The author of this report is to assess an ethical dilemma that involves a couple of important factors. The two main ethical issues are patient privacy and when the proper time to blow the whistle on a doctor truly comes, not to mention how to do it. Kendra finds out that a family member is about to get gastric bypass from a doctor that has had a staggering amount of people that have had complications or died post-surgery. She feels compelled to warn her mother even though this would be a breach of privacy laws and ethical guidelines. While privacy regulations are in place for a reason, patient safety is also a valid concern and that is clearly an issue with Dr. Russell and his practices.
Sue’s internal forces would include the fact that Dr. Russell, her boss and employer, is facing a lawsuit due to the death of a patient and it is also known that other patients have died or have complications and this is bring stress to Sue. Sue’s external forces would be the current patient that is threatening to sue as it involves her employer. Kendra’s internal forces are similar in that the doctor’s apparent malpractice is affecting her work stability and structure and she’s getting pressure from Sue to dig up records that are certainly going to implicate the doctor and/or the practices of the office. Kendra’s external pressures include the fact that all but one gastric bypass patient have had complications and roughly a third of them actually died and this is going to mushroom in the form of pressure against the office and lawsuits from the patients and/or families of patients. The ultimate external pressure is that Kendra’s mother is due up for a surgery from that same doctor (AMA, 2014).
One of the ethical concerns in this case is when it is acceptable to breach patient/doctor privacy and how exactly it should or should not be done. The question is extremely important in this case because there is a doctor that is ostensibly killing patients through his own malpractice or the malpractice of his staff, if not both. To be sure, the ostensible odds of Kendra’s mother dying or at least having complications are 33% or nearly 100%, respectively. The American Health Information Code of Ethics would seem to stipulate that while only blowing the whistle to family members or friends would be unethical but that doing so for the health of all patients in general would absolutely be called for. However, there are legal issues here as HIPAA and other laws are potentially going to be violated as a result. However, if Kendra follows the right avenues she will be better off. For example, if Kendra told her mother to not have the surgery but didn’t offer details why, that would be better but immediately going to the proper authorities and licensing boards and having all surgeries halted until an investigation could be conducted would be the best way (Medical Malpractice, 2014).
However, that is not what happened. It obviously registers with Sue that the way Kendra initially revealed this was improper but the ultimate problem is that patients are dying or having complications entirely too much after these surgeries and something must be done. Sue and Kendra should both make reports of the problems to the proper authorities. Kendra made several violations including looking at charts and such without the medical need to do so, not to mention she is not a doctor, and she divulged the information to a person that did not have a “right to know,” at least not at the level that was divulged to her (AACAP, 2014).
From Sue’s point-of-view, it would seem that Dr. Russell only seems to be focusing on the one death because of pending litigation when he should actually be a lot more concerned and careful than that given the two dozen overall deaths that have occurred. From Kendra’s perspective, the aforementioned odds of her mother having complications or dying is sky-high and she has the same overall concerns as Sue about the doctor’s competence. However, despite Kendra’s transgressions, it is crystal clear that Dr. Russell’s ostensible malpractice is the overarching issue here and both Sue and Kendra should approach the licensing board and other proper authorities and make them aware of the beyond unacceptable level of complications and deaths that are occurring. Gastric bypass is by no means completely safe but the level of problems being experienced by Dr. Russell is by not acceptable by any means or measure as the overall rate for complications in gastric bypass are usually less than ten percent, let alone deaths. Even lower-skill surgeons see rates only in the teens (Birkmeyer, 2013).
It is clear from the case study that Kendra’s heart was in the right place but her reaction to the problem broke a number of ethical rules as well as laws punishable by both criminal and civil penalties, not to mention the loss of her job or the ability to find a similar one. Kendra absolutely should have taken action but she needed to use the proper channels. Warning her mother could be done in a way that is not specific but still to the point such as simply telling her that she needs to put it off or simply not do it and the reasons behind this are more than sufficient to give her cause. It is reasonable and almost expected that Dr. Russell will lose his license to practice medicine as something is obviously terribly wrong with his practices and procedures.
AACAP. (2014, July 11). Know Your Rights: Consent and Confidentiality. Know Your
Rights: Consent and Confidentiality. Retrieved July 11, 2014, from http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for
AMA. (2014, July 11). AMA’s Code of Medical Ethics. AMA’s Code of Medical Ethics.
Retrieved July 11, 2014, from http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics.page
Birkmeyer, J. (2013, January 1). Surgical Skill and Complication Rates after Bariatric
Surgery. NEJM. New England Journal of Medicine. Retrieved July 11, 2014,
Medical Malpractice. (2014, July 11). How to Report Doctor or Hospital Malpractice or Unsafe Practices | MedicalMalpractice.com. MedicalMalpractice.com. Retrieved July 11, 2014, from http://www.medicalmalpractice.com/resources/how-to-report-doctor-hospital-medical-malpractice.html
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