CO 506 Assignment 2

Health Care Law Learnscape 1: Hospital Nightmare Health Care Law Learnscape 1 Final November 28, 2012 1 Hospital Nightmare Introduction: After an incident where a patient developed a life -threatening staph infection following surgery at the hospital, a negligence lawsuit was filed against Bright Road Health System . As the Hospital Administrator, you will gat her information about the incident from the parties involved, and work with Bright Road ’s General Counsel to determine the Hospital’s liability. You will need to consider:  Whether a duty to care was established  Whether the duty was breached  Whether there was an injury  Whether the cause of the patient ’s inj ury was due to negligence  Whether the concept of Respondeat superior applies in the case  Whether to file an indemnification against any of the staff members involved You will then submit an analysis to B right Road’s General Counsel, with your thoughts regarding the hospital’s liability. Characters: 1. Jeff Passmore , General Counsel at Bright Road Health System 2. Jennifer Brainard , RN in post -surgical unit at Bright Road 3. George Paltrow , Hospital employed Chief of Surgery (not independent contractor) at Bright Road 4. Holly Brigham , Pulmonologist, Bright Road Locations: 1. Student’s Office 2. General Counsel’s Office 3. Hospital Conference Room 4. Coffee Shop Health Care Law Learnscape 1: Hospital Nightmare Health Care Law Learnscape 1 Final November 28, 2012 2 Scene 1: Meeting with Mentor, Jeff Passmore In this opening sce ne, the Student meets with mentor figure and Chief Counsel for Bright Road, Jeff Passmore. Jeff asks for help on this new negligence suit, and offers suggestions about who to talk to. The student is asked to gather sufficient information to form a conclusi on on whether the hospital is liable or not. Location Chief Counsel’s Office Scene setup Student faces Jeff who sits behind his desk . On -screen characters Jeff Passmore Off -screen characters None On -screen text: Chief Counsel for Bright Road , Jef f Passmore, calls you into his office today . . . JEFF Glad you could come by. Did you hear about the new negligence suit that just came in? STUDENT No. What’s the case ? JEFF Well, t here’s a Mrs. Smith who claims to have received a deadly infection due to negligence on the hospital’s part. While she recovered from this infection , she’s also claiming that an autoimmune disease she contracted shortly after the incident was due to complications caused by the infection. STUDENT OPTION 1 How is she claiming she got this infection? STUDENT OPTION 2 In what way can I help you with this? STUDENT OPTION 3 Can I talk to the parties involved? Student can click on any of these options to proceed. Student must click all eventually. JEFF RESPONSE 1 Mrs. Smith c laims, when conducting routine exams the day after her surgery , the Chief of Surgery didn’t change glo ves when examining patients in her room . She was the last to be examined . She allegedly contracted a staph infection from another patient in the room during the examination process . Response 1 kicks the Student back to options . JEFF RESPONSE 2 I need you to gather all of the information about this case so we can de termine Bright Road’s liability, if any. Response 2 kicks the Student back to options . JEFF RESPONSE 3 It’s not prudent at this point to talk with Mrs. Smith or her representative or family, but you can talk with anyone on our side of the fence. Health Care Law Learnscape 1: Hospital Nightmare Health Care Law Learnscape 1 Final November 28, 2012 3 Response 3 allows the Student to proceed . STUDENT Do you have names and titles? The notepad icon is highlighte d and an on -screen text bubble appears. On -screen text: Remember to take notes as you go . These notes will be available throughout, and will help you form your recommendation at the end. Student is able to open the notepad and take notes during the rest of the scene with Jeff . JEFF Yes, Dr. George Paltrow is the Chief of Surgery and Dr. Holly Brigham is the pulmonologist who saw Mrs. Smith. STUDENT OPTION 1 What about a nurse who was there in the room that day ? STUDENT OPTION 2 Not changing gloves ? I’m sho cked that happens. Student can choose either option to continue. Student must choose both eventually. JEFF RESPONSE 1 I’ll email Ken Bloom, our Chief Nursing Officer , to see if he can get you a name of a nurse to talk to. Response 1 kicks the Student back to options. JEFF RESPONSE 2 Right. It seems that history keeps repeating itself because no one seems to want to learn from it. I was just reading earlier how, in 1847, there were an alarming number of deaths from puerperal (py -ûr p r - l) fever, because medical students and physicians were coming directly from the dissecting room and then treating maternity patients. It’s