Risk Management – Case of a Paralyzed Patient Who Can Only Communicate through Head Nods

Risk Management – Case of a Paralyzed Patient Who Can Only Communicate through Head Nods

The case at hand revolves around Lydia, a 45-year-old woman who is paralyzed and can only communicate through head nods due to a car accident. The hospital CEO has requested a briefing on the situation, legal considerations, and alternative actions that can preserve the patient’s rights while minimizing risks to the hospital. Key players in the case include Mr. Bevins, Lydia’s spouse, who claims to be her guardian and believes she would not want to be kept alive in her current condition. On the other hand, Eileen Redfield, Lydia’s mother, opposes ending her daughter’s life and hopes for a potential recovery. Lydia’s physician, Dr. Bob Pritchard, reports minimal progress and uncertain long-term survival due to her paralysis and pre-existing breast cancer.

One important component of the case is the existence of Lydia’s advance directive, although a copy is currently unavailable. An advance directive lies in its ability to outline a person’s healthcare wishes in advance, particularly regarding end-of-life decisions, ensuring that their preferences are respected and followed even when they are unable to communicate or make decisions themselves (Rosen, 2023). Efforts should be made to locate the advance directive, such as searching through the hospital’s electronic health records system, Lydia’s personal belongings, or reaching out to previous healthcare providers. Collaboration with legal counsel may be necessary to explore options for accessing the advance directive. Determining Lydia’s decision-making capacity is crucial, and a comprehensive evaluation by a multidisciplinary team should be conducted. This evaluation, involving specialists like neurologists, psychologists, and speech-language pathologists, will assess Lydia’s cognitive abilities, decision-making capacity, and ability to communicate, providing crucial information for subsequent actions.

Open and empathetic communication between Mr. Bevins, Eileen Redfield, and other concerned family members is essential. Mediation and family meetings can be organized and facilitated by a professional mediator to guide discussions. This approach allows all parties to express their perspectives, concerns, and hopes, aiming to reach a consensus through shared decision-making. In complex cases like this, seeking input from the hospital’s ethics committee is advisable. Their expertise can provide proper guidance on balancing patient autonomy, beneficence, and non-maleficence in decision-making. The involvement of a professional mediator in the mediation and family meetings can help create a safe and supportive environment for dialogue, ensuring that all voices are heard and respected. Seeking input from the hospital’s ethics committee adds an additional layer of expertise and impartial analysis to guide decision-making, ensuring that ethical considerations are carefully evaluated and addressed (Schupmann, 2023). The ethics committee’s recommendations can provide valuable insights into the complex ethical dilemmas involved in the case.

Further, legal assistance is crucial to navigating the legal aspects of the case. Engaging a healthcare attorney experienced in healthcare law will ensure compliance and protect the hospital’s interests. The attorney can provide guidance on guardianship laws, advance directives, and applicable state laws. Furthermore, involving the hospital’s palliative care team is crucial to provide holistic care. They can assess and manage Lydia’s pain, provide emotional support to the family, and ensure her comfort and dignity throughout the decision-making process. By implementing these strategies, utilizing available resources such as the multidisciplinary evaluation team, mediator, ethics committee, legal counsel, and palliative care team, the hospital can navigate complex situations, preserve patient rights, and minimize risks while maintaining its reputation for quality care in the community.

References

Rosen, B. (2023). Supported Decision-Making and Merciful Health Care Access: Respecting Autonomy at End of Life for Individuals with Cognitive Disabilities. Washington and Lee Law Review, 80(1), 555. https://scholarlycommons.law.wlu.edu/wlulr/vol80/iss1/11/

Schupmann, W. (2023). “We are not the ethics police”: The professionalization of clinical ethicists and the regulation of medical decision-making. Social Science & Medicine, 322, 115808. https://doi.org/10.1016/j.socscimed.2023.115808

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Case of a Paralyzed Patient Who Can Only Communicate through Head Nods

Scenario Summary
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 a 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 6 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.
Your Assignment
You have been asked by Felicia Larue, the hospital CEO, to brief you 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 journal and website research must be used as a reference to support your analysis.

Key Players
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 lying 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
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.