The Story of the Harvey Family and the Interprofessional Care Team

Drew Harvey was undoubtedly one of the most popular students at Mountmore College. In his senior year, he was captain of the college basketball team, which had had its best season ever, going to regional competition, and he had his own band that played every Saturday night at the most popular local pub, the Mole Hole. He had played more than studied during his first 2 years of college, never having had to “crack the books” in high school. But after his sophomore year, he worked as an assistant to a physical therapist who treated the members of the locally based professional football team during their summer training. When he returned in his junior year, he announced that he was going to become a physical therapist. He buckled down and gained an almost straight “A” record, without having to give up basketball or the band.
May 20th
The violent incident that occurred the weekend before commencement rocked the entire university community. Drew’s band was playing at the Mole Hole at an event reserved for graduating students and their friends. At the end of the first set, just as Drew was acknowledging the band members to the applause and howls of the audience, he suddenly staggered; blood splattered across his forehead as he fell forward off the platform. After a moment of stunned silence, someone screamed, “He’s been shot!” Pandemonium broke out. Everyone frantically dialed 911 on their cellular phones. Drew mumbled, a confused and frightened look on his face, 4“What’s going on?” and then lost consciousness. He was rushed to the emergency department of a hospital where a bullet was determined to have lodged in his skull, penetrating it above his left temple.
The entire emergency room team flew into action. The physician assistant and nurses on duty took over the first aid trauma measures from the ambulance technicians. By now, his parents had arrived. The physician on call asked Drew’s mother, Alice, to sign informed consent, insurance, and other forms and began to prepare Drew for immediate surgery to remove the bullet and for subsequent admission to the hospital.
Mrs. Harvey wept. When a nurse put an arm across Alice’s shoulder and said, “I’m sorry,” Alice began to cry inconsolably. Alfonso Harvey, Drew’s father, stood off to one side, staring straight ahead, pale with shock. The nurse offered to get Alice a drink of water and guided them to a private waiting room while explaining what would happen next. Police swarmed everywhere.
June 11th
After 2 weeks in the intensive care unit (ICU), Drew regained consciousness. The shunt that had been placed in his skull to relieve the swelling of his brain was working well. He was beginning to focus his gaze, and the nurses believed he was trying to say something, although no one else saw this gesture yet. On the 18th day, the ICU team met and determined that Drew was in a condition to be transferred to the medical unit and that his care would now be assumed by the medical unit team. The morning of June 11, 22 days after the shooting, the physician told Alice that Drew’s condition was stabilized and he would be going home soon. “Home!” Alice gasped. “How can we possibly manage at home? He can barely talk; he can’t walk and can’t go to the bathroom alone!” The social worker explained that Drew’s student insurance did not cover inpatient rehabilitation but that the Harveys would be referred to Mountain Home Health, a home healthcare agency for continued nursing and therapy services. The Harveys would be visited by yet another interprofessional care team: a nurse and, for some time (depending on his progress), an occupational therapist, physical therapist, speech language pathologist, and others. The social worker added that a home health aide also would visit periodically. She reminded Mrs. Harvey that Drew’s progress exceeded their expectations, likely a reflection of the excellent physical shape he was in before his trauma. The team did caution that although Drew’s condition was improving, how much it would ultimately improve was impossible to predict.
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July 11th
At home, Drew’s right arm and hand regained function to the point that he could almost dress himself. He could not walk independently because of spasticity of the right leg, although the spasticity seemed at times to be subsiding. He suffered from a limited vocabulary but increasingly caught himself when he used a wrong word. Because of this progress, the case manager authorized another 6 weeks of physical therapy, speech therapy, and occupational therapy.
Mr. and Mrs. Harvey were understandably anxious but very supportive throughout the entire ordeal, encouraging their son toward as much independence as possible and offering support when needed. Drew’s older brother made some adjustments in the Harveys’ home to accommodate Drew’s limited mobility and also made himself available to help his parents so that they could go out at least once a week without worrying about Drew at home alone.
Today (August 20th)
The home care team working with Drew has grown attached to him and his family. They have rejoiced with every sign of progress and have struggled with him through the frustration and depression that accompany such a catastrophe. But the health professionals are now faced with a difficult situation. Another treatment review is due. Understandably, when no further progress can be shown, authorization for his treatments (and therefore, the reimbursements for them) will be discontinued. At the moment, his progress in select areas seems to have stopped.
Drew’s speech and progress in performing activities of daily living in the home setting have reached a plateau. However, the team as a whole has not reached an agreement regarding whether more improvement may be on the way if his condition is not allowed to slip back. Maybe he will be able to avoid lifelong use of a wheelchair and become more independent in his basic dressing and hygiene tasks if his physical and occupational therapy treatments are not discontinued at this critical juncture. Maybe his language and cognitive skills will continue to improve after a brief plateau. But his university’s health plan insurers use success (“outcomes”) measures that make it unlikely he will continue to be reimbursed for therapy costs in the home setting. The health professionals know that continued payments for treatment depend on their report of his continuous progress. They have also come to realize that Drew’s student insurance covers 60 days of home healthcare but only a total of 15 outpatient therapy visits, which makes his transition to this level of service even more challenging.
Professionals who work with patients like Drew know that his care team faces a critical and delicate situation. The rate of “progress” overall is not always constant. It may be marked by periods of rapid improvement interspersed with other periods of almost no perceptible change (plateaus). Moreover, different team members may see varying degrees of improvement because each continues to see the patient through the lens of progress in his or her area of expertise. Yet many insurance plans or other methods of payment for services make little or no allowance for these plateau periods, and treatment is generally discontinued when gains cannot be shown at a consistent rate. In this case, a patient must have a symptom that becomes acute again before treatment can be reinstituted. In summary, although progress eventually does end, the failure to allow for a plateau period often results in the patient’s premature discontinuation from treatment altogether. This is precisely the problem that faces the home care team who is treating Drew Harvey.

In a 3-5 page paper (excluding title page and reference list), address the following:
• Summarize the story briefly providing the ethical dilemma and parties involved.
• Discuss the varying perspectives from the parties involved. Be sure to discuss potential reasoning for the varied perspectives. Please note that you may need to include fictitious information to complete this.
• Discuss ethical standards relevant to the unique scenario.
• Identify possible personal moral convictions which may influence the direction of the story.
• Foreshadow potential events in the story of what could happen if ethical standards did not exist.