staggering we’re still making the same mistakes. Response 2 allows the Student to proceed. STUDENT So, what type of information do I n eed to gather for this suit? JEFF First, let’s determine if a duty to care was established, and then whether the duty was breached or not. We’ll need to conclude whether or not the patient was injured due to negligence and whether the concept of Respondeat (res - pon' -dee -aht ) Superior ap plies in this case. Last, we’ll have to decide if we should file an indemnification against any of the staff members involved. STUDENT OPTION 1 I assume a duty to care is always understood . STUDENT OPTION 2 I doubt anyone wil l admit negligence. Health Care Law Learnscape 1: Hospital Nightmare Health Care Law Learnscape 1 Final November 28, 2012 4 STUDENT OPTION 3 It’s been a while since I’ve used it… remind me what Respondeat Superior mean s. Student can click on any option to proceed. Student must choose booth eventually. JEFF RESPONSE 1 Well, as you know, the plaintiff must pr ove the existence of a legal relationship between him or herself and the defendant. D uty to care is defined as a legal obligation of care, performance, or observance imposed on one to safeguard the rights of others . A physician -patient relationship is a pr ime example. Duty to care can arise from a simple telephone conversation or out of a physician’s voluntary act of assuming the care of a patient. Although, establishing when a legal relationship begins between a physician and patient is not always clear -cu t or clearly established, for example, in cases where injured people are in transit to the hospita l by a private ambulance service . Response 1 kicks the Student back to options . JEFF RESPONSE 2 That’s why your idea of talking with a nurse on duty that day is a good one. We need unbiased eye witnesses to the events that took place. Response 2 kicks the Student back to options . JEFF RESPONSE 3 Respondeat Superior translates to “ let the master respond ” and it ’s a legal do ctrine holding employers liable in cert ain cases for the wrongful acts of their agents or employees . This doctrine has also been referred to as vicarious liability, where an employer is answerable for the wrongful acts committed by its employees. Response 3 allows the Student to proceed . STUDE NT Thanks. I’ll get started on this right away. JEFF Perfect. Just let me know if you run into any trouble, or if you have any questions. I appreciate your help with this. Health Care Law Learnscape 1: Hospital Nightmare Health Care Law Learnscape 1 Final November 28, 2012 5 Scene 2: Discussion with RN, Jennifer Brainard The student meets with the nurse from the post -surgical unit, Jennifer Brainard, who was on duty the day of the incident. Jennifer provides important first -hand information. Location Student’s Office Scene setup The Student faces Jennifer who sits on the other side of the desk . On -scree n characters Jennifer Brainard Off -screen characters None. On -screen text: Meeting with post -surgical nurse, Jennifer Brainard . . . JENNIFER I hate to start this way, but is it okay if we keep this brief? I have to be on shift in fifteen minutes. STUDEN T That’s no problem at all. I’m happy with whatever time you can give. JENNIFER When Ken said you wanted to talk about the Mrs. Smith incident, honestly, I was torn. I still have very mixed feelings about that whole situation. STUDENT OPTION 1 Why do you h ave mixed feelings ? STUDENT OPTION 2 Can you tell me what you saw that day ? STUDENT OPTION 3 Were you surprised by what happened with Mrs. Smith ? Student can click on any of the thr ee options to continue, but must choose all eventually. JENNIFER RESPONSE 1 Look, whatever my feelings for Dr. Paltrow personally, I don’t necessarily want to see his whole career go down the drain, his life ruined. People make mistakes, and he, especially, is normally very careful . Response 1 kicks Student back to options. JENNI FER RESPONSE 2 I know he was preoccupied. There’s really no other explanation. Basically, this is what happened : After surgery and discharge from the recovery room , Mrs. Smith was placed in a room in the post -surgery patient care unit with four other patie nts. When Dr. Paltrow came in with the residents , neither he nor the residents change d their gloves as the y progress ed from one patient to the next . And, Mrs. Smith was the last patient examined. Response 2 kicks Student back to options. JENNIFER RESPONSE 3 Yes and no. Like I said, Dr. Paltrow is normally very particular and goes by the book. He prides himself in it and , believe me, he lets everyone know . But, here ’s Health Care Law Learnscape 1: Hospital Nightmare Health Care Law Learnscape 1 Final November 28, 2012 6 the thing. T here is not always adherence to policies and procedures , especially in that