult to calibrate—she processed the blood work ordered by Dr. Garcia. She then placed the test results in her outbox and returned to studying for the final exam in a college course she was taking. It was now 3 pm.
That Saturday evening at 6 pm, Dr. Garcia called the lab for Sarah’s test results. He was surprised when the tests indicated that the white blood cell count was significantly elevated. He contacted the parents and asked them to bring Sarah back to the hospital. Dr. Garcia met John and Susan at 6:30 pm that evening and reexamined Sarah. Her fever had elevated since her initial examination. Further, her very low blood pressure and listlessness caused him concern.
Dr. Garcia ordered additional Stat lab work. Results were provided within 15 minutes. Dr. Garcia then quickly decided that Sarah should be transported to more definitive care as he believed she was becoming septic. Sarah was immediately transferred to the neighboring Level IIIhospital via ambulance and arrived at8:45 pm. She was admitted and immediately placed on high potency antibiotics for septicemia, a life-threatening diagnosis. By Tuesday morning Sarah could no longer urinate as she was experiencing the early stages of renal failure.
In the Office of the CEO Monday Morning 9 am. In completing her review of the facts related to Sarah’s case, Dawn read the final bullets from her notes.
• Sarah Jones was discharged from the Level III hospital after a two week inpatient stay.
• The specialist who had treated her at the Level III hospital determined that Sarah had suffered permanent damage to her kidneys.
• The extent of the damage was unknown, but the specialist believed that Sarah was likely to have health complications in the future related to the kidney damage.
• The information contained in a written statement provided by Dr. Garcia regarding his treatment of Sarah Jones was consistent with that collected by the CEO. He concluded his statement by declaring that for his part in the treatment he had maintained the standard of care. He also maintained that the Laboratory Technician should have contacted him once the results of the requested test were available given the significantly elevated white-blood cell count.
• Staff morale is a bit low. All are aware that the CEO has been conducting an investigation into the case and are speculating as to the outcome. Dawn’s assistant informed her that several members of the clinical staff have approached her regarding the status of the investigation. Her assistant’s sense is that they are concerned that she might be searching for someone to blame.
Had WTCH failed to provide proper treatment to Sarah Jones?If answering this question wasn’t difficult enough, Dr. Garcia, was headed her way. What did he want? Did he have additional information important to this case, or was he concerned about the possible impact that this sentinel event could have on his career? Her thoughts were cut short by a knock on her door.
Case Analysis:
(1) List the salient facts of the case.(Critical Thinking and Analysis) – what are the most important facts of the case?

(2) Sarah, represented by her parents, and Dr. Garcia are two primary stakeholders in this case. Describe the perspective and needs and/or desires of each, i.e. how does each view the situation and what is each seeking from the CEO? Are there other key stakeholders in this case? If yes, what are their perspectives and needs/desires? (Relate: Interpersonal Communication and Understanding, Critical Thinking and Analysis)

(3) Examine the above information from an ethical perspective using the four pillars medical ethics model put forth by Beauchamp and Childress discussed during the first semester of the program and summarized below. What,if any, ethical considerations emerge from your analysis? (Professionalism)
Important: Address all four principles of biomedical ethics, autonomy, Beneficence, Non maleficence, Justice

(4) Based on 1-3 above what are the critical issues facing the CEO?(Critical Thinking and Analysis; Collaboration) Address the issue on teamwork and any other. ect

(5)If you the CEO what action steps would you take to address the issues you have identified? (Relate: Critical Thinking and Analysis; Collaboration)

(6) Dawn’s boss, the President and CEO of the health system, has directed her to provide a one page summary of her analysis and proposed course of action related to the primary issues of the case. It is very important to Dawn that the president view her as fully capable of addressing these issues. Further she would like to make it clear that her approach is a collaborative one especially with regard to the clinical staff. As such, she is careful to write a well-reasoned and articulate report with the hope that the president will fully accept her assessment and proposal. Provide that one page report. (You may include attachments as necessary though they are not required).(Relate: Impact and Influence; Collaboration)

VERY IMPORTANT SECTION: Address in solutions, must write clearly and in a compelling way. Thank you.
(7) What is the most appropriate course of action for the CEOwith regard to Dr. Garcia? Why?
Very important

(8) What should the CEO say to Sarah’s parents during their meeting?

Competencies called upon to address this case
1. Interpersonal Communication and Understanding. Ability to understand other people including hearing and understanding the unspoken or partly expressed thoughts, feelings, and concerns of others as well as the ability to communicate one’s position with others.
2. Critical Thinking and Analysis. Ability to break a situation, issue or problem into smaller pieces or trace its implications in a step-by-step way.
3. Collaboration. Ability to work cooperatively with others as part of a team or group, including demonstrating positive attitudes about the team, its members, and its ability to get its mission accomplished, and the ability to effectively resolve conflict.
4. Professionalism. Ability to demonstrate ethics, sound professional practices, social accountability, and community stewardship.
5. Impact and Influence. Ability to persuade and convince others (individuals or groups) to support a point of view, position, or recommendation.
Philosophers Tom Beauchamp and Jim Childress identify four principles that form a commonly held set of pillars for moral life.

Respect for Persons/Autonomy Acknowledge a person’s right to make choices, to hold views, and to take actions based on personal values and beliefs
Justice Treat others equitably, distribute benefits/burdens fairly.
Nonmaleficence (do no harm) Obligation not to inflict harm intentionally; In medical ethics, the physician’s guiding maxim is “First, do no harm.”
Beneficence (do good) Provide benefits to persons and contribute to their welfare. Refers to an action done for the benefit of others.
Initial instructions

Academic major: Master in healthcare administration
IMPORTANT: This case study is worth 20% of the class grade. Therefore, it is extremely important for the writer to nail this assessment and fully exceed beyond my expectations.
The writer is responsible for reading the case study (3 pages) and answering eight equations to address the case study. critical thinking skills and brainstorming must be applied. It is very important for the writer to also use the competencies that are on pg.6(uploaded file) to address the case. There are no requirements for using references, but he writer may use them appropriately depending on their own judgment to reinforced the work and writing.
Everything needed will be on the the uploaded file along with additional instructions in red font.
Any questions or concerns?don’t h

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