CONTRACTUAL RELATOINSHIP OF ORGANIZATIONS AND STAFF
THE LEGAL AND ETHICAL ISSUES OF PHYSICIANS
A doctor contracted to a hospital has a legal and ethical responsibility to the hospital and to the patients who uses his services. However, in situations where a doctor is not an employee of the hospital he may legal issue all on his own. In this case, it appears that the doctor – having “privileges” at the hospital – may simply be an independent contractor. According to Pozgar (2014), an independent contractor may assume employment without being directly controlled by anyone. Being an independent contractor, however, does not ward issues of ethics and legality from a hospital where the services are provided.
Circumstantial Liability for the Hospital
Physicians are expected to be in a state of good health and well-being. Nevertheless, they are human beings and not immune to life’s challenges and struggles – personal and professional. A hospital is at great risk for maintaining employment to a contract of some sort to a physician that could be incompetent. As mentioned in the text, independent contractor or employees can have their privileges terminated if company bylaws are broken (Pozgar, 2014). On the other hand, a hospital can be liable for an independent contractor if the organization is perceived as the medical provider. A foreseeable act of negligence is ar stake in this case and must be addressed.
Authority of the Hospital
In this situation it is believed that the hospital maintains an expressed authority – by means of possessing the power to enforce new rules and/or bylaws. Pozgar (2014) notes that a healthcare corporation may possess express or implied power granted to them by the state. A hospital has the responsibility to the patients it serves first, ensuring safety and quality. Priority should be given to patients, allowing then the care they need using skill, compassion and respectful providers (American Hospital Association, 2014). Implementing systems that protect patient should be the aim of the hospital.
Generally, hospitals are not liable for the negligent acts of its independent contractor physicians. If the physician was an employee the hospital the company would be liable under vicarious liability. West (2014) states, the employer is bound by the act of the employee. A partnership between the hospital and Dr. Smith means that he would be equally responsible for any liability as does the other partners. It would also provide a basis for a conflict of interest – being aware of his drinking issues – but in an effort to expand into other markets is still willing to work him. The board may choose to overlook this situation – under the influence of monetary increase and other factors to make a decision contrary to the good of the organization
Additional Information for Proceeding
Before proceeding it is important to run a thorough investigation based on the information provided by the other staff members. Further steps should be taken to evaluate the competency of Dr. Smith, especially that of psychological nature. The scenario noted that several errors were made during other procedures. Although this was not life threatening and the use of alcohol was not determined to be present at the time, further steps should be taken to ensure it never becomes dangerous for any patient. A possible alcohol test should be taken before Dr. Smith is allowed to perform surgery. In an article by Peterman and Desbiens (2005), it is made clear that that there is zero tolerance for physicians practicing under the influence of alcohol even if the amount of alcohol consume is undetermined.
Medical Staff Process
There is no question that a medical staff process is relevant in this situation. Hospitals are required to implement mechanism and enact regulations that address any illegal action of its employees or anyone with privileges to work there. As the conduct of the hospital is the legal responsibility of the Governing Body, the Medical Staff is held accountable by the Governing Body to ensure quality care for patients (Hamilton, 2014). The medical staff process could be included in dealing with this situation to evaluate Dr. Smith’s qualification and competency – including his ability to adhere to medical staff rules.
Several committees are involved in the process, as well as the medical director. However, the Governing Body makes all final decision to revoke, deny or limit a physician’s privileges. The committees involve in the process includes the executive committee – overseeing the medical staff; credential committee – for reappointment if applicable; and the medical director – enforcing bylaws and ensure quality improvement (Pozgar, 2014). The outcomes may vary as sufficient proof is required of Dr. Smith’s incapacity to perform duties as outlined in his contract. It is possible that his privileges to practice is limited, discontinued, he is allowed to continued or just a simple revision takes place.
