Leadership, Ethics, and the Law

A brief explanation of the issues and considerations at work in the Incident in the ER scenarios. Explain the lesson(s) you see illustrated in this comparison and the principle(s) that you would identify to guide legal and ethical decision making in healthcare settings. From a leadership perspective, explain your recommendations for nurse executives on safeguards to avoid “incidents” like that portrayed in Part 1 and responses to ensure the outcome in Part 2. Support your post with Learning Resources or current literature.

Incident in the ER – Scene 1 Program Transcript

MALE SPEAKER: Last night, an 83-year-old patient arrived at the hospital emergency room with his daughter. The patient had diabetes and was suffering from respiratory distress. What happened next raised questions about whether or not the ER staff behavior legally and ethically when determining the patient’s autonomy.

The next day, the hospital’s director of emergency services met with me, the director of risk management, to debrief me about the incident. She asked for the meeting because she knows that mistakes were made.

So tell me what happened.

FEMALE SPEAKER: Well, last night, around 6:00, a Mr. Hector Jimenez was brought to the emergency room by his daughter Maria. Mr. Jimenez Is 83 and a diabetic. When he arrived at the emergency room, he was suffering from respiratory distress. He was then examined by the physician on duty, who found that he had gangrene in his right foot up to his ankle. His daughter also stated that he had been diagnosed with Alzheimer’s.

MALE SPEAKER: Was a preliminary assessment done?

FEMALE SPEAKER: Yes, and according to the ER staff’s assessment, it was consistent with mild dementia. However, one of our nurses noted that part of the confusion may have been brought on by his respiratory distress and that the atmosphere of the ER could’ve also attributed to his disorientation.

MALE SPEAKER: Who was assigned to take care of him?

FEMALE SPEAKER: Let’s see, that would be Dr. Jason and Nurse Hattie. And because of the severity of the gangrene in his right foot, Dr. Jason recommended performing a below the knee amputation, but the patient refused at that point.

MALE SPEAKER: Take your time. What happened next?

FEMALE SPEAKER: Let’s see, a social worker, Carol Grimes, was called into interview Mr. Jimenez and his daughter. Mr. Jimenez told the social worker and the doctor that he had lived long enough and that he wanted to die with his body intact. Of course, the daughter disagreed with that, and she wanted the amputation performed immediately. She also said that she wanted her father to be taken home as soon as possible and threatened to sue the hospital if we didn’t cooperate with her.

MALE SPEAKER: Must’ve been quite a scene.

Incident in the ER – Scene 1

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FEMALE SPEAKER: Yes, it was. The amputation was performed, and I’m just waiting to hear back from the surgical team now as to the outcome and to the patient’s current health status.

MALE SPEAKER: Anything else to report about what happened?

FEMALE SPEAKER: A couple of things– in the nurse’s medical report the nurse reported that the patient was diagnosed with mild dementia. She also notes in there that the patient might be more lucid if he was moved to a ward where he could receive treatment for his respiratory condition. But at that time, Dr. Jason went ahead and called the on-call surgical team, and the surgery was completed at 2:00 AM.

Something else– the social worker, she also reported that the daughter might be afraid of an elder neglect investigation if her father died. In her opinion the daughter failed to provide proper care for her father and should be reported for suspected elder abuse or medical neglect. While the father suffered advanced gangrene in his right foot, the daughter did not seek care for the open wound but instead saw care for the respiratory problem.

MALE SPEAKER: So what do you think about what happened?

FEMALE SPEAKER: Well, I think we have good, competent people working in the ER. No one wants a lawsuit, but I think mistakes were made, and I need your help in identifying them. I’m feeling really overwhelmed right now, and I’m worried that maybe we amputated the leg too soon without consideration for the patient’s mental status.

This scene contained information about numerous errors that were made by the emergency room medical team when dealing with the patient and his daughter. Now it’s your turn to get involved. Assume that you’re the director of risk management. Tell the director of emergency services what specific policy errors you spotted in her oral report.

Incident in the ER – Scene 1 Additional Content Attribution MUSIC: Creative Support Services Los Angeles, CA Dimension Sound Effects Library Newnan, GA

Incident in the ER – Scene 1

© 2015-2019 Walden University 3

Narrator Tracks Music Library Stevens Point, WI Signature Music, Inc Chesterton, IN Studio Cutz Music Library Carrollton, TX