Breach of duty/ breach of contract
You can use the attached document as a guide for any common law issues that need to be addressed.
Medical Law Journal. Betsy Spring, a University of Moldavia junior, has come to talk to you about what happened to her deceased uncle. She wants you to write a five to seven-page article for the journal about her uncle’s experience with the medical system.
She would like you to emphasize the legal and ethical issues related to the experience. You should be objective but at the same time indicate possible violations of laws, causes of action for possible lawsuits, possible defendants in any lawsuit, and regulations, whether state, federal or common law. She also wants you to address any ethical issues that arose. Her intent is to alert the medical, regulatory and legal community of the flaws in the system.
The story goes as follows…
Jason Spring is 78 years old and has been diagnosed with stages of Alzheimer’s Disease by his family physician, Mary General, M.D. At Jason’s last checkup on May 1, Dr. General noted bleeding in a stool sample and recommended a colonoscopy. Her scheduler contacted Moldavia General Hospital (MGH) and was told that the first available appointment was on October 1.
When Dr. General is advised of this, she indicated that she did not want the procedure to wait that long. As a result, she called her brother in law, Dr. Sam Innovate. She knew Sam and his partners were opening a brand-new ambulatory surgery center, named One Day Easy Surgery Center, Inc. (One Day). One Day intends to rely on colonoscopies as a major revenue source. In fact, the bill coding system purchased from Maximize Medicare Payments, LLC is set up so if a colonoscopy is performed the bill will reflect all possible complications regardless of what actually happens.
Sam advised Mary that the Center planned to open on May 15. He asked her to pick up the tab for the next family dinner in exchange for making Mr. Spring the first patient. He also advised Dr. General to make sure that Mr. Spring obtains his “prep” for the procedure at Dr. Innovate’s father’s independent pharmacy, Moldavia Drugs.
On May 12, One Day faxes a medical record request to Dr. General. Her office manager promptly transmits the information to One Day via the Moldavia unified EMR system.
What the office manager did not know was that One Day was not online with the EMR system since it had not yet received the license necessary to join the system.
On May 15, Mr. Spring is driven to One Day by his 19-year-old niece, Betsy Spring. Betsy’s family lives in Kentucky, but she attended the University of Moldavia at the time and lived with Mr. Spring during the school year. She and her parents are the only surviving relatives of Mr. Spring.
At the entrance of One Day, there are large banners welcoming Mr. Spring as its first patient. Reporters and television cameras are there to report this opening. It is a big deal in Moldavia since it is the first ambulatory surgical center independent of MGH ever built.
As they entered, Dr. Dray was there to welcome them. He explained that he would perform the colonoscopy using the most modern equipment in the state. He handed them his business card for the Surgery Center (Chief Diagnostician) as well as another card indicating he is President of the Moldavia Medicinal Marijuana Clinic.
As soon as they entered, Betsy excused herself to run to the bathroom.
While Betsy was in the bathroom, Mr. Spring was handed an iPad that connected to a 55-inch television that hangs over the reception desk and is visible in the waiting room.
On the iPad, there was a questionnaire asking what drugs Mr. Spring took and whether he had completed the required prep. Mr. Spring had never used an iPad, let alone a computer before. He randomly checked the boxes including those about what drugs he takes and whether he completed the prep.
During the colonoscopy, Mr. Spring goes into shock and becomes unconscious. Dr. Dray is dismayed. Lucy Pain, the nurse practitioner administering the Valium IV, suspected that Mr. Spring might have had an allergic reaction to the anesthesia. She looks for the epinephrine but apparently, One Day did not have it in stock because of a back order in supplies by All Too Generic Medical Supplies of Moldavia, Inc.
An ambulance was called. The dispatcher checked her Medicare information databank. It indicated that Mr. Spring had not enrolled in Part B or Medigap coverage. As a result, the dispatcher refused to dispatch an ambulance. It is later discovered that UnitedBIGRED Medicare Insurance Company miscoded Mr. Spring when he enrolled in a Medicare Advantage Plan.
Finally, a Moldavia fire department ambulance agrees to transport Mr. Spring to MGH. What could have taken 10 minutes from the 911 call to the ER takes an hour. When Mr. Spring arrived he remained unconscious.
Betsy did not accompany Mr. Spring in the ambulance. Instead, she rushed home to find Mr. Spring’s medical paperwork. She had texted a nurse friend while waiting for the ambulance. The nurse had texted back indicating that Betsy should try to find any advanced directives or DNR notices that Mr. Spring might have possessed.
Betsy arrived at the home and climbed the three flights to the attic where she believed Mr. Spring stored his records. It was an unusually warm May day and the attic was extremely hot.
She found what looked like a medical proxy that named Mr. Spring’s deceased wife as his medical proxy. No one else was named. Betsy did see that there were instructions to Mr. Spring’s wife to not have medical personnel use any resuscitation procedures if he is ever unconscious and cannot be revived through other means.
Betsy was sweating profusely, and she collapsed. When she awoke minutes later, she just proceeded to go back down the stairs but felt woozy. As reluctant as she was to do so, she called an ambulance. She was worried about its expense since she did not have medical insurance through her parents. Their medical insurance had stopped when her mother and father, both nurses, became unemployed during a nurses’ strike at their hospital.
The ambulance came quickly and she was also transported to MGH. The transport was delayed for ten minutes while the driver questioned her about her medical insurance. Ultimately, she signed a form obligating her to the costs of the ambulance trip.
As soon as Betsy entered the ER she insisted on seeing her uncle. She could hear people saying his name in the next medical bay and someone was discussing intubating the patient.
The nurse in her room refused to allow a distraught Betsy to leave the medical bay. She was diagnosed with heat exhaustion and dehydration and given an IV. There was some delay in this as Betsy again had to sign a form obligating her to personally pay for any hospital charges.
A social worker came in to assess Betsy and help calm her as Betsy screamed, “You need to let me see my uncle!” The social worker looked at the health care proxy information and promised to see what she could do about Betsy obtaining information about her uncle.
The social worker came back 10 minutes later and told Betsy that privacy requirements forbade her from indicating anything about any other patient’s condition. When asked if the social worker could confirm her uncle was even in the ER, the social worker stated, “As I said, I cannot provide you any information about any other patient in the ER.”
In the meantime, an emergency intubation was performed on Mr. Spring. Minimal brain activity was shown. He was transferred to intensive care and then three days later to a Long-term respiratory facility in Oklahoma- a five-hundred-mile drive. Moldavia does not have an adequate facility for these medical needs.
Mr. Spring survived for 300 days, finally passing away peacefully from pneumonia after he did not respond to IV antibiotics. This was the third time during his stay he had contracted pneumonia.
Two years later, Betsy’s parents, as the sole heirs, were still getting bills for Mr. Spring’s care. UnitedBIGRED Medicare Insurance Company argued that Mr. Spring’s failure to pay his first premium bill negated any responsibility it had due to the coding error.
The bill from OneDay was for $95,000; MGH $284,000 and $2,456,762 from the Oklahoma facility and $1800 from the Moldavia Fire Department for ambulance services.