Ethical, Legal and Practice Standards

Discussion

Read the ethics case study below.

In your initial comment discuss the actions of the case manager. Do you agree with the case manager’s actions? Would you have done something differently? Use the assigned readings to back up your statements.

Reply to one of your classmates and comment on their posting. Do you have any additional information or an alternative view to share?

Review the Discussion Grading Rubric prior to posting comments.

Ethics Case Study
A 50-year-old female was admitted to acute care for treatment of substance abuse
(opioid dependence). During the course of her treatment in acute care, Options Unlimited learned of her history of drug use and abuse, which she said began after a motor vehicle accident many, many years ago. Her “neck problems” continue, she is “in constant pain,” and she needs further care and treatment of her cervical disc situation. The MD who prescribed all of her addicting drugs was (per the patient) “recently brought up on charges for issuing too many prescriptions for drugs.” We also learned that she was molested as a child and that she is currently employed as an individual who works with mentally handicapped young adults.

Concerns/questions that arose:

1. Ability of patient to perform her job requirements.
2. Concern of abuse for those committed to her care:
   a. Neglect due to her drug use.
   b. Possible physical abuse to those in her care due to her own history of abuse.
   c. What, if any, responsibilities or obligations does Options have in this matter?
3. Need to determine (or rule out) actual medical-surgical concerns that need to be addressed in addition to her substance abuse and psychological issues.
4. Do we have any obligation with regard to the report about the physician who ordered the numerous addictive drugs?

Dilemma:

1. What are our responsibilities to the patient versus responsibility to her employer and the young adults in her care (as far as disclosure of our information obtained and the concerns that followed)?
2. What are the legal ramifications of any actions taken on the part of Options Unlimited in all regards?

What we did:

1. Consulted with psychiatrists and medical doctors to rule out any physical conditions that would or should be monitored or addressed.
2. Followed the case through discharge from acute care.
3. Set her up with outpatient care for follow-up treatment regarding psychiatric and substance abuse issues and continued treatment of same.
4. Negotiated fees for care and treatment by nonparticipating providers.
5. Monitored monies used because of a limited dollar benefit to maximize her care and treatment.
6. Reported the patient’s information with regard to her past history (social and medical) and job function, as well as her statement regarding her physician being brought up on charges to the benefit plan so they could note their system. We also encouraged the plan to have this physician removed from their preferred provider listings.
   What we wanted to do but did not (because of concerns over breach of confidentiality and legalities):
7. Report our findings about the patient’s job functions and our noted concerns regarding the same to the employer’s human resources department.
   a. No evidence of abuse toward those in her care was found, which tied our hands in the matter. We understand that without reported misconduct or question of abuse, no action is possible.

Outstanding questions:

Should we or could we have intervened further: If so, in what regard and to what degree?