un it, to prevent or control infections. Frankly, I always thought it was a matter of time before something like this happened. You would think that a post -surgery patient care unit like this one would be given a lot more housekeeping attention then it was. Response 3 allows the Student to continue. STUDENT OPTION 1 You said, “there is not always adherence to policies and procedures .” Does that mean policies and procedures for infe ction prevention and control were in place but not always practiced ? STUDENT OPT ION 2 Can you summarize the importance of changing gloves between patients? Student can click any option to proceed, but must choose both eventually . JENNIFER RESPONSE 1 I think the Mrs. Smith incident was a bit of a wake -up call. I mean, really, we’re luc ky she didn’t die. The staph infection spread so quickly. It was a good thing that the pulmonologist was called in and the infectious disease specialist placed Mrs. Smith on an aggressive antibiotic regimen when she did. So, yes, af ter that, we now have im proved training, along with clearer hand hygiene signage as well as visual reminders for both staff and visitors throughout the hospital on how to keep a clean environment and how to protect patients from hospital -acquired infections. Response 1 kicks the Student back to options. JENNIFER RESPONSE 2 Even if you think your gloves are clean, they harbor disease. De adly microbes and bacteria aren’t visible to the naked eye. In Mrs. Smith’s case , the patient in the first bed had had a leg amputated for gangren e. Dr. Paltrow examined this patient first . Bacteriology testing confirmed the amputee had a staph infection . Response 2 allows the Studen t to proceed . STUDENT Did t he other patients in the room besides Mrs. S mith get the staph infection as well ? JENNIFE R I believe t hey all got a staff infection . Sometimes you can get a staph infection and it stays dormant in you until your system is weakened or compromised in another way. Then, it presents itself. All I know is that Dr. Paltrow and the residents were cha nging dressings, examining each patient and none of them changed gloves. N one of them washed their hands until the end , when they threw the gloves in Mrs. Smith’s wastebasket and then washed their hands at her sink literally five feet from her bed. Health Care Law Learnscape 1: Hospital Nightmare Health Care Law Learnscape 1 Final November 28, 2012 7 STUDEN T OPTION 1 Did you say anything to Dr. Paltrow at the time ? STUDENT OPTION 2 It sounds like the staff was not as reactive as they could’ve been when they found out Mrs. Smith had the staph infection. Why? Student can click on either option . Both options must be chosen eventually . JENNIFER RESPONSE 1 Are you kidding? The quick est way to get fired is to challenge someone of his stature , especially in front of a patient. I tried to find him in the hallway afterwards, but he took off before I could catch him . He was on a ski trip. So, all I could do was watch and wait, and hope nothing bad would happen . Response 1 kicks the Student back to options. JENNIFER RESPONSE 2 Well, off the record, I’ll tell you it’s because no one wants it to be true and t hey don’t w ant to get fired. There were only two of us on duty that day, because it was the weekend . I remember Kyle Jones was the other nurse. We talked about her condition and the attending physician knew about it, too . Mr. Smith was very concerned about his wife so h e demanded that a special duty nurse be brought in to take care of his wife . He even got hold of the CEO to get some results. I think when I asked Mrs. Smith if she wanted to have a priest visit her it really shook him up . Response 2 allows the Student to proceed . STUDENT You called a priest? You must have thought it was serious, then. JENNIFER Well, you never know how these things can t urn out. I wanted to be proactive . STUDENT But, you didn’t think a specialist, someone from infectious disease shoul d be called in? JENNIFER Don’t get me wrong. I may have thought that, but there was nothing I could do.

It’s not my decision. Thankfully, the husband got through to the CEO and he had both an infectious disease specialist an d a pulmonary specialist examine Mrs. Smith . STUDENT So, it seems clear that the duty to care was breached, then, s ince Mrs. Smith should have promptly been administered antibiotics and provided a clean, sterile environment. This was not provided? JENNIFER Yes, certainly a sterile env ironment. But, isn’t it the hospital’s duty to make sure the physicians that attend their patents are competent and trained properly too? Think about it . Her temperature nearly reached 106 de grees , a clear sign of infection . Health Care Law Learnscape 1: Hospital Nightmare Health Care Law Learnscape 1 Final November 28, 2012 8 STUDENT Good