vulnerable populations

6.1.1. Written Assignment: Vulnerable Populations
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Scenario

Vulnerable Population: Mental Health and Intellectually Disabled

You are the Senior Administrator in a large hospital’s Physical Therapy Department. A Physical Therapy patient, Lisa Wallace, is a thirty-nine-year-old divorced mother of two young children ages five and six, who has been coming for physical therapy for past six months. Lisa is undergoing physical therapy because she was involved in a car accident. As far as you know, she was hit and dragged by a bus while crossing a street outside of the crosswalk. As a result, she sustained multiple injuries including bilateral fractured femurs, a crushed calcaneus, an L2 fracture, neck and shoulder sprain, and deep dermal wounds to the trunk that required skin grafting. Lisa is now able to ambulate independently, but she is not able to drive and relies on either her mother or her sister to get her to and from her appointments.

From talking with Lisa and Lisa’s therapist, Renee, you’ve learned that she is also receiving therapy that includes scar management, and that she has become obsessed over her body image. She is worried about the permanent scarring from the accident and that she has not yet gained her figure back after the birth of her children. She has mentioned that her mother and her sister both managed to sustain an upbeat attitude despite being “disfigured by mastectomies.”

Lisa appears to enjoy coming to physical therapy and has been steadily reaching her goals, but you believe her progress has been slow compared to other, similarly situated patients.

You suspect that Lisa may be “intellectually disabled”, as she sometimes appears to lack the ability to comprehend simple instructions or to have difficulty finding words or processing information when she communicates. Just last week, she tried to pay for her physical therapy session, despite the fact that you have told her numerous times that her insurance will be billed, and they will take care of it. And she is constantly wiping your counters every time she approaches them. Her therapy is generally scheduled for 45 minutes, but because she often appears confused, sessions can take up to 75 minutes, for which the providers are not able to bill the insurance company. Nonetheless, you have had good conversations with her over time during her check-in and check-out of her appointments, since she sometimes has to wait up to 15 or 20 minutes before starting her physical therapy or she stays behind to chit chat about cartoon characters and dolphins or her kids. She has confided with you about many personal events, and items about her kids, such as she sometimes lets them go to school and forgets to comb their hair or brush their teeth. Nonetheless, she “appears” to be a very good mom and her face lights up when she talks about her kids. Lisa’s medical record documents diagnoses of bipolar-manic depression and obsessive-compulsive behavior and, although not documented in her medical record, you’ve been told she has an IQ of 68 but she appears to you to be functional.

Recently, after Lisa’s last physical therapy session with Renee, Lisa shared with you that her family practice doctor, Dr. Izzy, discovered a small lump in her right breast. She stated that the doctor suggested that she make an appointment with an oncology provider right away for follow-up. You could sense that Lisa was distressed over this information and was extremely agitated. Nonetheless, she stated that she did not want Renee or anyone to know anything about what she confided with you. She said she would “kill herself” if she had to get a mastectomy or had any scars whatsoever on her breast as she can barely tolerate the scars on her body now.

Two months have passed since Lisa first discussed the discovery of the lump on her breast. Today, after her physical therapy session, Lisa admits to you that she has not yet gone to see a doctor and that the lump is getting bigger, but she doesn’t want to discuss it anymore. Lisa was adamant that if she finds out that Renee knows, she will quit coming to physical therapy. She also stated that Dr. Izzy is also no longer her doctor and that she removed the doctor’s hand-written notes from her medical record so no one in the either the Physical Therapy Department of the hospital would find out. This was possible because her former provider, Dr. Izzy, did not use an electronic medical records system preferring instead to hand-write his records and provide paper copies to his patients.

You think Lisa is not facing up to the realities of her situation and is not making sound choices about her health; especially given the immediate family history that she has shared with you about her mom and her sister’s history of mastectomies. While you believe she may have reduced intellectual or mental capacity, you are unaware of any medical or legal determination that Lisa is medically or legally incompetent to make her own medical decisions.

