Tag Archives: ethics

Pop Quiz: Do We Really Need To Do All That?

Here are some philosophical musings to keep you thinking over the weekend.

You are the trauma surgeon on duty one evening, and you receive a call from the emergency department. They have received a mildly demented elderly woman who fell at her nursing home 12 hours ago. The staff believes that her mental status is slightly “off” from what it usually is.

Your trauma program has a well-defined practice guideline for elderly TBI care (not on anticoagulants) that involves an initial CT scan, and then a repeat scan after another 12 hours if anything but a simple subarachnoid hemorrhage (SAH) is present. For just SAH, only serial neuro checks are performed for 12 hours and a TBI screen is performed prior to discharge.

Here are my questions for you:

  1. What scan(s) do you need to perform given that 12 hours have already passed since her injury?
  2. Does the patient need to be admitted? For how long?
  3. What other important information do you need to know?
  4. Should the patient have been sent to the ED at all?

I am very interested in your input on these questions. I’ll discuss them in detail in my next post. Please leave comments below, tweet, or email your responses and I’ll see how much we think alike. Or not!

Ethics Quiz: The Answer?

The hypothetical question I posed yesterday centered around what to do in a case where a patient is assaulted, sustaining easily survivable injuries, but then dies while being treated in the hospital due to a medical error. The police will escalate the criminal charge from simple assault to manslaughter, but the death was no longer really a direct result of the assault. Yet the assailant and police don’t really know any better. What to do?

There are many possible answers to this question, and it depends on who is being asked:

  • The police / prosecuting attorney will say that it makes little difference. The assailant caused the victim to be injured and admitted to the hospital. Medical errors do occur in any hospital, and the assailant placed the victim in the position where this could occur. They will proceed with prosecuting the assailant on the higher charge.
  • The hospital attorney will say that only the family may be informed of the error and resultant death. It is a privacy violation (in the US) to directly report any specific patient information to the police unless allowed by the family.
  • The family will inform you that they are hiring an attorney to bring a civil malpractice case against you and the hospital.
  • The assailant will say that you damn well better report it, and remind you that he’s facing years in prison if you don’t.
  • The trauma professionals involved in the medical error will say that they should notify the police on ethical grounds so that the assailant will know that he was not responsible, and that he should not be punished as severely.

So what’s the right answer? As with any ethical questions in health care, there are only shades of gray. In the US system, the usual answer is to communicate the error to the family only. The justice system will not alter the charges based on the new information, so reporting the police is of no use and violates privacy laws.

Bottom line: In any situation as complex as the one described, proceed with great care. Seek out the advice of your mentors, the ethics committee, and the hospital attorney. One person’s idea of what is ethical may be very different from another’s, and the legal realities may render some of the arguments moot. Hasty and uninformed action without proper due process can have grave consequences for all.

Ethics Quiz!

What would you do in this case? And better yet, what should you do? And why might the two answers be different?

First, an important note. This is a hypothetical case. It has never happened in any hospital I’ve worked in, and I have not heard of it happening in one. I have completely fabricated it to make a point.

An elderly man is walking to the store in his neighborhood, and he is assaulted and knocked to the ground by a young man. Witnesses restrain the assailant, and police arrive to take him away to jail, while prehospital providers arrive and transport the victim to the hospital. The assailant is charged with assault and released.

The victim has a facial fracture and a very small intraparenchymal hemorrhage. He is expected to be discharged the following day after a repeat CT scan. The fracture does not need treatment. However, while being monitored in the ICU, a medical error occurs and the patient dies.

The police re-arrest the assailant and charge him with manslaughter, which has a much stiffer jail sentence.

Do you (or your hospital) have a responsibility to let the police know that the new charge is not justified? Is there a potential opening for a civil suit against you (or your hospital)? Can you do anything given current privacy laws?

Tweet out your answer or leave comments below. I’m interested in comments from my legal colleagues, too. What would you do?

Driver Sues Family of Teen He Killed. What Do You Think?

An interesting trauma ethics question today.

A Connecticut driver was charged with manslaughter last year after striking a 14 year old bicyclist and killing him. The driver, who is serving a 10 year sentence for manslaughter, is now suing the family for putting him there.

According to the prosecutor, the driver was passing another vehicle at 83 mph in a 45 mph zone. The teen was with friends who were jumping bikes at the curb of a busy street. He entered the street and was struck, sustaining multiple severe injuries and was brain dead the next day.

The driver is suing the parents for “contributory negligence” because had they “complied with the responsibilities of a parent and guardian and the laws of this state and not allowed their son to ride his bicycle without a helmet and to play out in the middle of Rt. 69 … this incident and Matthew’s death would not have happened.” He’s also asking for more than $15,000 in damages, saying he’s endured “great mental and emotional pain and suffering,” wrongful conviction and imprisonment, and the loss of his “capacity to carry on in life’s activities.”

On one hand, what is the responsibility of the teen and his family, or anyone for that matter, for taking reasonable precautions to be safe? On the other, no pedestrian, bicyclist or motorcyclist can survive an impact with a car traveling at 83 mph.

One attorney commented on the case, saying "I can see their side of it. I’m a parent. But I can also see the other side of it. If you’re driving down the street and your car makes contact with a pedestrian and you think it’s the pedestrian’s fault, you have to raise the issue.“

Interesting scenario? Read the full story and tell me who you think is right, and why?