point. Thanks for your time, Jennifer. I don’t’ want to keep you any longer. JENNIFER I appreciate it. Health Care Law Learnscape 1: Hospital Nightmare Health Care Law Learnscape 1 Final November 28, 2012 9 Scene 3: First Meeting with Dr. George Paltrow , Chief Surgeon Next, the student meets with Dr. George Paltrow, but the meeting is cut short. Discouraged, the Student calls on Jeff for guidance . Location Hospital Conference Room Scene setup Student faces George on the right side of the table. On -screen characters Dr. George Paltrow, Jeff Passmore (on phone ) Off -screen characters None On -screen text: You meet next with Chief Surgeon , Dr. George Paltrow . . . GEORGE Before we start, I thought I would just let you know, I have a patient of mine that is in critical condition, and, at any moment, I may have to cut our meeting short. STUDENT OPTION 1 I will be brief. Can you tell me what you’ve heard about the lawsuit involving Mrs. Smith already ? STUDENT OPTION 2 This won’t take much time. What are your thoughts about the case with Mrs. Smith ? STUDENT OPTION 3 No problem. Can you tell me what you remember about the day you examined Mrs. Smith after her surgery ? Student can click on any option to proceed, but must choose all three eventually. GEORGE RESPONSE 1 I haven’ t heard too much, honestly. I am very bu sy when I’m not traveling and conduct ing my lecture series at uni versities . I know she contracted a staph infection, which is an unfortunate reality we face in our hospitals today. Response 1 kicks the Student back to options . GEORGE RESPONSE 2 I’m not sure exactly what you’re asking, but I think it’s a good thing that she was given the right attention and that the infection was eventually aggressively treated . As far as claims that this had some sort of impact on her future health situation, I don’t see any connection. Sometimes laymen make conclusions that are outside of their realm of knowledge and it’s usually to pad the settlement, if you know what I mean. Response 2 kicks the Student back to o ptions . GEORGE RESPONSE 3 It was such a long time ago, I honestly can't recall. I mean, I know I examined Mrs. Smith after su rgery when she was in the post surgery patient care unit and Health Care Law Learnscape 1: Hospital Nightmare Health Care Law Learnscape 1 Final November 28, 2012 10 she was fine at the time. Beyond that, nothing out of the ordinary presented itself. Response 3 allows the Student to proceed . STUDENT OPTION 1 You don’t remember anything about the examination i n particular? STUDENT OPTION 2 What do you think caused the staph infection ? Student can choose either option to proceed. GEORGE RESPONSE 1 Like I already told you, there was nothing out of t he ordinary. It was all very routine, as I recall . Response 1 ki cks the Student back to options. GEORGE RESPONSE 2 Look, these things are more common than people think. It could’ve been ANYTHING . A irborne infections in hospitals can easily spread between patients especially when they share the same room. Hospitals are a breeding ground for the spread of infections . . . I mean, I’ve said for years that we need to improve that situation. Excuse me for a moment. I’m sorry. It looks like that patient I mentioned needs my attention. I have to g o. Oh before I leave, could you ask engineerin g or whoever, to clean the filthy vents ? They appear to have some black and green mold growing on them, especially in the bathrooms. Oh, and those wet ceiling tiles should be replaced.

They are growing mold. Ne ed I go on ? (sighs) I have to go. STUDENT Dr. Paltrow, before you go. Can we set up a time to talk again? GEORGE I’m sorry, I need to be on my way. Check my calendar and set up an appointment . George stands and exits the room. NOTE: The Student’s phone ap pears, dialing Jeff Passmore’s number. Jeff answers and a call ensues. STUDENT Jeff, sorry to bother you. Do you have a minute to talk? JEFF (on phone) Sure. This is a good time, actually. What’s going on? STUDENT I could use a little guidance. I feel li ke I got stonewalled by Dr. Paltrow . Health Care Law Learnscape 1: Hospital Nightmare Health Care Law Learnscape 1 Final November 28, 2012 11 JEFF (on phone) Let me guess, he said “I don’t recall” a lot and tried to divert your attention to other things? Then, he had a convenient message come through to get him out of the room in a hurry ? ** STUDENT OPTION 1 How did you know? I don’t think I’m going to get him to admit anything. STUDENT OPTION 2 I don’t know what to do from here. Student can choose either answer to continue. JEFF I should’ve warned you that your first meeting might not go so well. Here’s w hat you can do: First, you can talk to the pulmonologist who worked with Mrs. Smith after she was diagnosed with the staph infection. This will give you more concrete information.

