How do they affect ones character? How are they acquired? How can they be helpful in resolving health care ethical dilemmas? (content cr

Healthcare in Turmoil

The United States healthcare system is one of the most complex systems globally. The complexities surrounding the health care system have led to an increase in issues that adversely affect the consumers and communities. They have also led to the nation being ranked last in most healthcare aspects among developed nations. The last decade saw major improvements in the system with the sole aim of improving access. The Affordable Care Act was one of the changes that improved access to health insurance leading to over 20 million people being able to access health insurance (Somberg 2013). However, several issues still plague the health care system and adversely affect consumers and communities.

High Cost of Healthcare

The United States has the highest health care spending compared to other developed nations. The expenditure on health care has been increasing over the years. This has increased the share of health expenditure on the gross domestic product. In 2020, the health expenditure was highest, accounting for 19.7% of the GDP. According to CMS (2021), U.S. health care spending grew 9.7% in 2020, reaching $4.1 trillion. This can be translated to $12,530 per person. The assumption is that an increase in health care expenditure should translate to quality services and other aspects of health care. The increase in health care expenditure also means an increase in health care prices over the same period.

The average health care prices have increased annually with the increase of health care expenditure. The Health Cost Institute (2018) report shows an annual increase in healthcare prices of up to 15%. What was being charged in 2018 is not what is being charged in 2018, as there has been an increase of 15%. The per-person spending between 2014 and 2018 grew at an annual rate of 4.3%, increasing to $5,892. It is estimated that the annual growth rate of health care prices will outpace GDP growth. Consumers and companies in the United States keep spending more on health care. The cost has increased annually, making it difficult for some consumers to access health services.

There has been an increase in certain costs like hospital admission prices, prices for medication, and other services like laboratory charges. This means the consumer has to spend more annually to obtain medical services. The consumer faces the risk of bankruptcy if they develop a severe condition. Those who are uninsured cannot afford the rising cost of health care in the United States. This increases the prevalence rate of certain diseases, which are highly expensive as communities cannot afford the rising costs. The rising costs of health care also mean the prevention of certain diseases in communities will become problematic. Those who cannot afford the prices and lack medical insurance have to contend with living with the condition.

Health Care Access and Quality

Health care access in the United States is uneven. In most cases, it is tied to employment. This is an issue that has been around since the Second World War when employers used healthcare to attract employees to their firms. A scenario like the economic crisis of 2008 and pandemics like the COVID-19 will decrease the number of people employed. This will mean fewer people have access to health insurance. The COVID-19 pandemic led to massive lay-offs in the United States and globally. This meant that those who had access to health insurance could not access health services. Through various provisions of the Medicaid and Medicare programs, the government provided safety nets during this period (Randy, n.d.).

The ACA has had its share of criticism in improving healthcare access. The legislation's politics has led to uneven application of legislation that was meant to improve access in the U.S. The numerous court cases have threatened the full implementation of the law. The ACA does not fully guarantee access to all the citizens of the United States. This makes the country lag behind in the number of people who can access medical insurance. An increase in the number of people who cannot access medical insurance hurts the health care outcomes of the nation.

The mortality rate is likely higher with an increased number of people lacking access to affordable care and quality services. Consumers are affected by the quality of care being offered. The United States also lags in the quality of care among the developed nations. Poor quality of care means an increase in the number of medical errors. Medical errors are ranked as the third cause of death in the United States. Consumers and communities can benefit from improved quality of care as it will ensure positive health outcomes.

Benefits and Risks of National Health Insurance

Benefits

The national health insurance model has the overall benefit of reducing health care costs (Akande et al., 2012). The government will be able to control the rising prices of medical care as it will negotiate with physicians and other stakeholders. The government will also be able to control the cost of medical through legislation. Physicians will only deal with one government agency, a factor that will reduce the administrative costs that lead to the increase in medical costs.

National health insurance will improve coverage and access to medical services. The national insurance model is a system where the government can allocate funds and ensure all its citizens have access to the same level of health care. This improves access as everyone in the nation will access medical services through the system. This will eliminate the lack of access in the nation as all the citizens are covered in the program. One of the potential benefits of the national insurance system is the elimination of all the health-related barriers. These include barriers to health education and health services. The system will eliminate the factors that do not promote equality. Access to health care is made based on the needs if the patient. This removes the barriers where access to health care is based on the ability to pay for medical services. This will also promote equality in health care as all the citizens will receive equal treatment based on their health care needs.

