Use your knowledge of nursing and the following articles for this homework assignment/case analysis.
1. 42 U.S.C. §1395dd(a)-(e). Available at: https://www.law.cornell.edu/uscode/text/42/1395dd
2. EMTALA – INFO A guide to the Emergency Medical Treatment and Active Labor Act and Court Opinions Interpreting This Federal Statute: Screening Requirements. Accessible at: http://emtala-info.com/screening-requirements/
Think of yourself as both a lawyer working for the hospital whose job it is to provide the CEO an understanding of the legal issues arising from a care issue that occurred a patient that presented to the hospital’s emergency department and as a nurse or physician.
When presenting a legal case to the CEO you will want to provide a thorough yet brief understanding of the facts, potential legal issues including potential violations of EMTALA as well as potential medical malpractice claims.
Please consider the following scenario to complete this assignment:
Susan Power was brought by her fiancé to the emergency room at Arlington Hospital on February 24, at approximately 5:45 a.m. At the time, she was 33 years old, unemployed, and had no health insurance. Arlington Hospital is a large 400 bed teaching hospital with the most current and up to date equipment and facilities.
Upon arrival to the emergency department, Power complained of pain in her left hip, lower left abdomen, pain in her back running down her leg, and that she was unable to walk. She was shaking and had severe chills. Power also had a sizeable boil visible on her cheek that she reported she had tried to “pop” earlier that week.
Power was initially taken to a treatment room and seen by a nurse, Barbara Goldy, R.N., who took a brief medical history from her, did a nursing assessment that indicated the patient could not walk, was shaking and felt chilled. Along with the medical information recorded on Power's chart were also the notations that indicated that she was unemployed and uninsured.
Power was next seen by an emergency room physician, Dr. Heiman, who spoke with her, examined her hip, did a motor examination and leg extension test, all of which were within normal limits, and ordered x-rays of her hip. No other tests were ordered.
Another nurse, Christine Stadher, R.N., completed the patient information data and took Power's vital signs, including her blood pressure, all of which were within normal limits. Nurse Stadher, also indicated that Power was complaining of pain in her abdomen and her back that ran down her leg. The boil on Power’s cheek was not documented anywhere in the nursing notes.
Shifts changed at 7:00 a.m., and Dr. Semmes, another emergency room physician, examined Power. Dr. Semmes did not look at the patient intake information, he did look at the x-rays that had been taken but did not record the results of the x-ray on Power's chart. He did record on Power's chart acute left hip pain of unknown etiology. Dr. Semmes performed a neurological examination he documented a normal assessment but did indicate that "she did not look ill in terms of toxic, but she was uncomfortable." He ordered a urinalysis test; he did not order any other diagnostic procedures, including a blood test.
Based on his examination, Dr. Semmes believed that Power's pain was localized and musculoskeletal in nature, and that she did not have an infection and was not ill. The hip x-ray was negative in all respects. Before the results of the urinalysis came back from the lab, Dr. Semmes discharged Power. He gave her a prescription for anti-inflammatory and pain medications and instructed her to avoid bearing weight on her left leg. Dr. Semmes also told Power that if her pain persisted or became worse, she should return to the emergency room or call the orthopedic surgeon whose name, address, and phone number he had given to her in her discharge paperwork.
After Power was discharged, Dr. Semmes, told the charge nurse that he probably would have ordered some more tests to see if there was something else going on but he knew there was no way she would ever pay for any of it since she was unemployed and didn’t have insurance. When her pain worsened, Power returned to the Arlington Hospital emergency room at approximately 10:15 p.m. on the following day, February 25th. She presented with the same symptoms as the day before except that by this time she was in a very unstable condition with a very low blood pressure and elevated heart rate. Her vital signs signified that she was in severe shock, which the doctors believed was probably septic in nature, and she was admitted to the intensive care unit at Arlington Hospital at approximately 1:00 a.m.
An orthopedic surgeon concluded that the hip pain was not the source of Power's problems. The hospitalist in consultation with an infectious disease specialist, decided to treat her with antibiotics pending the results of a blood culture. The ultimate etiology of Power's illness was that she had "seeded" an infection in her blood approximately 10 days earlier when she had attempted to lance the boil on her face.
Power was in critical condition for the first several months of her hospitalization. Because of her level of shock, the medications required to control her infection and maintain her blood pressure, and the circulatory problems caused by these medications, Power had to have both legs amputated below the knee. She also lost sight in one eye and developed severe and permanent lung damage. By mid-April, Power's status was no longer critical.
On July 1st, Power was transferred to a rehab facility where she stayed as an inpatient for 6 months while recovering her strength and learning to walk with the use of prosthetics. She is unable to do any physical activity without supplemental oxygen because of her lung damage.