You can also take some of t he pressure off of Dr. Paltrow by discussing the conc ept of Respondeat Superior with him first or putting the focus on the hospital, not him . STUDENT OPTION 1 Should I have mentioned that I have a nurse who actually saw that he didn’t change gloves? I didn’t want to be confrontational or jeopardize that nurs e’s job . STUDENT OPTION 2 Will the pulmonologist be just as defensive ? Student must choose both options before they can continue. JEFF RESPONSE 1 Yes, you can mention this when you meet him again without mentioning any names. Just tell him he was observed not changing gloves between patients. Plus, if you explain to Dr. Paltrow that he is a hospital employee, not an independent contractor , you may g et him to concede to not changing gloves . Respons e 1 kicks the Student back to op tions. JEFF RESPONSE 2 No, no t at all. Dr. Holly Brigham is very conscientious, and besides, she was called in on the case after Mrs. Smith contracted the staff infection , to clean up the mess caused by others. I already notified her that you would be contacting her , and she said she’ d be happy to talk to you. Response 2 allows the Student to proceed. STUDENT Thanks, Jeff. I appreciate your help! JEFF Sure. Call any time. Health Care Law Learnscape 1: Hospital Nightmare Health Care Law Learnscape 1 Final November 28, 2012 12 Scene 4: Discussion with Pulmonologist , Dr. Holly Brigham The student meets with pulmonologist, Holly Brigham , to establish that injury was in fact verified, and that the causation can be traced to t he failure of some staff to follow proper hand hygiene protocols . Location Coffee Shop Scene setup Holly sits across the table from the Student. On -screen character s Holly Brigham Off -screen characters None On -screen text: Dr. Holly Brigham meets you at the coffee shop the next day . . . HOLLY Tough situation, huh ? I don’t envy your job. STUDENT Well, it’s Mrs. Smith’s position that I don’t envy. HOLLY Well, no one is perfect, and mistakes h appen . B ut if you don’t enforce the policies and procedures already in place, you are negligent . STUDENT OPTION 1 So, you think the physician and hospital are at fault here ? STUDENT OPTION 2 Is it clear that it was negligen ce in this case? STUDENT OPTION 3 What do you think caused the staph infection ? Student may click on any option to cont inue, but must choose all eventually. HOLLY RESPONSE 1 I’m not sure exactly who is at fault, the hospital or the doctors involved. I just know that Mrs. Smith should’ve bee n examined with a clean set o f gloves . Gloves need to be changed between patients. Response 1 kicks the Student back to options. HOLLY RESPONSE 2 Yes, I think it was clearly negligence. There is definitely a standard of c are that was not met by hospital staff . Response 2 kicks the Student back to options. HOLLY RESPONSE 3 I’m confident that Mrs. Smith caught the staph infection as a result of the physicia ns not changing their gloves between patients in the room that day. In fact, I’m pretty sure that the patient in the first bed was diagnosed with a staph infection as well. This person was examined first and the infection spread to all of the others in the room , including Mrs. Smith. Response 3 allows the Student to procee d. Health Care Law Learnscape 1: Hospital Nightmare Health Care Law Learnscape 1 Final November 28, 2012 13 STUDENT OPTION 1 Can you tell me what happened next? STUDENT OPTION 2 Dr. Paltrow said that the staph infection could’ve been contracted through the air. Is that likely ? Student must choose both options . HOLLY RESPONSE 1 Well, the staph infection entere d Mrs. Smith’s bloodstream and spread to her left lung , resulting in empyema ( empīˈēm ə). This basically means there was a build -up of pus in her pleural space, caused by the massive infection. I began to drain th e fluid from the pleural space. At the same time, the infectious disease specialist began a n aggressive antibiotic treatment regimen . I believe Mrs. Smith ended u p staying in the hospital 30 days instead 5 days. Response 1 kicks the Student back to options. HOLLY RESPONSE 2 That’s ridiculous. I’m s orry, but if it was confirmed that the firs t patient had a staph infection and that the same gloves were used during an examination of Mrs. Smith ’s surgical site , there’s no doub t that it was spread through contact made with those gloves, not through the a ir. The fact that it made it to her lungs doesn’t mean that it started there as a result of breathing it in. No, it entered the blood stream through direct contact with the contaminated gloves and spread throughout her body . Response 2 allows the Student t o proceed. STUDENT OPTION 1 Did the nurses wait too long to contact you and the infectious disease control specialist ? STUDENT OPTION 2 What about the long -term effects of the incident ? Could they have led to Mrs. Smith contracting the autoimmune disease l ater in life? STUDENT OPTION 3 Are there any other factors or details that I should know about? Student must choose each option to proceed. HOLLY RESPONSE 1 Yes, reaction time was far too slow. I think they said, at first, that they didn’t want to bother Dr. Paltrow who had left on vacation. I still can’t believe that. I mean, I know they were understaffed that day, but clearly, time was of the essence. I know the patient’s husband was very vocal and would not let up about getting her the help she needed. In my opinion, he saved his wife’s life. Response 1 kicks the Student back to options. Health Care Law Learnscape 1: Hospital Nightmare Health Care Law Learnscape 1 Final November 28, 2012 14 HOLLY RESPONSE 2 The treatment left Mrs. Smith with a permanent pocket of sterile, encapsulated flu id in her pleural space when she left the hospital . As strange as this sound ’s, it’s not uncommon. I am fairly certain that this pocket was not drained because they wanted to ensure that the infection wouldn’t return. I couldn’t tell you whether or not this led to the future illness, though. Response 2 kicks the Student ba ck to options . HOLLY RESPONSE 3 There was an infection control committee in place at the time of the incident.

