Health Services Management and Legal Issues

In order to ensure that quality service is provided to the clients, the need for effective management is paramount in all forms of businesses including the healthcare business. The individuals who supervise, direct, plan as well as coordinate healthcare in a healthcare institution are known as health services managers. Owing to the swiftly changing health services industry, which is becoming progressively more complex in terms of financing and organization, health service providers are likely to be involved with the law in different ways, either as complainants, defendants or even as expert witnesses in court cases. Although both legal and medical practitioners have roles to play in deciding if, and when to violate the sovereignty of an individual so as to protect them, anecdotal evidence implies that there is underlying tensions between the two professions. The medical profession is concerned with the assessment of physical and mental capacity while the legal profession’s main concern is competency and although cooperation in regard to this area of practice is necessary, miscommunications and misunderstanding characterizes the inter-professional discussions. simpler terms, it can also be argued that lawyers and medics do not understand each other’s world and thus are not receptive to each other’s appearance nor have a complete appreciation for the fundamental differences.( Forrester & Griffiths 2005).

In the given case study, some of the legal issues that present themselves in the medical profession from time to time, as well as the legal obligations that healthcare providers face are identified. Doctor Ima Genius is a credentialed pediatric surgeon at the Cosmo Factory Private Hospital in Ruddville. She has been a Visiting Medical Officer since 2000 and is allowed to perform all forms of pediatric and cosmetic surgery. Doctor Genius was approached by Mary Wright, a 15 year old student at Elite College in Ruddville, with an IQ of 155 and is a member of Mensa Society. Mary’s grandfather who died about 3 years ago left her with a substantial trust that provided her with unregulated access to a large annual income that went directly into her credit card account ( Staunton & Chiarella 2008).

Mary is does not like the shape of her nose and chin as well as her ears and as a result she suffered from an inferiority complex. She therefore approached Doctor Genius and inquired about cosmetic surgery. After normal procedure, Doctor Genius asked Mary about parental consent to which she replied that it was a personal decision, she was in the capacity to pay for it herself and did not want to involve her parents. Despite the doctor not being in total agreement, she gets Mary the consent forms. When Mary’s parents learnt of the looming surgery they objected strongly but Mary told them that she did not need their consent. Mary’s father, who is a lawyer, calls the CEO of the hospital and Doctor threatening to sue them if they operated on his daughter. The CEO is frightened but the doctor stands her ground and vows to continue with the surgery. Due to a strike by the hospital anesthetists demanding additional payment, the timid CEO is afraid of the daily revenue flowing outwards thus succumbing to the anesthetists and Doctor Genius’ demands.

However, the Registered Nurse Ethical Practice says that Mary did not have parental consent as she reviewed her admission papers and refused to let the surgery proceed without parental consent. After discussions with Doctor Genius, the CEO ordered Registered Nurse Ethical Practice to prepare the operating room to which she refused. The CEO then terminated her work on grounds of not carrying out her duties and she in turn vowed to report this to the press and the union. This however did not deter the operation from proceeding. Unfortunately, after the removal of the bandages two days later, Mary did not like what she saw and she screamed at Doctor Genius claiming that she had been negligent and sloppy. According to the doctor, there was no negligence and although Mary did not like the results, she would still have to pay as there had been a contract signed by her stating that cosmetic surgery was highly subjective and differences of opinion would not be entered into. The Doctor believed she had done a good job. After her discharge, Mary sought the services of her father’s lawyer friend and on the same day, the hospital received two claims from Mary’s parents and the NSW Industrial Commission, representing the Registered Nurse Ethical Practice, respectively.

Doctor Genius being the primary healthcare provider had no mistake in this case and she complied with her medical and legal obligations. The practitioner to whom the hospital delegates any kind of patient handling is seen as having assumed in respect, the medical needs of the patient and therefore owes a regular duty that is independent of the hospital’s duty, of caring for the patient. According to the Minors (Property and Contract) Act 1970, a child who is above 14 years of age is allowed to give consent to any medical or dental treatments. This is in regard to either personal treatment or for his or her younger siblings who are below 14 years. The Children (Care and Protection) Act 1987 states that a child’s consent is considered invalid if the treatment that is required is branded as “special medical treatment”. In such a case then, consent should be obtained from the Supreme Court.

