LEGAL & ETHICAL CONSIDERATIONS IN HEALTHCARE
Risk management, quality improvement, and compliance programs have discrete applications within a healthcare organization, yet they have complementary goals. The motive for these programs is to improve all aspects of the patient experience. There are external regulations and requirements imposed on all organizations, and these regulations are controlled by the internal processes designed by each organization.
There is an expectation of care and trust between patients and their healthcare providers. An organization needs to be vigilant in all circumstances, particularly those involving patient safety.
A. Analyze the “Compliance Management” scenario by doing the following:
1. Describe the mistakes made in this scenario step by step as they occurred.
2. Analyze whether any of the mistakes identified in part A1 were a violation of organizational compliance, a legal concern, or both.
3. Describe specific solutions the compliance officer and Sue, the manager, should implement to prevent reoccurrence of the identified mistakes from part A1.
B. Identify Health Informatics and Information Management (HIIM) areas of expertise in compliance and explain how the HIIM Department staff could assume a leadership role in teaching compliance behaviors to the clinic’s staff members to mitigate legal risk.
1. Explain the importance of staff understanding informed consent in order to ensure patient safety and trust.
2. Describe release of protected health information (PHI) and how it protects patient privacy.
C. When you use sources, include all in-text citations and references in APA format.
Compliance Management Scenario
Sue is the manager of a five-physician practice affiliated with a large healthcare system. She oversees a dozen nurses, front office staff, a two-person HIIM department, and several technicians. As a mid-level manager, she reports to administration of the healthcare system.
One morning Sue was stopped abruptly in the hallway by one of her nurses. The nurse had received an irate telephone message from a patient’s daughter-in-law and was passing the information on to Sue for her to follow up on the call. “That’s your job to handle,” the nurse blurted out, while accompanying a patient into a room.
Soon after, Sue phoned the daughter-in-law to ask how she could be of service. The daughter-in-law, Mrs. Stevens, spoke loudly and excitedly, explaining that her husband and the rest of the family had no idea that her father-in-law was being seen for cancer treatment. She was upset that no one had told the family and was requesting more information about her father-in-law’s diagnosis, treatment, and anticipated outcomes.
Sue stated she could not speak about any of those issues on the phone and told Mrs. Stevens that she needed to visit with her father-in-law’s physician for any information. Mrs. Stevens replied that her father-in-law had told his son and family that he was being treated for back pain and was improving. Her father-in-law lived alone about a half hour from his son and family, and Mrs. Stevens and her family usually visited weekly.
Sue then asked why Mrs. Stevens was asking about the cancer treatment if she believed that her father-in-law was being treated for back pain. Mrs. Stevens replied that someone had called and left a voicemail yesterday evening on their phone, reminding her father-in-law about his appointment for chemotherapy that day. Mrs. Stevens questioned why the message would have come to their home and not to her father-in-law’s.
Mr. Stevens, the patient’s son, had retrieved the voice mail when he returned home early from work, and Mrs. Stevens had arrived home to find her husband distraught, having just had a heated discussion with his father. Mrs. Stevens reported that although the family was very upset by the call, they were glad to know the truth about his condition. Her husband, however, was angered by the call because he felt blindsided and unprepared for the information.
Sue calmly stated that Mrs. Stevens needed to speak directly with her father-in-law about any information related to his medical condition. She promised she would investigate the incident and would call her back with any further information as to how this could have happened. Sue apologized repeatedly, and the call ended amicably.
Sue went up to the busy front desk where phones were ringing and patients were waiting to schedule appointments. She knew it was not a good time to speak with the front desk staff. She decided to check the patient management system to see who had been making the reminder phone calls the day before. She saw that it was Denise and went back up to the front, leaving a note on Denise’s desk that requested she come see her in her office when the front desk cleared.
Sue then opened the patient’s medical record through the electronic record system to gather more information on Mr. Stevens. She saw that he had just begun treatment for prostate cancer and saw nothing in the physician dictation indicating that Mr. Stevens was keeping his medical condition confidential from his family. She also noticed as she was scrolling through the last name Stevens that there were three Joseph Stevens who were clinic patients.
About a half hour later, Denise stood at Sue’s door. She looked worn out, and it was only 11:00 a.m. Sue closed the door and questioned Denise about the call. “Yes, I called the number listed in the scheduling system,” Denise said. As Denise watched, Sue opened the patient management system and saw the name Joseph Stevens listed on the chemotherapy schedule for that day. She also saw Denise’s initials in the system, indicating she had phoned him the evening before with the reminder. Sue jotted down the phone number and went back into the patient’s electronic health record.
The phone number in the patient’s health record did not match with the number listed in the patient management system. Denise looked worried. “It wasn’t my fault,” she said. “I called the number in the scheduling system listed by his name.” Sue decided to dig a little deeper. With ten years of employment at the clinic, Denise was not prone to mistakes like this.
Sue found that the patient’s son, Joseph C. Stevens, was also a patient at the clinic. Sue compared the addresses and phone numbers for both men in the electronic record system and found that they were different. However, the son’s phone number had been listed under the father’s name in the patient management system.
Sue directed Denise to return to her desk and to input the correct number immediately. She also asked her to look through any other records on Mr. Stevens in the patient management system to determine if there were any other inaccuracies. They then discussed the importance of leaving only minimal information on voice mail. Denise should not have left any information pertaining to the patient’s treatment and should only have stated his appointment time and date. Sue would need to document this mistake in Denise’s employment documents. “I’m not officially writing you up for this,” Sue said, “but I am noting it in my own personnel files I keep here in my office. You should know better.” Denise left, seeming a bit upset.
Sue’s phone rang. It was one of her nurses asking her to come over to the infusion area right away. Mr. Stevens was there for treatment and was very upset. He was asking to speak to the clinic manager.
“My privacy rights have been broken by this clinic,” he said. “I’m going to be calling my lawyer about this. I didn’t want my family to know about my cancer, but now they are all blubbering about it like I am going to die. This is exactly what I didn’t want! I thought I had rights!”
Sue walked down the hall toward the infusion area, making a mental note of the paperwork that she would be submitting, such as an incident report, and whom she needed to notify. She would first speak with Mr. Stevens to see if she could calm him down by explaining what had happened. Then she would begin her phone calls and documentation. Finally, she would be contacting the healthcare system’s compliance officer to discuss her findings and seek any further advice from the compliance officer.