Ethical & Legal

Healthcare institutions are responsible for the quality of care that is provided within their settings. Institutions need to ensure that the healthcare professionals they employ have a strong working knowledge of ethics and law to be competent and successful. A qualified professional knows how to provide safe, quality healthcare to a population of culturally diverse consumers. To address the needs of all patients, institutions can adopt models such as shared decision making, where patients are encouraged to share their preferences and needs with providers. On a daily basis, healthcare institutions must ensure that ethical dilemmas involving patients and providers are addressed.

Under certain circumstances, healthcare institutions and the professionals employed by the institutions can be sued by patients for negligence or malpractice.

For the Final Project of this course, you will analyze a court decision in which a hospital was found vicariously liable on a theory of apparent authority for professional malpractice in the form of negligence of an independent contractor. You will focus on facts pertaining to the medical standard of care, breach of care, and causation, and explain how they were applied to law. You will then use the facts of the case to identify an ethics issue and determine an ethical theory that would help provide a safe, quality healthcare experience for the patient. Next, you will apply a clinician–patient shared decision-making model to describe how the ethics issue could be resolved. You will also include a discussion about possible violations of the code of ethics in your given field. Lastly, you will augment or vary the facts of the case to create a hypothetical scenario that changes the outcome so that the hospital is no longer vicariously liable for professional malpractice in the form of negligence of an independent contractor.

The Final Project is divided into two milestones, which will be submitted at various points throughout the course to scaffold learning and ensure quality final submissions. These milestones will be submitted in Modules Three and Five. The final product will be submitted in Module Seven.

In this assignment, you will demonstrate your mastery of the following course outcomes:

Analyze the impact of healthcare-related policy and legislature with regard to culturally diverse healthcare consumers and providers
Determine ethical theories and decision-making models appropriate for healthcare providers to use for providing a safe, quality healthcare experience for the patient
Analyze the role of professional regulation, the standard of care, and codes of ethics in determining healthcare providers' wide-ranging accountability to self, their profession, their patients, and the public
Prompt
In this project, you will analyze a court case involving medical malpractice in the form of negligence. Using your analysis of the case, you will address the facts pertaining to the medical standard of care, breach of care, and causation. Further, you will use the facts from the original case to identify an ethics issue, determine an ethical theory that would help provide a safe and quality healthcare experience for the patient, apply a clinician–patient shared decision-making model, and augment or vary the facts of the case to change the outcome.

You will analyze the following case for your Final Project:

Popovich v. Allina Health System
Specifically, your case study must address the following critical elements:

Introduction:
Summarize the selected case, including information on the stakeholders involved, the problem, and the time period in which the incident occurred.
Medical Malpractice Component: In this section, you will evaluate the case to address the legal components, the malpractice policies similar to this case, and the standard of care given to the patient and how it was breached. Then, you will draw connections to how this malpractice case impacted stakeholders and healthcare consumers outside of the case.
Explain the key legal components of the case, including the nature of the issue and the rules that applied.
Determine relevant malpractice policies in place for addressing the issues within the case.
Analyze the malpractice case for the standard of care provided to the victim. Be sure to apply what the law states about standard of care to support whether or not it was breached in the case.
Analyze how the malpractice case would impact healthcare consumers from different cultural backgrounds. For example, would this case have a similar impact on a person from a culture different from the one in the case? How could this incident change the views of these healthcare consumers toward the healthcare system?
Assess the malpractice case for accountability based on its severity. To what extent was the healthcare provider held accountable?
Ethical Component: In this section, you will evaluate the case to identify the specific ethical issues and determine ethical theories and shared decision- making models that would help resolve the issue and provide a safe, quality healthcare experience. Then, you will propose and defend ethical guidelines for healthcare providers to follow in order to avoid future incidents.
Describe the ethical issues that led to the malpractice case and explain why the issues are credited with causing the incident. Support your response with research and relevant examples from the case.
Describe an ethical theory that would help resolve the issue and provide a safe, quality healthcare experience for the patient. Support your response with research and relevant examples from the case.
Select a physician–patient shared decision-making model and explain how it would provide a safe, quality healthcare experience for the patient.
Propose ethical guidelines that would have helped prevent the incident and would help the organization prevent future incidents.

Medical Malpractice Component

Key Legal Components

The central legal issue in this case was whether Allina Health System could be held vicariously liable for the negligence of the independent contractor physician. The general rule is that a hospital is not liable for the negligence of a doctor who is not a direct employee. However, the court applied the doctrine of apparent authority, which states that an employer can be held liable for the actions of a non-employee if the patient reasonably believed the individual was an employee. The rules that applied here were based on factors that would lead a patient to believe the physician was a hospital employee, such as the use of hospital uniforms, signs, and the lack of a clear disclaimer regarding the physician's independent status. The court found that because the hospital's public-facing materials and the overall clinical environment did not adequately inform the patient of the physician's independent status, it was reasonable for Mr. Popovich to assume the doctor was an employee.

Relevant Malpractice Policies

The case highlights the importance of institutional policies for managing relationships with independent contractors. Relevant malpractice policies that could have prevented the outcome include:

Clear Disclosure Policies: Hospitals should have a policy requiring all patients to sign a document explicitly stating that the physicians they are seeing are independent contractors, not hospital employees.

Credentialing and Oversight: Institutions must have robust policies for credentialing independent contractors, ensuring they meet the same high standards as direct employees.

Quality Assurance: There should be a policy for the hospital to oversee the quality of care provided by independent contractors, including a process for reviewing complaints and adverse events.

Standard of Care and Breach

The medical standard of care is defined as the level and type of care that a reasonably competent and skilled healthcare professional, with a similar background and in the same medical community, would have provided under similar circumstances. In the Popovich case, the physician breached the standard of care in several ways:

Failure to Obtain Informed Consent: The physician failed to adequately inform Mr. Popovich of all risks and benefits of the steroid injection, especially the rare but severe risk of infection, and did not discuss viable, less invasive alternatives.

Improper Diagnosis and Treatment: The physician did not perform a proper differential diagnosis to rule out other possible causes for the back pain and proceeded directly to an invasive and risky procedure without first trying more conservative treatments.

Failure to Monitor and Respond: When Mr. Popovich presented with worsening symptoms after the procedure, the physician and the hospital failed to respond with the necessary urgency and thoroughness, leading to a delay in diagnosing the severe infection that caused the paralysis.

Impact on Diverse Consumers

Sample Answer

Introduction

The case of Popovich v. Allina Health System centers on a lawsuit for medical malpractice against a hospital based on the negligence of a physician who was an independent contractor. The plaintiff, Mr. Popovich, suffered severe paralysis and other complications following a steroid injection to relieve chronic back pain. The incident occurred after the physician, who worked in a pain clinic affiliated with the hospital, administered the injection. The core legal issue was whether the hospital could be held vicariously liable for the actions of a professional who was not a direct employee. The key stakeholders involved were Mr. Popovich (the patient and plaintiff), the physician (the independent contractor), and Allina Health System (the defendant). The problem was a tragic medical outcome that raised questions about institutional responsibility, informed consent, and the standard of care provided by independent contractors within a hospital setting.

Ethical & Legal

Medical Malpractice Component

Sample Answer

Introduction

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