The doctor therefore did no error in agreeing to perform the surgery on Mary because she was 15 years old and in a position to give consent for medical treatment including cosmetic surgery. In addition, despite Mary’s parents objecting the performance of the surgery and threatening to sue the hospital and Doctor Genius for battery and assault, they actually had no voice in the whole issue as according to the act, a parent or legal guardian may only give consent on behalf of a child who is under 14 years. In fact, the competence of a child to consent to medical treatment is determined on the basis of the child’s ability to comprehend the treatment that is being offered. Mary’s high IQ and her membership in Mensa was a clear indication that she did not have mental problems and she was able to understand the kind of treatment she was about to undergo.

The CEO was also unable to fulfill his legal obligation in the above case. In this case, he represents the hospital and is expected to carry out all legal duties and responsibilities amassed on the hospital. The hospital is allowed to delegate the performance of tasks to a competent employee, independent contractor or another agent. In the court case of X (Minors) versus Bedfordshire County Council, Lord Browne Wilkinson stated that “It is established that those conducting a hospital are under a direct duty of care to those admitted as patients to the hospital (I express no view as to the extent of that duty). They are liable for the negligent acts of a member of the hospital staff which constitute a breach of that duty, whether or not the member of staff is himself in breach of a separate duty of care owed by him to the plaintiff” (Clinton 2004).

Therefore, even when the hospital, in this case represented by the CEO delegated the performance of the surgery to Doctor Genius who was an independent contractor, it had directly or indirectly agreed to provide protection for the patient and was therefore still liable for any negligent performance by the practitioner. Mary’s parents were therefore sanctioned to sue both the hospital and Doctor Genius for the careless exploitation. However, the CEO did not commit an illegal act when he dismissed the Registered Nurse Ethical Practise from her job on the basis that she did not perform her duties. The nurse did not have a firm reason for not performing her duties since Mary was not obligated to have parental consent for the surgery to proceed. In view of the fact that she was 15 years, her consent was enough for the Nurse to allow surgery to carry on. However, the nurse declined to do her duty by not allowing the surgery to continue, even after being instructed by the CEO to prepare the patient for the operating room. She was therefore not loyal to her employer and she failed to obey directions as issued to her by the CEO. In addition, she failed to display competency and diligence in the performance of her work. Consequently, the CEO had no choice but to terminate her for failing to do her duties for breach of confidence and insubordination.

The anesthetists went against their legal obligations by the fact that they went on strike and created a dispute with the hospital management based on the payments of on call allowances. The anesthetists had already had an agreement with the hospital on the prices to which the anesthetists who were on call were entitled to be paid. By withdrawing their services from Cosmo Factory Private Hospital, the anesthetists were going against the agreement made with the hospital which was to adhere to the fee scale recommended earlier on. As an alternative, the anesthetists should have appointed a committee of health professionals to negotiate with the hospital for an increment rather than opting for a strike (Bartels & Otlowski 2010). This would have guaranteed a cordial and mutual agreement in the establishment of professional fee structures.

Lastly, Mary did not have a right to sue or take any legal action against either the doctor of the hospital. After the operation, she did not like what she saw and even though the doctor apologized for the patient’s dissatisfaction, there was actually no damage or harm that had resulted from the surgery. According to section 69 of the Civil liability Act 2002, “An apology made by the health professional does not constitute an admission of fault or liability in the matter under consideration is not relevant to the determination of fault or liability in that matter. An apology is not admissible as evidence.” (Corones 2005) Mary should have either let the issue go and learn how to live with her new self or paid for another cosmetic surgery to make further alterations to her features.

Reference list

Bartels, L. & Otlowski, M. (2010). A right to die? Euthanasia and the law in Australia. UTSOnline, 17. Web.

Clinton, M. (Ed.). (2004). Management in the Australian health care industry (3rd ed.) Sydney: Pearson Prentice Hall.

Corones, S. (2005). The uncertain application of competition law in health care markets. UTSOline, 33. Web.

Forrester, K. & Griffiths, D. (2005). Essentials of law for health professionals (2nd ed.). Sydney: Mosby.

Staunton, P. & Chiarella, M. (2008). Nursing and the law (6th ed.). Sydney: Churchill Livingstone.

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