The key problem in hospitals is not so much having policies and pr ocedures, it is having polices and procedures that are clearly written , communi cated, and strictly enforced. STUDENT Isn’t it common knowledge, like you said, that doctors should change their gloves between patients ? HOLLY Yes, and wash their hands, but the question is whether or not the liability falls with the hospital or the docto r. I’m not too sure how that works. STUDENT Well, you’ve definitely have give n me a lot to think about and look into. Thank you , Holly . HOLLY You’re welcome. Health Care Law Learnscape 1: Hospital Nightmare Health Care Law Learnscape 1 Final November 28, 2012 15 Scene 5: The 2 nd Meeting with Chief of Surgery, George Paltrow The student meets with Doctor P altrow again . The Student is able to set the doctor at ease and then gain more insight in to the events and how to proceed by focusing on positive changes the hospital can make to reduce the number of hospital acquired infections and prevent the spread of i nfections between patients . Location Hospital Conference Room Scene setup George Paltrow sits on the left side of the table. On -screen characters George Paltrow Off -screen characters None On -screen text: You meet once more with Dr. George Paltrow . . . STUDENT OPTION 1 (correct) I do appreciate you making time to talk, Dr. Paltrow. And, I actually hope to focus our efforts on how improvements can be made to the hospital’s infection control program and its policies and procedures this time. STUDENT OPTION 2 Thanks for meeting with me again, Dr. Paltrow. I’ve pretty much confirmed, since our last talk, that the staph infecti on was caused due to failure to change gloves between patients . Student must choose the correct option (1) in order to proceed. GEORGE RESPONSE 1 Well, okay . I will certainly do all I can to help you in this area. Response 1 allows the Student to proceed . GEORGE RESPONSE 2 I didn’t know you were still bent on blaming Me . I really don’t have time for this. Response 2 kicks the Stu dent back to options. STUDENT OPTION 1 First of all, I’ve heard that the hospital did not have a clean environment as a priority in the past. Do you feel that’s true? ** STUDENT OPTION 2 How can the hospital improve its clean environment policies ? Student c an choose either response to proceed. GEORGE I definitely believe a commitment to a clean environment has bee n seriously lacking in the past. Staff training has been inadequate and there seems to be a shortage of housekeeping staff . Basically , the hospital did not make infection control practices and training a high priority. P olicies and procedures were not Health Care Law Learnscape 1: Hospital Nightmare Health Care Law Learnscape 1 Final November 28, 2012 16 effectively communicated to the staff. But, above all, it takes cooperation by all staff in all departments to help prevent hospital -acquired infection s. STUDENT OPTION 1 [BRANCHING 1] Can you give me specifics regarding how all this related to Mrs. Smith’s case ? STUDENT OPTION 2 [BRANCHING 2] What about the nurses’ failure to notify you of the infection ? Student can choose either option. Both must be c hosen eventually. GEORGE RESPONSE 1 As I’ve told you before, her case in particular is hazy to me, but I can talk about the hospital conditions in general . Response 1 allows the Student to proceed to Branching 1 Options. GEORGE RESPONSE 2 Yes, this was una cceptable. Vacation or not, I should have been called immediately . Response 2 allows the Student to proceed to Branching 2 Options. BRANCHING 1 B1: STUDENT OPTION 1 Can you talk to me about hand -washing protocols, then ? B1: STUDENT OPTION 2 What about cros s-contamination ? Student must choose both option s. B1: GEORGE RESPONSE 1 Now, you see posters highlighting the preferred hand hygiene protocol consistently placed in patient rooms . But, these are fa irly recent, within the last few months. They say you mus t wash your hands outside of the patient’s room, but it is often very inconvenient for you to do so because the sinks are often far from the patient’s room . Response 1 kicks the Student back to BRANCHING 1 options. B1: GEORGE RESPONSE 2 Of course this is a danger. But, again, the hospital never had boxes of glove s in every patient room and bio hazard waste bins to deposit used gloves safely. Now they do, of course, since they’re worried about being hit with a huge settlement in this case. Respo nse 2 kicks the Student back Main options. BRANCHING 2 Health Care Law Learnscape 1: Hospital Nightmare Health Care Law Learnscape 1 Final November 28, 2012 17 B2: STUDENT OPTION 1 Does this mean the nurses were incompetent or that the hospital did not train them properly in this area ? B2: STUDENT OPTION 2 How can this be improved ? Student can choose either option. B1: GEORGE : I won’t say that whoever was o n duty that day was incompetent . I’ve hear d of some cases where nurses did not know that a post -surgical infection was something of significant concern, or that a staff infection was life