Ethical Dilema At Mt Hope Hospital

TABLE OF CONTENTS

PROJECT OUTLINE 2

CASE HISTORY 3

EXECUTIVE SUMMARY 5

LIMITATIONS AND ASSUMPTIONS 7

ANALYSIS 9

CONCLUSIONS 18

RECOMMENDATIONS 19

APPENDIX I 21

REFERENCES 27

PROJECT OUTLINE

Ethical Dilemma:

Injuries sustained by Justin Paul (Baby Justin) while under the professional care at the Mt. Hope Maternity Hospital.

Ethical Issues:

1. To determine whether the nurses involved in this case were negligent in providing a duty of care to Baby Justin, and

2. To determine whether the disciplinary action taken by the Nursing Council of Trinidad and Tobago were just and fair

CASE HISTORY

On April 17, 2007 James & Justin Paul were born prematurely, both weighing approximately four pounds each, at the Mt Hope Maternity Hospital. Mere hours after their birth, Justin's parents were told that he had received second degree burns to his left shoulder, arm and hand from a hot water bottle in a hospital incubator and was sent to the Intensive Care Unit of the Hospital. The hot water bottle which was used to keep the baby warm was wrapped in a blanket and kept close to Justin but it was too hot.

Hospital Administrator, Davlin Thomas, said that millions of dollars were spent on upgrading the Neo-natal Intensive Care Unit and it was not necessary to use water bottles to keep babies warm as there were machines to do that. However, the doctor who examined Baby Justin suggested that the bottle be placed in his cot because he risked getting hypothermia.

The Medical Professionals Association of Trinidad and Tobago (MPATT) requested a quick, thorough and unbiased investigation into the matter. The investigator was required to look at the procedures that were followed and the personnel and equipment involved. Subsequent to this, two employees from the North Central Regional Health Authority (NCRHA), Registered Nurse - Natasha Richardson and an Enrolled Nursing Assistant (E.N.A.) - Janiece Chalres, were suspended pending investigations. However, when the final report was submitted it claimed that the Nurses were on their cell phones when they should have been monitoring Baby Justin. The Nurses were later fired having been found guilty of negligence.

The matter was then pursued by Head of the Port of Spain General Hospital (POSGH), Dr. Petronella Manning-Alleyne, who found that the decision taken was harsh and unnecessary and that the Nurses were simply following instructions. Health Minister, John Rahael believed that the decision taken was fair and argued that two reports were done, one by the NCRHA and another by the Quality Director at the Ministry of Health. It was found that if employees are provided with equipment and tools, yet do not do their duty according to protocol and someone is injured in the process, then the necessary disciplinary action had to be taken.

The incident was then brought to the attention of the Public Services Association (PSA) President, Jennifer Baptiste-Primus, who argued that such incidents occur because of staff shortages and when nurses are asked to perform duties which are not in their job specifications. She also claimed that the nurses were not given the opportunity to defend themselves and were only informed of their dismissal through the media. The PSA also objected to Nursing Administrator who issued the instructions to the Nurses, being a member of the disciplinary tribunal.

The dismissal is being currently being challenged by the Nurses.

EXECUTIVE SUMMARY

On April 17 2007, at just five hours old, premature baby Justin Paul (Baby Justin) received second degree burns to his left shoulder and arm after a hot water bottle, wrapped in a towel, was placed in the incubator to keep him warm.

Subsequent to this incident, Baby Justin's parents, Nicola Carter and Jerome Paul, made a public outcry for justice to be served to the parties who were morally responsible. The North Central Regional Health Authority (NCRHA) in response to their concerns, suspended three nurses pending further investigations.

Further to the advice of the (then) Honorable Minister of Health, John Rahael, reports were submitted to the Nursing Council of Trinidad and Tobago by the NCRHA and the Quality Director at the Ministry of Health to take whatever disciplinary action the Council might deem necessary. Since the Nursing Council had the authority to license nurses, the action to fire the Registered Nurse and the Enrolled Nursing Assistant (E.N.A.) who were held accountable for the incident, fell under its jurisdiction.

The ethical issues in this case are: (i) whether the nurses were negligent in providing a duty of care to Baby Justin and, (ii) whether the disciplinary measures taken against the nurses involved was just and fair.

In fulfilling the first criteria for ethical reasoning i.e. moral reasoning must be logical, the group recognized that there were several limitations resulting in assumptions being made.

Limitations included:

 Short time-frame for a thorough investigation

 Primary data collection was inhibited due to the sensitivity of the matter, thus forcing the group to rely mainly on secondary data sources e.g. electronic and print media

 A conclusion of the case is pending since investigations are still ongoing

Assumptions included:

 Secondary data gathered from media sources was relatively reliable

 Given that there was the need to place a hot water bottle in the incubator suggested that the equipment may have been faulty or non-functional