Case study:Physician Impairment

Physician Impairment: University Hospital UNIVERSITY HOSPITAL HAS long been designated as the Level l trauma center serving a tri-county area of a northwestern state. It enjoys a favorable reputation among healthcare professionals and the public it serves. Its teaching, research, and patient care programs are of the highest caliber. Its trauma center is nationally known for its excellent medical staff, and the resident physicians who train there are in demand across the country when they graduate from the program. Jan Adams has been the second-shift operating room (OR) supervisor for ten years. She knows her job and is well liked and highly respected by staff and physicians alike. She makes certain that the surgeons follow protocol and never get out of hand. She probably knows more about the skill levels of the surgical staff than most of the surgeons themselves. Jan likes working second shift and likes working with trauma patients. She receives a great deal of satisfaction from the life-saving immediacy so visible with trauma patients. Friday nights have always been the busiest of the week for trauma, and this Friday was no exception. The helicopter was on its way in with a 42-year-old who had been in an automobile accident, struck head-on by a drunk driver going the wrong way on the interstate. The resident, Dr. Truman, was already scrubbing, as were the two other house staff who would be assisting. The scrub nurse and circulating nurse had the room set up and were waiting. Dr. Spalding, the trauma surgeon on call, was on his way to the hospital, and the anesthesiologist was setting up when the patient arrived. Things looked grim — lots of bleeding, vitals fading. Dr. Truman quickly prepped and draped the unconscious patient and readied to make his incision. Although Dr. Spalding had not yet arrived, Dr. Truman knew he had to proceed if the patient was going to make it. Jan was concerned that Dr. Spalding had not yet arrived. As the trauma surgeon on call, he was responsible for being in attendance when a resident performed surgery. Jan tried calling him several more times but received no response. She considered calling the surgeon on second call but was reluctant to cause any problems for Dr. Spalding. She checked to see how the surgery was going and waited. The patient’s ruptured spleen had been removed, and his lacerated liver was being repaired. He was still losing blood, and the residents were looking for additional sources of the bleeding. Almost three hours had elapsed when Dr. Spalding finally arrived. As Jan began to brief him on the patient’s status, she noticed the unmistakable odor of alcohol. This was not the first time Dr. Spalding had arrived in the OR smelling of alcohol while on call. He was known to have a drink or two, but no one had ever questioned his operating skill. In fact, Jan had said that if it were she or one of her family members on that operating table, there was no surgeon she’d rather have operating than Dr. Spalding. He was a superb teacher as well; the residents consistently voted him “Faculty of the Year.” He was well liked, confident but never arrogant, and always considerate of the staff. The scrub nurses would volunteer to work overtime if it meant the opportunity to scrub for him. This Friday night was different. His speech was slurred, and Jan knew he was drunk. She suggested they talk in the doctors’ lounge, and once there, she gave him coffee and told him she thought it best if he stayed in the lounge instead of scrubbing in. When she went back into the OR, they were closing and the patient was stable. Jan breathed a sigh of relief, believing a crisis had been averted. On Saturday morning, she received a call at home from the vice president of nursing, who had been contacted by a reporter from the local newspaper. He said the reporter had information that emergency surgery had been performed last night on a critical patient by a physician in training because the surgeon showed up drunk. He was giving University Hospital an opportunity to comment before he contacted the patient’s family. The story would appear in that afternoon’s newspaper.

Question: In the above case study, a health care executive is faced with an ethical problem. a). Explain the executive’s ethical issues faced. b) Proposed a solution to the issue.

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