You are the new director of risk management at Little Falls Hospital, which is a 450-bed tertiary care facility in a major urban area in the Northeast. The hospital is an integrated health system that provides the full array of inpatient and outpatient services. The hospital enjoys a reputation for quality care in the area.
As the new risk manager, you have been briefed about a patient care case that needs your attention.
• The patient is a 45-year-old woman, Lydia, who is currently paralyzed and can only communicate through head nods as a result of a car accident over six months ago.
• The patient is currently on a ventilator for respiratory assistance and receives tube feedings.
• The professionals in the hospital are uncertain as to whether the patient is capable of understanding information and making her own decisions.
• It is reported that the patient has an advance directive, but no one has been able to secure a copy of the document.
You have been asked by Felicia Larue, the hospital CEO, to give a briefing on the patient situation and alternative actions that may be taken by the hospital to ensure that the rights of the patients are preserved and the risks to the hospital are minimized. Prepare a 500-word summary of the important components of this case, the laws that may have an impact on this case, and alternative courses of action that the hospital may pursue to satisfy the parties that are involved with the scenario. The strategies and recommendations should be as specific as possible and include the resources needed for implementation. Your primary text and journal and website research must be used as a reference to support your analysis.
Mr. Bevins—Patient’s Spouse
Lydia and I have been married for 4 years, and I know that she would not want to be kept alive in this fashion. She and I have had many conversations and discussions about end-of-life decisions, and living like this would not be her choice. I do not know the whereabouts of the advance directive, because she did this prior to our marriage, and my attempts to obtain a copy have failed. I am her guardian, and therefore the decision should be mine.
Eileen Redfield—Patient’s Mother
I am Lydia’s mother and it hurts me to see my daughter laying there so incapacitated. Ending her life is not the answer. A couple of the physicians have implied that she might get better and live a better life, although others have given me little hope for recovery. A miracle is always possible, and I want to give my child every chance she can to live.
Dr. Bob Pritchard—Patient’s Physician
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I have been taking care of Lydia for the past 90 days. Although she does demonstrate progress in very small increments, her level of functioning has not significantly improved. This is compounded by the fact that Lydia also suffers from breast cancer—a condition diagnosed and treated successfully before the accident. I am not sure what advice to give the family about the patient’s long-term survival.
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