Risks

The national health insurance model has been lauded for improving access to health care. However, the improved access means the citizens have to be taxed more for the state to fund the system. This means the government has to tax its citizens more as the system is costly. Those who are healthy have to pay for those who are the sickest. In the United States, chronic diseases make up 90% of the health care costs. Those who are the sickest will create approximately 50% of the health care costs, while the healthiest will create only 3% of health care costs. Therefore, the healthy have to pay for the sickest for the system to thrive. The government has to increase the taxes for everyone to fund the system.

The payment model for this system means that providers receive low payments for their services. This has an adverse impact on the quality of services being offered. The providers are not motivated to improve the quality of services being given. The government has to intervene with incentives and programs to ensure the quality of services is improved. The high cost of the system also means the government has to cut various costs that will also interfere with the quality of services being offered. Providers may reduce the number of services they offer to balance their books.

The funds being provided by the government may focus on offering primary and emergency health care. The system may be focused on offering primary care. This will lead to longer wait times for other procedures like elective procedures.

References

Akande, Tanimola & Salaudeen, A.G. & Babatunde, Oluwole & Durowade, Kabir & Emmanuel, Agbana Busayo & Olomofe, Charles & Ayomide, Aibinuomo. (2012). National Health Insurance Scheme and its effect on staff’s financial burden in a Nigerian Tertiary Health facility. International Journal of Asian Social sciences. 2. 2175-2185.

Respondeat Superior is a legal doctrine that holds the employer liable for the employee's action. The doctrine is also referred to as the master-servant rule, as the employer can only be held liable for the torts committed by the employee if there exists a master-servant relationship (Pozgar, 2012). According to the doctrine, the employer will be held liable in certain circumstances for the employer's actions. In a healthcare setting, the organization is held liable for the wrongful acts of the employees. This is whether the organization is in the wrong or not.

Respondeat Superior is a common law doctrine that means 'let the master answer.'The doctrine can only be applied under certain conditions. The two conditions are; that there must exist a master-servant relationship between the employer and the employee, and the illegal act of the employee must have happened during the scope of employment (Pozgar, 2012). The question of liability is whether the employer had control over the acts of an employee. In normal employment, the employer will have control over all the employee's actions. This is based on the duties and responsibilities the employer has given the employee.

The doctrine relies on the vicarious theory of liability (Thornton, 2010). The doctrine of vicarious liability is a rule of responsibility where the defender may be held liable for the actions of another. The theory of vicarious liability is not based on finding improper action by the employer. Actually, the employer has the best interests when they can hire, train, supervise, and retain the employee. However, all these are irrelevant as the assumption of Respondeat Superior is the cost of the torts committed in the conduct of a business enterprise (Thornton, 2010). Therefore, based on vicarious liability, the cost of the torts committed is borne by the employer as the torts were committed during the course of business.

The employee should be able to perform their duties according to the duties given by the employee. Therefore, any wrongful acts committed during the employment will fall under the doctrine as they are within the scope of the employment. However, independent contractors are different as they are liable for their actions. In a healthcare setting, questions will arise about whether the organization has control over the activities of the contractor. In most cases, the organization has limited control over the contractor's actions. The independent agents are usually responsible for their own actions. The organization will have control over the physical acts of its own employers. Visiting and attending doctors are considered independent contractors and must bear full liability when sued for malpractice.

Tort Liability

A tort is an act or omission that leads to injury or harm to others, amounting to a civil wrong. Courts will usually impose liability due to the injury or harm caused by the act or omission. The liability is imposed on the persons responsible for the harm to deter them and others from committing harmful acts. The burden of loss is shifted from the injured party to the person at fault, who may be a person or organization. The most common type of tort in healthcare is the negligent tort. This is the most common type of liability of healthcare organizations and professionals. This is where the actions of the health professional were unreasonably unsafe.

Independent Contractors

The relationship between the doctrine of Respondeat Superior and independent contractors is in who bears the liability. An independent contractor is defined as a person who will perform work for another person. They agree to undertake work without the direct control of the client. The independent contractor will perform the work based on their processes and methods. The independent contractor will carry out business on their own accord. The independent contractor is usually under no control over the client, who is the business owner. They are bound under the terms of their contract with the client. The client will have no control over the manner in which the independent contractor performs their work.