On the last few visits, either Lisa’s mom or her sister with her two small children has accompanied Lisa and has waited for her physical therapy to end. While waiting, her mom and sister have shared with you that Lisa seems more depressed than usual and that she is no longer doing the home physical therapy because she seems “just too weak” on some days. They are not aware of Lisa’s most recent issue over the significant lump on her breast, but they know that something is wrong.

You are concerned about whether your knowledge of this sensitive medical information places you, Renee, and/or the hospital at any ethical or legal risk or liability. You have been advocating that the hospital create an Ethics Committee, but, to date, they are still working on a policy to implement one. You are not sure what your next action or actions you should or should not take. You have decided to meet with your departmental staff, research the issues, and forward a decisional memorandum to your senior hospital administrators and Board of Directors seeking a determination on the issue of whether you can or should disclose or not disclose the Lisa’s medical information.

Assignment

Draft an internal hospital decisional memo to assist the hospital in deciding whether or not to release Lisa’s medical information without her prior authorization/consent.

Assignment Instructions

Structure your memorandum using the following decisional memorandum format:

Executive Summary: (A concise, one-line summary statement of issue(s)/question(s) – In this case use “Does the organization have the legal right and ethical authority to disclose Ms. Wallace’s personal health information without her knowing and voluntary consent?”); BLUF – Bottom Line Up Front: (A concise, on-line summary answer to the Executive Summary. For Example, “Yes, release of the information to [x, y] is authorized/not authorized), Facts :(a succinct summary of relevant facts from the assignment scenario); Analysis: (1. Protected Information? Is the information provided confidential patient information protected from release without the patient’s prior authorization? Why or why not? 2. Ethical Issue Analysis: identify, define, and objectively assess the facts using at least one applicable ethical decision-making models or frameworks from Module 1 that provide the rationale to support or prohibit release of the information. 3. Legal Issue Analysis: identify, define, and objectively assess the facts using applicable regulations, laws, court decision, etc. that provide the rationale to support or prohibit the information release. For example, HIPPA Privacy Rule.); Conclusion(s): (A summary of your determination, based on your Analysis Section, that the release of the information is ethically and/or legally permitted or prohibited and why. Provide both your ethical and legal analyses conclusions. You must answer the question whether the hospital may properly disclose Lisa’s information. If so, why and to whom? If not, why not?); Recommendation(s): (Your proposed course(s) of action(s) for the hospital to take based on your Conclusion(s) Section. For example, release the information, do not release the information, release the information as modified [provide specific modifications], etc.)

Entitle the memo “Decisional Memorandum,” address it From: [you] To: “Hospital Administrator” use “Subject: Release of Patient Information ” and include the date.

NOTE: Best practices recommend not using a patient’s name or any other personal identifiers. So, for the purposes of this assignment refer to Ms. Wallace as “Patient A” and include, just to be safe, the following header to each page “Confidential Patient Information – Do Not Release”.

NOTE: You must provide an objective, fact/issue-based, and supported assessment covering both the pros and cons of your chosen position. Accordingly, your personal, subjective, and unsupported opinion or beliefs concerning the matters are neither relevant nor solicited for this assignment.

NOTE: You are drafting and submitting this document to assist the hospital’s Board of Directors in their decision-making process and the entire organization will be relying on your assessments to avoid costly legal liability and any actual or perceived ethical misconduct, as well as potential adverse impacts to Ms. Wallace, her family, and hospital employee morale and effectiveness.

The submission must also:

Be submitted as a Word document

Have a minimum of 400 words

Use and cite at least four credible references. Your textbook may be cited as one of your credible references.

Address one or more ethical principles addressed in Module 1

Address one or more laws and/or reported legal case

Be completed using APA 6th ed

Include applicable supporting citations within the body of the memo

List all references at the end of the document.

Read the instructions carefully and ensure you fully comply with all of the above requirements.