Ethical Issues Paper

Ethical Issues

University of Phoenix

Ethical, Legal, and Regulatory Issues in Health Care HCS/578

August 29, 2011

According to Aiken (2004), ethics deals with the rightness and wrongness of actions, and refers to standards of behavior that dictate how human beings ought to act in many situations. A fair statement of ethical principles includes respect, truthfulness, consistency, fairness, and compassion (Povar, Blumen, Daniel, & Daub, 2004). When a physician makes a decision to deliberately violate a patient's rights including unprofessional conduct in medicine, making false reports, gross overutilization of health care services, violation of standard of care quality, and failure to keep adequate records, consequences are inevitable.

Ethical Dilemma

Between 2008 and 2009 an interventional cardiologist in Maryland implants unnecessary stents exposing patients to the risk of harm. According to the Maryland State Board of Physicians (2010), this cardiologist's violations were repeated and serious, which not only placed risk of harm to patients, but also increased the cost of the patient's medical care. This cardiologist had a complete disregard of nonmaleficence, and veracity. According to Aiken (2004), nonmaleficence is the requirement that health care providers do no harm to their patients, and veracity requires that health care providers be truthful and not intentionally deceive or mislead his or her patients. Patients have a right to expect that health care professionals will be forthright in dealing with them. This cardiologist told his patients they had blockages that were in the 90% range, when in fact a subsequent review revealed 10% or less blockages in these patients (Mahar, 2010). The actions of this cardiologist were deliberate, and he willingly fabricated medical records to justify unnecessary stent placements.

Competing Loyalties

The hospital where this cardiologist was employed is responsible for prevention of injury to patients. According to Aiken (2004), under the American Hospital Association's Patient's Bill of Rights; activities within a facility "must be conduced with an overriding concern for the values and dignity of patients" (p. 120). According to Woodruff (n.d.), hospitals have felt a sense of immunity serving as an administrative entity for practicing medicine; however, the liability envelope has expanded and immunity has become obsolete. In the case of unnecessary stents, the cardiologist was a direct employee of the hospital, which has established physician and hospital liability, and the hospital failed to monitor the competence of the physician. The patients in this scenario were clearly at risk and suffered harm and loss, and rightfully this physician and hospital are responsible.

Ethical Response

An ethical dilemma as defined by Aiken (2004) is when a situation requires one to make a choice between several equally unfavorable alternatives. Although this writer was not directly involved with the unnecessary stent placements, but was an employee at the same hospital, it is clear that this cardiologist opted to choose the most unfavorable alternative, which was ethically wrong, shameful, shocking, and disturbing. If it were not for one patient who complained that a second opinion showed the stent this physician wanted to implant was unnecessary, this cardiologist would still be committing fraud, violating patient's rights, falsifying medical reports, and violating standard of care quality. The patients are left behind with foreign bodies in their vascular beds; they have to take blood thinners, and are subjected to a lifetime risk of mortality and morbidity (Watcher, 2010).

Other Responses

Although the cardiologist charged with implanting unnecessary stents continued to stand by his inappropriate decisions, a review committee had a different response. According to the Maryland State Board of Physician's (2010), through bringing in an outside firm to do a peer review of patient cases, it was determined that this cardiologist implanted 585 unnecessary stents between 2007 and 2009. As a result, the hospital employing this physician paid a $22-million dollar fine and entered into a corporate integrity agreement with the Office of Inspector General to promote compliance, which will be closely monitored for a period of five years. The cardiologist lost his license to practice medicine in the state of Maryland on July 13, 2011. Everyone's ethical response to this situation was the same; everyone agreed that this physician was unethical in his decisions, and as a result the patient's he cared for will continue with a lifetime of health and cardiac risks.

Implications of Risk Management

According to Aiken (2004), risk management has evolved over the years and is not just the act of purchasing insurance for financial coverage, but is also a coordinated effort to prevent and controlling loss. In the case of unnecessary stents the cardiologist was performing his own peer review. According to Watcher (2010), this cardiologists was cherry-picking his own cases for