The independent contractor is personally liable for their negligent acts (Pozgar, 2012). This is because the independent contractor is negligible for their acts. However, there are scenarios where the client may be liable for the independent contractor's actions. The scenarios may be when the client has direct control over what the independent contractor does. The contract may limit some of the duties of the independent contractor and hand over most of the control to the client. An organization may employ a doctor as an independent contractor and maintain most of the duties for the organization. The hospital employs those surrounding the doctor, and any negligent action in the department will lead to the hospital being held liable. In the case of Mehlman v. Powell, the court ruled that the hospital was liable for the actions of the emergency department (Pozgar, 2012). This is because of the hospital-maintained control over various aspects of the emergency department, including billing procedures.

The independent contractor relationship can only be established when the client has no control over the manner in which the agent performs their job. This means the contractor has the expertise to perform their role as per the contract with the client. In a hospital setting, an independent contractor's negligible acts or omissions will mean that the liability is on the independent contractor and not the organization. Physicians who the hospital employs are not independent contractors. However, physicians who are independent contractors are liable for their acts and omissions that may cause harm to the patient.

Respondeat Superior in Healthcare

The doctrine of Respondeat Superior applies to hospitals, attending physicians and surgeons, resident physicians, and allied hospital staff (Shenoy et al., 2021). Today, resident physicians are held accountable for their own actions as attending physicians. They are theoretically accountable for their acts and omissions. In surgery, the attending surgeon is vicariously liable for acts or omissions of the surgical residents. All these cases in the healthcare context show that under the doctrine of Respondeat Superior, the employer is liable for the employee's negligent acts while acting on the scope of employment. The application of vicarious liability in hospitals implies that hospitals and physicians may be responsible for the negligent acts of their subordinates (Shenoy et al., 2021). This includes; physician-hospital relationships, physician-technologist relationships, and others. The application of Respondeat Superior means that all persons are held liable for the actions of those who are answerable for them.

There are cases where hospitals are held accountable for independent contractors. Courts will use three tests to hold hospitals liable for the acts of independent contractors. The tests include; apparent agency, control test, and non-delegable duty of the hospital for patient care. Anesthesia is looked like an independent specialty which is different from surgery. Therefore, the anesthetist is held accountable for the anesthesia administered to the patient. Three distinct roles emerge in a hospital setting: employer-employee, principle-agent, and owner-independent contractor. The employer and principal are held liable for the negligent acts or omissions of the employee and agents.

References

Legal Risks of Nurses

Evette Grayson

Ashford University

MHA 622 Health Care Ethics & Law

Dr. Jamie Galbreath

April 11, 2022

Legal Risks of Nurses

Over the last century, the role of nurses has continued and continues to evolve. The evolvement and expansion of the role of nurses are due to various factors like shortage of physicians, increase in specialization, improvements in technology, public demand, and expectations of the profession (Pozgar, 2012). This may be considered a good thing as the nursing profession will be highly advanced in the coming decade. However, the expansion of the role of nurses has also increased ethical and legal risks for nurses. An example is that a nurse who exceeds their scope of practice has violated their licensure provisions. Legal risks for nurses have increased with the increase in nursing roles and responsibilities. This paper looks at a case scenario to examine the increase in legal risks for nurses while highlighting the legal risks involved in the case.

What happened?

The case involves the death of a patient, Mr. Ard. Mr. Ard had been admitted to the hospital, where on May 20th, he started feeling nauseated. The patient was in pain and had shortness of breath. Mr. Ard's Wife rang the bell several times in search of help. The nurse responded after a while and gave the patient medication for nausea. However, nausea continued to worsen, with the patient having difficulty breathing. The wife kept ringing the bell for 1.25 hours before anyone responded to the call for help. A code was called, but unfortunately, the patient did not survive the code. The medical records did not show any documentation on May

20th between 5.30 PM and 6.45 PM, which would indicate whether the medical professionals checked the patient's condition.

The patient's wife filed a case for wrongful death action against the hospital. The District Court granted judgment to Mrs. Ard, with the hospital appealing the judgment. Various aspects emerged during the case that is worth noting, including the information provided by the expert witness in general nursing. Ms. Krebs, the expert witness, felt that it would have been evident to the nurses that the patient was at high risk for aspiration based on the physician’s notes. Ms. Florscheim, the nurse, assigned to Mr. Ard, never performed a full assessment of the patient's respiratory and lung status. The records also did not show that an evaluation was completed after the patient vomited.

Why did things go wrong?