threatening. Staph infec tions are very dangerous . B2: GEORGE: I th ink a little training for all caregivers in this area can go a long way. Sometimes staff members are so rushed with a plethora of things to do that t hey just simply forget or cut corners. STUDENT OPTION 1 What about im provements to hospital procedures? STUDENT OPTION 2 Why do you think it took the husband calling the hospital CEO himself, in the case of Mrs. Smith, to finally get some serious attention? Student can click on either, but must choose both option s eventua lly to proceed. GEORGE RESPONSE 1 Yes, improvements are needed, too . For example, the minute a patient tests positive for a staph infection, t he patient should be placed in an isolation room and an infectious disease specialist consulted with when necessar y. The hospital’s policy should be based on the Centers for Dis ease control hand hygiene guideline , and should be strictly adhered to by all staff . Along with that, it should be standard proced ure to have the patient’s surgeon notified immediately when an infection is suspected . Response 1 kicks the Student back to options. GEORGE RESPONSE 2 Again, the proper procedures were not in place. The standard of care that was required once the staph infection was discovered was much higher than where the hospital h ad been operating STUDENT So, it seems that the hospital did not meet its obligation to provide the necessary level of care to Mrs. Smith, and can be held liable for this. GEORGE Yes, that’s safe to say. I know it’s not easy to hear, but if it helps save l ives in the future, hard knocks like this are necessary. STUDENT I definitely agree. Thanks for your help, Dr. Paltrow. Health Care Law Learnscape 1: Hospital Nightmare Health Care Law Learnscape 1 Final November 28, 2012 18 GEORGE You’re welcome . Health Care Law Learnscape 1: Hospital Nightmare Health Care Law Learnscape 1 Final November 28, 2012 19 Scene 6: Review and Analysis with Mentor In this scene, the Student meets with Jeff to review the information th ey’ve discovered. Jeff will ask questions to help the Student analyze and prepare for writing a recommendation on the liability issues in the case of Mrs. Smith . Location Chief Counsel’s Office Scene setup Student faces Jeff who sits at his desk. On -scree n characters Jeff Passmore Off -screen characters None On -screen text: Reviewing your notes with Jeff . . . JEFF So, how did it go with Dr. Paltrow the second time? STUDENT Much better, thanks. Taking the pressure off and making it more about the hospital helped a lot. JEFF So, are you ready to put the pieces together on this case and help me make a decision on liability? STUDENT Can we go through some of the details before I make a final call? JEFF Of course ! What have you got? STUDENT OPTION 1 [BRANCHIN G 1] I’m sure that a duty to care was established and was breached . STUDENT OPTION 2 [BRANCHING 2 ] The injury to the patient has been verified, as well as causation. STUDENT OPTION 3 [BRANCHING 3] I have an opinion about wheth er Respondeat Superior appli es in this case, but I’m not 100% sure. Student can click on any option to proceed. Student must choose all eventually. BRANCHING 1 JEFF RESPONSE B1 How did you determine this ? STUDENT OPTION 1 The patient was a dmitted to the hospital for surgery and post -surgical care. STUDENT OPTION 2 The hospital is required to provide the highest level of care, both with its staff members and with its policies and procedures . STUDENT OPTION 3 The fact that the patient not only contracted a staph infection, but had such a prolonged harrowing experience is proof that the duty to care was breached . Health Care Law Learnscape 1: Hospital Nightmare Health Care Law Learnscape 1 Final November 28, 2012 20 Student can choose any option to proceed. JEFF RESPONSE 1 Yes, that is enough to establish the duty to care . Good work! Response 1 kicks the Student back to Branching 1 options. JEFF RESPONSE 2 Yes, and this is supported by prior cases like McKowan vs Bentley , which solidified the hospital’s requirement to have best practices in place . Or Helmann vs. Sacred Heart Hospital , which sets a precedent for the hospital’s responsibility to prevent cross -contamination. Response 2 kicks the Student back to Branching 1 options. JEFF RESPONSE 3 Yes, there’s no denying the staph infection was contracted by every patient in the room, including Mrs. Smith . Then, you have the lack of timely respon se by the nurses and staff , which led to more serious complications. I agree. Response 3 kicks the Student back to Main Branching options. BRANCHING 2 JEFF RESPONSE B2 Right, there’s no doubt about the injury. But, causation is the tricky point here. STUD ENT OPTION 1 We have the eye witness report of the nurse, Jennifer Brainard, who witnessed Dr. Paltrow using the same gloves on each patient, and then washing his hands in Mrs. Smith’s sink. STUDENT OPTION 2 Dr. Holly Brigham, the pulmonologist says that th ere is no doubt the infection was caused by shared contact between patients. Student must choose