Use the following structure to help guide your analysis:
a. Identify the main issue in the case.
i. Phrase the issue of the case in the form of one or two brief statements.
b. What are the facts of the case?
i. These should be summarized in clear, concise, and chronological statements. Only the major facts, important to the issues in the case, should be included.
c. Were the 2 basic guiding principal obligations of EMTALA breached?
i. Explain each guiding principal and the required obligation(s) to the patient.
ii. Apply the facts of the case to the 2 basics guiding principal obligations of EMTALA, and describe in detail how the obligations were upheld or breached.
d. Assume that the patient has a valid medical malpractice claim. What would the basis of the claim be?i. What elements must be proven for the patient to prevail on a medical malpractice claim (negligence claim)?
1. Apply the facts of the case to the elements required for the plaintiff to prevail.
2. What defense could the defendant(s) have to the plaintiff’s medical malpractice claim?
e. What penalties may the defendants in the case be subject to if a violation of EMTALA is found?
f. What damages may be awarded to the patient if she prevails on a medical malpractice claim?
a.
i.The actual reason behind her Power symptoms are problems are she had seeded an infection in her blood 10 days earlier when she had attempted to lance the boil on her face.Actually her condition is septic in nature but instead of doing the blood tests and culture the doctors in the Arlington hospitals gives priority for giving the X-ray for diagnosing of disease but during the admission she reported that that she had tried to "pop"earlier that week.The emergency room doctors tried to manage the problems of the hip and leg.The main issue in this case is instead of treating the sepsis the doctors are given main importance to the problems of pain in hip,leg and abdomen thus conditions goes severe as day by day to a severe sepsis.
b.
i.Susan power she is unemployed nad uninsured and arrived to the emergency department of Arlington hospital with the complants of pain in left hip,lower left abdomen,pain in her back running down her leg thus she was unable to walk with shaking and severe chills.She complaints of boil on her face but any where in the doctors or the nurses notes it were not charted where the shift of the doctors and nurses changed no one reported regarding her boil on her face.Allthe test has done to confirmthediagnosis of pain in the hip,abdomen and leg by physical examination,motor examination,X-rays and no one prescribed regarding any blood tests and urine tests and her vital signs also are normal.According to the physical examination the doctors beleived that her pain is localized in nature and according to that they prescribed anti-inflammatory medications and instructed to avoid bearing weight onher left leg nad discharged the patient.She again readmitted in the same hospital with the same complaints on the following day with the same condition with an unstable condition and her vital signs shows the signs of severe shock and shows her conditions as septic in nature and shifted her to the intensive care unit.The orthopaedic surgeon concluded that her condition is not related to the hip problem and the hospital consultants diagnosed it as a infection and suggested to treat her with antibiotics.Her condition was critical level because of her level of shock and she is treated with antibiotics and amputated her leg below the knee and the circulatory problems arise due to her medications and lost sight of one eye and developed severe and permanent lung damage and the conditions was not critical after several months after hospitalization.She is on supplemental oxygenation because of her lung damage and was transfered to rehab facility where she is stayed as inpatient for 6 months and she recovers her strength and learning walk with the use of prosthetics.
c.
i.
*Accurate history taking and physical examination
*Correctly handovering of patient condition to the next shift staff
*Timely diagnostic tests
*Early detection of diagnosis actual treatment
*correctly discharge of patient after getting the timely management and treatment
ii.
*Improper history collection and improper charting of patient problem (where no staff were not mentioned regarding her problem of boiling in her cheek)
*Improper handovering of patient problem to the next staff
*Delay inproper diagnosis (any way patient is having shivering and chill while admitting and also reported regarding that she had tried regarding "pop" on her face during the admission she has boil on her cheek)
*Delay in diagnostic studies
*Early discharge without proper diagnosis and treatment
d.
i.surely,the patient has a valid medical malpractice claim where after the initial admission of the patient the staff who cares the patient ignores the patient main subjective data and as well as delay in proper diagnostic studies for the detection of case/disease of the patient.
She can have the right to go for the medical claim regarding the breach of duty by the staff cared during the initial admission,thus when during the readmission her condition was gone to critical and serious to a stage of severe septic shock.
1.The plantiff or defendant,who substantially prevails against the other party.Here if a written offer of compromise made by either party is not accepted by the either party is not accepted by the other party within 30 days after receipt and the party not accepting such offer fails to obtain a more favourable judgement,the non accepting party shall not be entitled to recover its costs of suit and reasonable attorney's fees and costs and shall be obligated to pay the costs of suit and reasonable attorny's fees and costs incurred by the offering party.
2.Hire expert witnesses,select a jury,make an opening statement,cross-examine the plaintiff's witnesses,testify a trial,deliver a closing argument,wait for verdict,file a motion to reduce damages
e.The civil penalties (financial penalty) may the defendants in the case be subject if a violation is found.
f.As a financial penalty the average payout for a verdict or settlement in a medical malpractice claim nationally is approximately is $242,000
Use your knowledge of nursing and the following articles for this homework assignment/case analysis. 1. 42...
Please provide citations using APA-style and provide links to resources as well as a bibliography. a. Identify the main issue in the case. i. Phrase the issue of the case in the form of one or two brief statements. b. What are the facts of the case? i. These should be summarized in clear, concise, and chronological statements. Only the major facts, important to the issues in the case, should be included. c. Were the 2 basic guiding principal obligations of EMTALA breached?...
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