Various things went wrong in the case of Mr. Ard. Some of them were highlighted during the case. Ms. Krebs highlighted that a full assessment of the patient’s respiratory and lung status was supposed to be done based on the patient's risk level. The first assessment by the nurse involves assessing the level of consciousness. The rationale behind the assessment is that the level of consciousness is the primary risk factor for aspiration. This was not done by the nurse who was attending to Mr. Ard. An assessment is also needed on the presence of nausea or vomiting. Mrs. Ard had complained that the husband was feeling nauseated. During the court proceedings, it was established that the patient had vomited. The rationale behind the assessment

is that nausea or vomiting will place the patient at the most significant risk of aspiration. However, there was no report of the medication given to the patient for nausea.

The patient's situation worsened or worsened because the standard of care offered to the patient fell below the expectations for a patient with the type of distress. The expected standard of care would require precautionary measures to be put in place to reduce the risk (Kollmeier et al., 2022). Nursing diagnosis includes the risk of infection, risk of short body fluids, and

impairment in breathing. Things got worse when the nurse failed to provide better standards of care. The patient's standards of care would have involved constant monitoring, a full assessment of the patient’s respiratory and lung status, and any other assessment required for a high-risk patient. If the nurse had followed the guidelines for the type of patient, the outcome might have been avoided.

What were the relevant legal issues?

In the definition of medical malpractice, the American Board of Professional Liability Attorneys (2020) refers to a negligent act or omission which causes the patient harm. Negligence may result from diagnosis, treatment, aftercare, or health management errors. There is an increase in nurses being named as defendants in malpractice lawsuits (Croke, 2003). Why the increase? The number of malpractice payments being made by nurses has also increased. Various factors have been attributed to the increase in the number of nurses named defendants in malpractice lawsuits and those making malpractice payments. Lack of education has been named one of the factors for the increase in the number of nurses in malpractice lawsuits. However, the

last three decades have seen an improvement in education for nurses and nurse students. The increase in the role of nurses has also led to an increase in legal risks for nurses.

In the case scenario, various legal issues arise that medical malpractice under the law can be considered. According to the American Board of Professional Liability Attorneys (2020), a claim for medical malpractice must-have characteristics like an injury caused by negligence, a violation of the standard of care, and the injury resulting in significant damage. Standards of care are guidelines offered to nurses that provide a foundation for how they should act, what should be done, and what should not be done in their professional capacity. A violation of the standard

of care emerged from the case where the patient was in distress, and the nurse had to wait for 1.25 hours before responding to the call.

The other legal issue that emerges is that the patient sustained injury due to negligence by the nurse. The District Court ruled in favor of the patient's wife, agreeing that negligence caused the patient's suffering. During the appeal, the two expert witnesses were able to show the standard of care for such a patient. The expert witness for the hospital showed the standard of care may have been below expectations for the level of distress being described. The case also falls under medical malpractice as the injury resulted in significant damage. It led to the death of the patient.

How could the event have been prevented?

The event could have been prevented had the patient's care been within the standards of care prescribed. Various aspects of the case can be regarded as negligent acts and omissions that

led to the event. If the physician's progress reports showed that the patient was at high risk for aspiration, the various assessments should have been done according to the standard of care. These included preventive measures to reduce the risk or care for the patient. These measures would have reduced the risks of aspiration for the patient and avoided the event. Constant monitoring of the patient could also have prevented the event. The nurse assigned to the patient could have discovered more information through constant observation of the patient.

What is your verdict?

My verdict is that the hospital is liable for medical malpractice. The hospital violated the standard of care for the described kind of distress. The patient's wife had called for help several

times when the husband was experiencing shortness of breath. The hospital staff responded 1.25 hours later, which is below the expected standard of care. The nurse might have responded late to

a limited number of nursing staff in the hospital or due to their negligence. The late response and some of the omissions of the nurse and hospital led to the event in the case. The violation of the standard of care led to injury to the patient, and later the injury caused significant damage. The hospital should be held accountable for the actions of its staff. This is based on the policies at the hospital, which can lead to a response happening after 1.25 hours.

References

Croke, Eileen M. EdD, ANP, LNC-C. (2003). Nurses, Negligence, and Malpractice, AJN, American Journal of Nursing: September 2003 – Volume 103 – Issue 9 – p 54-63

Kollmeier, Brett. Michael Keenaghan and Chaddie Doerr. (2022). Aspiration Risk (Nursing). StatPearls.