Unit 6 Discussion - Domko

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Dec 6, 2023

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Memo Date: 11/22/2023 To: Chief Medical Officer and Chief Financial Officer From: Manager, Social Services/Ethics Committee Member RE: Obstetric Services Problem: According to Toolwire (n.d.), the administration has been discussing whether Bright Road should continue providing labor and delivery services. This is a contentious issue due to competing interests such as the willingness and ability of the hospital to continue providing these services in a cost-effective manner weighed against the overwhelming demand by the community. Reason for Recommendation: To ensure that Bright Road makes a decision that is both ethical and legal while preserving the business and the service to the community. Module 6: Ethical Implications of Patient Rights 1
Labor and Delivery Services Keri M. Domko Park University HA517DL : Legal and Ethical Issues in Healthcare Administration Dr. James Baird November 22, 2023 Module 6: Ethical Implications of Patient Rights 2
Problem Statement Currently, Dr. Miller is the only OB/Gyn at Bright Road (the hospital) with no staff for back up. There is staff that can help in an emergency until Dr. Miller arrives, but none with her qualifications. Bright Road is currently the only hospital in the community that provides labor and delivery (L&D) services, but the hospital does not have a budget to hire a second OB/Gyn. Does the hospital terminate L&D services or come up with a plan to maintain services without continuing to overburden Dr. Miller (Toolwire, n.d.) Recommendations It is recommended to keep the labor and deliver department. There are a few things that can be done to help drive the costs down and ease the burden on Dr. Miller. The family practitioner can act as a backup labor and delivery since malpractice insurance is not paid by the clinician, but the hospital. This would decrease our overall cost of insurance since the workload per provider will drop which will decrease the risk along with malpractice insurance premiums. According to Gallagher (n.d.), hospitals need medical malpractice insurance. When hospitals purchase insurance, it is known as hospital professional liability (HPL) insurance. The hospitals will insure many of the doctors and healthcare providers who work there. While hiring a second OB/GYN is not currently in the financial budget, it is something to look at in the future. It is imperative to involve the public affairs officer with education to the community about the importance of prenatal care. This should be provided in all languages spoken within the community. A greater availability of knowledge will help new mothers make more informed decisions about their health as well as that of their unborn child. The U.S. Department of Health Module 6: Ethical Implications of Patient Rights 3
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and Human Services (n.d.) states that getting early, and regular prenatal care improves the chances of a health pregnancy. This care can begin even before pregnancy with a pre-pregnancy care visit to a health care provider. There is an underserved portion of the community that is afraid to come into the hospital because they are not citizens and don't have health insurance from the government, nor can they afford private health insurance. This causes delay in prenatal care, resulting in a higher risk to both mother and baby. It would be a beneficial practice to allow qualified nurses to provide basic prenatal education in a satellite location outside the hospital where more of the young mothers are comfortable to be seen and at a lower cost than our normal private hospital rates. Yu et al (2017) shows that Mobile Health Clinics (MHCs) are an innovative model of healthcare delivery that could help alleviate health disparities in vulnerable populations and individuals with chronic diseases. Indeed, some studies have concluded that MHCs are particularly impactful in the following contexts: offering urgent care, providing preventative health screenings, and initiating chronic disease management. There is a local clinic, but it is not a satisfactory substitution for hospital labor and delivery services as the quality of care is not an adequate level. Again, with education, these members of our community are more likely to engage in early prenatal care. Summary With more mothers participating in first trimester pre-natal care, the risk of complications is greatly reduced and will also lower the malpractice insurance premiums for both Dr. Miller and her back up. There is currently a great relationship with the community. If the hospital discontinues this valuable service, that relationship could be damaged in a way that would not be favorable to the hospital nor the community. There would likely be a risk of greater financial loss by causing the community to think that the "bottom line" is more important than the health and Module 6: Ethical Implications of Patient Rights 4
well-being of the community members. According to Health Management (2017), In today’s challenging healthcare climate, hospitals are competing fiercely over patients and qualified staff. Reputation plays an essential role in this battle, and more and more hospitals are taking an interest in enhancing their reputations. References Gallagher. (n.d.). Common medical malpractice insurance policy forms . Gallagher. https://www.gallaghermalpractice.com/resources/introduction-to- medical-malpractice/#:~:text=When%20hospitals%20purchase %20insurance%2C%20it%20is%20known%20as,this%20because%20of %20the%20size%20of%20the%20hospital. HealthManagement.org. (2017, April 7). 7 ways to maximize your hospital’s reputation . HealthManagement. https://healthmanagement.org/c/hospital/whitepaper/7-ways-to-maximize- your-hospital-s-reputation Toolwire. (Producer). (n.d.). Health Care Ethics: Navigate 2 Scenario: Labor and Delivery Services. (Scenario) [Video file]. Module 6: Ethical Implications of Patient Rights 5
https://canvas.park.edu/courses/77636/discussion_topics/1629142? module_item_id=5575103 U.S. Department of Health and Human Services. (n.d.). What is prenatal care and why is it important? . Eunice Kennedy Shriver National Institute of Child Health and Human Development. https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/prenatal- care Yu, S. W. Y., Hill, C., Ricks, M. L., Bennet, J., & Oriol, N. E. (2017, October 5). The scope and impact of mobile health clinics in the United States: A literature review . International journal for equity in health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5629787/ Module 6: Ethical Implications of Patient Rights 6
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