both option s to proceed. JEFF RESPONSE 1 Yes, and we have Mr. and Mrs. Smith as witnesses, as well. Although, they probably can’t testify fully to whether Dr. Paltrow changed his gloves before co ming to Mrs. Smith’s bedside . They can attest to him washing his hands in the sink next to Mrs. Smith’s bed . Response 1 kicks the Student back to Branching 2 options. JEFF RESPONSE 2 Remember, the plaintiff does not hav e the full burden of proof as they would in a criminal case, where proof has to be “beyond a reasonable doubt. ” All they have to do is make sure their evidence outweighs that of the defendant in proving fault, and I think you’re right. It clearly does in t his case. Response 2 kicks the Student back to Main Branching options. Health Care Law Learnscape 1: Hospital Nightmare Health Care Law Learnscape 1 Final November 28, 2012 21 BRANCHING 3 JEFF RESPONSE B3 Okay, let’s break it down, then. What are the key points in Respondeat Superior ? STUDENT OPTION 1 The question is whether Bright Road can be held liable for the actions of its employees . STUDENT OPTION 2 Well, since the hospital can enforce policies or procedures on their employees, they are held liable for their actions, right? STUDENT OPTION 3 In this case, all pa rties involved have stated the right p olicie s and procedures were in place but not consistently practiced , which could have prevented the patient’s injury , so I think Respondeat Superior applies here . Student can click on any option to proceed. JEFF RESPONSE 1 Right, and you’re correct in using the term “ employees.” If it was an independent contractor, then there is a lot more grey area, and in many cases the hospital can escape liability. But, in our case, these are all employees involved. Response 1 kicks the Student back to Branching 3 options. JEFF RESPONSE 2 Yes, you’re right. Remember, supervision is an important fact or, here, too. Hospitals are responsible for supervising their employees. Independent contractors , however, are responsible for their own acts of negligence . So any negligence on their part is generally not made the fault of the hospital they were working at, as in the case of Hoffman vs Moore Regional Hospital . Response 2 kicks the Student back to Branching 3 options. JEFF RESPONSE 3 Can you outline these specifically? These are important details in determining liability. Response 3 allows the Student to proceed. STUDENT Yes, from lack of training and signage, to an inadequate supply of gloves in the room or a convenient washing station outside the room, I have enough on this, I think . JEFF Okay. I actually have a meeting in a few minutes, so could you put your recommendation in an email, so I can review it later? The last thing I want you to consider, and we haven’t discussed this too much, is indemnification. The board of Brig ht Road is required by law to provide a healthy and sanitary Health Care Law Learnscape 1: Hospital Nightmare Health Care Law Learnscape 1 Final November 28, 2012 22 environment for its patients, as well as adequate staffing, and both areas were clearly seriously lacking in this case. That said, we should still consider whether any of the parties involved fol lowed the standard practice required at the hospital . Also , did they neglect professi onal and ethical requirements as well ? STUDENT Well, Dr. Brigham thinks it ’s common sense that you change gloves between each patient in a room, and the nurses did say th at Dr. Paltrow was distracted due to problems with his trip . He did finally admit t o rememb ering trip complications . JEFF Well, why don’t you think about it a little more. L et me know what you think in your email later . Health Care Law Learnscape 1: Hospital Nightmare Health Care Law Learnscape 1 Final November 28, 2012 23 Scene 7: Making Your Recommendation In this scene, the Student will write an email to Jeff Passmore with a recommendation on Mrs. Smith’s case. The recommendation will include details from the previous conversations to support the Student’s position. Location Student’s Office Scene setup Student is sitting at their desk. On -screen characters None Off -screen characters None On -screen text: In the body of the email below, t ype your recommendation on Mrs. Smith’s case to the Chief Counsel . Your response should be 250 -500 words in length. Don’ t forget, you can use the notes you’ve ta ken throughout your interviews. B e sure to use details and cover duty to care, breach of duty, verification of injury, causation, negligence liability and indemnification . To: Jeff Passmore , Chief Counsel, Bright R oad Re: CONFIDENTIAL: Recommendation on Mrs. Smith’s case Body of Email: NOTE: Student will be able to fill in their recommendat ion here. NOTE: The student will be given an option to “Submit” the email afte r writing the recommendation . After the s tudent submits the email, the computer screen fades to the previous view of the student’s office. On -screen text: Congratulations! Your recommendation to Jeff Passmore has been sent! Nice work! FADE OUT. End of Learnscape 1