The Situation’s Ethical Issues
The issues of substance abuse is not quite relevant in this situation as there is no clear evident that the physician ever operated while in a drunken state. Some may say that what one does in his free time is his prerogative. Does the same idea apply to doctors, on call or not? I would believe that health care providers would put ethics as a top priority knowing that at any point in time their services may be rendered to someone.
Several ethical issues arise for Dr. Smith in this situation. As an individual going through the emotional process of a divorce, those effects can have a negative impact on professional responsibilities. It is up to Dr. Smith to make moral judgments as he is still practicing the profession and alcohol can take a toll when performing his duties. Ethical issues of malpractice is at stake; in a state of inebriation the doctor could cause harm to one of his patients. Not abiding the Hippocratic Oath is also an ethical issue as this creed outlines the values and virtues physicians place in the profession (Pozgar, 2013).
As for the other health care staff, they should have the right to be concerned if they believe Dr. Smith is partaking in unethical activities. However, the physicians was not witnessed to be drunk while on the job and that the technical errors were a result of intoxication. Other staff members, especially nurses, have an ethical and legal responsibility to patients and keeping them protected.
Organization Ethical Responsibility
Healthcare organizations have an obligation to monitor its medical staff and be prepared to intersect during any issues. Failure to intersect could result in malpractice lawsuits (Richards, n.d.). According to the code of ethics for organizations, an organizations will develop and maintain an environment that fosters the highest legal and ethical standard (Pozgar, 2013, p. 263). The duty of the organization and the power possessed is to address any suspicious concerns that may negatively impact the organization.
Appropriate Resources to Assess the Situation
While each organization has its own code of ethics conduct, provision have been made where resources are available to address issues of legal and ethical concerns. A resource I find to be most helpful because it breaks down organizational responsibility at every level is the American college of Healthcare Executives Code of Ethics. The resource highlights the responsibility to patients, employees, the administration profession, the community and the organization (ACHE, 2014). Another resource to assess is the Code of Ethics and Standards of Practice for Healthcare Quality Professional by the National Association for Healthcare Quality (NAHO). Every aspect is broken down and shows how to treat every party involved in the growth and stability on the organization with respect and dignity as well making provision to address wrong-doings and penalize accordingly. (National Association for Healthcare Quality, 2011). The American Medical Association is also am valid resource as it entails information pertaining specifically to the ethical performance of physicians. (American Medical Association, 2014).
Advise, Preparation and Prevention of the Situation
My first advice to the CEO is to approach the physician about the issue and express concerns related to possible negligence. I would then suggest that a detailed documentation be made regarding his actions and attitude towards his duties that may be of questionable nature. The next thing I would suggest is to inform the appropriate committee – an intervention may remedy the situation. Several ways to prepare for and prevent the situation is as follows: leaders must be the example they want to see in the organization by doing ethical things and approaching things from a legal point of view. The next thins is there should be transparency in the organization for employees to feel comfortable speaking about something that is not right; allowing incentives for doing the right thing should be encourage. Another measure is to develop an understanding about the impact of unethical behavior and implementing a risk management system to regular audit employees so that opportunities to act unethical is reduced.
American Hospital Association. (2014). Patient Care Partnership (English). Retrieved
American Medical Association. (2014). AMA’s Code of Ethics. Retreived from http://www.ama
Hamilton, T.E. (2004). Center for Medicaid and State Operations/Survey and
CertificationGroup. Retrieved from https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/downloads/SCLetter05-04.pdf
National Association for Healthcare Quality. (2011). Code of Ethics and Standard of Practice.
Retrieved from http://www.nahq.org/uploads/files/about/codestandards.pdf
Pozgar, G. D. (2014). Legal and ethical essentials of health care administration (2nd ed.).
Sudbury, MA: Jones and Bartlett.
Pozgar, G. D. (2013). Legal and ethical issues for health professionals (3rd ed.). Sudbury, MA:
Jones and Bartlett.
Richards, E.P. (n.d.). The Medical Staff. Retrieved from
West, R.V. (2014). Part 9: Employee vs. Independent Contractor: Exceptions to the Rule: